Working In The NHS - Midwife Wellbeing

Mothers and babies in the UK are at risk because maternity services are providing unsafe care, according to the NHS independent regulator 2023 (1).  This is despite a series of scandals that have cost lives, and despite the fact that safe staffing has been a significant concern for maternity healthcare professionals for decades.

The Royal College of Midwives (RCM) has made it clear that this is not just about training more midwives (2). Midwives are leaving the profession in such high numbers that for every thirty midwives trained, the NHS gains only one midwife. Focusing on recruitment alone has been described by the RCM as like running the taps in a bath while the plug is out.

The experiences highlighted in this section are from midwives quoted in ‘Free From Harm’, a resource by White Ribbon Alliance UK (3):

In a 2021 survey RCM found that 57% of midwives were planning to leave the NHS within the next year, with many concerned that staffing levels were unsafe and that they were unable to provide quality care (4). 2021 saw the fastest fall in midwife numbers since reporting began 20 years ago.

The most recent NHS staff survey (5) paints a poor picture of midwives’ experiences of their workplace which have deteriorated significantly over the past five years. These may have been exacerbated by the COVID-19 pandemic but midwives’ experiences appear to be worse than those of other healthcare professionals.

The problem does not lie within the job itself; the very nature of midwifery, of being with woman, may in fact protect against burnout. The ability to provide compassion and to work in ways that are congruent with workers values and identity protects against workplace stress adding satisfaction, joy, and meaning to the professional role.

Yet as our map shows, there are marked differences in midwife experience by NHS Trust, offering opportunities to learn from both positive, and negative practices.

Fighting a losing battle

Burnout and compassion fatigue result from prolonged exposure to workplace stressors, with midwives reporting emotional exhaustion, cognitive dissonance and ultimately distancing themselves to protect themselves.

The multitude of occupational stressors in the maternity environment include factors such as long working without breaks, lack of time, lack of professional autonomy, challenging clinical situations, lack of support, high levels of fear relating to compromised safety and potential retribution, and witnessing the mistreatment and/or traumatic treatment of women whilst feeling unable to intervene.

These stressors result in a culture of self-sacrifice where maximum levels of effort are required to maintain even minimal levels of care – and as the stressors increase, the ability to provide compassionate care decreases. (6)

As a result, health care workers withdraw from women and ultimately from the profession. It’s crucial to put and end to this vicious cycle of staff leaving - which increases the enormous stress already on those still in the profession - giving them even more cause to leave.

CALL TO ACTION

• Assess staff experience and wellbeing to identify areas of difficulty - and potential solutions.
• Analyse and action the results of existing data such as the annual NHS staff survey.
• Identify and build on trusts with higher than average staff satisfaction and develop examples of best practice
• Set up preceptorship schemes and other forms of mentoring and support for newly qualified staff. (7)
• Use evidence-based interventions for workforce support, and give midwives and other relevant professionals real time to attend.
• Institute high quality management and leadership training appropriate to the challenges of UK maternity care, underpinned by a supportive, empowering and collaborative approach to leadership.
• Develop and embrace flexible working practices to enable midwives to balance work and childcare or other responsibilities. (8)
• Address negative “blame culture” and foster a wider working environment which supports open and respectful interdisciplinary communication and collaboration.(9,10) 

Reference links

1.  Care Quality Commission (cqc.org.uk)
2. Fears for maternity as staffing shortages hit safety and morale says RCM 
3. End obstetric violence now - Free From Harm — White Ribbon Alliance UK
4. RCM warns of midwife exodus as maternity staffing crisis grows 
5.  Working together to improve NHS staff experiences | NHS Staff Survey (nhsstaffsurveys.com)
6. Disempowered midwives and traumatised women: Exploring the parallel processes of care provider interaction that contribute to women developing Post Traumatic Stress Disorder (PTSD) post childbirth - PubMed (nih.gov)
7.  A fresh perspective to recruitment and retention of Newly Qualified Midwives - Maternity & Midwifery Forum % (maternityandmidwifery.co.uk)
8. More flexible working will support staff retention says RCM
9. ‘Blame culture’ in midwifery affecting staff retention, committee told | Nursing Times
10. NHS England » Nursing and midwifery retention self-assessment tool