Maternity wards in crisis with mums labouring in car parks, babies developing sepsis & midwives on anti-depressants

Why are our maternity wards in crisis?

Since the start of the pandemic, almost 1,000 burned-out midwives have been forced to leave the job they love. Fabulous investigates the ticking time bomb that is Britain’s maternity service.

Last November, at the end of a gruelling 12-hour night shift, pregnant midwife Melissa Connelly felt so exhausted she barely had the energy to walk to her car. After only managing to grab one quick break all day, she’d barely sat down or eaten in over 11 hours. 

“I’d started the job just two months earlier, but already felt exhausted,” says Melissa, 27, from Manchester.

“This wasn’t a one-off – days like that happened all the time because we were so understaffed. Midwives are very physically active, running up and down the ward non-stop. I loved helping mums and babies, but not under that level of stress.”

As a mum to her four-year-old son, who has a complex genetic condition, and with another baby on the way, Melissa decided she would not return after her maternity leave, which began in January this year, just four months after qualifying in September 2020.

“I’d always wanted to be a midwife and trained really hard for three years, so was heartbroken to leave so soon,” she says. “But doing the job in the midst of a pandemic was unmanageable for me. 

“I’d heard things were quite bad when I started training in 2017, but nothing could have prepared me for the kind of stress that would be involved.

"Working in the postnatal ward, there could be eight mums and babies to care for and help feed, but only two staff. You need double that. It was just exhausting.”

Melissa is far from alone. A survey by the Royal College of Midwives (RCM) in late October found that 57% of midwives are considering leaving the profession within the next 12 months, and 84% of those blame insufficient staffing numbers. 

Concerned about the shortage in hospitals and the community, CEO of the RCM, Gill Walton, tells Fabulous: “This situation has been escalating for years, and we estimate we’re now 2,000 midwives short in England alone. It’s very worrying.” 

The Nursing & Midwifery Council says there are currently only 39,000 midwives in the whole of the UK, while numbers leaving the profession have been increasing over the past decade, with former PM David Cameron’s 2010 goal to increase midwives by 3,000 never materialising.

Between 2013 and 2018, the number of people applying to be a midwife actually fell by 35%, according to the RCM – and those currently in the job are facing burnout after the pandemic has pushed maternity services past their tipping point.

“Midwives are now doing longer hours and working harder than ever. With the pandemic on top, it’s been a perfect storm,’ says Gill.

“So many have been off sick, isolating or looking after their families, which further impacts on available staff. Those who are left are saying: ‘I can’t do it any more. Show me the door.’”

At least 500 midwives in England quit between November 2020 and August 2021, according to NHS Digital figures, which also show that more than 300 left between May and July 2021 alone – one of the steepest rises in recent history. 

Dr Sally Pezaro, a midwifery lecturer at the University of Coventry and panellist on the Nursing & Midwifery Council’s Investigating Committee, says: “There’s a huge lack of value placed upon the job.

'MASSIVELY OVERSTRETCHED'

"People watch Call The Midwife on TV and see romanticised scenes of cosy births and cups of tea. The reality is that midwives are massively overstretched and working in incredibly difficult situations.

"They’re not paid much – a full-time starting salary is £24,000 – those with kids struggle to afford and arrange childcare for the unpredictable hours, and they’re not celebrated, which is dangerous because if they aren’t valued or supported, the quality of care may drop.”

As a result of the maternity staff shortage, many services have been axed – including in Oxfordshire, South Wales and London. 

“Several birth centres have had to close, or home births have been suspended in certain areas because we just don’t have enough midwives to run them safely,” says Gill.

"Inevitably, removing these services limits women’s choices and adds to the numbers being funnelled into already overcrowded hospitals. 

“What’s especially concerning is the fact that so many new midwives are leaving within five years of qualifying,” Gill adds. “It’s sad, because after completing three years of training and with decades of caring for mothers and babies ahead of them, they are the most precious of all.”

For Melissa, the challenges became apparent just days into her role at a hospital trust in the north of England. “As a student midwife, I was part of the cohort who stepped up early due to Covid.

"While I was shielded from the realities of the job during training, I realised as soon as I started how difficult it was going to be.” 

Three months pregnant with daughter Penelope at the time, Melissa worked three 12-hour shifts a week – either during the day or all night.

“Whatever the time, it was always frantically busy. We had only half the staff we should have in, due to colleagues leaving or being off sick. I was on my feet throughout, and regardless of being pregnant, anyone would find that tough.

"Thankfully I was having a good pregnancy, but I still began dreading going to work, which was not how I imagined my new career to be.”

Although her bosses were aware she was struggling, she knew there were no solutions. “The managers were always apologetic, but it was out of their hands.

"They were even more stressed than us, trying to coordinate staffing – you could see the strain on their faces. I never blamed them for a second. I knew I had to just get on with it.” 

As Gill points out, saying “no” is not an option for midwives. “They don’t just go home when they’re needed. They always put mothers first, often to their own detriment. It’s a vicious circle, because the more they do that, the more tired they are, and then they can’t go on.”

For Melissa, when she went on maternity leave at 28 weeks pregnant, in late January this year, she knew she probably wouldn’t return.

“I realised working under those conditions just wasn’t tenable for me long-term – especially when it was already so difficult to arrange childcare around my changing shift patterns.

"I know several others who qualified when I did who’ve also now left.” Her partner Ste, 30, who works in manufacturing, fully supported her decision, too.

In September, six months after giving birth to daughter Penelope, Melissa began a new career as a health visitor, using her midwife training and experience.

“I love it so far, and because it’s nine-to-five, I can organise childcare and work around my family, without feeling constantly shattered.” 

Although Melissa says she never provided poor care as a midwife, she says: “I’ve seen stories on social media about women having horrific birth traumas because of staff shortages.

"And I know of other midwives who do feel they’ve given bad care because of the situation at work. I never wanted to find myself in that position.”

Alarmingly, it seems expectant mothers and babies could be at increased risk of errors because of the midwife exodus, and in an RCM survey last November, more than three-quarters of NHS midwives said they felt staffing levels were unsafe.

Then in July this year, the Care Quality Commission (CQC) branded 41% of maternity services “inadequate” or “requiring improvement.”

One practising midwife who lives in fear of making a catastrophic mistake is Sophie*, 45, from London. She qualified over a decade ago and works in the community, managing home births and GP clinics. 

“The trust I work for is around 26 midwives short, either due to vacancies or staff off with stress,” she says.

“Although I’m not based in a hospital, colleagues tell me staff are constantly crying on wards. It’s devastating.”

'WE'RE WRECKS'

After serving as a whistleblower for the CQC, Sophie believes lives are at stake.

“One woman I heard about was left alone on the ward for so long after her waters broke that her baby developed sepsis,” says Sophie. "Women are delivering babies on the toilet, in wheelchairs or the car park.

"Another lady having her fifth baby told me she’d never been so frightened in her life after being left on the ward for hours. She said she had seen maternity services becoming more stretched and care diminishing with each child she’d had.”

Away from the wards, Sophie believes community midwives are under just as much pressure. “We’ve seen the home birth rate rise because Covid made people afraid of going into hospital,” she explains.

“Sometimes I work all day, go home to sleep at 4.30pm, and am then on call from 8.30pm. Often I’m back out all night to cover a birth. I’ve worked 23 hours straight before and it kills you.

"I’ve fallen asleep at the wheel of my car driving home, as have colleagues. It’s only luck that stops you hitting a bus. We’re wrecks.”

Being short-staffed at a home birth is another of Sophie’s biggest fears. “Two midwives should always attend, but sometimes you’re asked to go on your own.

";That’s risky, because if there’s an emergency – like the mother starts bleeding out and the baby needs resuscitating – you have to pick one to save. The mum always comes first, but if you lose the baby, the fallout and sense of personal guilt would be enormous.”

As she cannot afford to leave her job and feels unable to start a new career in her mid-40s, Sophie relies on antidepressants and sleeping pills prescribed by her GP to cope. “I’m quite a strong person, but my mental health is shot,” she says.

“Failure to prioritise the wellbeing of midwives is shocking to me, and if things don’t change, they will continue leaving,” agrees Sally. “The result could be poorer care, poorer outcomes and more medical errors, which could potentially cost the NHS millions of pounds in litigation.”

Experts insist midwives themselves are not to blame for this crisis. “It’s not their fault at all – it’s a long-standing underfunding of maternity services that has created such fragility, which has tipped over the edge in the pandemic,” Gill says.

"We need a commitment from the government to keep funding maternity services over a number of years, so we’re never in this situation again. We’ve got to do more to retain midwives, and keep working to make them feel better supported.”

For Melissa, regrets about her own experiences linger. “Even though I’m happy in my new job, being a midwife, you genuinely feel as though you are making a difference at such an important time in a woman’s life,” she says.

“It seems incredibly short-sighted that women like me have been forced out of a profession we love. It’s a massive waste, and leaves babies and new mums in an incredibly vulnerable position.”