TThe image of midwives coming into my home is as vivid today as it was almost four years ago at the height of Covid. I remember the sound of their voices. Light and airy. Calm and confident. They must have masked the fear they had after my phone call begging them to come right away. I couldn’t move. I was 19 hours into my labor and refused to go to the hospital. I almost gave up. I had been on my hands and knees on the bed the entire time and the pain was too intense to make the drive to the birth center. I was scared and my body had stopped doing whatever it was doing.
‘Thank God,’ I thought when I heard them. “They have arrived.” The sense of relief I felt was enormous. I took one look at it and I knew everything was going to be okay. Within a few hours, my son was finally born. I was so grateful for the midwives and their support that I tried to go into the kitchen and bring them tea and cake. The umbilical cord was still attached and I had not yet given birth to my placenta.
“You’re not going anywhere,” someone replied, laughing. Clearly my oxytocin levels were through the roof.
I’m not sure anyone forgets their midwife. At what can often be a woman’s most vulnerable and scariest moment, we depend on them to keep us safe, comforted and courageous.
Yet too many women are rushed through our maternity wards on what some midwives call an assembly line. I had an unexpected home birth and overall I would describe the experience as an eye-opener. Empowerment even. But afterwards I discovered that colleagues and friends who had given birth in the hospital had had traumatizing experiences with limited aftercare. They did not feel heard or cared for. They felt abandoned, stressed, forced and rushed. They had lost blood, suffered infections and become delusional. There wasn’t one positive birth story among them. I started looking at it and found that approximately Every year, 30,000 women develop post-traumatic stress disorder after birth. I increasingly wanted to know what happened behind those hospital walls.
About a year after my son was born, when I started to feel a little less sleep-deprived, I started contacting midwives to find out more. Many were preparing for a so-called campaign March with midwives – organized to raise awareness of the impact working conditions had on them and the women who used the services. The Royal College of Midwives already announced this a shortage in England of 2,500 midwives. A staffing and safety crisis, midwives said, was making maternity care untenable, so I decided to make a documentary on the subject, using their stories.
By this point, three pregnancy reviews had taken place at individual trusts. After each time, midwives said they felt guilty and as if they could not defend themselves. They were too afraid to speak out for fear of losing their jobs or scaring women into coming to the hospital to give birth. Essentially, they felt like they had no voice. But now some started to feel like enough was enough and courageously agreed to talk to me over Zoom.
“I don’t want women and babies to be put at any further risk,” says Sharon, from Gloucestershire Hospitals NHS Foundation trust, who has been a midwife for almost 30 years. “What we considered safe when we first opened the department was a minimum of eight staff on a day shift. Now you could get four.” An anonymous whistleblower at the trust also told me that on some nights there were only two midwives working instead of six.
One evening I received a call from a midwife in need. She told me that young midwives should only work on triage; sick midwives were given Lemsip and Tic Tacs instead of being sent home, and long delays for women who had been induced. Inductions are often recommended when a baby is overdue or when there is a risk to the health of mother or baby; they occur in almost a third of all births. “But when it comes to their induction day, they are postponed again and again because we have half the staff we need,” the midwife explains. If the introduction is delayed, the delivery often does not take place, which increases the risk. “One day we will find out that a baby died because we couldn’t do things in time.”
And a year after my research this happened at Gloucestershire Royal Hospital. A woman who was induced for medical reasons ultimately had to wait five days before being taken to the delivery room, where she could give birth with the recommended individual care. Essentially, her labor was interrupted while she waited for a midwife to become available and on the fifth day the baby’s heartbeat could no longer be found.
The trust summary of an independent investigation into the death confirmed that “staffing levels influenced the mother’s initiation of labor and sufficient staffing could have changed the outcome for the baby”. Gloucestershire Hospitals Trust said it had introduced a quality improvement project aimed at uptake, and was committed to learning and changing when things go wrong.
But problems with inductions are not limited to the Gloucestershire Trust. Midwives from two other British trusts told me of similar incidents, and the Care and Quality Commission has highlighted the issue in a number of other trusts. We submitted an information form to the NHS’s research arm, the Maternity and Newborn Safety Investigations Program (MNSI, formally HSIB), and found that over the past three and a half years it has investigated more than 200 cases where induction of labor occurred . one of the causes that led to injury or death.
James Walker, emeritus professor of obstetrics and gynecology at the University of Leeds, says: “One of the problems is that the number of inductions has increased – partly because the induction methods are easier (and partly due to) a change in policy about how long a pregnancy should last and what is dangerous – without anyone actually sitting down to figure out how best to approach this, to make sure to ensure that you have the right number of staff and facilities to do this within the all-important timeframe.” It is also questionable whether such high numbers of inductions are indeed necessary.
I can’t imagine what it must be like for a midwife to go to work wanting to deliver healthy babies and instead worry about whether a preventable infant death will occur under their watch. In the Panorama documentary I made on this subject, we hear from midwives who are told not to worry about escalating staffing levels by management. “You’re almost greeted with, ‘Well, we know staffing levels are bad. What’s the point of filing another complaint about it?’”
This culture of not listening is something that Dr Bill Kirkup, who led major pregnancy reviews in Morecambe Bay and East Kent, is present in every study: “There is huge common ground between all these reports. If you make a kind of word cloud of the things you read, the same terms will come up. And it does indeed involve things like culture, compassion and listening.”
A Facebook group called Beyond obstetrics has more than 4,000 members – all of whom have left the profession or are desperate to leave it. They post about being away from work due to anxiety and depression. One midwife says the impact on her “mental health is too great”. Another says she has “suicidal thoughts as she sits at train stations late at night thinking about how to get out of work.” In my research, midwives also told me how they had turned to self-harm to cope.
In Gloucestershire, an anonymous whistleblower said her biggest fear is that it will take the death of a midwife for anything to change. “That doesn’t even necessarily mean women and babies die,” she said. ‘Does it have to get to the point where a midwife commits suicide because of her feelings about her work, because of the pressure she experiences?’ The Gloucestershire Trust says it has increased the number of midwifery posts from 243 to 264 over the past three years and strengthened the ways in which staff can “safely express their views”.
I became pregnant while making the documentary last fall, but lost the baby when I was three months old. It meant going through the system I was exploring. During a routine scan, an ultrasound expert early in pregnancy broke the news to me: “I’m afraid your baby is incompatible with life.”
I felt shocked and heartbroken at the same time. My work on the documentary made me all too aware of what was probably happening behind the scenes. I experienced a constant rush of adrenaline and found it difficult to take it all in. I turned again to the attending midwife to help me navigate the process physically and emotionally – and found myself, through tears, apologizing to her for clogging the system. . “I’m sorry for taking up so much of your time,” I told her. “I know how busy you are and what you’re dealing with.”
The Maternal Fetal Assessment Unit, where I ended up, is by nature a different pace than the labor or antenatal units. The midwives there deal with miscarriages and pregnancy problems, not with babies on the way. But I was grateful for her calm demeanor and reassuring demeanor, despite her workload. “Don’t be silly,” she replied, before leaving to train the newly qualified midwife who followed her.
Midwives tend to put on a brave face. They will always want to be the force when we don’t have it within us. But they are desperate for help – and we need to start listening.
Panorama: Midwives under pressure is now available to watch on BBC iPlayer.