Work Stress Made Me Self-Harm: The Grim State Of UK Midwifery

Photographed by Laura Chen
Leah* is a 27-year-old midwife with six years’ experience. But the stress of the job has forced her to take a step back and she is now studying part-time to become a teacher. She continues to work part-time while raising her two children. 
Leah came back to work from maternity leave last year, right in the middle of the pandemic. She worked in community midwifery at the time and found the stress of the work completely unmanageable. 
"Every day that I felt like I couldn't remember if I'd done something, because there was just so much work, I didn't sleep," she recalls. "I would wake up at 2am and ring the unit and ask them if we'd chased a blood result that I thought I'd forgotten to chase – it had always been done."
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She struggled with her mental health for months but when she began self-harming, she realised that she urgently needed help. She was signed off sick in February, received counselling and medication through her GP, and returned to working on a maternity ward. 
She feels frustrated at how long it took to get it all under control. "That's a year of my life I spent trying to put myself back together because of how work has affected me," she reflects. 

My husband said: 'You haven't been yourself for years.'

Leah*
Even before COVID, Leah says, midwifery was incredibly stressful.
"After I’d gone through all of this my husband said: 'You haven't been yourself for years.' He meant the last three or four years of work," she says. 
"We were in the kitchen at the time and I was doing little jobs. I'd said to him, offhand: 'I don’t think I’ve been myself for a little while because I’d forgotten that I could actually feel this way.' At the time, I’d been on antidepressants for about four or five weeks and was due back at work the next week," Leah continues.
"We’ve been together since we were 17. He’s seen me go from college student to student midwife to qualified midwife so when he said that it really hit home," Leah reflects. "I was shocked that the change in my behaviour was so marked for other people. I thought I was covering it all up and getting by but even my mum said the same thing. I found out later just how worried they had felt about me."
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Colleagues are also struggling, Leah says. "Staff walk in in the morning, see their pile of work and burst into tears because they've just had enough of it all," she says. "Others have resigned. I feel lucky that I am here and I am well, and none of my colleagues have done anything irreparable or damaging to themselves."
Sarah* is 26 and has worked as a midwife for five years. She says she has felt "burned out for about six months now". Stress has been a serious problem at work for over a year but one particular night shift – when she found herself one of two midwives responsible for a shift – marked a kind of uptick in her stress levels. She was alone with a newly qualified midwife and two midwifery assistants, working with a full ward of mothers and babies, including one suicidal patient. 
"I cried throughout the shift," she says, "although not where anyone could see me. On a full ward like that you can’t operate with that few staff but if you ask the labour ward for help, they just laugh – bullying is rife in midwifery. But if there's no other midwives, there's no other midwives. You just have to suck it up and get on with it."
Like Leah, Sarah has struggled to sleep. For the past year she’s had trouble staying asleep after the first hour, and in the last six months she’s felt much worse. In September her GP prescribed sleeping tablets, which she’d used once before, but this time they didn’t work. Like Leah, Sarah is kept awake by the worry that she’s missed something and has had to call the ward in the middle of the night to check. 
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The staffing crisis makes it hard to say no, she says. "The guilt eats away at you. We get texts every day with shifts that need to be covered. You think, I don't want to do any more shifts because I'm so exhausted. And I know that even if I do the cover, the ward will still be short-staffed."
She gets the impression that managers are avoiding midwives. "It's gotten to the point where managers avoid coming in or being seen. Because they know they're just going to get asked: 'When is this going to get better? What are we going to do?'"
The last time Sarah took annual leave without working was for her birthday in May. Since then she’s had four weeks of annual leave but worked shifts during every break. She says she often comes home hungry and thirsty, and her partner has remarked on the stress she’s under. "My partner is just used to me getting home and not wanting to speak to him, because he knows if I speak to him, I just cry," she admits. "It's overwhelming."
Midwives have been sounding the alarm for a year about how COVID-19 is worsening the existing workforce crisis in midwifery. Over the summer, home births were suspended in areas including London and maternity units in Oxfordshire and south Wales closed. In October, the chief executive of the Royal College of Midwives (RCM), Gill Walton, revealed that six in 10 midwives plan to leave the NHS within the next year – with early-career midwives unhappiest. 
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My partner is just used to me getting home and not wanting to speak to him, because he knows if I speak to him, I just cry. It's overwhelming.

SARAH*
"Staff are reaching the end of their tether," the RCM’s executive director for external relations, Jon Skewes, tells Refinery29. "Our survey showed that 57% of midwives are looking to leave – and the highest level of dissatisfaction among those surveyed came from those who had only worked for five years or less in the NHS."
Even midwives with prior NHS experience are shattered. Jo*, 32, is a midwife in London who retrained after working as an ICU nurse, qualifying in 2018. She loves midwifery and chose the profession because it connected with her values. As a newly qualified midwife, she felt she had some natural advantages for coping with stress, compared with some of her peers: her nursing experience, and her age. 
But she soon found that the workload and pressure were getting to her. She would cry in private at work and experienced some workplace bullying. In 2019 she began to experience panic attacks and agoraphobia. Physically unable to get to work, she was signed off sick for four weeks.
"I didn't leave the house for those four weeks," she says. "Everything felt supremely unsafe and my brain had kicked over into full-on panic, all the time. I was just gone."
After four weeks Jo went back to work and was transferred into community midwifery. She felt much happier at work and was just getting into the swing of it when COVID hit. She worked throughout the pandemic on wards and in the community, got pregnant last summer and stayed on the front line through the winter lockdowns. 
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During the pandemic Jo and her partner decided to leave London. But after being offered a midwifery job in the town they were relocating to, the offer was then revoked. HR specifically advised that it was because she had had "too much time off" when she took sick leave for work-induced stress in 2019. 
"I feel quite strongly that my workplace gave me a mental health problem. And now I'm being denied a new job because of that," she says. "I feel shut out."
Last month thousands of midwives and protestors took part in vigils to raise public awareness about the state of UK maternity services. Giving birth in the UK is becoming "critically unsafe" according to organisers of March With Midwives (MWM). The grassroots group brought together thousands of midwives in under a month and held over 70 vigils around the UK on 21st November to protest pressure on UK maternity services. 
Steering committee member Kay King says: "March With Midwives stemmed from a collective frustration at the current crisis. Desperate to raise public awareness of the rate of burnout and poor work conditions for UK midwives, the movement brought together 22,000 members in under five weeks." They’ve already seen the beginnings of wider awareness and with it the promise of change, she says. "Our collective activism has led to confirmed meetings with politicians and parliamentary groups, and we are both hopeful and persistent in our work to bring about a reform to the maternity sector."

Midwives save the lives of women, people who birth and babies every day but they are not valued or remunerated in a way that reflects their contribution.

Dr Sally Pezaro
Change can’t come soon enough. This month it emerged that more than 20 hospital trusts have suspended home births, with many citing staff shortages. Standing on the sidelines, you can’t help but wonder what it will take for the government to acknowledge the situation. 
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Dr Sally Pezaro is an award-winning midwife, fellow of the Royal College of Midwives and recently published a groundbreaking study into substance misuse in midwifery. She says that midwives have tolerated years of being overlooked and underfunded, and movements like March With Midwives are finally giving voice to midwives’ anger and frustration about pressure on services. 
"Midwives save the lives of women, people who birth and babies every day but they are not valued or remunerated in a way that reflects their contribution," she says. "Whether it's because the profession is predominantly female or seen as a subsection of nursing, or whether it's part of broader social attitudes towards caring work or women's health, midwifery has been sidelined for years. 
"This historic underfunding and undervaluing of these roles and services has put people's health and lives on the line. To prevent harm, the government must make an urgent commitment to improving the recruitment and retention of UK midwives."
Evelien Docherty, interim CEO of Make Birth Better, has seen the effect the crisis is having in real time. "We hear so many stories from midwifery staff on their knees and exhausted. It’s heart-wrenching. At our training we have midwives in tears simply because we mention their needs matter."
She praised the March With Midwives vigils and the work of Cheryl Samuels, whose petition for urgent government funding has now reached 120,000 signatures.
"What’s incredibly important to realise is how this is a systemic issue," explains Docherty. "The pressure on midwives has an immediate impact on birthing women and people under their care. Currently, we have an unsafe system to work in and therefore an unsafe system to birth in. The government sets maternity staff up to not be the best birth worker they can be, causing them to leave their profession, become mentally unwell or feeling they have no choice but to stay in their job. These factors all compromise patient safety.
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"We will keep highlighting these issues on our platforms, providing support for professionals and parents through our training, but what we really need is for the government to start acting."
Today, Jo doesn’t know if she’s burned out like she was in 2019. But she has no plans to return to midwifery in the next couple of years. Instead she’ll relocate as planned, teach antenatal classes and spend more time with her baby. 
"I genuinely feel numbed by the job that we've been doing," she says. "It’s so unfulfilling – it feels like I’m giving crap care. It's so far away from the kind of midwifery that I wanted to do."
Leah is retraining for fear of what might happen because of understaffing. "I love midwifery," she says. "It makes my heart happy, you know, when someone hugs you and says, 'Thank you so much', and their baby’s safe. But I need to move into a job where my bread-and-butter work doesn't absolutely petrify me," she says. "At the moment if I was to pull an emergency buzzer at work, part of me is petrified that no one's going to come and help me in time. It's not because my colleagues aren't supportive – they are amazing – there simply aren’t enough midwives."
Sarah is well aware that her work is unsustainable and she has begun developing a service offering contraception clinics for women facing domestic abuse or who’ve had children taken into care. She doesn’t want to leave midwifery – she has wanted to do this job since she was 14 – and feels guilty about how her decisions might affect colleagues but says she can’t keep working like this.
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"I love my job to pieces but I just don't know how much longer I can do this for," she says. "There's so many times that I've wanted to go to the GP for them to sign me off but then you feel bad knowing that you're leaving the rest of the staff."
When midwives on Sarah’s ward organised a local event as part of March With Midwives, the head of midwifery tried to discourage them from doing it, Sarah says, because she said it would worry women unnecessarily.
"But if people don't know that there's a crisis going on," Sarah reasons, "then how are we supposed to do anything about it?" 
*Names changed to protect privacy. 
If you are thinking about suicide, please contact Samaritans on 116 123. All calls are free and will be answered in confidence.

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