Perhaps an Explanation for Low Breastfeeding Rates in the UK
Posted Dec 15 2009 12:00am
I've just finished reading the following fascinating account of working life as a UK midwife.
What it made very clear to me is that it's all too easy for us to criticise the lack of breastfeeding support available to women in UK hospitals. This real life account of the realities facing midwives goes some way to explaining why so many UK women quit within just a few days of giving birth.
With two sisters who are nurses I have no doubt every word of this account is true since I've seen for myself how stressful working conditions can be for those employed by the NHS.
Thankfully, I had no real problems breastfeeding but I've met far too many mothers over the years who've told me they wanted to breastfeed but their births were just too traumatic for them to follow through with their plans.
I know what these women feel like as I had a particularly traumatic birth with my last baby and had flashbacks for several years following his birth during which I was so drugged up that everything seemed completely out of my control.
Thankfully, after my son's birth I was left alone with him for a few moments whist the midwives on duty wrote up their notes and by breastfeeding him I felt very sure I was back in control.
Anyway, here's the story. Don't forget to let me know your thoughts on this and whether your own breastfeeding plans went out the window because of the birth you experienced or the lack of help afterwards.
Clutching her husband's hand and with agony and exhaustion etched on her face, a young woman struggled into a room in the maternity unit where I worked.
She was in the early stages of labour with her first baby, she was terrified, in excruciating pain and desperate for any crumb of support.
Helpless beside her, her overnight bag in his hand, her poor husband looked equally traumatised.
My heart went out to them. But I knew there was little I could do. With five other pregnant women to care for at the same time, all with hugely different and complex problems, I was rushed off my feet and didn't have the time to look after her properly, to allay her fears or to hear about how she wanted the birth to unfold.
I longed to sit with this poor young woman, calm her and remind her gently to breathe deeply through each contraction.
Just half an hour of my time could have made all the difference. Instead, I put on my cheeriest smile and followed hospital procedure. 'Would you like a painkiller?' I asked.
Ten hours later, after she had been drugged to the eyeballs to dull the pain, I heard she'd given birth.
Her baby was healthy, but I knew I'd let her down.
As I watched her being wheeled into the ward, I felt eaten up with guilt. She'd effectively been ignored from the moment she turned up until the moment she gave birth.
Plonked on an antenatal ward until her time came, with no one to reassure her during what was most likely the most terrifying moment of her life.
No woman should have to give birth in these conditions - let alone in a modern hospital with professional staff at hand.
Welcome to the modern NHS maternity ward. A world of shoddy practice, poor hygiene standards and a shocking disregard for patients' individual needs.
When I read about newly qualified midwife Theresa Naish, who hanged herself in January after a premature baby died on her shift, I couldn't help wondering if she, too, was a victim of the over-worked and under-resourced labour wards I have experienced.
Her father Thomas told the inquest into her death: 'Like all NHS staff, she was over-worked, doing too many hours in a department that was understaffed.'
Although the child had little chance of survival, poor Theresa spent weeks torturing herself that she was to blame, before killing herself.
I don't want to alarm people for, of course, the vast majority of babies are born healthy and safe, but I think it's time we admit what is happening in our hospitals.
Driven by targets and mired in red tape, our NHS maternity wards are becoming baby-producing factories where mothers' needs come very low on the agenda.
The quicker midwives turn out babies, the more successful everyone tells us that we are. We might as well be producing sausages. It's utter madness.
I started working as a midwife in Basildon in 1995. I left to work as an independent midwife in January last year because I simply could not bear to let any more women down.
Special job: Midwives play a vital role throughout the birth
During a typical 12-hour shift, I could be the sole midwife in charge of six women in the antenatal ward - some in early labour - or one of two qualified midwives running a postnatal ward with up to 32 women.
If I was in the delivery unit, I would assist in the births of up to three babies a shift.
Obviously, if there was a crisis during a woman's labour - such as a sudden need for an emergency Caesarean - there was always a surgical team on call, and there would be an anaesthetist available to administer epidurals and so on.
But in terms of the normal care through labour, that was all down to the midwives.
Although we were under huge stress even back in 1995, current cutbacks mean fewer and fewer midwives are caring for more and more women.
No wonder new mothers are encouraged to leave hospital just hours after giving birth.
When I started in the mid-Nineties, there were 35,000 midwives working in Britain. A year or two ago, that number had fallen to 25,000, more than half of whom were part-time.
So, how bad did it get? Take one typical day I remember a few years ago. I found myself with up to six patients to look after at once and no back-up.
From the moment I stepped into the admissions ward, the area was crammed with women clamouring for attention.
Two women were in early labour. I longed to reassure them. But my stress levels rocketed when I saw the dramas that lay ahead.
One young woman, expecting her second baby in three months, had arrived in an ambulance with high blood pressure.
She had been sent by her GP, who feared that her life and her baby's were in danger.
High blood pressure is often a symptom of pre-eclampsia - one of the most serious risks facing a pregnant woman and one of the most difficult to detect.
Terrified she was going to lose her baby, or die, or both, she was frightened. I tried to reassure her.
All the while, half my brain was on the screams of the two women in early labour a few doors away.
Did they need more pain relief? When would they need to go into the delivery suite?
I had to check my new patient's blood pressure every 15 minutes as well as taking blood samples to be sent for analysis to see exactly what the problem was.
It was a race against time because if her blood pressure carried on rising I'd have to ensure she was whisked off for emergency surgery.
As I ran between her bed and the two women in early labour, I barely had time to greet another patient.
Bonding: But staff need to teach mothers how to feed their infants and are rarely given the time
She was in floods of tears. Her baby was due in a month. He had stopped moving and she was convinced he was dead.
Strapping her up to a monitor to check the baby's heartbeat, I tried to calm her. But I didn't even have time to offer her a cup of tea before rushing to another new arrival.
She'd arrived in an ambulance after her waters broke while she was out shopping. The baby wasn't due for another week. Again, her unborn baby had to be urgently monitored.
I was frantically checking my watch to ensure I remembered my patient with high blood pressure when a young woman, hair matted with sweat and eyes wild with fear, staggered towards me.
'I can't take any more,' she said, gripping my hand. 'You've got to help me.' She'd been in labour for five hours and the pain was excruciating. I knew she'd be happier in a delivery room - which is more comfortable and has better specialist equipment - rather than a bed on the ward, but my heart sank. There was no room.
I felt sick with guilt as I led her back to her bed. She was in agony, but she'd have to wait.
It was an hour before she was wheeled into the labour room. And in between nursing, I had to write up notes on each patient.
There were days when I barely had time to go to the toilet.
In the 13 years since I joined the NHS, conditions have deteriorated. Starting from the moment they arrive through the hospital doors, birth plans tucked neatly in their overnight bags, women are being betrayed.
There is reams of evidence to prove that a woman's labour is likely to be shorter and she runs less chance of needing medical intervention if she feels calm and relaxed in the early stages. It's not rocket science.
Yet because midwives don't have time to sit with women in early labour for more than a few minutes at most, we are encouraged to do the next best thing.
We offer them strong painkilling drugs such as pethidine or diamorphine - which is a form of heroin.
Drugs keep the mother nice and quiet which, of course, suits staff.
But they also likely to make her and her unborn baby terribly sleepy.
Although these drugs can sometimes increase contractions, they all too often slow them down.
The end result at the woman will need more drugs, not fewer, and labour will take longer.
But, of course, we don't explain of that as we dole out our pain killers. Besides, on a busy ward, what's the alternative?
Once a woman is in full labour, you'd thought we'd put her needs first. But I'm embarrassed to admit that, all too often, we were not allowed to.
Most hospitals rigidly enforce the rule that, once in labour, a woman's canal must dilate at the rate of 1cm an hour.
If that isn't happening, midwives are encouraged to tell the her that her baby may be getting in distress - even if that isn't the case.
Terrified and exhausted by a haze of drugs, the woman agrees to anything which is offered.
In practice, this means we give her extra drugs to intensify the contractions and so speed the arrival of the child.
Her pain levels increase and she'll need an epidural injection in her spine to numb the pain around her groin.
It's a vicious circle. I felt terribly mean persuading women to go along with it. I knew I wasn't always acting in their best interests. But what could I do?
It's a joke to say women have choices over how they give birth. The truth is - thanks to the drive to cut costs and improve efficiency - births are turning into conveyer-belt productions.
Women dream of having a natural birth and there is often no medical reason why they can't.
Instead, they leave the delivery room with a healthy baby, but feeling like a failure because they have used drugs.
Some are on such heavy drugs they don't remember giving birth at all. It's heartbreaking.
I also get very angry when I hear NHS authorities extolling the virtues of breastfeeding.
According to the NHS website, it's the 'best start in life'. I couldn't agree more.
But the truth is that breastfeeding rates are plummeting in the hospitals I've worked in.
The reason is simple. Midwives don't have the time to spend helping mothers to feed properly.
And without that vital support in the early days, women give up. With three women arriving on a ward at any one time, and three ready to leave, how could I possibly sit for an hour and help a new mother?
It's physically impossible, particularly as we are encouraged to rush women home as soon as they are on their feet.
It's to save money, but it does at least reduce the risk of the new mums and their babies picking up an infection.
It's no news that hospitals are often dirty. By the time I left, I was almost inured to the filth around me.
With so many women and too little time, it was impossible to keep the wards spotless.
I regularly found myself wiping off blood which had been missed by the cleaners in their rush.
It's a huge relief to have left the NHS. As an independent midwife in Northwich, Cheshire, I am finally able to help women the way they deserve.
Calm, supported and not rushed, my mothers give birth in six to seven hours. In the units where I worked, the average labour was ten to 14 hours.
I feel guilty about the women I let down as an NHS midwife. Weak and in pain, they don't have the knowledge or strength to stand up for themselves.
Instead, they end up being patronised by doctors and bullied by midwives into taking drugs they don't want.
But what makes me most sad and angry is that those hospital staff - everyone from managers down - are taking advantage of women when they are at their most vulnerable.