17:00 EST, 15 December 2012
17:46 EST, 15 December 2012
With Call The Midwife and One Born Every Minute enjoying huge success, bringing babies into the world has rarely had more attention.
Yet the reality could hardly be more different from the cosy TV image. In fact, maternity care is facing crisis.
Here, one midwife describes for the first time the conditions she and her colleagues endure at a London hospital: the emergencies, the danger, the exhaustion – and the joy. Names, locations and timings have been changed to protect identities. But the episodes are all too real.
Call the midwife: One London midwife reveals the truth about what it is like on a busy shift at a maternity ward in the capital
Code Amber means we’re running out of room; Code Red, and there’s no room at the inn. I’m back on nights at a big London hospital. It’s mid-September and we’re Red. The first thing I look at is the rota. Who else is on? Will they muck in? Are they agency staff, who are expensive and often don’t know where anything is? And the most basic question of all: are there any delivery packs, with swabs, scissors, cord clamps? If not, we’re in trouble.
Tonight, it’s a good team and it needs to be.
The antenatal ward, my responsibility for the next 12 hours, is packed. Postnatal ward is full. The labour ward is rammed. All the festive alcohol at Christmas and New Year means an annual wave of new babies in the autumn, and the deluge is upon us. We have six women in early labour, most of them already have children and may give birth quickly. They all need beds and, more importantly, one-to-one care.
A woman in her late 20s is hooked up to a fetal heart monitor and we notice that the heart rate is dipping, dipping, dipping. There are no doctors here, so we page. All three theatres are open tonight; no one responds. We may have a bad outcome on our hands – serious brain injury, maybe even death – unless we do something. After 20 minutes, I run downstairs to get a doctor myself.
When I get there, the labour ward is Armageddon. Doctors and midwives running in the corridors, trolleys clattering, emergency buzzers going off.
Then, a Brazilian woman walks in supported by her husband. When she removes her trousers, the baby’s head is visible.
She’s never been to our hospital before – in fact, she’d planned to have her baby elsewhere – but they got on the wrong bus in panic and it just happened to stop outside our hospital.
The baby arrives; mother and baby are fine. I say fine. At this point, we have no idea of her HIV status or blood group. We’re supposed to be on top of all these things. But often we’re not.
Real-life miracle: The reality of the maternity wards in the UK is far away from the image portrayed on television shows like Call The Midwife and One Born Every Minute
I get back up to the antenatal ward at 2am to find Julia, one of our early labourers, is now delivering her baby on the bed, in the middle of a four-bedded bay. I grab one of our two remaining delivery packs and help her as the baby is born noisily, quickly and – thankfully – safely.
Julia sustains a second-degree tear, which will need to be stitched, on the wrong sort of bed (this is not a delivery suite) in barely adequate light. The other women in the bay cope stoically. But the two women pregnant with their first babies are shocked. It’s a far cry from what they’ve been led to expect.
At 6.30am, the buzzer goes again. Keren, a young woman who lives near the hospital, is pushing uncontrollably. She is fully dilated, the baby’s head is advancing fast.
A colleague joins me. There’s one delivery pack left. Despite knowing the answer, I phone the labour ward to be told that there are no beds free, so it’s down to us.
Keren is 17 and she’s extremely frightened. Her two friends are by her bed and so are the remains of a recent KFC.
Faced with a girl I’ve barely met, I try to calm her, persuade her to trust us when we tell her not to push, to ‘breathe’ the baby out. It seems to work.
While her friends text furiously on their BlackBerrys – and again, in the middle of a fully occupied four-bedded bay – she gives birth to her first baby.
We shouldn’t be doing this, delivering
babies on wards, with little or no privacy for the mothers, let alone no
one-to-one care in labour – but we are. It’s unavoidable; if a baby’s
going to arrive quickly, there’s not much we can do.
It’s better than delivering a child in the lift, which I’ve done on more than one occasion. Often, there’s simply no room, or too few staff on our labour ward.
The baby’s fine, but now Keren is bleeding. The trickle of blood turns into a gush. We call for help, and I shout to the healthcare assistant to page the doctor. The friends are freaking out. We’re on autopilot now, and within minutes Keren has two intravenous (IV) lines in her hands. A doctor arrives. Keren has fluids, some medication and the bleeding stops.
It’s 7.30am and the traffic is roaring past outside. I started my shift 12 hours ago, and I’ve forgotten to eat, drink or go to the toilet. But there is paperwork to be completed, and lots of it.
I sit with Keren in her room while she breastfeeds her baby and try to write a clear account of events in her notes. My hands are shaking as I drink one, then another cup of coffee. It’s nearly 10am by the time I escape.
The following night, I’m back for more. This time I’m on the postnatal ward, full of exhausted new mothers sleeping in bays of four, cots at their bedside. For once, it’s quiet. I’m looking forward to a rare break. It’s 3.30am. After last night, I need sleep.
Cue the sound of a young first-time mother in bed 19 close to our desk, shouting incoherently at the other babies in the ward to be quiet.
I offer her a cup of tea. But once we’re in the office, she loses it, swearing, shouting that no one understands. She picks up a large folder from the desk and hurls it at the wall. A coffee mug lies in pieces on the floor.
Thirty-five women, now wide awake, peer out from behind their curtains. Some emerge, wheeling their babies in cots, to see what’s going on.
The mother is completely out of control, screaming abuse – and heading straight for her baby. A fellow midwife steps deftly in her way, which is brave of her, and I call security.
We’re trying to raise the psychiatrist, who tells me she’s stuck in AE with a suspected schizophrenic. When she arrives, we get a hasty diagnosis of puerperal psychosis – a severe form of postnatal depression – before her pager goes again and she runs back to AE.
With medication, the mother calms down, but for the rest of the shift we’re running on adrenaline. We don’t know where this poor woman is from.
Under pressure: Medical staff rush a patient to theatre where lack of staff, long hours and underfunded wards add to the stress of midwifery
This is a maternity ward, not a psychiatric unit. She will be a guest of the postnatal ward for another week, with a firm diagnosis of full-on psychosis.
We’ve all seen programmes such as Call The Midwife on BBC1 and Channel 4’s One Born Every Minute. We don’t talk about them much at work because they bear no relation to what we go through.
Call The Midwife makes me smile even if it’s for the wrong reasons: a show where a missing bicycle is a crisis! At least, for all its rose-tinted nostalgia, it depicts a time when midwives knew the women they cared for. The close relationship between midwife and mother produced a level of individual care that policy-makers can only dream of now.
Despite appearances, One Born Every Minute – a popular ‘structured reality’ account of life in an NHS maternity unit – is just as removed from our daily reality.
Seeing the midwives sitting down for a staff-room chat with cakes and steaming mugs of tea, is a far cry from our working lives on the ward, in which we are often on our feet for 12 hours without a break. Or with a snatched 30 minutes at 5pm. Since when was lunch at 5pm?
We often joke that if One Born Every Minute came to our unit, they’d get the shock of their lives. I don’t think the television cameras could move fast enough.
The facts paint an altogether more worrying picture than the moving image on TV. The Royal College Of Midwives (RCM) says we are short of more than 5,000 full-time midwives around the country. One in 20 posts are unfilled. London has particular problems. Recent research shows that more than 100 mothers have died in childbirth in the capital in the past five years, twice the rate of the rest of the country. London’s maternal death rate has doubled since 2005, from 11 deaths in 2005-06 to 29 in 2010-11.
Ministers have promised to spend £25 million on new maternity facilities around the country. They will be needed: England is just at the start of the biggest baby boom in 40 years. This year alone we’re expecting more than 700,000 new lives.
Even as it stands, nine out of ten midwives say they can’t give the care they need. Government figures say that one in four hospital trusts is failing to provide adequate quality or safety of care to mothers and new-born babies. If this carries on, the consequences could be dire.
Last month, Cathy Warwick, chief executive of the RCM, said: ‘NHS maternity services, especially in England, are on a knife-edge. We have carried shortages for years, but with the number of births going up and up and up. I really believe we are at the limit of what maternity services can safely deliver.’
Our managers tell us we’re fully staffed, but even they admit that’s questionable.
So, with high rates of sickness, and staffing often skewed towards newly qualified, we frequently run the ward on a staffing shoestring.
Yet to play any part in this is life affirming, which, for all the difficulties, is why I do the job. There are moments of absolute joy.
Such as meeting Pamela. She was expecting a baby after IVF treatment. She was admitted to the ward at just 22 weeks because the risk of her going into premature labour was high. No one expected a good outcome. When she arrived, she was terrified and determined to follow the ‘bed rest’ advice to the letter.
Special duties: The cast of Call The Midwife, left to right, Helen George, Miranda Hart, Jessica Raine and Bryony Hannah
Each day, we tried to keep her spirits up. Days turned into weeks, and at 28 weeks, she even began to be hopeful that her baby – if delivered now – would have a good chance. At 33 weeks, after ten weeks spent on the antenatal ward but still terribly early, her waters broke. She was distraught.
Yet the baby boy hung on. And after another two agonising weeks, her baby was born safely. I finally discharged her home a week later. It sounds a cliche, but it really had been a privilege to be part of it.
Nights are the worst, for us and for the mothers. No one gets much sleep in wards that must often feel like station waiting rooms, only noisier and more chaotic and, occasionally, rather frightening. The constant racket serves one purpose, at least: few of the mothers want to hang around. Some of our beds take three or four women a day.
If we’re lucky, my colleagues and I will get 30 minutes on a sofa in the staff room. I’ll glug down a Diet Coke before nodding off so there’s plenty of caffeine in me when my phone alarm goes off.
People laughingly call night-time on the health service the ‘graveyard’ shift. It is no joke.
During waking hours, there will be four midwives, three or four support staff and countless student midwives.
At night there are just three of us for 35 women and their babies. So that’s more than 24 lives each – including the babies – most of them rather fragile lives.
On any given night there will be three or four social-services cases, the ones waiting for a court to decide if they can keep their child. The risk of them absconding is high. And there will be and one or two with mental-health problems, at least one requiring one-to-one care.
This is usually the job of the least-trained member of staff: the healthcare assistant. Or a registered mental health nurse (RMN). We have frequently found the RMNs sound asleep. They are looking after the most dangerous patients in the ward; how can it happen?
Not that the day shift is easy. In early December, I meet Tina, a new mother, for the first time at 8.30am; by 10.30 I’m in a meeting with her, a social worker, a drugs worker, a specialist midwife and a psychiatrist and they want my opinion. Should she be allowed to go home with her baby? How should I know?
I’ve had a few minutes to look through her notes before the meeting – all looks to be well, so I fudge, as professionally and as honestly as possible.
Then there is Sarah, currently waiting to be discharged. She left home when she found out she was pregnant – she says she didn’t get on with her mum – and has been living in a local hostel. It is only after her baby is born that she discloses her cannabis use and her alcohol dependency. She’s been self-harming for the past two years. The father of her baby has been violent towards her in the past, ‘but it’s OK now’, she says.
Suddenly, we’re not simply sending her back to the hostel any more. A bewildering array of agencies and professionals is now involved. It takes a huge amount of time to liaise with them all– time we don’t have on a busy ward – but what choice do we have? I’m on first-name terms with the hospital’s social workers and psychiatric senior house officers.
I’m with Maria, from Albania. She’s an asylum seeker staying in a hostel alone. She’s the victim of rape and the child she’s just brought into the world is the result. She speaks no English. She’s a long stayer – six days already – and we can’t communicate.
On-screen joy: A scene from Channel Four show One Born Every Minute depicting life on a maternity ward
So, day by day, Maria comes into the office, packed with computers, midwives, students, doctors, litter and coffee cups, and sits with her ear glued to a translation service on the phone so that she can have her postnatal checks.
The questions are intimate: about her soreness, her body parts and so on. It is deeply personal stuff. Yet here she is explaining everything with the other phones ringing, the chit-chat, the visitors . . . I don’t know what’s worse, the tawdry circumstances, or the fact that she seems to accept it all as normal.
On any day on the ward, there are several women who speak no English at all. I use the phone translation service when I need to convey something important even though it is expensive.
There are many more with poor English, and sometimes we get by with family members to interpret (far from ideal), or mime. Have you ever tried miming bleeding, or worse? We laugh about it, because we have to, but the potential for things going wrong is huge.
We can only hope to give the most basic care to these women – any conversation about how they’re feeling emotionally is almost impossible. I once found a doctor just inches away from examining a Chinese woman for piles. All she wanted to say was that she was feeling a bit sore.
Doctors and midwives with iPhones often communicate via Google Translate. Hardly what it was designed for, I imagine.
Who are these women who arrive knowing almost nothing of the language? The truth is we don’t really know. Many have no papers. But we have a duty to care for them.
The hospital has something called a ‘foreign visitors’ department and its staff come round our wards regularly. They stress upon the women that there are bills to be paid for the care they’ve received, but mostly they’re far too late. With or without English, the new mothers have left.
When I finally discharge Maria back to her hostel, I look through her notes.
She’s a qualified physiotherapist. She is unusually loving towards the child conceived in such terrible circumstances. It is not uncommon.
August brings new contracts and an influx of new doctors, most of whom have a lot to learn, and fast. If you’ve been a midwife for more than six months you’ll know considerably more than any senior house officer.
After a couple of weeks, though, they are just fine; if they don’t come when we call for help, that’s because they can’t come.
Like us, they’re hopelessly overstretched. On a number of occasions, I’ve been driven to walk into the operating theatre mid-caesarean to ask for an opinion on some worrying notes or a cardiotocography (CTG) trace. And they’ve always helped without complaint.
We are under pressure to move our women out of hospital, baby in arms. The ‘conveyor belt’ comparison is compelling. Bear in mind, too, the growing alcohol and social problems, and that an increasing number of mothers have medical complications, often due to obesity.
I’m told one morning that a Vietnamese woman is another dead cert for discharge home, although she doesn’t speak much English. Through a mix of mime and broken English, I discover that her baby hasn’t been fed for ten hours. And, worryingly, there is no sign of said baby.
Gesturing ‘where is the baby?’ to the mother, she smiles and responds by lifting three hospital blankets. There he is, in danger of suffocating.
Responsibility: ‘On the night shift, three of us each have 24 lives to look after’, out whistleblower reveals
So where do I start? Through a mixture of yet more broken English and arm-waving that in less critical circumstances would be comical, I tell her about basic baby care and postnatal health. Armed with our emergency contact numbers, she goes home that afternoon.
In the next bed, I have Claire, a 38-year-old woman who has been on the ward for six days. She’s already been on the ward far too long. It turns out she’s a lawyer, and no, she can’t possibly leave.
She says she felt frightened and confused by her birth experience, no one had explained what was happening, and she ended up having emergency caesarean section.
She’s physically well, but emotionally shaky. No one has given her the time and attention she needs. She’s angry, upset and wants to complain.
I do what I can, and she goes home with the promise of a referral to our counsellors.
The significant few who need more time and help to come to terms with their birth experience are often bypassed – because we need the bed space.
Across the country, the middle classes are choosing home birth in ever greater numbers. The ones who come to us often have issues – such as the woman from Afghanistan, currently in bed five. She’s just had her seventh baby and is at a high risk of bleeding.
I’m trying to watch her like a hawk. But I’m juggling an in-tray that would have the chief executive of a multinational breaking into a cold sweat.
It’s common – and heart-breaking – to be with new mothers who have already had children removed by social services, but who somehow hope it will be OK with the third.
Drug-addiction is an ever-present worry, too. A couple of years ago, my colleagues dealt with someone who kept disappearing for a cigarette break.
It took them days to realise she was going down to on to the street to score methadone. When they found out, they prescribed it for her.
The financial rewards are fairly limited in my job, and there can be few occupations that have such persistent levels of stress.
Yet, a few weeks ago, I bumped into Shelley in Brent Cross shopping centre.
I remembered caring for her after the birth of her first child, and she remembered me. She gave me a warm hug.
My mind flashed back to the three nights I’d spent with her on the postnatal ward, after a long labour. I thought the care and support I’d given was pretty fragmented – trying to help her as she coped with the difficulties of breastfeeding but being called away to answer the phone, or to care for someone else. Yet she saw it very differently.
‘You helped me so much when I had my first,’ she said. ‘I couldn’t have got through those early days without you – I ended up breast-feeding him for a year!’
So, perhaps we’re doing something right. Meeting Shelley, who is pregnant for the second time, was a timely reminder that I can’t imagine doing anything else.
Right now, I’m simultaneously tackling paperwork, monitoring a five-time mother awaiting her sixth, and attempting to free up yet another bed on the ward. And the buzzer is going.
But I’m still looking forward to meeting Shelley’s new baby this Christmas.
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We have frequently found the RMNs sound asleep. They are looking after the most dangerous patients in the ward; how can it happen?
==============================this is quite common . Nurses operate a one sleeping and one working on night shift. This is why you can never find a nurse at night. The Quality Care Commission rarely inspects during the night.
Atleast you wouldn’t have a 10-20,000 bill or more for having no health insurance and giving birth in the states! You could go broke having a baby in the United States!
I do blame the staff. This has been going on for so long, this nurse had a DUTY to report it but STILL hasn’t. She is anonymous as she wants to cover up the fact she is aware that patients are in danger. She risks losing her licence too just for not wanting to be seen as “a grass”. Sleeping on duty is a sackable offense, as are the multiple other things that are happening on the NHS. If the good medical staff would properly whistleblow on their colleagues who are not doing their job then perhaps patient safety would not be at risk and people would be AWARE of the state of things, after all that is the entire POINT of whistleblowing procedures, not to wait until it’s too late or to use it anonymously in a woe-is-me story. More importantly, if this woman had of blown the whistle earlier (or at all as like I say she still hasn’t) perhaps this nurse would have an easier time herself, rather than them no doubt taking their frustration over the work-dodging nurses out on vulnerable patients
Monicle – is that the best you can do? And as our government is democratically elected we only have ourselves to blame. Whats your suggestion for a better system?
My sister recently gave birth. Had a Caesarian. The she struggled to cope that first night and the staff asked her if she had someone to call to come up to the hospital to help her. Cue her big sister.
Armed with slippers. Coffee (no coffee machines, and visitors were not allowed a drink) I made my way up at 2030pm. I arrived to her trying to get out of bed with no assistance and in pain. So I helped her. That night I assisted the midwives who told me they were under staffed. I left my sister at 5am and then our other sister arrived and took over till her partner who needed some sleep at home arrived the next morning.
Had we not have loved out sister dearly her first night would have been a disaster. She couldn’t reach her new baby son as she had stitches and everyone he cried she cried. The nurses shouted at her and couldn’t help. I didn’t blame the nurses. They were so obviously over stretched but I was disappointed that we pay all the national insurance etc and she had no care.
Very interesting- I often wondered whether these fly-on-the-wall documentaries are shot in conveniently well-performing hospitals. (I stopped watching One Born Every Minute as I could not stand to hear grown women being told that they are ‘good girls’ when pushing out their babies. How patronising!) A couple of my friends have dreadful experiences of delivering in crowded London hospitals, with waiting rooms full of groaning women who had not even been assessed and admitted to wards as there was no room. One was told to go home as the baby was ‘hours away’; the woman got home, felt the urge to push and made it back to hospital with 5 minutes to spare. The other endured a 3-day labour which culminated in a caesarean delivery. Her baby was in a special care unit and she was horrified to be told there was no wheelchair access to the unit. She was bullied into climbing 2 flights of stairs to breastfeed the baby, hours after major surgery. I’m not sure how a wheelchair user would cope…
Don’t worry the government will have private healthcare so they won’t have to endure any of this! Us? Well we know were we stand in the governments eyes… peasants! More where they come from!!!!
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