My current thoughts on NHS midwifery

Since returning to NHS midwifery post maternity leave, I’ve found myself beginning to fall even more out of love with the ‘system.’ I’m just totally uninspired. Frustrated. Endlessly disappointed. Let me tell you why.

But firstly, let me start off with the positives. Because the joys for me have been joyous. Engaging with women and their families, my amazing colleagues, using my brain again! I’m so proud of what I do, and I care about it so much. Being back working as a clinical midwife has felt good at times. I’ve enjoyed it.

To be able to facilitate a beautiful birth, to provide meaningful labour care, to help a woman, birthing person or her family when they are scared or fearful; to hold someone’s hand when they trust you and share with you something private: it’s a privilege. I feel humbled. Having recently experienced my own midwifery care during my own pregnancy and birth, I know how much your midwives can mean. I still think of my own often, what they did for me, how they made me feel.

And to be there when things don’t go to plan is a privilege too. To cry with them when they tell you of their losses, to hold their hand and sit with them through their pain, these moments stay with me as do the families I’ve supported. Being a midwife means having the wisdom and experience to know when pregnancy or childbirth needs help; to know when to step up or when to stand back, to suture, cannulate, supervise and teach: being a midwife makes me proud. I’ve trained hard for this. Midwifery is in my bones.

Midwives not only train hard, but we work hard too. We work for hours and hours, without breaks to eat or to go to the loo. I know of midwives who have told me they frequently get UTIs because they are not able to empty their bladder when they need to. But still, we turn up to shift, we take our caseload and we somehow how make it through the day, even when all the odds are against us. Nothing can prepare you for the rather insane responsibility, the exhaustion, what could happen if you don’t get it right. We stay late in order to ensure women are not left without midwives and to make sure that babies are born safely. And we navigate the consistent short staffing. Day in, day out.

And honestly? Sometimes I can get a momentary buzz from working in this fast paced environment where I’m needed and my skills are needed and I believe I can make a difference. I’ve enjoyed that part of being back in NHS midwifery. Returning to clinical work has reiterated to me just how much midwives matter. How needed we are. It's felt good to be purposeful. To remember I have this professional identity, this skillset, these abilities. During maternity leave I sometimes felt robotic: naps, feed, nappies, repeat. So work has felt, at times, like a breath of fresh air.

But when it comes to the way that NHS maternity care is both structured and facilitated, I feel so disappointed. Sad. Numb. Uninspired. Upset. This system feels unrecognisable to what I thought midwifery would be. There are still brighter moments. Amazing moments. But also… oh my. The intervention. Sometimes it’s lifesaving. Sometimes it appears so unnecessary that it frightens me. This is when work stops feeling like a break and I long to hold my baby, breathing him in close to me. I long for the naps, feeds, nappies, repeat.

I can’t help but feel the NHS maternity care system won’t change, or not in the way it needs to. There seems to be report after report highlighting something desperately wrong that can never happen again. I’ve been reading more appalling cases recently. Both midwives and families repeatedly harmed. I wonder how we got here. And I wonder when and how it can get better.

Sometimes I worry that I’ve become numb to it. Too used to seeing it all. Knowing that positive birth experiences seem so few and far between. That women’s bodies are ultimately harmed in a system that was designed to protect them. That women and babies are being repeatedly failed. That the system has become so defensive and litigious that it feels documentation matters more than care.

Sometimes I feel disengaged. Busy raising my son and just going through the motions of my job. Surviving. Sometimes I don’t feel I have the fight that I did. The energy to keep raising my head above the parapet and speaking up.

I teach so many antenatal classes and birth preparation workshops where I spend most of my time talking about how to empower, protect and advocate for yourself. How to navigate the NHS maternity care system. Explaining how it operates, how it’s defensive, how it’s litigious. It’s exhausting. But I think it’s necessary.

And yet I wish I could spend more time talking about what life with a baby is like. What to expect, how that might feel. We shouldn’t need to prepare people to go into battle with their healthcare providers. And yet sometimes that’s the reality. The people who say “I will leave it all up to the experts” when asked if they are going to do their own birth preparation make me anxious. Because the system just isn’t set up for birth without intervention.

Returning to the NHS post maternity leave has reminded me just how defensive the system is. In many ways it’s impressive too, I really think my colleagues are phenomenal. NHS intervention saved mine and my baby’s life. Sometimes it’s everything we need. But sometimes it’s not. And sometimes this means that NHS midwifery becomes not only a challenging place to work, but a challenging place to birth. The system as it is just isn’t working. And this truth hurts.

Midwives are burnt out and fed up. They continue to leave, sometimes to protect their own well-being and mental health; sometimes because they realise they just can’t function in the ‘system’ any longer. Meanwhile birth trauma, intervention rates and poor postpartum mental health is on the rise. And still nothing changes.

I remain dedicated to my profession, but I also know that I can’t stay working in a system that can cause this much harm to those working in it, and those of us birthing in it. I don’t want to be complicit in this. But I also can’t turn my back, and so I remain feeling there’s no choice but to keep speaking up, to keep showing up, to keep doing what I can.

I’d love to hear your thoughts, your comments, your experiences.

Midwives working conditions are women’s birthing conditions.