An experienced midwife claims she is at "breaking point" due to the lack of staff at Wales' biggest maternity unit. The NHS employee, who works at the University Hospital of Wales (UHW) in Cardiff, claimed daily shortages of midwives were creating an unsafe environment for mothers and their babies.
She said the maternity unit was currently operating at 25% below staffing capacity due to Cardiff and Vale University Health Board's failure to recruit and retain its workforce. Managers in the unit have had to "beg" midwives to cover vacant shifts to ease the pressure on those on duty, she claims.
"The trust is unable to retain its staff because we are overworked and undervalued so those who continue to turn up shift after shift are completely burnt out and either quit the profession we all love, and worked tremendously hard to be in, or end up on long-term sick due to stress and significant mental health issues," she said.
Read more: Man told 'urgent' hip operation will be done in four and a half years
"The unit is supposed to have a minimum of 24 qualified midwives per shift to cover all areas – recently they have been as low as 16. Managers and coordinators are then having to beg for staff with most shifts needing covering for 'any hours' even just to cover staff breaks or just to ease a bit of pressure. It is soul-destroying if you're rostered into that shift because you know how bad the situation is before you even start."
A Cardiff and Vale University Health Board spokesman said the NHS was "under extreme pressure nationally contributed to by a shortage of nursing and midwifery staff" and said this was the case within their area. "The health board is acutely aware of the challenges facing maternity and obstetrics services and we would like to provide reassurance that sustaining safe service provision is a key priority," they added.
“Our ability to safely maintain services for women, those birthing, and their families remains our main priority and under constant review. Services are being managed in a way that allows us to prioritise the safe delivery of care."
The midwife said the midwifery-led unit, where low-risk women give birth and receive postnatal care, is often closed due to low staffing levels. She added that the homebirth service for Cardiff and the Vale of Glamorgan was currently suspended meaning every woman and their partner has to attend the main delivery suite for labour care.
"We are a large unit which does hold a big capacity but rooms are stretched," she admitted. "Eleven rooms sounds a lot but it's not when you're rushing patients out of rooms to the postnatal ward because you need rooms for incoming patients which can come from many sources – home by their own transport or an ambulance, the induction ward/antenatal bed, obstetric assessment unit, and even A&E."
She added that the induction ward, where women go to have their labour induced, is so short-staffed that it is assessed "shift by shift" as to whether it can operate safely. "Once in labour, or if someone is needing their waters broken, they need a midwife one-to-one. If there's not enough staff on shift it's not safe to commence or continue the inductions," she said.
"It means women are left waiting on the ward for days to have their waters broken. The midwives spend their days apologising to the patients they already have or on the phone breaking the news to disappointed women and their partners. They are defeated at a broken system. This is a nine-bed ward and often the following day there are more than nine inductions booked to come in, with no beds for them, and thus the cycle continues."
The midwife added that when there are not enough beds to admit antenatal patients (women before they give birth) they are placed in a side room within the postnatal ward – something that she claims should not happen. "This results in midwives looking after both antenatal and postnatal women with babies. Mistakes will be made, things will be missed," she said.
"Midwives on the wards are also affected by the lack of staffing, often being left without a maternity care assistant who are our 'angels in green'. Sometimes you are the only midwife looking after 15 patients with babies plus one or two antenatal patients or those whose babies are on the neonatal unit."
She said that community midwives are also getting burnt out by the lack of staff with some having as many as 100 women on their caseload. "They dread being on call because they know they will be called in to help staff the unit when they've already worked – probably over their hours – in the day," she added. "Some haven't worked on delivery suite or the wards for a number of years and feel unsafe and very much unsupported if they are made to do so."
In addition she mentioned that women were occasionally left in the assessment unit waiting area to be reviewed by a doctor for 12 hours. She added that a bereavement suite has had to be used as an inpatient bed due to lack of space. "Sometimes there is no receptionist or specific telephone triage midwife during a day shift – there isn't either by night. That means the midwife has to man the phone, assessing and advising and taking referrals, whilst triaging women, assessing women, calling on and waiting for our doctors, transferring and discharging women, and seeing women the day before elective surgery."
She concluded: "We are exhausted but we still turn up for our shift. We try our very best for those 12 [paid hours] but we often stay over to finish tasks or write documentation we haven't got around to doing. We often don't have our – unpaid – break.
"We can go a whole shift and only use the toilet once. We bounce from patient to patient with a smile on our faces. We're like ducks – calm on the surface but furiously paddling underneath."
Julie Richards, director for Wales at the Royal College of Midwives (RCM), shared the midwife's concerns. She said: "The RCM is working hard to support the health board to address the shortages in staffing they are facing. This is though a national problem across Wales and we do need a concerted effort to address this. The Welsh Government are putting investment into maternity services but it is clear that more is needed to ensure that women get the quality of care and the choices they rightly deserve.
"It is also clear that midwives, maternity support workers, and other staff are under significant pressures. What is important is that they are supported through this and that more ways are found to retain staff and bring more into midwifery. This includes a decent and inflation-busting pay offer and better ways of working for staff such as more flexible working and supporting those who have retired to return, working hours that suit them. There are challenges facing maternity services and I hope that working together we can support our health boards and the government to improve care for women and the working lives of staff."
The RCM is urging all members working in the NHS in Wales and England to vote for industrial action over pay. The move comes after a month-long consultation which saw members overwhelmingly reject their governments' below-inflation pay award. RCM will launch a four-week ballot on November 11.
Responding to the concerns raised a spokesman for Cardiff and Vale University Health Board said: “We are sorry some members of our team feel unheard or undervalued and that they have concerns. We are always keen to further understand the experience of colleagues and their insight into the quality of care provided and colleagues in midwifery and across the organisation are encouraged to be open with their line manager in escalating challenges and concerns.
“Colleagues are also able to anonymously share concerns via our new Staff Voices digital platform, which are reviewed and addressed by the leadership team, or through the organisation’s wider Freedom to Speak Up process. Recognising the impact of these challenges on our midwives we are working with the Cardiff Royal College of Midwives branch to support the wellbeing of colleagues through the Caring for You campaign. One of our midwives has recently taken on a new role as the team’s wellbeing lead to actively support colleagues and ensure they are able to access a range of materials and resources should they require further support.
“Healthcare staff have worked through long periods of sustained pressure influenced by the pandemic and workforce issues. The wellbeing of colleagues is paramount and we encourage colleagues to access support via the People Health & Wellbeing Service.
“The NHS is under extreme pressure nationally contributed to by a shortage of nursing and midwifery staff – this is also the case in our area. The health board is acutely aware of the challenges facing maternity and obstetrics services and we would like to provide reassurance that sustaining safe service provision is a key priority.
“Our ability to safely maintain services for women, those birthing, and their families remains our main priority and under constant review. Services are being managed in a way that allows us to prioritise the safe delivery of care. Our midwives are working tirelessly to maintain service provision and we are grateful that the public continue to show kindness and compassion to our colleagues who are going above and beyond to support patients. We would also like to take this opportunity to thank colleagues for their ongoing commitment and professionalism.
“We are working alongside maternity and obstetric colleagues to recruit new midwives and retain and support our existing team. We have recently recruited 29 new midwives who following induction will join us towards the end of the month.
“To manage our services safely we have had to initiate intermittent closures of the midwifery-led unit and temporarily pause our home birthing service. We apologise that this restricts the choice for women, those birthing, and their families. This is not a decision we make lightly, however, it remains crucial to prioritise the safety of mothers and babies during this time. The team is committed and doing its best to re-establish a home birthing service as soon as it is safe to do so.
“Recently the health board has issued a series of updates on the pressures facing our maternity services we would like to reaffirm our sincerest apologies to families affected by the recent changes to provision that we have had to make. We will continue to work with the team to improve the experience for women, those birthing, their families and colleagues.
“We would like to reassure women and those with midwife-led birth plans that these will continue to be followed but in some cases may be in a different environment. One-to-one care in labour will be maintained and expertise in midwifery-led care is still available within the main delivery suite, which offers limited access to water birth facilities.
“All are encouraged to make their labour and delivery space their own and will be supported to do so by our midwives. Infection prevention and control measures remain in place to help keep everybody safe.
“For anyone who wishes to discuss their options we encourage them to contact their midwife. Thank you to our dedicated team who continue to go above and beyond for patients and to the public for your continued co-operation and support at this difficult time.”
READ NEXT:
- Man told 'urgent' hip operation will be done in four and a half years
- A smaller percentage of the Welsh population has had Covid compared with England
-
Boy suffers life-changing brain injury after being starved of oxygen at birth
-
Two Welsh health boards placed under higher level of government intervention
-
'I spent six days in a chair in Wales' busiest A&E department and it felt inhumane'
