When the baby comes out, he isn’t breathing. The other midwife looks at me and doesn’t need to say a word. In less than a second, I have leapt up to yank on the emergency bell to summon help as she starts resuscitation.
I rush back to assist her as she fixes the mask onto the baby’s face and starts pumping in air. I can hear the fear building in his parents’ voices but not the words they’re saying as I focus entirely on the baby, counting in the pumps: 1-2-3-4-5.
I look up at the bell – it’s still flashing but no one is coming. We keep pumping. The baby takes a breath on his own. The parents are crying. I am sweating. My heart is pounding. No one came to our aid.
We later find out that everyone else was busy in those few, frantic minutes before the baby took his first breath. Thankfully, he is fine but the experience stays with me. I feel shaky but it’s hard to tell whether that’s the adrenaline or because it’s mid-afternoon and I haven’t eaten anything since I started my shift at 7.30am.
I sit down in the “staff room” (a large cupboard with no windows) under strip lighting, chewing the sandwich I made yesterday. I can’t help but think about what could have been. I think about how I so often have this feeling of being on edge, of dreading awful things that could so easily happen.
If you’ve been reading the news in recent weeks, you may have seen a swathe of negative stories about maternity services in the UK. Last week, a report featuring the voices of hundreds of midwives, published by the campaign group #Saynotobullyinginmidwifery, revealed a “toxic culture” in NHS services was putting mothers and babies at risk of harm.
The care regulator told BBC News that two thirds of maternity services were “not safe enough”. Labour MP Bell Ribeiro-Addy added her voice to calls for the Government to act, after it was revealed a shortage of staff and beds meant women were waiting days for urgent inductions.
Staff shortages are a huge problem. But it’s not just midwives. Oten delays are caused by a lack of theatre beds, obstetricians or anaesthetists, who are stuck dealing with emergencies in A&E. But for a newly qualified midwife – like I was a couple of years ago – a lack of staff also means a lack of support.
When everyone is busy, it means there’s no one to ask for help if you’re monitoring a high-risk woman and you’re concerned about the baby’s heart rate. It means you’re on your own when doing procedures, like breaking a woman’s waters, which take experience and confidence to do correctly. No one has the time to offer guidance – you’re left having to take the risk and hoping you’ve done it right.
On a busy labour ward, it can be difficult to even know who to ask for help. So many shift gaps are filled by bank or agency staff who don’t know the systems and don’t have time to help you. It means that newer midwives like me are left dealing with things we’re not necessarily comfortable with. And that only intensifies that feeling that something terrible could happen at any moment – the feeling one midwife in the recent report described as “a warped game of Russian roulette”.
At university, we learnt about the “art of midwifery” – the idea that there is this incredible set of skills and knowledge, which has been honed over generations by women supporting women. The reality is completely different. Everything is so medicalised. There were definitely times I suspected procedures were performed just to get the baby out. Not necessarily just because it was more convenient for the clinical staff, but because everyone is so risk averse.
The constant fear of risk affects your confidence in your ability to do your job. It also means there’s a complete lack of trust in women’s bodies and abilities. You’re always hearing things like: “She’s only 2cm dilated”, or: “Her labour is progressing too slowly”. It makes women feel like they’re on a conveyor belt – especially as we then send them home with so little aftercare.
A woman can have a difficult birth and then be counselled and given support to recover, but that’s just not happening. There is no support. No one has the time to give it.
I wanted to become a midwife because I’m passionate about empowering women. Instead, I saw healthy, young, fit people come into hospital to have their babies, leaving with trauma, scars and surgery – a lot of which wasn’t necessary. It’s so disheartening. It feels like the fulfilling, lovely parts of the job are being stripped away.
The practical side of the job is also unworkable. Day and night shifts can run together – shifts are often 9am to 2pm in the day, followed by a 10pm to 8am night shift. That’s 15 hours within a 24-hour period. The rota changes week-by-week, so you’re constantly switching between nights and days. It’s so disorientating and means you can’t plan anything. The majority of the workforce are women but there is no accommodation at all for childcare. Legally, you are entitled to ask for flexible working but practically, you’re not. The shifts are the shifts.
Not having enough time to eat or drink properly also messes with your health. I put on weight from surviving off biscuits, felt exhausted all the time and didn’t have periods for about a year because my body was under so much stress. I’m not surprised a Royal College of Midwives (RCM) survey in June showed two thirds of midwives felt burnt out or exhausted at the end of most or all of their shifts, while a quarter felt that way at the end of every working day. And when midwives feel that way, they’re not capable of providing the best care to women and babies.
The RCM union has been campaigning for better pay. While it’s true that no one goes into midwifery for the money, when you’re working in incredibly stressful conditions, giving up your weekends and nights, and compromising your own family and health, it’s depressing to know you could earn the same working as a delivery driver. We just want appropriate recognition for the work we do.
I tried reducing my hours and taking time off with stress, but every time I walked back into the ward it was the same. The job was so physically and emotionally exhausting that I knew I was burning out, so I finally made the difficult decision to leave during the pandemic for a desk-based role. I had worked as a nurse in the NHS for nearly a decade before training as a midwife, but I lasted less than three years in midwifery. I was devastated it ended like this but I don’t think I could ever go back. Most of the people I trained with have also left. I have nothing but admiration for those who have kept going.
There are signs some things are changing for the better. At least one NHS trust has introduced a senior midwife whose entire job is to support junior staff. Others have brought in 10-minute mandatory breaks. But the big question is whether these changes are sustainable. The government needs to take midwifery much more seriously if we are to have any real chance of making things better for women and babies.
As told to Rosie Taylor
