A Midwives Tale...
I really have been in two minds about whether to post this or not. I really don't want it to seem damning in any way. But as International Day of the Midwife approaches (May 5th) I felt someone should really explain what a real shift can be like. I don't necessarily mean tragedy or drama, it usually means high ward activity and low staffing levels. Here is a glimpse in to a particular shift that I can't forget, I am confident in saying this is all too common across our maternity units these days, I know I have experienced days like this in both private and public care. I have worked in three different NHS hospitals, all on a large scale and one smaller private unit.
My midwifery career was in its infancy when this happened. At my choice, I worked permanent night shifts on a busy labour ward (almost from the get go), pretty much always have, I love labour ward, the buzz, the drama, the people. It is a common misconception that night shifts are quieter, people who spread these rumours have clearly never set foot on a real labour ward. I feel like I should also point out that this is not a ‘woe is me’ story…. More of a ‘you need to know what it is really like’ kind of story. This is why, in my opinion, midwives are leaving not only their posts, both public and private, but the profession altogether.
Starting a nightshift at 8pm I usually arrive 5 minutes beforehand, adhering to the stereotypical midwife image I make a cup of coffee. I chat to my colleagues and catch up with things I have missed. We stand together, look at the board, taking in each patient and their situation. The handover begins. The coordinator tells us about the high risk patients and the perinatal deaths on the ward, there is not a shift that goes by where we do not have a grieving family or a critically ill woman on the ward. We then discuss the amount of frustrated and fed up women awaiting induction of labour, this list is always in double figures and never seems to get less. Then we are allocated a room, often 2 or 3 if you are the midwife caring for delivered women or high risk women.
It is always a good night when you look at the board and you see your name next to just one patient. A labouring woman. The kind of patient that needs your full attention. Oh wait….. that’s every patient. Realistically speaking to achieve an optimum safe working environment for both women and midwives we should have enough midwives on duty to cover each woman one to one. On a good night we may break double figures and have 10. A great shift is 11 or 12.
So, patients allocated we head off to our rooms to receive handover from weary day staff. Tonight I have two women to care for. The first woman has just delivered a lovely baby girl an hour ago. She still requires stitches. I note that as high priority on my mental to do list…. Which is getting longer by the second.
I then head off to my second room. To get a second handover. This woman is at the other end of the spectrum. She is in premature labour at 20 weeks. She has been betrayed by her body. Doctors have told her that her cervix is opening and her tiny baby girl will be born in due course and unfortunately she is just too small to survive. Naturally these parents are inconsolable. Their hopes and dreams for their first child destroyed. They are both terrified of what is to come next. What I really want to do more than anything is to sit with this family, after all that is what my job is, at its core. I want to get to know them, discuss their fears and attempt to prepare them, talk about their baby girl, learn her name. But I can’t. I have to leave and stitch my other woman. So I offer my condolences on the situation. Tell them to call me for anything.
I head back to the other room, complete this woman’s care. I make sure she has pain relief, give her the famous NHS tea and toast, help her breastfeed the baby and then leave her and her lovely family to complete the endless paperwork. It is at this point I am asked by the shift co-ordinator “Can we get her gone yet?”. It’s her job to find beds and find midwives. Impossible when you actually have no resources, I don’t envy her task. It is only 10.20pm. And my answer is no.
I head back to my scared and grieving couple. They have extended family there to comfort them. They do not have any needs right now. She is pain free, physically at least. So I return to the office, allowing them the privacy they need to grieve. A drop of watrer has barely passed my lips when I am asked to receive a woman from Triage. Patient number three. This is midwife chess at its finest. Who can be manoeuvred into the most logical and safe position to receive another patient? If we are asking that question then the answer is that there is no safe option. My third woman has very high blood pressure. She needs medication and close monitoring.
By 3.00am I have ploughed through half of the paperwork, controlled my third woman’s blood pressure and now I go to the woman who needs one to one care the most. Constant support and just someone to hold her hand. We discuss what her baby girl will look like, that she may try to breathe and may be
able to move, what to expect when her daughter makes her way in to the world. We discuss dressing her and taking her photographs, until I am interrupted by a knock on the door informing me my other patient’s blood pressure has risen and I am needed there. I apologise, check she if she is having contractions. She is not. Check if she is any pain. She is not. Unhappy with the interruption in care I give her the call bell and head out to the other room.
I return to my woman with dangerously high blood pressure, aware in my mind that I still haven’t managed to return to my delivered lady. Hoping she is ok, I treat the woman in front of me. I reassure her, check her blood pressure, give her medication, look over the baby monitoring and involve the doctors. On my way to send some bloods for this woman the call bell goes off from my other woman’s room, the woman with the premature baby. And I know. In my gut, I just know. She is having her baby. And I am not there.
I race down the corridor. I enter the room. And my gut feeling was right, it usually is. It's a midwife thing. In front of me I see two terrified parents. A mother delivering her own beautiful, tiny baby girl on the bed, a father and husband watching, helpless and bereft. I take over. I deliver their daughter. Wrap her in towels. She is beautiful, a fighter, she is trying to breathe, she is moving her arms. Her parents hold her until her fight is over. They are beyond distraught as I attempt to offer support and document their daughters time with them at their request.
They are not the only ones who are distraught. I wasn’t there. When this couple needed me most I was not there. The guilt weighs heavily on me as I remain in the room with them, in the back of my mind, I’m concerned about my other two patients. To have to swing from a room filled with immense joy, to one filled with worry and the unknown, to one filled with such grief it is unbearable. I cannot be in three places at once. I cannot provide the care I want to give when I am stretched so thinly.
When I finally manage to leave the room I find that it is nearly time to handover to the day shift. It is morning. I have not had a break nor been to the bathroom, which is the norm on this, and I suspect most other, maternity units. All of my colleagues are exhausted. Their nights just as challenging. This is the norm, this is what midwives deal with daily. I handover my women to the day staff. Three different midwives. Day shifts are usually slightly better staffed. I get my coat and my bag and walk out of work. I feel guilty, disappointed and angry. Whilst I love my job and find it a great privilege to care for families during their pregnancy journey it; drains me in every way.
My drive home consists of thoughts of ‘what could I have done better?’, ‘how could I have prioritised my time more efficiently?’, ‘how will that family cope with their loss?’, and selfishly ‘what if I am disciplined for this?’. Ridiculous really, considering my colleagues and I are stretched to physical and emotional limits and no one is disciplined for that. The irony of working in a caring profession who do not care about their staff is not lost on me. Nor on any of us. This is why we are leaving in droves, being replaced by doe eyed, eager, newly qualified midwives. I fear for them, for what they will have to go through. I wonder how long it will take them to reach the point my colleagues and I are at now….. breaking point. We are a profession which will always rally together and carry on. But just because we survive an overworked and understaffed shift does not make us successful, it simply means we managed to tread water for 12 hours. It seems being a midwife these days means doing the best you can and hoping it is enough…. But I’m left feeling like it never is.
I wrote this when I was a relatively new midwife. I wanted to quit somedays. Somedays I still do. I continued to learn so much from this, after this. I am still learning. I think I always will be. I just thought I should share this story. It isn't my most dramatic day, it isn't even the worst day in my career to date. It is just a memorable one and it highlights things your health professionals juggle that you just don't know about. I am posting it because compassion goes both ways in a midwife/patient relationship. We don't give to get back. But for the most part, we really try our best in challenging circumstances. I think we all bear burdens other people don't know about. But now I hope you know a bit more about our burdens as midwives. And we still turn up with a smile, we laugh, cry, empathise with you. Because it really is a special job!