A Merseyside midwife nearly left her job after an "absolutely beautiful" baby died just after birth.
The 33-year-old, who asked not to be named, said she "cried with that family" and "stayed in bed for about four days" when the newborn died "despite the efforts of the amazing staff". That was her first experience of neonatal death, and she almost quit until the couple sent her a letter two months later.
Sarah (not her real name) told the ECHO: "It just amazed me that, in their grief, they thought of me and sent me that letter just to thank me for even being in the room helping them through it. That snapped me out of my really low period and made me think, 'Do you know what, if I can, as a team, make those experiences 1% less hurtful, than I'm doing okay'."
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Midwives provide care, advice and screening to pregnant people and their families before pregnancy, during childbirth, and in the month after the baby is born, according to the NHS. They have to be prepared to support patients emotionally as well as physically, particularly when things go wrong, like in the case of stillbirth, miscarriage, termination, and neonatal death or abnormalities.
Sarah, who's been in the job for five years and works with high-risk pregnancies, said: "Midwifery covers pretty much the whole experience of women and families throughout the pregnancy and postnatal period. That sort of connection you can get with women and families, helping them become a family, whether it's the first baby, or the 10th sometimes, is a special moment you can be part of.
"It's almost selfish really to be like, 'I get to be part of this special moment and it's really joyful'. I mean, it's not always joyful, but that's what I love about it. It's never the same day in, day out. If I was to work in an office, I'd know what I was doing that day and what my goals were that day.
"But I can walk into the unit and get a low-risk pool birth, or I can get someone who's a little bit more complicated and needs a little bit more TLC. It's different every day, but I can still have that connection with people who are going through such a vulnerable time."
But with a shortage of at least 2,000 midwives in England, according to the Royal College of Midwives (RCM), plus shortages of nurses, doctors and other healthcare professionals, Sarah feels they're "so stretched across the board, we just can't provide the care that we want".
She described toast and tea delivered by support staff going cold on desks because midwives struggle to find time for breaks. She said staff are burnt out, but she keeps going to work even when "my head's too heavy for my neck", saying: "If I don't, there's going be no one there for my colleagues and there's going to be no one there for my women."
The RCM is currently balloting its 30,000 eligible NHS members in England and Wales on whether to take strike action or action short of strike for only the second time in its 142-year history. The ballot closes on Monday, December 12.
It comes after members "overwhelmingly" rejected a below-inflation pay rise of 4%, on average, which the government offered to NHS workers on the Agenda for Change contract, which also includes nurses, paramedics and cleaners. Roughly 88% of RCM members in Scotland have already voted in favour of strike, and respective unions are also balloting some of those other NHS workers on strike action. The Royal College of Nurses has already announces strike dates.
Pay isn't the only issue in the midwives' dispute, or in the disputes of other NHS workers. The RCM highlighted the impact of long-term staff shortages on working conditions, which it says are driving midwives out of the profession. More than half of midwives, who start on under £26,000 and earn an average of £36,000 a year, are considering leaving the NHS, according to the union.
It called on the UK and Welsh governments to invest in "better care for women, babies, and families" by "making a meaningful pay offer and an urgent retention package". Sarah, who's on a higher salary of £40,000, said some colleagues are having to work nights or weekends as overtime before switching back to day shifts just to afford commuting to work, pay energy bills and raise kids.
She feels the 4% pay rise is "a slap in the face, especially after the pandemic where politicians were like, 'These people are too important to stay home, clap for the NHS'". She said: "If me and my colleagues were too important to stay home during a global pandemic, why can you not pay us properly? They need to fund the NHS because it's collapsing, it's all around us, it's terrifying."
Sarah is "scared" of the prospect of walking out while patients are in labour, but "things are so dire" she feels she has to go on strike. She said: "I can't even explain to you how scary it is to go into work sometimes. The fear a lot of people have when we walk in is there'll be two staff when there should be seven, or seven staff when there should be 15. That's the scary bit. If you make the NHS a desirable place to work, maybe we'll get the staff in, maybe we'll get the students in."
The RCM said safe services would be maintained in the event of industrial action, and staff would not be asked to take action that puts women or babies at risk. Dr Suzanne Tyler, the its director of services to members, said: "Midwives and MSWs (maternity support workers) have been pushed to the brink, with this latest pay award being the last straw for many.
"It clearly shows that governments do not value the skills, dedication, and incredible commitment of midwives and MSWs. It also shows that they either don't understand or simply don't care about the financial pressures facing our members and their NHS colleagues.
"It is scandalous and shameful that in one of the world's richest countries we have highly trained professionals having to use foodbanks to feed their families and think hard about whether they turn the heating on. The decision to take industrial action will not be one midwives and MSWs take lightly. But they clearly feel they have no other recourse than this."
The Royal College of Nurses (RCN), which represents two thirds of NHS nurses, will stage its first ever national walkout on December 15 and 20 as Health Secretary Steve Barclay refuses to even discuss pay. The union is calling for a pay rise of at least five percentage points above inflation, which would be roughly 17% at current inflation levels. A Department of Health and Social Care (DHSC) spokesperson told the ECHO this would cost an extra £9b if applied to all staff on the Agenda for Change contract, which Prime Minister Rishi Sunak described as "not affordable".
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