Understaffing, staff burnout and fears they cannot provide safe care could see many midwives heading for the exit, according to a Royal College of Midwives (RCM) survey of its members in Scotland. A staggering half of respondents say they rarely have enough staff to provide safe care for women.
The RCM said it is deeply concerned by the survey results, which showed seven out of 10 midwives are also thinking of leaving due to low staffing levels and frustration with the quality of care they can provide. As one midwife responding to the survey said, “I love being a midwife, but I hate the care I am giving.”
The RCM lays out several recommendations to move forward positively and address the issues in the survey. These include a call for more support for midwives early in their career to ensure they feel well supported and positive about their chosen career rather than leaving.
There is also a need to ensure midwives have time to undertake essential education and development which is key to delivering safer and better care. An accurate tool to determine midwifery staffing levels is also overdue and a proportionate and substantial increase in the number of consultant midwives and clinical educators – who play a key role in ensuring safe care.
Jaki Lambert, RCM Director for Scotland said: ‘I know midwives and maternity support workers provide excellent care daily to families, but we cannot rely on goodwill alone.
“This shows deep seated and longstanding issues, certainly worsened by the pandemic which midwives fear are already impacting on the quality of care for women and their babies. There is a worrying catalogue of issues and discontent with an exhausted and a fragile maternity workforce with rock bottom morale.
“They have also been emotionally and physically battered by the pandemic and left feeling that their work and efforts are not valued. We need to move forward together with the Government from this point.
“There is a real disconnect between what maternity services need and what resources are available to them in terms of funding, professional development, resources, and staffing. It is only the incredible determination, skill and sheer willpower of midwives and their colleagues that are holding services up.
“Without action the staff, and the system they are propping up, will break. This is not safe, it’s not sustainable, and it’s not acceptable.”
Fears about understaffing run through the survey. Levels of staffing were consistently described as unsafe, with midwives raising concerns for the safety of women using seriously overstretched services.
Concerns with the quality of care being given was cited by six in 10 of those thinking of quitting.
Women with complex care needs benefit from additional midwifery support but the resources needed to support these women are often not factored into funding calculations, says the RCM.
The RCM says they are concerned that more experienced midwives and those near retirement who delayed leaving to help in the pandemic are starting to head for the exit. The loss of such rich experience impacts on the support available to early career midwives and the students following in their footsteps.
Mandatory training, designed to improve safety in maternity services, has also been a casualty of the workforce crisis, with more than four in 10 respondents unable to do this training during working hours, instead having to do it in their own time or not at all.
The RCM calls for staff to be given the time to do this vital training. One midwife summed up the situation saying, “mandatory safety training cancelled due to short staffing making a dangerous situation even less safe.”
Growing pressures are also leading to worrying levels of strain and anxiety for maternity staff. Nearly all (88%) in the survey say they have significant levels of work-related stress. One midwife said, “I have nothing left to give my own children and family at the end of the day. I am at breaking point.”
Nearly every respondent said they are missing breaks with over half (52%) saying this happens two to three times a week and has become the norm. Many are not even getting the chance to have a drink or go to the toilet on shifts that can be as long as 12 hours. One midwife reported, “When I say no break, I mean flooding through sanitary products onto my clothing because I cannot take 10 minutes to change my tampon in a 12-hour shift.”
Jaki Lambert added, “The pain and anguish of midwives was very difficult to read about and I hope their words are captured in this survey. It paints a deeply worrying picture of staff that are on their knees and are not currently seeing a way forward or access to the support they need to deliver the safest and best possible care.
“We can and must do better for midwives, women, babies, and families in Scotland. We know that the Scottish Government wants to fix this and we want to work with them to make sure that midwives are valued and their expertise recognised.
“It is essential that we recruit new midwives into the service, treat the midwives we have better to make sure they stay in post, and that they can continue to develop throughout their careers so that women in Scotland get the maternity care they deserve.”
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