The lives of mothers and babies are being put at risk by a ‘toxic culture’ in NHS maternity care, a damning report has found.
Midwives on the frontline warned that working in NHS units was like playing a ‘twisted game of Russian roulette’ as there was a risk of injury or death at any time.
‘Dangerously’ low staffing levels meant laboring women were treated as if they were ‘on an assembly line’, midwives revealed – adding that individual care was ‘a thing of the past’.
Maternity wards ‘often’ had less than half the staff needed to operate safely, and unqualified students were left to care for multiple women in postnatal or labor wards.
Midwives reported having to care for so many patients that they often did not have enough time to perform basic care tasks, such as giving women painkillers or properly sterilizing equipment, putting patients at risk of infection.
The chart shows the NHS trusts in England that recorded the biggest fall in midwifery numbers between September 2022 and July 2023 – according to the latest data available. Northern Care Alliance NHS Foundation Trust has seen its midwifery workforce fall by 12.8 per cent in the past nine months, while Royal Cornwall Hospitals NHS Trust has seen an 8.8 per cent reduction in staff compared to 10 months earlier, NHS workforce data shows
Your browser does not support iframes.
The report from the #Saynotobullyinginmidwifery campaign group – a team of leading midwives and academics in midwifery – included the experiences of hundreds of midwives who are currently working in the NHS or have recently left the NHS.
Many of those who contributed had witnessed babies being harmed 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 how midwives were leaving midwifery because they could not provide the care they wanted to provide. It’s gotten so much worse.’
She warned that ‘care has been pushed aside in the interests of efficiency’ and that the service was being ‘run on an assembly line’ which was ‘so inappropriate’.
The report’s authors pinned the problems on chronic staff shortages, as well as pressure on midwives by senior management to discharge mothers and babies as quickly as possible to free up beds.
It follows a call from relatives last month to ex-health secretary Steve Barclay for a statutory public inquiry into English maternity care.
The request, made by the Maternity Safety Alliance, followed a number of high-profile reports exposing poor care and toxic cultures in maternity care at 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, launched today, featured 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 midwives 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 in the ward is dangerously understaffed, often short of midwives by more than 60 percent… students have to run the postnatal wards and manage women in labor with ‘remote supervision’,” one midwife revealed.
A newly qualified midwife told how she was left alone on her very first shift to deliver the baby of a woman with multiple high-risk health conditions. The baby died hours after birth.
Another recalled how they pressed the emergency bell when they noticed a baby’s heartbeat was difficult during delivery, but it went unanswered because no senior was available to help. “It’s absolute hell,” they added.
One said she never had enough time to properly care for women and babies and so prioritized the tasks most likely to prevent harm “because at least you can tell them when you hand them over (to the staff of the next shift) that no one has died’.
Newly qualified midwives said they regularly suffered panic attacks when they started work because they feared the worst would happen. “It’s scary, disturbing and stressful,” one person added.
More experienced midwives said the ethos of maternity units had changed in recent years and women were now treated just ‘like numbers’ during labour.
One of them said: ‘One of the most important moments in a woman’s life is entrusted to us, and we are expected to treat people as if they were on an assembly line: numbers, bodies, problems that need to be addressed as quickly as possible. are resolved and removed. ‘
That midwife said that when she raised her concerns, she was told by senior staff to ‘lower your expectations’.
Midwives warned that working in NHS units was like playing a ‘twisted game of Russian roulette’
A midwife quoted in the report said midwives working at her hospital had to care for 10 high-risk women and 10 babies during each shift. “That’s 37 minutes to give each individual everything he or she needs… it’s unfathomable,” they said.
Another said, “I’m tired of feeling like I can’t provide the care I want to provide (and the care the people in my care deserve).”
The report told how midwives who raised the alarm to senior staff about unsafe conditions were often bullied or threatened, resulting in many leaving their jobs.
According to the authors, pressures in the workplace meant there was an ‘endemic’ culture of bullying, especially against newly trained staff, with managers ‘colluding and sometimes directing in this ethos’.
Becky Millar, a senior midwife and co-author of the report, said midwives had seen the profession move from ‘Call The Midwife style care’ to a situation where a basic level of care could only be achieved if safety issues were repeatedly brought to management reported. .
“Many of the reports provide examples of cases where midwives felt care was unsafe but requests for help were ignored, leaving the midwife unsupported and vulnerable and impacting the safety of women and babies,” she added to.
The report is compiled from the personal stories of current and former maternity nurses 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 maternal safety. We know that maternity nurses who feel supported and valued provide better care and when there is a positive working culture, the quality of care improves.
‘We also know that midwives are working harder than ever before and that services are under pressure; many of our members are confronted with burnout. Fostering a positive workplace culture also means ensuring that the health and wellbeing of maternity staff is prioritised. Healthy, well-rested and valued staff can deliver safer, better care and in turn improve outcomes for women and their babies.”
An NHS England spokesperson said: ‘The NHS is committed to working closely with local trusts and partners to make the necessary improvements so that we can provide the best possible services to women, babies and their families, and it is entirely unacceptable that any staff member remains silent or cannot talk about matters that affect them.
‘The NHS Long Term Workforce Plan sets out the need to grow the education and training of midwives in line with the conclusions of the Ockenden review, and we continue to take action to strengthen maternity services across the country by providing £186 annually million to invest to grow the workforce. , strengthen leadership and improve culture.’