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 most when it comes to their birth experience. This blog is some of the things that those caring for women during birth said mattered to them.
Caring for a woman, her baby and her family during birth is a heavy responsibility. It is a time that is precious to all involved especially new parents, making memories that will last a lifetime.
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. The culture of a maternity unit, its management, the general day-to-day running of units, as well as the responsibility of keeping women and babies safe, all impact the role of helping women in birth. This of course doesn’t include also trying to maintain a work-life balance while supporting emotional wellbeing.
What then did staff say about 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 felt 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 able to give the care that women want or need.
When staff do give time the time needed to address concerns or provide the care needed, they are often then behind with appointments in clinics or other responsibilities or with paperwork. In fact, many voiced they felt that staff are often at breaking point, not able to take breaks and generally worn out.
When we hear this we can see how greatly this can affect care given. Being rushed, having paperwork that needs to be completed with low levels of staffing, as well as trying to give good compassionate care, it’s no wonder staff can be stressed out, tired, and struggling.
Anyone who works 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, and nature works at its own pace. Each woman will be different with different needs and concerns. Some births will be straightforward forward others more complex and require more aftercare. Finding ways that services can address these issues and allow for managing time is difficult and low staffing only makes this worse. Women voiced the wish for continuation in their carer but this again requires time. Yes, time is in short supply and has a real impact when it comes to providing a maternity experience.
Litigation
Another big point is Litigation. The litigation costs of maternity services are massive. This is something that the National Maternity Review highlighted in its review. For those working in maternity services, it is a real, daily concern. Litigation scares staff. It has its place and is definitely required. However, it is immensely stressful for all those involved and the worry of litigation has a huge impact on the way that women are often cared for in birth.
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 increasingly 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 bit of ‘chicken and the egg’, when fear of litigation grows, staff do more to protect themselves with policies, procedures and paperwork. Staff voiced that 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 by learning from failings in the care they provide an opportunity to learn from and improve care for staff and families alike. This also means that it is not something to be feared or dreaded but instead, a chance to do better. 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.
Work-Life Balance
Another issue staff face is managing of their own families and their vocation of helping women. Many voiced that it is so hard to balance work with a family. Most work 12-hour shifts, often 7 am till 7 pm, and finding childcare that opens early 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 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 staffing levels 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?
Many voiced that they would welcome childcare within the hospital. When new hospitals are being developed and built, why are we not considering childcare 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? Others say that more flexible hours would support them in their job.
We all want to do the best for 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
Culture was mentioned 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 of staff and helps them in turn to be supportive of families.
Bullying in maternity units was brought up over and over. It is devastating not only to the person who is being bullied but also to those who witness the cruel treatment. Managers need to ask what kind of culture is in 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 been reported to be run on fear, where everyone ‘tows the line’, everyone is 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 won’t overlook poor practice has led to some staff being bullied to the point of having to leave units. I heard of one case where 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? The midwife reported she was told it was because she cared too much about the women and wasn’t willing to compromise on care. If the culture isn’t right then you can bet the care won’t be either.
Also, staff voiced that they felt a divide from what was expected at a national level to what was actually possible on the frontline. While recommendations are important, so is listening to those providing care. If staff are voicing that they will struggle to make changes or provide a certain service they must be listened to. Simply telling them that they ‘must’ do it will only result in harm to women and babies.
When we talk about improving maternity services it is not just for women, their babies and families, but importantly 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, and support to balance work and family life, they need help to break the litigation cycle and have a caring culture to thrive in. They need to be listened to, after all, they are the frontline, and they know what works and what needs to improve. They need policies 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, or wonderful recommendations and not being able to implement it because there are no staff or no funding.
There is no point in listening to patients and then not being able to do anything about it because the culture or system doesn’t support 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 practices 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.
I’ve heard it said that sometimes it feels like there are two camps, birthing women and the staff that care for them. This cannot be so, because for change to happen, for care to improve, and 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.
Let’s make sure that we make memories that last a lifetime and bring joy to women, babies, families and staff alike because we are in this together and happy staff often means happy women and babies.