• Helen Shallow

Midwives OverWHELMed

Helen Shallow

Several events occurred this week that I want to share with you in the hope that you will share with your networks and take action: these events reinforce my concern for the crisis in maternity services in our struggling NHS.

Getting ready for an autumn trip to Wales, I arranged to call on two unconnected friends whom I have not seen for 27 years. M was a good friend to me in the 1970s when, as a single parent, my two sons were toddlers. The other friend B and I did our midwifery training together in the 1980s.

Day one

After a joyful reunion and reminiscences with M, my husband and I listened to M and P’s disturbing accounts of their recent encounters with the NHS. What they shared amounted to alarming episodes of fragmented care, disjointed service provision and painful, life threatening delays in treatment. Notably, their year-long encounters with the NHS were interspersed with praise for surgeons and nurses who despite seeming chaos, ‘did their best’. Their stories of suboptimal care were alarmingly familiar to us. As a midwife and obstetrician /gynaecologist our first-hand experiences of the bureaucratisation and contraction of NHS maternity services have impacted on our lives as we increasingly have struggled to provide the type of care we are trained to give, and that we passionately want to provide. Day two

Now to my reunion with my midwife friend, B. Inevitably, within a short space of time we shared our experiences of changing maternity services and challenging times. B commented that we cannot be negative all the time especially with new midwives and students as it would put them off and frighten them. That, I countered, was where we go wrong and why our new midwives’ expectations are shattered by the system they encounter which crushes their expectation to provide quality care in relationship with mothers. We have not given them strategies to insist on providing good care without compromising. I was minded of Jo Murphy-Lawless and her tireless quest to educate midwifery students so that they started their careers politically aware, and with strategies to resist a system that mitigates against autonomous and accountable midwifery while paying lip service to women’s needs. Day three

The next day, while participating in a conference in Cardiff, I learned of the WHELM study. It was commissioned by the RCM, led by Professor Billie Hunter, and published in May of this year but although it is available on the RCM website, it has still not been publicly launched. In other words the voices of 2000 midwives who shared their grief and pain about not being able to do a good job, are hardly being heard.

Day four

Reading the WHELM report on my way to London the following day, I realised that I could have predicted the findings, as they mirror my own humble PhD. The direct quotes from the midwives were heart breaking and I had to suppress my tears and anger. The RCM response for not going public with this important study is that midwives need, and say they want, hope and positivity. There’s that juxtaposition again: if anyone tells it like it is, they are accused of negativity. Day five

Back in my camper van on a wet Saturday morning I had a FaceTime call with another midwife friend: with her permission I share her account here, as it has haunted me all day. The free standing Birth Centre where my friend usually works was closed due to staffing shortages and high activity in the acute unit. ‘So last week as things were getting worse, I worked several shifts on labour ward as they needed all hands on deck. I went into one room and was shocked at what I saw: a young 18-year-old lying flat on her back, groaning with pain. Her partner didn’t seem interested, as she writhed on the bed naked with the overhead light shining directly on her vagina. And where was the midwife? She was sitting apart from the young girl and not communicating. I approached the midwife, and Helen, the back of her uniform was wet, and when she looked up at me with a vacant expression in her eyes, and spoke, I could smell the ketones on her breath. She said “I need the toilet and a drink”. I told her to go. ‘ I’ll take over’. I responded, ‘I’m sure you sorted out the young woman?’ ‘Yes I did. I washed her face and brushed her hair, covered her. But she couldn’t get off the bed. I tried but she just crumpled to the floor. She couldn’t even go on all fours on the bed. So I got her comfortable on her side, ...But you know what Helen, that midwife, she never got to the toilet or had a drink, she was grabbed outside the room and sent to theatre. They are not bad girls Helen. They are trying to do their best. And you know, a consultant told me the other day, in a few years we will have a 50% induction rate and it just gets worse with the interventions. We’re expected to do more and more whilst everything is collapsing around us. This is not sustainable’. I shed tears hearing her account of her workplace. She said, ‘You know I read that WHELM report. My boss gave it to me but told me I can’t share it with the midwives. All the MLUs round here are closing and did you know that Halcyon had closed over in Birmingham?’ I did know and realised that the situation that was forcing closures in my friend’s locality mirrored the shocking news from Oxford of suspended home birth services and closure of their MLUs. Are we to stay positive at these stories of neglect of women in labour and abuse of midwives while ministers and senior Trust bureaucrats take advantage of health workers’ good will? Is it enough that they soldier on and do their best? This cannot be allowed to continue. My friend finished up by comparing their situation to the crisis in Telford and Shrewsbury, ‘We are no better, we are all going that way. What are we supposed to do?' Casting a positive veil over this worsening crisis in maternity services and not advocating for midwives by burying the WHELM study is reprehensible and does a serious disservice to midwives.

This very real and present crisis is NOT going away: Government ministers have pinned their colours to the Brexit mast; American companies are queuing to come in and further privatise our health care and Health Minister Hancock is in China, maybe he is negotiating further sales of NHS assets. We are selling our soul, our healthcare, our country, to the cheapest bidder. Our citizens are suffering. But by God we’ll stay positive.

Helen Shallow.

Future blogs will provide analysis and identification of the causes of the crisis in maternity care and evaluate potential solutions.

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