Working as a Midwife in the UK
I was told by a non-birth professional woman, last week in London, that there is a severe shortage of midwives, presently, in the UK. My own understanding was that there were literally tens of thousands more practicing midwives in the UK than in the USA, so I was surprised to hear her say there is such a shortage? Any comments?
The reason why there is a shortage of midwives in this country even though there are thousands more than in the US is because nearly ALL births, whether at home, in a birthing centre or in hospital, are attended by midwives. Consultant obstetricians are only called in for serious complications and surgical deliveries. The vast majority of antenatal and nearly all postnatal care is also provided by midwives.
In general, I would think this is a very good thing–more midwife attended births–and I would guess that surgical and/or instrument assisted deliveries are far fewer in the UK than in the US — and it would seem a more satisfying place to practice midwifery, than in many US hospitals, where it seems midwives are too often “under the thumbs” so to speak, of OBs. – Laura
This reminded me of a talk by Michel Odent, where he was talking about breech birth. I think an American woman was amazed when he said most women could give birth vaginally to breech babies safely, and commented on how US obstetricians wouldn’t hear of it. Odent said that since obstetricians in the US did most routine pregnancy care for all women whether high risk or not, and since there are so many obstetricians in the US relative to the number of clients, they often simply did not see enough cases of genuine obstetric problems to be confident about different ways of management. For example, he said that he had attended well over 400 vaginal breech births, whereas a US obstetrician would be lucky if he had one client a year who had a breech baby and wanted to go for vaginal birth, so basically you couldn’t blame these obstetricians for being worried. There were various other examples that I forget, but you get the gist.
I work three nights a week, on my own in an eight-bedded midwifery led unit, based within a community hospital. We are 20 minutes by ‘blue light’ away from our consultant unit. I’ve joined the list to try a bring some normality back to my thoughts on midwifery.
I have recently had an extremely horrific experience, I don’t feel able to expand here due to confidentality, and also it brings me out in a cold sweat just thinking about it. I now have real problems about stand alone midwifery units, although I am well aware of all the research surrounding home/unit versus consultant units. I guess that l’m hoping that time does help.
I too practised midwifery in a local community based hospital which had 10 maternity beds. I too, was on my own (apart from a superb auxiliary nurse), on night-duty and we were 1 hour by “blue light” to the obstetric unit.
<P>I know how you feel about your “extremely horrific experience” as I had a couple of these myself. One, a significant PPH – no indication beforehand, beautiful birth, Mum in control, everything an absolute joy ………… and then the haemorrhage. It shook me up for weeks, nay months, and it still does. I had to rely on an emergency call to the RGN who was working the General Wards to help. I still shudder to think of what could have been, had she been busy in our small casualty unit with an emergency of her own. (For the record, the GP helped out too.)
Anyway, what I am trying to say is Keep The Faith. Afterwards, I spent some wonderful hours in this small unit (now closed and centralised and lost to the local women who loved it), had beautiful births, knew “my” women, and loved the whole set-up. I was especially proud when helping to birth subsequent babies of the women in my care. It felt right, it felt special and I loved being able to practice in this relaxed atmosphere. Please, please hang on in there. It DOES get better. It will make you a stronger midwife, and ultimately add to your experience and ability to manage these situations – however awful it was.
Carol, I hope you can look back on your dreadful experience and extract SOME sort of positive feelings. My confidence was shattered for quite some time but it came creeping back & now, I make an effort to reflect on how well I coped when the “chips were down”. I don’t mean to sound flippant – I guess this is MY coping mechanism.
I know that there are many of us Wise Women who have gone through the same ordeal of losing heart, losing confidence and losing the ability to see the way forward. This list helps me enormously; it gives me support & generally brightens my day when I think of all the like-minded individuals who are willing to support one another.
Confidentiality can be maintained by discussing your experience ‘off-list’ with a chosen expert who can help you deal with your anxieties and distress. It can also be maintained by ensuring that you do not pass on the name of the woman, her family, or where she lives. Confidentiality is important but it should not be a block to understanding and exploration of a problem. I suspect that at the moment you are too bruised to deal with it, but time to use an overworked cliché is a great healer and you may arrive at the time when you are ready to address this.
In the meantime, you may well have to deal with the ‘I told you so brigade’ so you need to keep in the forefront of your mind that such disasters (or near disasters) more often happen in large centralised obstetric units but there is a greater culture of ‘everything possible was done’ even when sometimes it manifestly was not.
In times of crisis one should use the one thing I think obstetricians do very well and we should copy i.e. adopt the herd instinct and gather around you people who support you.
I know how difficult it is to question medical staff; I’ve been there. But until we midwives do just that, we are not midwives – we are obstetric nurses.
I first learnt how to be more assertive way back in 1976 at the first Association of Radical Midwives meetings where we role-played and learnt how to deal with people (and others) who hadn’t apparently ever had their pontifications questioned.
I first was assertive about episiotomies (they were mandatory in most places in 1976), Vulval shaving and routine enemeta equally mandatory.
It was hard to stand up and I remember how I shook when I informed a consultant that I would only perform an episiotomy if in my professional judgement it was necessary. Kate Newson likewise informed a consultant that if he wished all his “patients” to have enemeta she would telephone him and he could come and administer them. It was amazing how it became easier to confront and assert.
WE WILL ONLY HAVE MEDICS GET OFF THEIR THRONES WHEN WE GET UP OFF OUR KNEES. They are our medical colleagues, not our superiors!
During my community placement as a student midwife, the midwife with whom I was working ‘phoned me at some ungodly hour to tell me that a lady was on her way into the G.P. unit at the hospital in strong labour and to meet her there.
This was the woman’s second baby and she had woken with a start in very strong, rapid labour. No sooner were we all in the delivery room (lights down, mattress on floor) than the lady’s GP turned up. Baby followed almost immediately and was pink and gorgeous but quite obviously (to the midwife and me anyway) fast asleep!!
The GP was taken aback and insisted on checking the little dreamer on his lap. He quickly reached the same conclusion and as he was gazing at this incredible sight, the baby woke up, looked up and saw what she must have thought was her mother – complete with bright red beard!!! I swear the baby looked horrified!
Love and laughter from Rachel
I just thought I’d share with you my experience over the last two days and let you know that normal midwifery is alive and well here.
I am a third year student midwife on clinical placement at a midwifery led unit and over the last two days I have been lucky enough to care for two labouring women.
The first was a multip who had had a previous long, augmented labour and ventouse delivery with an epidural. She arrived on the unit contracting well, entered the birthing pool at 8cm dilated and progressed to a normal waterbirth delivery which she was extremely happy to experience.
The second birth was another multip who was having a home birth. She laboured well and gave birth to a 4550g baby with ease and no stitches. I had had alot of contact with this woman so being present at the birth was a very fulfilling moment for me and it really gave me a boost (I know I am making the right career move).
I work in a midwifery led unit which offers antenatal, intrapartum and postnatal care to women, with a birthing pool available and it supports a large percentage of home deliveries. The unit is a part of a larger consultant led unit 20 miles away and is supported by a local GP practice. As a student I have spent the first 18 months of my course based here and it has been invaluable part of my development as it has shown me normal midwifery right from the start. I have now returned as a senior student and love it and would ideally like to practice here once qualified.
On working over christmas…
I am a midwife dedicated to her job, but often exhausted mentally & physically from endless hours on-call/working. I work in a midwifery group practice, part-time ha-ha!!!
I was called out at lunch time on christmas day last year, delivered the baby went home to a dried up, alcohol free lunch before returning to do my actual shift immediately after (I think I saw my family at some point?).
This week I spent 12 hrs with a woman in labour; I was on a day off. This is not unusual. The team I work in has an unnofficial “second on-call” rota as often there would not be enough cover for home births( We’re not paid for this!). Hours worked over contract have to be taken as time owing, but in an already short staffed unit when can we ever get the time back?
Last week, I went to a homebirth (I had already done 10 hours that night on delivery suite.) One of my colleagues came as 2nd. she was not on call or on duty. I called her knowing that she would rather me call her than the woman having to have a hospital birth because there were no other staff available. All the the other staff on call were already working . Its not Christmas or New year, there just aren’t enough of us. In our area women who want homebirths get homebirths, and midwives love homebirths & are commited to providing the care.(some of it in their own time).
We all want to have time to be with our friends & family over the festive season, and no matter how important your job is to you, to hear your child say “mummy you can’t go to work, it’s Christmas day” certainly tugs at the old heartstrings, doesn’t it?
(From an independent midwife)
I have just come home from a birth of a baby boy. The couple were not rich quite the opposite in fact they live on a caravan site connected to the husband job on the channel tunnel rail link. The lady is from Bali where most births are in villages and mountains so not much care!! This was the first baby and they begged and borrowed the money .
They wanted everything natural and it was. Due to her culture, I am sure, the lady thrashed and screamed with every contraction quite opposite to “going into oneself” The liquor and show was covering the quilt that was on the floor due to the amount of rolling around she was doing and it was hard to keep clean let alone sterile (as if that is needed).
When I left she had the biggest smile and was happily breastfeeding. I felt terrible taking their money until they asked me the question “what sort of birth would I have had in Hospital”? I initially wanted to say that as everything had been straightforward then a hospital birth would have been much the same , as it did indeed turn out……………..and then I remembered that blasted bed that fills the hospital room. She would not have been able to thrash and roll around and coupled with the amount of noise she was making, (she was really screaming “the pain the pain” ) probably someone, maybe with best intentions, would have given her pethidine…………………………..the cascade may have begun!!!
Maybe I am being cynical but I have seen it all too often with “loud” women……….so maybe we should encourage our culture to scream and thrash……………but after thinking it through at least I do not feel guilty about taking their money.
I just wish money would follow women like it does in New Zealand then I would really have the cream.
Virginia Independent M/w
AH updated 11 October 2001