The lives of mothers and babies are being put at risk by a “toxic culture” in NHS maternity services, according to a damning report.
Frontline midwives warned that working in NHS units was like playing a “warped game of Russian roulette” as there was a risk of harm or death at any time.
“Dangerously” low staffing levels meant women in labor were treated as if they were “on a conveyor belt”, midwives revealed, adding that personalized care was “a thing of the past”.
Maternity units “often” had less than half the staff needed to operate safely and unqualified students had to care for multiple women in postpartum or delivery rooms.
Midwives reported being assigned so many patients to care for that they often did not have enough time to complete basic care tasks, such as giving women pain medications or properly sterilizing equipment, putting patients at risk of infection.
Frontline midwives warned that working in NHS units was like playing a “twisted game of Russian roulette” as there was a risk of harm or death at any time.
The report by campaign group #Saynotobullyinginmidwifery, a team of leading midwives and midwifery academics, presented the experiences of hundreds of midwives currently working in NHS services or who have recently stopped working.
Many of those who contributed had witnessed harm to babies as a result of their “unfathomable” working conditions.
In her foreword to the report, Mavis Kirkham, emeritus professor of midwifery at Sheffield Hallam University, said: “Twenty years ago it was reported that midwives were leaving midwifery because they were unable to provide the care they desired.” Things have gotten much worse.
He warned that “care has been removed for the sake of efficiency” and that the service was “operating on a conveyor belt model”, which was “highly inappropriate”.
The report’s authors attributed the problems to chronic staff shortages, as well as pressure from senior management on midwives to discharge mothers and babies as quickly as possible to free up beds.
This follows a call from grieving parents last month to former Health Secretary Steve Barclay for a statutory public inquiry into England’s maternity services.
The request, made by the Alliance for Maternity Safety, followed a series of high-profile reports revealing poor care and toxic cultures in maternity services in individual NHS trusts, including the Ockenden Review into Shrewsbury and Telford Hospital NHS Trust and the Kirkup Report into East. Kent Maternity Services.
The latest report, published today, features similar stories from across the UK.
Community midwives revealed how they could be forced to work for 24 hours or more at a time, meaning they were unable to provide safe care.
While newly qualified and student midwives said they were often given responsibilities beyond their training and left alone to deal with multiple patients or complex births.
“Each shift on the unit is dangerously understaffed, often more than 60 percent midwives…Students must manage postpartum rooms and care for (women in labor) with ‘remote supervision.’ “revealed a midwife.
A newly qualified midwife told how she had been left alone on her first shift to deliver the baby of a woman with multiple high-risk health problems. The baby died hours after being born.
Another recalled how they pressed the emergency bell when they noticed a baby’s heart rate was struggling during delivery, but got no response because no elders were available to help. “It’s total hell,” they added.
One said she never had enough time to properly care for women and babies, so she prioritized tasks most likely to prevent harm “because at least when you hand over (to the next shift’s staff) you can tell them that no one died.”
Newly qualified midwives said they regularly had panic attacks when going to work because they feared the worst would happen. “It’s scary, disturbing and stressful,” one added.
More experienced midwives said the ethos of maternity units had changed in recent years and women in labor were now treated simply “like numbers”.
One of them said: “We have been entrusted with one of the most important moments in a woman’s life and we are expected to treat people as if they were on a conveyor belt: numbers, bodies, problems that we must solve and eliminate as much as possible. as quickly as possible. ‘
That midwife said that when she raised concerns, senior staff told her to “lower her expectations.”
One midwife cited in the report said midwives working at her hospital were assigned 10 high-risk women and 10 babies to care for each shift. “It’s 37 minutes to give each individual everything they need… It’s unfathomable,” they said.
Another said, “I’m sick of feeling like I can’t provide the care I want to provide (and the care the people in my care deserve).”
The report tells how midwives who raised the alarm to senior staff about unsafe conditions were often intimidated or threatened, and many left their jobs as a result.
Its authors said workplace pressures meant there was an “endemic” culture of bullying towards newly qualified staff in particular, with managers “colluding, and sometimes leading, this ethos”.
Becky Millar, senior midwife and co-author of the report, said midwives had seen the profession move from “call the midwife” type of care to a situation where a basic level of care was only achieved by repeatedly reporting to the midwife. manage security issues.
“Many of the stories provide examples of cases where midwives felt care was unsafe, but requests for help were ignored, leaving the midwife unsupported and vulnerable, impacting on the safety of women and children. babies,” he added.
The report was compiled from personal accounts of current and former maternity workers who responded to the question: “Why are midwives leaving?” in October and November 2021.
Commenting on the report, a spokesperson for the Royal College of Midwives said: ‘Poor organizational culture has been identified as a key factor in recent research and reports into maternity safety. We know that maternity staff who feel supported and valued provide better care and when there is a positive work culture the quality of care improves.
‘We also know that midwives are working harder than ever and services are under pressure – many of our members are facing burnout. Fostering a positive workplace culture also means ensuring that the health and wellbeing of maternity staff is prioritised. A healthy, well-rested and valued staff can provide better, safer care and, in turn, improve outcomes for women and their babies.’
A spokesperson for NHS England said: “The NHS is committed to working closely with local trusts and partners to make the necessary improvements to provide the best possible services to women, babies and their families, and it is completely unacceptable for any member of staff feel silenced or unable to speak out about issues that affect them.
“The NHS Long Term Workforce Plan sets out the need to increase midwifery education and training in line with the findings of the Ockenden review, and we continue to take steps to strengthen maternity services across the country through an investment of £186 million each year to grow the workforce, strengthen leadership and improve culture.’
