Mothers’ and babies’ lives are being put at risk by a ‘toxic culture’ in NHS maternity services, a damning report has found.
Frontline midwives warned working in NHS units was like playing a ‘warped game of Russian Roulette’, as there was a risk of harm or death occurring at any time.
‘Dangerously’ low staffing levels meant labouring women were treated as if they were ‘on a conveyor belt’, midwives revealed — adding that one-to-one care was ‘a thing of the past’.
Maternity units ‘often’ had less than half the number of staff needed to operate safely and unqualified students were left to look after multiple women on postnatal or labour wards.
Midwives reported how they were given so many patients to care for they often did not have enough time to complete basic care tasks, like giving women painkillers or properly sterilising equipment — putting patients at risk of infection.
Maternity units ‘often’ had less than half the number of staff needed to operate safely
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The report by the #Saynotobullyinginmidwifery campaign group — a team of leading midwives and midwifery academics — featured the experiences of hundreds of midwives who are currently working in or have recently left NHS services.
Many of those who contributed had witnessed babies 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 give the care they wished to give. Things have got so much worse.’
She warned ‘care has been squeezed out in the interests of efficiency’ and that the service was ‘run on a conveyor belt model’ which was ‘so inappropriate’.
The report’s authors pinned the problems on chronic staff shortages, as well as pressures on midwives from senior management to discharge mothers and babies as quickly as possible to free up beds.
It follows a call from bereaved parents last month to ex-health secretary Steve Barclay for a statutory public inquiry into England’s maternity services.
The request, made by the Maternity Safety Alliance, followed a number of high-profile reports which revealed poor care and toxic cultures in maternity services 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 longer at a time, meaning they were not capable of providing safe care.
While newly-qualified and student midwives said they were frequently given responsibilities beyond their training and were left alone to deal with multiple patients or complex births.
‘Every shift in the unit is dangerously short staffed, often more than 60 per cent short of midwives… students are left to run postnatal bays and manage [women in labour] with “distant supervision”,’ one midwife revealed.
A newly-qualified midwife told how she had been left alone on her first ever shift to deliver the baby of a woman with multiple high-risk health problems. The baby died hours after it was born.
Another recalled how they pressed the emergency bell when they noticed a baby’s heart rate was in difficulties during labour, but it went unanswered because no one senior was available to help. ‘It’s utter hell,’ they added.
One said she never had enough time to care properly for women and babies so prioritised the tasks most likely to prevent harm ‘because at least when you hand over [to staff on the next shift] you can tell them that nobody died’.
Newly qualified midwives said they regularly had panic attacks going into work because they feared the worst would happen. ‘It’s frightening, and upsetting, and stressful,’ one added.
More experienced midwives said the ethos of maternity units had changed in recent years and women in labour were now just treated ‘as numbers’.
One said: ‘One of the most significant times of a woman’s life is entrusted to us, and we are expected to treat people as though they are on a conveyor belt — numbers, bodies, problems to be solved and removed as fast as possible.’
That midwife said when she raised concerns, she was told by senior staff to ‘lower your expectations’.
Midwives warned working in NHS units was like playing a ‘warped game of Russian Roulette’
One midwife cited in the report said midwives working in her hospital were given ten high-risk women and ten babies to care for on each shift. ‘That’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 that the people in my care deserve).’
The report told how midwives who raised the alarm with senior staff about unsafe conditions were often bullied or threatened, with many leaving their jobs as a result.
Its authors said workplace pressures meant there was an ‘endemic’ bullying culture towards newly-qualified staff in particular, with managers ‘colluding in, and sometimes leading, this ethos’.
Becky Millar, a senior midwife and co-author of the report, said midwives had seen the profession moved from ‘Call The Midwife-type care’ to a situation where a basic level of care was only achieved if safety concerns were repeatedly reported to management.
‘Many of the accounts provide examples of where midwives have felt care was unsafe but requests for help were ignored, leaving the midwife unsupported and vulnerable, and impacting on safety of women and babies,’ she added.
The report was compiled from the personal accounts of current and former maternity workers who responded to the question: ‘Why do midwives leave?’ in October and November 2021.
Commenting on the report, a Royal College of Midwives spokesman said: ‘Poor organisational culture has been identified as a key factor in recent investigations and reports on maternity safety. We know that maternity staff who feel supported and valued provide better care and when there is a positive working culture the quality of the care improves.
‘We also know midwives are working harder than ever before and services are under pressure — many of our members are facing burn out. Nurturing a positive work culture also means ensuring the health and wellbeing of maternity staff is being 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 spokesman said: ‘The NHS is committed to working closely with local trusts and partners to make necessary improvements so that we provide the best possible services for women, babies and their families and it is completely unacceptable for any member of staff to feel silenced or unable to speak about issues affecting them.
‘The NHS Long Term Workforce Plan sets out a need to grow midwifery education and training in line with the conclusions of the Ockenden review, and we continue to take action to strengthen maternity services across the country through £186million investment each year to grow the workforce, strengthen leadership and improve culture.’