The mother-to-be on the bed gives me a hard stare. ‘Well, you can’t be the midwife!’ she snaps irritably. ‘I am,’ I reply with a smile.
‘Nice to meet you. I’m Philippa, but you can call me Pippa.’ ‘Pippa? Are you even old enough to be a midwife?’ the woman goes on, unconvinced.
OK. Deep breath. This one is going to be tricky.
‘I am, indeed,’ I say, scanning the notes at the end of the bed. They tell me that the woman is called Emily, it’s her first baby and that she seems to be progressing well. I give her what I hope is my most winning smile.
Every day I witness over-worked and under-appreciated staff undertake minor acts of heroism that would make most people weep – is it any surprise we cherish those little notes from patients as if they are the Crown Jewels? [File photo]
‘How old are you?’ she continues. ‘I bet you haven’t any children of your own. How can you understand what I’m going through?’
‘I may be young but I’ve already delivered tons of babies, so don’t worry,’ I reply. ‘You’re in safe hands. You’re going to be just fine.’
The problem is that I’m only 20 years old, and Emily is scared. Her husband is at her bedside, nervously clutching a water bottle.
I introduce myself and he offers a warm smile. Now I start to take Emily’s blood pressure and she asks me sharply: ‘What’s that for?’
‘It’s a monitor. I’m just going to take a look at your blood pressure.’
‘Just making sure everything is nice and normal – not too high, not too low.’
‘Well, it can make a difference to your labour if your blood pressure is too high. It increases a little during labour, so we’d expect it to be higher, but not too high or that could place extra stress on your heart and kidneys.’
Phew. This is like a police interrogation.
Over the next six hours or so, it transpires that Emily is the finance director for a law firm and her husband is a solicitor. They have a large farmhouse in the countryside and three labradors, so are obviously well-off.
At 38, Emily is nearly twice as old as me. It is a long time until her guard finally begins to drop and she starts to look at me with that mixture of trepidation and trust that I know so well among new mothers.
For the first few years, my job was a complete joy. Challenging and exhausting, yes, but also infinitely rewarding. It was a privilege to help families at one of the most vulnerable, yet exhilarating, times of their lives [File photo]
She doesn’t know what to do and without my help she’ll struggle. She needs to have complete faith in me.
When Emily finally delivers her perfect baby boy into my arms, it’s an emotional moment for all of us. I give the little one a quick rub down and hand him to his exhausted mother. She is beaming with pride and astonishment.
That look! That first look between mother and child is so precious that I feel the familiar catch in my throat. ‘Oh, look at you!’ she whispers to the tiny bundle. Her husband’s eyes are shining with tears. Quietly, I leave the room.
On the day they go home, Emily presses an envelope into my hands. ‘For you,’ she says.
Inside is a letter. It says: ‘Dear Pippa. Thank you for all you have done for us and for helping to bring our little boy into the world safely.
‘I’m sorry I was so rude when you first came in. You handled the birth with great care and expertise and I believe you are a fantastic midwife. A million thank-yous would never be enough.
‘Best wishes, Emily.’
Fifteen years later, I still have that letter. I take it out and read it sometimes, and every time it gives me the confidence and reassurance that I’m in the right job.
It’s small gestures such as this which mean so much to midwives like me, because frankly there is precious little in the way of gratitude from our NHS bosses and managers. Quite the reverse, in fact.
In the NHS Trust where I work, there are no thank-yous, no annual reviews, no awards or even any acknowledgement of the tremendous care and dedication we give to the women and families we look after.
Every day I witness over-worked and under-appreciated staff undertake minor acts of heroism that would make most people weep – is it any surprise we cherish those little notes from patients as if they are the Crown Jewels?
According to the Royal College of Midwives, the profession is losing one midwife a day as a result of the pressures of the job.
A new management team had taken over and the walls of the staff room were now plastered with lists of do’s and don’ts, ‘good practice’ reminders and signs telling us about new guidelines. ‘What on earth is that?’ I said, pointing to one of the signs on my first day back [File photo]
In England alone, this means almost half of maternity units are turning mothers away each year due to staff shortages.
For those of us who remain in our jobs, we are so overloaded that we can’t even spend five minutes sitting talking to a new mum, showing them how to do their first feed, or helping them to the bathroom. The days when we could offer those small but meaningful gestures of support are long gone.
In my 15 years as a qualified midwife, the number of managers doubled while the number of midwives has halved. Meanwhile, I have no idea who my actual line manager is or who I’m meant to approach if something goes wrong, so poor are the levels of communication.
So while our service is increasingly top-heavy with administrative staff, there are far fewer people actually delivering babies – with the result that the health and wellbeing of mothers and babies is put at risk.
Worst of all, in the brutal blame culture that now pervades NHS delivery wards, it is usually those of us at the bottom of the heap – not the doctors or managers – who carry the can when things go wrong. No wonder so many midwives are at breaking point.
For the first few years, my job was a complete joy. Challenging and exhausting, yes, but also infinitely rewarding. It was a privilege to help families at one of the most vulnerable, yet exhilarating, times of their lives.
I loved being part of a team of close colleagues and supportive bosses who would all work above and beyond to make sure the women we were looking after had the best possible experience of childbirth.
But as the years went on, things began to change and a less trusting, more suspicious, them-and-us culture began to pervade our profession.
For me, I can pinpoint the exact moment it happened. Gemma had been a difficult patient right from the start. She’d come in at 34 weeks (full term is 37 weeks) with an infection, but instead of letting us look after her, she refused to stay on her bed and allow us to monitor her properly.
My colleague Sam, who’d been assigned to look after Gemma, firmly believed that she was in labour.
As one of the senior midwives on duty, I thought so, too. But when I spoke to the doctor, who had already been asked several times to attend, she had exploded at me: ‘Pippa, I have seen that lady already and she is not in labour.’
‘Yes, I know,’ I replied. ‘But we think the situation may have changed since you last saw her.’
‘Not that quickly. Look, I’m extremely busy. Later, OK?’
I went back to Sam, and she knew from my expression I had been sent away with a flea in my ear.
When Emily finally delivers her perfect baby boy into my arms, it’s an emotional moment for all of us. I give the little one a quick rub down and hand him to his exhausted mother. She is beaming with pride and astonishment [File photo]
As we were conferring, Gemma appeared in the corridor. ‘I’m going out for a fag,’ she said.
‘Gemma, I really don’t think that’s a good idea,’ said Sam.
‘I need a f***ing fag,’ Gemma snapped. ‘It hurts, OK? You can’t give me anything and I need something to take the edge off. I can’t just lie around in agony.’
It was an impossible situation. We couldn’t give her any pain relief other than a paracetamol because she wasn’t officially in labour.
And as often as we asked for the registrar to come back and review Gemma, we kept getting knock-backs. The doctor was busy, it seemed, first with a caesarean and then a difficult birth.
Although I understood that emergencies came first, I was beginning to feel that the whole situation had become a battle of wills rather than a genuine response to a medical situation.
The registrar had dug her heels in, pulled rank and decided she was not going to see Gemma.
Finally, at 11pm, she was free to attend. By then, Gemma was beside herself, screaming in agony.
She had completely lost it: she was on and off the bed, in and out of her clothes, in and out of the hospital, taking herself off for a smoke.
I was with another mother when I heard the emergency buzzer go. I raced out to see the light flashing over Gemma’s room. When I went in the expression on Sam’s face said it all.
‘We’ve lost the heartbeat,’ said the registrar. It was only a matter of a few more minutes before Gemma delivered her baby, which was immediately handed over to the paediatricians and me. The tiny girl was pale and floppy.
‘Is she OK?’ Gemma was asking tearfully. ‘I can’t hear her crying.’
For 45 heartbreaking minutes we worked on that baby. The whole time I was giving her cardiac massage I could hear Gemma’s sobs behind me.
But it was no good. The baby never moved or took a breath, and eventually the consultant called the time of death.
‘We’ve lost the heartbeat,’ said the registrar. It was only a matter of a few more minutes before Gemma delivered her baby, which was immediately handed over to the paediatricians and me. The tiny girl was pale and floppy [File photo]
Outside the room, I leaned against the wall and sobbed. The paediatric consultant broke down, too. In fact, every member of staff who had been in the room cried for the baby we couldn’t save. Well, all except one. The registrar didn’t shed a tear or show any emotion.
Afterwards we heard that Gemma had submitted a complaint. ‘I don’t blame her,’ said Sam.
‘If the registrar had viewed her earlier, we could have done something. But we wasted so much time – hours – when she could have been given proper pain relief and we could have kept her on the monitor.’
Sam felt sure the investigation would bring to light the failings of the senior team, and that the doctor would be disciplined.
After all, the words ‘registrar asked to review’ were scrawled all over Gemma’s notes.
Six months later, the results of the investigation were announced, and, as expected, the hospital admitted negligence.
But to our astonishment and dismay, instead of blaming the registrar for what had happened, the management pointed the finger at us, claiming that we had not done enough to get her to attend.
I felt utterly shocked and betrayed. It was written all over the notes that we had done everything in our power to bring the doctor into the room, and yet we had been hung out to dry.
‘They’ve stabbed us in the back,’ said Sam. ‘How could they do that? How?’
For the first time in my career, I felt the trust between midwives and our managers had been broken.
Sadly, it was a sign of things to come. In recent years, court cases have become more and more common as unhappy and bereaved families seek to resolve their issues by legal means.
(Last week, it was revealed that the NHS England faces paying £4.3 billion in legal fees to settle outstanding claims of clinical negligence.) As midwives, we are right in the firing line, but so far we have been given no help, training or support.
In one particular case, none of us was given any advice from the solicitors representing the hospital about what we should do. It was like being sent into battle blindfolded and with both hands tied behind our backs.
Eventually, negligence was not proved. But my trust and confidence in the management had fallen even further. I became more and more convinced that our hospital trust didn’t care about protecting its staff, only its reputation.
It was after I returned from a year’s maternity leave following the birth of my daughter Betty in 2014 that I fully appreciated just how much our working environment had changed.
A new management team had taken over and the walls of the staff room were now plastered with lists of do’s and don’ts, ‘good practice’ reminders and signs telling us about new guidelines.
‘What on earth is that?’ I said, pointing to one of the signs on my first day back. One of my colleagues rolled her eyes. ‘I know. It’s madness, isn’t it?’
The notice said midwives were forbidden from taking tea, coffee or any hot drinks on to the ward. We were allowed to take in a water bottle with a sealable top, but that was all. The management team had even installed a ‘hydration station’ – otherwise known as a water cooler – in the staff room from which we could fill our bottles. Alongside it there was a long list of instructions. ‘Do not walk around with your drink.’ ‘Water bottles are not to be taken into the clinical area.’ ‘Do not wash your cup in a clinical area.’ ‘Do not use the hydration station as a social gathering area.’ Worst of all was the unbearably patronising sign-off at the end: ‘Don’t forget to put the patient’s needs before your own!’ What a way to treat experienced healthcare professionals.
It wasn’t the easiest transition back to work. I knew our hospital trust had come under increasing pressure in the past few years, but I hadn’t been aware of this having any serious impact on our ward until a new so-called Band 8 management team was brought in.
We never usually had contact with the Band 8s – Navy Blues, we called them, because of the colour of their uniform – as their offices were elsewhere on the hospital site.
Our only immediate contact was with the labour ward managers who organised the shifts and rotas. Band 8s controlled budgets and staffing, and we barely saw them.
Every now and again, though, they sent out reminder emails to keep us all in line, such as telling us not to eat on the ward.
Getting caught doing this meant an instant disciplinary – although it wasn’t an issue at night when all the Band 8s were tucked up in bed at home. When the cat’s away was our attitude.
I loved being part of a team of close colleagues and supportive bosses who would all work above and beyond to make sure the women we were looking after had the best possible experience of childbirth [File photo]
The new management team had brought in a raft of cost-saving measures. One was to change the method of clocking on and off the ward. Previously, each midwife would register the time she arrived and left the ward by swiping her badge on the door.
Thus management could keep an accurate record of how much overtime we had done – babies are not respecters of shift patterns, and nobody wants to abandon a mother nearing the end of her labour – and pay us accordingly.
But the badge method had been ditched, and now each of us needed to be signed off when we left for the day.
This worked fine if you did normal hours, but if I stayed to do overtime until late into the night, my manager might have left before me. In which case there would be nobody to verify my extra hours.
So naturally the amount of overtime we all recorded – and were paid – went down. It didn’t end there.
Since the hospital was on an efficiency drive, we were no longer allowed to pay for agency midwives to cover shifts when we were understaffed.
And if people left their jobs for whatever reason, the posts were left unfilled for months, putting the rest of us under even more strain.
Don’t get me wrong. I still loved being a midwife and our team was brilliant. It wasn’t always easy but we got through it together – we laughed, we cried, we ate pizza – and whenever anyone needed a hand, we were all there for each other.
Not just midwives either: doctors, healthcare support workers, receptionists, anaesthetists. We were a team, and when it worked, it worked so well.
But it was clear there was a growing feeling of alienation between midwives and those who managed us.
They hardly ever came on to the unit, so we had no relationship with any of them. If they ever appeared, they wouldn’t communicate with us. Everything was now done via email.
If there were new guidelines, or a change in policy, you’d be sent an explanatory email. There was precious little opportunity to give any feedback from our side of things, but they didn’t hesitate to relay criticism from patients.
Every decision seemed to be about money. For the first time in my professional life, we had to close the ward to new admissions. It was only a six-hour closure, but it was a shock to be told that we could no longer take any further admissions for ‘patient safety’.
And whenever there was a problem, it seemed that midwives were always the first to get the blame. I had never heard of a doctor being reprimanded for failure to attend (I still haven’t!). It was ridiculous.
I once telephoned the on-call consultant because a baby’s heartbeat had slowed right down.
‘Sorry, I can’t come,’ he replied. ‘I’m at a black-tie do. Let me give you my colleague’s number. She’s going to cover for me tonight.’
It took two more hours to reach his nominated stand-in, by which time we had managed to get the baby out safe and sound. But it was touch and go for a time, and I dread to think what would have happened if we had encountered a serious problem.
For four years after I returned to work, I did my best, working my socks off for the mothers and babies in my care. But in November 2018 I hit a brick wall. I could go on no longer, and was signed off with stress and depression.
As if that wasn’t bad enough, the way I was treated by my managers during and after my time off work was nothing short of farcical, as I will describe next week.
But tragically, the callousness shown to me was just a small example of the kind of behaviour that is now commonplace in our hospital.
The Secret Midwife: Life, Death And The Truth About Birth is published by John Blake on February 6, priced £16.99. Offer price £11.99 until March 8.
To pre-order, go to mailshop.co.uk or call 01603 648155. Free delivery on all orders – no minimum spend.