This is the third of three blogs looking at what matters in Birth. The previous blog looked at what women voiced about what matters to them when it comes to their birth experience. This blog is some of things that those caring for women during birth said mattered to them.
Caring for a woman, her baby and family during birth is a heavy responsibility. They are not only helping at a time that is precious to all those involved but they are part of making memories that will last a life time. While we all hope birth to be the joyous occasion it should be, sometimes difficulties arise and birth can become a very challenging situation for all involved. Culture of a unit, management, general day to day running of units as well as the responsibilities of managing a home life all impact on the role of helping women in birth.
What then did staff say about the what matters to them in birth?
Time. So many pointed to time being an issue. With staffing often at critical levels, while many wish to give as much time as needed to women many say they are finding this an increasing struggle. Many feel that while the expectations of women are one thing, the actual level of care that staff can provide can be very different and this concerns them as they feel they are not going to be able to give the care that women want or need. When staff do give time the time needed to address concerns or provide care needed, they then are left behind with appointments or other women to see or with paperwork. In fact many voiced they feel that staff are often at breaking point, not able to take breaks and generally worn out. When we look at this we can see how greatly this can affect care given. Being rushed, having paperwork that needs to be completed and low levels of staffing, as well as trying to give good compassionate care, no wonder staff can be stressed out, tired, and struggling. All of us that work in healthcare will tell you there just isn’t enough time, but with birth this can have very different connotations, birth has no time scales, nature does things at it own pace. Each woman will be different with different needs and concerned. Some births will be straight forward others more complex and requiring more aftercare. Finding ways that services can address this issues and allow for manage of time is difficult and have low staffing only makes this worse. Women too wish for continuation in their care but this again requires time. Yes time is short supply and a real impact when it comes to providing a maternity experience.
Another big point is Litigation. The litigation costs on maternity services are massive. This is something that the National maternity review highlighted at the Birth Tank. For those working in maternity services it is a real, daily concern. Litigation definitely scares staff. It has its place and is definitely required. However, there are reports of midwives who have been wrongly accused of things. It is immensely stressful for those involved. It is so hard to really understand the huge impact that this has on profession. Documentation has become imperative for staff to protect themselves as well as those they care for. It is important that while ligation is there to provide justice for those that are harmed or damaged, it is increasing becoming the issue that is the ‘elephant in the room’ and driving some of the choices around care given. I guess in some ways it is a little bit ‘chicken and the egg’, when fear of litigation grows, staff do more to protect themselves with policies, procedures and paperwork, this in turn takes them away from caring for the women or makes providing care in the way a woman wants more difficult, this leads to sometimes more failings in care and thus more litigation and so it goes round and round. No one would dispute that litigation is sometimes needed and sadly this will always be so, however failings in care too must be viewed as an opportunity to learn from and improve and not something to be feared or dreaded. We can never make birth perfectly safe but we can make it safer, but we must do this with women and staff in mind and not only the fear of litigation.
Another issue staff face is the managing of their own families and their vocation helping women. It is so hard to balance work with a family. Most work 12 hour shifts, often 7am till 7pm, finding any nurseries open at 7am can be difficult and expensive. Not even in hospitals, where staff work, is there childcare provided that is 24/7. If staff are in theatre attending a birth and can’t pick their baby up or contact anyone because they are busy saving a life, it is a huge issue. The result of this is that more and more staff are finding they have no option but to leave a profession they love. Staff are admitting that just can’t do the role and also have a balanced family life. So I guess this asks the question, when we see that staff level are low in our maternity units is this because we need to look at the way we are staffing the units and re-think the pressure we are putting upon staff, especially those with a young family? When new hospitals are being developed and built, why are we not considering child care provision that means all staff can be near their children, able to collect and pick them up in line with shifts and even perhaps pop in to see their little ones at Lunch? We are all want to do the best by our families and those that work in maternity are no different. Not only do they want to do right by those they care for, but by their own families too, surely we should be supporting them to do so.
If the culture isn’t right than you can bet the care won’t be too.
Culture is something that we mention a lot and it certainly does have a massive impact on staff. When staff are listened to, appreciated, treated with respect and truly valued, this goes a long way in providing a culture that is supportive to staff and helps them in turn to be supportive to families. Bullying in maternity units is mentioned a lot. It is devastating to the person who is being bullied but also those who witness the cruel treatment. Managers need to ask what kind of culture is on their units but also what example do they set? Pressure to work in ways that do not put women first, or make it difficult to give women care that is based on choice can discourage and wear staff down. An inflexible rota and not working together as a team also make for difficult working conditions and ultimately affect the care given. Some units have reported to be run on fear, were everyone ‘tows the line’, everyone afraid to speak out about wrong practices or poor care. Some units have reported a ‘them and us’ culture with different teams of staff not communicating with each other and even in some cases not working together. Jealous of the achievements of some staff members, or that they wont overlook poor practice has led to some staff being bullied to the point of having to leave units. I heard of one case were a midwife was consistently given shifts that the ward manager knew she could not possibly do, leaving her no option but to leave the unit she had worked in for 14 years, why, because she cared too much about those she cared for and wasn’t willing to compromise on care. If the culture isn’t right than you can bet the care won’t be too.
When we talk about improving maternity services it is not just for women, their babies and families but staff too. They are an important part of a maternity experience and the care given can greatly affect the outcome. Staff need support too, they need more time, support to balance work and family life, they need help to break the litigation circle and a caring culture to thrive in. They need to be listened to, after all they are the front line, they know what works and what needs to improve. They need polices and procedures that support them to support women, not tie them up in red tape and limit choice. There has to be better staffing levels and of course we know that more funding will always be needed to improve maternity care.
It is no good having a maternity review and not being able to implement it because there are no staff or no funding. There is no point listening to patients and then not really being able to do anything about it. If we are going to raise expectations and give people hope of change, we need to follow this through. Most likely funding will little increase, but then we need to look at creative ways, to use what we do have, to do better. Sharing good practice will help other units look at ways they can improve services for ALL. Of course one of the biggest challenges is engaging those in maternity services that do not wish to engage or feel that they don’t need to make any improvements.
Ive heard it said that sometimes it feels like there are two camps, birthing women and staff that care for them. This cannot be so, because for change to happen, for care to improve for maternity services to be better we must all work side by side. We must listen to each other, appreciate each other, see the difficulties for each other and join with each other. Lets make sure that we make memories that last a life time that bring joy to women, babies, families and staff alike, because we are in this together and happy staff often means happy mums and babies.