Midwifery hours fall well short at RNSH
Extra maternity beds at Royal North Shore Hospital not staffed properly.
RNSH midwife and NSWNMA branch member Sue Bullmore says midwives are committed to providing a safe birth environment and the best possible care for new mums and babies.
“However, when the workload is as heavy as it is now we are not able to give the women that optimal care,” she says.
RNSH maternity services are housed in a new building designed with future expansion in mind.
“We have more birth rooms and maternity beds than we are funded for. We go over census quite often and use those extra beds but we are not staffed accordingly.
“On top of that, vacancies in the maternity ward are often filled by AiNs, RNs and student midwives instead of qualified midwives.
“Under the nursing award if we accept anyone in the maternity unit who isn’t a midwife we are saying that we are covering for the work they do.
“If something were to go wrong the midwives would ultimately be held responsible.”
“Maternity staff often miss meal breaks and finish work late. We have a high staff turnover, which is largely a result of understaffing.”
BirthRate Plus doesn’t count babies
Sue says the failure of Birthrate Plus to take babies into account when determining staff numbers is a particular problem for a high-risk referral centre such as RNSH.
“We have a lot of women with high-risk pregnancies and we often have babies who need special care.
“They include late pre-termers, babies requiring phototherapy for jaundice, babies who are poor feeders or need to have their blood sugars monitored.
“None of that work is counted in Birthrate Plus because babies are not counted as patients.
“If these babies were moved up to the neo-natal unit they would be counted as patients. But because they are down with their mothers in the maternity ward the belief is that the mothers are caring for them, which is not necessarily the case.”
She says inadequate staffing is largely to blame for the number of babies who have to be readmitted due to weight loss.
“We think their mothers did not get the amount of input they should have got before they left hospital, especially with feeding.”
In the birthing unit, midwives are often pushed to complete inductions and elective caesareans when staff numbers are short.
On their own initiative, RNSH midwives have started four projects to look at ways of improving efficiency to alleviate the staff shortage.
“These initiatives have the support of the director of midwifery services and midwifery unit managers. They are open to suggestions so it’s not an ‘us against them’ situation.
“One project is looking at the role of discharge planning because our mothers are in hospital for longer than average.
“Another project is looking at whether team nursing or midwifery would work better than patient allocation.
“However, our main need is more midwifery hours to reach the minimum recommended by Birthrate Plus.”
Maternity workloads untenable
Royal North Shore Hospital midwives say the public need to know about staffing issues affecting midwifery services around the state.
The NSWNMA branch at Royal North Shore Hospital has called for a community campaign for adequate staffing of maternity services.
The branch issued the call after spending a year trying to resolve staffing issues through the reasonable workloads process of the nurses and midwives award.
Assistant General Secretary Judith Kiejda said RNSH management had made some positive changes but more should be done to ease untenable workloads.
She said Birthrate Plus, the work tool used in conjunction with the award to determine required midwifery hours, had failed to solve the problems.
This was mainly because the hospital had filled midwifery vacancies with unqualified staff and Birthrate Plus did not count babies in a midwife’s ratios.
The 7-bed birthing unit surges up to 9 when busy and pulls midwives away from the maternity unit, leaving it
The 32-bed maternity ward surges up to 41 when busy and vacancies are often filled by nurses and assistant nurses not qualified in midwifery.
“A statewide trend towards higher gestational diabetes and women having babies when they are older has increased the need for close monitoring of mothers and babies.
“RNSH is a tertiary referral hospital that admits high-risk mothers, and babies that traditionally would have been
in special care now stay with the mother on the ward.
“These factors contribute to unsustainable workloads, which have contributed to some midwives leaving the hospital. Midwives hold concerns for women’s safety if things don’t improve.”