Mums matter, babies count
Midwives at Royal North Shore Hospital have run an innovative campaign to educate the public about the need for appropriate staffing levels in birthing wards.
Corrine Cakebread has worked as a midwife for more than 15 years. Over that time she has seen increased numbers of mothers and babies with complicated health needs coming into the wards.
“We get a lot more women with complex health issues now. More women are being induced earlier,” she says.
There are a number of factors that have changed the birthing environment: the rising numbers of older mothers, more IVF births to women with complex health histories and higher rates of gestational diabetes. Babies being born at 35 weeks are now being cared for in regular maternity wards, rather than in intensive care.
But these increasingly complex care needs haven’t been matched with increased staffing levels says Corrine, a registered nurse and midwife at the Royal North Shore Hospital.
“We have the same level of staffing, the same hours as when I started,” she said.
The RNSH’s birthing ward – which also takes referrals for complicated cases from surrounding regions – averages 220–230 births per month. “We don’t get the time to help everyone who needs help,” Corrine says.
Compounding the problem is the pressure to “discharge babies earlier than ever means that many are coming back and being treated for jaundice”.
As a long-time union member, Corrine was happy to pay her fees knowing the union was representing nurses and midwives in the workplace. But last year Corrine’s growing concerns about patient safety led her to become active in the union for the first time.
“At the end of the day, if something happened to one of our patients it comes down to the midwife looking after the mother and baby and the team leader. And that is a huge responsibility. I was concerned that something would have to happen before something changed.”
Fighting to give mothers better care
After a couple of near misses last year, Corrine and other midwives worked with the union to create a campaign called ‘Mums Matter, Babies Count’.
The campaign slogan highlights both the staff’s desire to give every mother the best possible care, and to improve Birth-rate Plus®, which currently doesn’t count babies as patients, a key issue for calculating appropriate staffing levels.
NSWNMA Acting General Secretary Judith Kiejda says, Birth-rate Plus®, can be a clunky tool for calculating appropriate staffing numbers.
“When our organisers first sat down with RNSH staff to discuss staffing levels and workload pressures, midwives were crying. They were devastated they couldn’t provide the kind of holistic, woman-centred care they would like to,” she said.
Corrine explains that unlike nurses, who can have a four-to-one patient-nurse ratio, midwife loads can be much higher.
“On a good day you have five women to look after. On occasions there can be one midwife for up to eight mothers. But babies need to be cared for too, and embedded in Birth-rate Plus® is the assumption that babies don’t count as patients.”
She says management have been making up staffing shortfalls with assistants in midwifery (who are usually student midwives) but they are still learning and can’t be expected to do observations.
“Some babies [born pre-term or to diabetic mothers] need their blood sugar levels monitored for at least 24 hours,” Corrine says. “The only people who can do that are midwives.”
For Corrine, the bottom line for safe staffing levels is that “anyone who walks onto that ward should be able to resuscitate a neonate or a mother”.
In the post-natal ward, midwife shortages are being filled with RNs, who can’t be expected to have the expertise to get a woman breastfeeding correctly, Judith says.
“When baby and mother thrive, readmissions rates are lower.”
Talking to the community
Last year Corrine and other midwives, with NSWNMA support, met with the hospital’s reasonable workload committee to discuss possible solutions, including increased ward clerk hours and changes in ward layout.
While the committee was sympathetic, when the midwives’ concerns were put to management they “fell on deaf ears”.
As part of the campaign, they also held a rally outside the hospital last October. “Some of the doctors came and supported us,” Corrine says.
“We’ve also been wearing ‘Mums Matter, Babies Count’ badges, and talking to mothers and visitors when they ask us about it.”
Corrine has seen some small improvements in staffing levels since their action started, but more needs to be done.
“We would like at least five midwives on the maternity ward and at least five on the birthing unit every night.”
As part of the campaign, RNS midwives counted missed meal breaks: they found 96 missed meal breaks on the birthing unit over two weeks.
“Midwives will work through their lunch; we are not going to leave a birthing mother,” Corrine said.
Judith Kiejda says midwifery shortages are impacting maternity units everywhere, with the units at the RNSH down the equivalent of 15 FTE, while at least 40 FTE positions are missing at Westmead. She says long-term issues still remain unresolved in Wollongong Hospital maternity unit.
Corrine is also concerned that the work pressures are making it harder to retain new midwives coming through.
“We have at least 10 student midwives coming through every year. We don’t get the chance to educate them the way we should educate them. My fear is so many of our midwives are going to leave because they don’t get the support they need.”
She’s worried she doesn’t have time to sit long enough with mothers either as she bounces between patients.
“The main thing for me is trying to make sure we are working in a safe environment for staff and patients. That is our aim in having babies count.”
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