When Peggy Woodward began her career in the NHS in the early 1970s, women could stay in hospital for up to 10 days after giving birth - not because there were complications, but because it was just the norm. She has seen pressures on the NHS progressively get worse over the years, and spoke of a "bullying culture" and long shifts where taking a lunch break is too often seen as a privilege, rather than a legal entitlement.
The latest figures show that over 27,000 nurses and midwives left the profession in the last year alone, a sharp increase compared to previous years. Some of the key reasons staff gave for leaving the register were ‘too much pressure’ and ‘a negative workplace culture’.
The staffing pressures in midwifery have now led to the temporary closure of Cossham birth centre for the second time in the last four years, with all the women who were due to give birth there now being redirected to Southmead Hospital. A chronic shortage of beds, increased paperwork and unrealistic targets are said to be exacerbating the staffing shortage, all which increase the pressure on midwives.
READ MORE: Hundreds of NHS vacancies in Bristol as record numbers of staff leave the sector
After retiring from the profession in 2017, Peggy re-joined the register, helping out during the pandemic. While working in the vaccination centre in Ashton Court she was almost surprised when her shift leader told her that it was time for a break. In the hospital wards, she said it had become the norm for midwives to work 12-hour shifts without any breaks.
“What was interesting was that we were resourced, there were loads of us, we got our break. But the reality for midwives is that breaks are very hard to come by,” explained Peggy. This contrasted with her experience doing bank shifts on maternity wards in Bristol, when she says there wasn’t any time to take a break yet it would be deducted from her pay.
Peggy said: “I worked six hours and didn’t have a lunch break. I signed the form, looked at my pay slip and had only been paid for five and a half hours and they said you have to have a break legally.
“There are people who are working 12 hour shifts and only get paid for 11.5. The young ones were dragging their legs by the time it got to the afternoon.”
Apart from briefly returning to the NHS during the pandemic, Peggy has spent her retirement campaigning for the NHS and volunteering as a birthing companion at Project Mama. She said that the ongoing crisis predates the pandemic, and will lead to a rise in private healthcare for those who can afford it, which she believes is what “the government wants.”
Decades of cutbacks
She said shortly after the NHS celebrated its thirtieth anniversary in 1978, the stripping away of hospital beds began, a trend that has continued ever since. Peggy was working at the Middlesex hospital in central London at that time, before the building was demolished and turned into luxury apartments.
“The maternity ward had 43 beds and around 1,000 births a year, contrast that with St Michael's in Bristol which has around 53 maternity beds and around 6,000 births a year. The stretches on maternity have been increasing over the decades but particularly in the last 12 years,” explained Peggy.
While working as a young midwife in London in the 1980s, Peggy began to see the beds disappear, and says at the time surgical advances were used to justify the move. The NHS now has around 50 per cent less beds than it had 30 years ago.
Peggy said: “The government would like to blame it on covid but it was before that. When I was working at the hospital before covid I remember trying to get someone into the unit who was in labour but there weren't any beds.
“Since 2012 I noticed that there was just more and more desperation because there weren't enough beds and a lot of midwives were just trying to manage beds. Midwives are under a lot of pressure because they have to be all things to all women and then they get blamed if there are any complications.”
Continuity of care failure
By 2018, the British Medical Association (BMA) reported that the NHS winter crisis had become an all year round crisis. Jeremy Hunt who became the Health Secretary in 2012, introduced the ‘Continuity of Carer’ policy, a reform which was implemented with the aim of giving women one midwife who they would see throughout pregnancy and after birth.
Despite the reforms being implemented in a move that was said to increase safety following a series of maternity scandals, the NHS watchdog (CQC) warned in 2021 that babies and mothers could be at risk of injury or death because too many maternity units had not improved care. Many trusts have now reversed the model because they lack the staffing levels to roll it out safely.
Donna Ockendon who chaired an independent review into maternity services at Shrewsbury and Telford Hospital NHS Trust, has now said that the model 'is not sustainable or achievable' in written evidence submitted to parliament. Despite her review concluding that women would benefit from continuity of carer, the model has been implemented without sufficient funding or staffing levels to support the change.
Peggy believes that these reforms have put extra pressure on midwives and are impossible to implement safely, without the staffing numbers or funding needed to support the idea. Peggy said: “It’s a nice idea and even if they had a lot of staff, it’s still pretty impossible to have one midwife per woman.
“When they introduced it in Bristol, midwives were told they had to do 12-hour shifts and they had to do ‘on call’. Midwives aren’t able to do it properly because they are pushed from pillar to post.
“They’re not superhuman but they’d be trying to do that alongside a clinic. You can get plenty of people who want to be midwives but you don’t get many who carry on for long after they qualify.”
The government has committed to expand midwifery training places by 3,650 over a four-year period with an increase of 650 in September 2019 and 1,000 in each of the subsequent years. A survey last year conducted by the Royal College of Midwives (RCM) showed more than half of midwives who responded (57 per cent) said they were considering leaving the NHS, with fears about the quality of care they were able to deliver given as the main reason.
Following a month-long consultation with members of the midwives’ union (RCM), the government's current below-inflation pay offer was rejected and they may now go on strike over pay. The RCM has reassured both maternity staff and women and families using maternity services that midwives and maternity support workers will not take any type of action that would put women or babies at risk.
A Department of Health and Social Care spokesperson said: “We value the hard work of NHS staff and are working hard to support them – including by giving over 1 million NHS workers a pay rise of at least £1,400 this year. The NHS is investing £127 million in maternity services to boost the workforce and improve neonatal care.
"This is on top of £95 million invested into the establishment of 1,200 midwives and 100 consultant obstetricians - ensuring we have the staff in place to deliver high-quality, safe care."
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