I am a midwife and I am broken!
I don’t even know how or where to start with how I feel right now. I entered the midwifery profession knowing the demands and pressure as I’d worked previously on a maternity unit and felt like I could handle it. The reality is completely different from the dream job I’d wanted for so so long and it’s breaking my heart feeling this way on a daily basis. While training at university I struggled financially, gave up time with my partner and daughter, my family and social life suffered however I never questioned my decision. The first year after qualifying was a dream, everything I’d worked so hard for was worth it! I felt in control, I felt was giving the best care and I was making a difference to women and their families. I felt like everything was falling into place. How amazing that I bring new life into the world for a living, that I get to witness the most precious moments of peoples lives that some people will never see.
‘How many times?’
The rose tinted glasses soon disappeared and the darkness came thick and fast. Due to a number of factors often out of my control I felt I was failing and fast!
Some shifts I’ve cared for 23 mothers and up to 15 babies as the only midwife on the ward. How can you even possibly begin to meet the care needs of every woman and baby in those circumstances? How many times can I apologise for my failings? How many times can I say sorry for missed medication as there’s been nobody to check it with until hours later? How many times can I say sorry, I can’t help feed your baby or offer you a cup of tea and sit and chat with you about your fears and anxieties that can arise at this potentially extremely vulnerable time?
On the shifts when I’ve not been alone I’ve been moved to work from one area to another, over and over. How many times can I apologise to women for leaving them as soon as I’ve helped to bring their baby into the world as I’ve been pulled to look after the somebody else? How can I provide continuity of care and build up a rapport with women and their families when this keeps happening? How can they trust me when I have to keep letting them down so often? How can I keep letting the student midwife that I’m mentoring down? How can I not have time to teach them as I want to and make sure they completely understand what they need to without compromising patient care?
I’ve worked in the hospital and community settings and neither is better than the other at the moment, there is a break in the system and we can’t patch it. I’ve thought about leaving midwifery many times but the guilt that comes with the thoughts is unbearable. Who’s going to care for the women that need us with so many midwives leaving the profession?
The physical and mental impact midwifery has had on me has pushed me to my breaking point, however I feel I have no choice but to ‘suck it up’ as ‘I’m not the only one feeling the strain’.
I’ve suffered numerous kidney infections through lack of hydration and suffered palpitations and severe headaches to no end. Working with no breaks and not having anything to eat or drink for 13 hours seems to be he norm these days.
This is nothing however compared to the mental impact I’ve suffered and that I’m still enduring. The constant feeling that I’m failing, failing at everything I’ve worked so ridiculously hard for is too much to handle. I am failing the women and families in my care, failing my daughter, partner and family, failing my colleagues. Failing at the thing used to be the proudest of! My daughter and parents still speak with such pride in their voice when they tell people I’m a midwife, how can I tell them the reality of how much I’m not coping? I am just a number, I do not feel valued as a midwife and it is all too much.
The anxiety and panic attacks that come with this is pushing me to breaking point! I’ve been extremely lucky that I have a few amazing colleagues and family members, and I’ve found a fantastic counsellor for support. However it makes me sad and angry that I’ve had to reach out to somebody as I feel I can’t turn to the people that should be there to support me. They’re in as much of a rubbish situation as we are. How much longer can I continue to feel like I’ve failed, like it’s my fault? The failings in the care system go way beyond me yet that’s how I feel constantly. That it’s my fault and I’m the failure in all of this.
‘Midwives everywhere are working in these conditions…’
How can I be selfish and tell people how I feel when I’m not the only one in this situation? Midwives everywhere are working in these conditions and I’m far from the worst off of us. Many midwives are working with a lack of staff, lack of breaks, lack of support and not able to care for themselves. I just feel broken and it devastates me to admit this. No matter how many times I keep telling myself it will get better and it won’t always be this bad, nothing improves. I understand that my view on midwifery isn’t the view of everybody in the profession and I don’t intend on being ‘everybody’s voice’.
I honestly hope I get back a point in the near future where I can go home happy, back to the way I used to feel, full of passion and pride in what I do. Until then I will continue to put a smile on my face and continue to be the best midwife I can be in a broken system.
When I received this email, I felt broken too. Because this kind of message is relayed to me on a regular basis, sometimes in person, via social media, or like this midwife via my personal website. Here is another harrowing account, shared via social media, with the very same undertones. I wrote a blog post in 2016 about this very topic, and offered some potential solutions.
It is deplorable, heartbreaking, and must stop. This week, in the UK, the Royal College of Midwives has released the latest report on the State of Maternity Services Report 2018. The report clearly highlights that in England there is a shortage of 3,500 is midwives. The number of NHS midwives in England rose by just 67 in the last year, despite universities turning out over 2,000 newly-trained staff.
A few months ago, another report, commissioned by the RCM and undertaken by Cardiff University Wales and Griffith University, Queensland Australia was published. The Work, Health and Emotional Lives of Midwives in the United Kingdom: The UK WHELM study explored the relationship between the emotional wellbeing of UK midwives and their work environment, using a cross sectional research design. The findings are stark, and reflect what this midwife is articulating.
83% of participants were suffering from personal burnout and 67% were experiencing work-related burnout. Client-related burnout was low at 15.5%.
“I couldn’t sleep due to worrying about going to work. I once slept in my car in the hospital car park because I was so stressed about coming to work. At this point I realised I had to seek some help, I saw my GP and I am now on antidepressants and reduced my contract to zero hours. I still have anxiety at present but I’m trying to work through it as I don’t want to end my career this way. To look at me in the workplace you wouldn’t know but inside I’m burnt out”
Midwives described how they lacked agency and felt they were being used instrumentally, that is, solely to meet the needs of the organisation.
‘Two thirds of participants (66.6%) stated they had thought about leaving the profession within the last six months. The significance of such a disturbing finding for a professional workforce that is already understaffed should not be underplayed. It provides strong evidence that high level policy intervention is urgently needed to address the concerns identified. The two top reasons given for considering leaving were: ‘Dissatisfaction with staffing levels at work’ (60%) and ‘Dissatisfaction with the quality of care I was able to provide’ (52%). Midwives intending to leave had significantly higher levels of burnout, anxiety, stress and depression than those who had not considered leaving’.
There are worryingly high levels of burnout, stress, anxiety and depression within this sample of UK midwives. Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%) anxiety (38%) and depression (33%). This was well above population norms and those of other WHELM countries.
The report offers suggestions for improving the situation – so important that at high levels the recommendations are taken forward. At All4Maternity we are committed to supporting these recommendations, and indeed to lead on some of them.
So it seems we didn’t learn much from the ‘Why do midwives leave’ study that was published in 2003 (Curtis et al), or have we forgotten. With the current government’s admirable quest for safety, to reduce the number of stillborn babies and preventable harm, this is a huge concern. Every childbearing woman needs midwives, and having a shortage that is increasing will not make services safer. The opposite, in fact. About 20,000 women a year experience birth trauma in the UK – if midwives are stressed and burnt out, or lacking in support from colleagues – the potential for this serious issue getting worse is very real.
Instagram and Facebook is full of messages of excitement, of enthusiastic potential student midwives trying hard to gain access to university. If they are successful at interview for university, they work hard through social and financial sacrifice to achieve their dream – and then many, like the midwife above, find the work impossible. It is a vicious circle.
We have to ask different questions, and learn from the maternity services that are excelling, retaining staff through effective leadership, appropriate numbers of midwives and staff , and providing nurturing environments.
AND the government needs to listen to mothers, to families and midwives. #ENOUGH
Curtis P., Ball L., Kirkham M. (2003) Why do Midwives Leave? Talking to Managers, London, Royal College of Midwives/Women’s Informed Childbearing Group, University of Sheffield.