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A broken maternity system and what that means for expectant parents…

A recent article in All4Maternity, entitled I Am A Midwife And I Am Broken, states:

“On the shifts when I’ve not been alone I’ve been moved to work from one area to another, over and over. How many times can I apologise to women for leaving them as soon as I’ve helped to bring their baby into the world as I’ve been pulled to look after the somebody else? How can I provide continuity of care and build up a rapport with women and their families when this keeps happening? How can they trust me when I have to keep letting them down so often? How can I keep letting the student midwife that I’m mentoring down? How can I not have time to teach them as I want to and make sure they completely understand what they need to without compromising patient care?

I’ve worked in the hospital and community settings and neither is better than the other at the moment, there is a break in the system and we can’t patch it…

…Midwives everywhere are working in these conditions and I’m far from the worst off of us. Many midwives  are working with a lack of staff, lack of breaks, lack of support and not able to care for themselves. I just feel broken and it devastates me to admit this.”


This is reinforced by the UK WHELM study (Work, Health and Emotional Lives of Midwives in the United Kingdom) by the Royal College of Midwives & Cardiff University which found that midwives experience a range of issues:

  • 38% anxiety
  • 36% stress
  • 33% depression
  • 83% personal burnout
  • 67% work burnout
  • 66% think about leaving midwifery due to staffing levels (60%) and inability to provide the level of care they want to (52%)


As a busy practitioner who works with both expectant and new parents, I hear a range of experiences from 1:1 care for hours, to women seeing a range of midwives and feeling a bit lost and vulnerable, in pregnancy, during birth and postnatally.

As a birth doula I have worked alongside brilliant midwives who are able to provide 1:1 care and brilliant midwives who are rushing between labouring women to complete their checks and their paperwork. This is not about personal blame or fault, it is about a system which is not functioning as well as it could to benefit the women and babies who need it, as well as the staff who want it to be the best it can be.

According to the latest RCM report on the state of maternity services, the NHS only employed 67 new midwives last year and this is despite 2000 being trained. The Royal College of Midwives states that the NHS needs an extra 3500 midwives to plug the gaps in services.

Our maternity services are in crisis – The RCM are campaigning for midwives and maternity services and bodies such as All4Maternity are also supporting midwives, giving midwives a voice and championing best practice. We need maternity services that fully staffed so women and their babies are safe, supported and well looked after and we need our brilliant midwives to be supported, to be able to provide a consistent level of excellent care, without feeling overloaded and burnt out.


birth doula newcastle tynesideSo, what does this mean for expectant parents?

You may not see the same community midwife during your pregnancy, this has changed throughout my career when pregnant women would see the same midwife.

And, when you are in labour, you may receive 1:1 care or you may meet different midwives who have different ways of working and different perspectives, which could leave you feeling confused and unsupported.

As a mother of three, a birth doula and an antenatal teacher, I know there are several things that make a difference to women and their partners…

  • knowledge
  • questions
  • assertiveness

These all mean you are better placed to work well with your midwife, to listen to your body, to say what you need, to have more control and to be less scared.

  • book a doula if you can, to provide you with continuous 1:1 support so you can feel safe and able to work with your contractions. This support starts in pregnancy and can encourage you to feel better prepared for your labour and birth.


It is about knowing that:

  • labour & birth is not about waiting for instructions from your midwife to tell you what to do, it’s not about being allowed, it’s not about shoulds.
  • it is about going with what you need to feel safe and comfortable, it’s about being made to feel safe and supported so you can say what you need, do what you need, so you can respond to your body, so you can be more relaxed and calm, so you are not scared.


So pregnancy and preparation for birth has to be about equipping yourself with sources of support and information, leading the way with questions, arming yourself with knowledge and being prepared to assert yourself as and when you need to.

My antenatal practice is all about birth preparation with discussion and questions and good knowledge, to encourage more realistic expectations and an ability to take the lead and to say what you need. 

This is about working together with your midwives, it’s about understanding the potential limitations of busy midwives within this busy maternity system and taking control within that. It’s about having realistic expectations of what support you might need, what support might be available and not feeling lost in the system.

There’s nothing wrong with needing to be better prepared and to take more control. And maybe it’s time for that to be the norm.

Janine – mother, doula, antenatal teacher
a specialist in pregnancy, birth and parent support