Midwives’ fears over ‘too busy’ hopsitals

Larger health boards are often under pressure to deal with deliveries referred from other areas. Picture: Getty

The Royal College of Midwives (RCM) Scotland said it had recently approached NHS Lothian about staffing levels following concerns about the workload at Edinburgh Royal Infirmary (ERI) where midwives were struggling to care for women using the service.

But the college said “pressure points” also existed elsewhere in the country as midwives faced caring for growing numbers of women with complex needs and longer hospital stays.

It comes after a survey this year of women giving birth in Scottish hospitals found that a third said they were not always treated with kindness and understanding after having their baby.

RCM Scotland director Gillian Smith said its members had recently raised concerns about workload at the ERI, which the college had taken to the health board. The hospital’s Simpson Centre for Reproductive Health is the country’s biggest maternity unit, with around 6,000 babies born each year. “We have raised some issues around it just to make sure staffing is appropriate,” Smith said. “I know they are taking on more staff because they have assured me they are doing that.”

Smith said that when midwives raised concerns about their workload, they were often worried about the care they were providing to women. “When people are busy and they can’t give the level of care they would really want to give, it throws up some challenges,” she said. “Midwives were certainly concerned around the staffing levels.”

She said similar concerns had been raised previously about staffing in units in Glasgow. She said big boards like Tayside and Grampian also had “pressure points”. Smith said larger boards often had to take in women referred from other areas as well as look after their own patients. Midwife numbers have remained relatively stable in recent years in Scotland, with 2,963 full-time staff at the end of last year – down from a peak of 3,032 in 2010. The annual number of births has also remained stable at between 58,000 and 59,000 for the past five years, after falling to 50,000 in 2002.

But Smith said the concern was that some parts of maternity units were more deprived of midwives than others, with women not getting as much support after birth due to staff being moved to labour wards.

“If you have a really busy labour ward, inevitably the one area they call on to take staff from is the post-natal ward.”

Smith said another issue adding to workloads was an increase in women with complex care needs, such as patients who are obese. “Also, people who would have been discouraged from getting pregnant years ago are now getting pregnant – cardiac patients, serious diabetics,” she said.

The National Childbirth Trust (NCT) said the concerns at hospitals such as the ERI reflected its fears about maternity care across the UK. Caroline Libberton, NCT facilitator for practitioners and volunteers across Scotland, said: “Over-stretched units and staff shortages are widespread and, as a result, more women and families are experiencing less than high quality care.

“The service in very large units may be perceived as good value, but the personalised approach to care can be lost. “Complications in both physical and mental health can arise in women who have recently given birth and need prompt identification to avoid potentially devastating impact on the mother and the family.”

Sarah Ballard-Smith, nurse director at NHS Lothian, said: “We recognise that we need to enhance our maternity services and we have begun recruiting more midwives and… at the same time, building work to upgrade facilities in St John’s Hospital is nearing completion.”

A Scottish Government spokeswoman said: “We now have mandatory workforce planning tools in place across Scotland, and these are working well in helping health boards to plan for the number of staff they require.

“The number of qualified nurses and midwives working in NHS Scotland has increased by 3.7 per cent under this government.”

Case study: ‘We were left there for four hours’

WHEN Claire’s waters broke in the early hours of the morning, she headed to hospital for checks, suspecting she might be sent home.

But the family were not expecting the delays in getting a bed they experienced at Edinburgh Royal Infirmary, which left them having to walk around the grounds for hours as her labour progressed.

Claire’s waters broke early on the Monday morning, but after checks showed she was still in the very early stages of labour she was told to go home and return by 9am on Tuesday to be induced if necessary due to the risks of infection after waters break.

She returned with her husband on the Monday evening due to increasing pain, before being sent home again.

“We had to walk about for six hours in the waiting room because here were no rooms available. It was just a disgrace,” the mother-of-two said. “They had told me to go home and walk around which I had done for nine hours before we went back in.”

The couple, from Edinburgh, saw a doctor before being sent home a second time.

“My husband was getting very stressed,” Claire said.

“The doctor said to my husband that she would phone St John’s (hospital in Livingston) but she came back to say there were absolutely no beds available.

“My husband said ‘well where is the next place?’ She said it would have to be the Borders. But there were no beds there either.

“She then said have you thought about the home side of birth and I said ‘I don’t want a home birth, I’ve not prepped for that’.”

They went home and returned again the next morning at 9am as instructed only to be told there were still no beds and to walk around the hospital.

After walking for an hour-and-a-half they returned and were found a waiting room to sit in.

“We were left in there for four hours and I was in a lot of pain by then. I was walking up and down the corridor begging for a bed.”

She was eventually found a room by 4pm and gave birth to her son at 8pm.

Claire said the midwives who cared for her in the end were “fantastic”, but criticised the wait for a bed.

The name has been changed at the mother’s request