Mainstream media representations of midwifery exist on a binary, with headlines either reporting long hours and staff shortages or recapping an episode of Call The Midwife. The realities of the job lie somewhere in the middle but public understanding of midwifery (or lack thereof) doesn’t do the profession justice.
The act of birthing a child is as precious as it is challenging, but unless you’ve been there yourself there are many aspects of the job that aren’t spoken of. In Hard Pushed: A Midwife’s Story, NHS midwife Leah Hazard gives a candid, sometimes laugh-out-loud, sometimes brutal account of her career in midwifery. Recounting the highs and gut-wrenching lows of her time as a midwife, the book is an ode to her colleagues and new mothers.
As if being responsible for the life of a newborn and its mother wasn’t a big enough feat, midwives have to cope with a system at breaking point. Understaffed maternity wards and tough working conditions mean being an NHS midwife is both physically and emotionally draining. Hazard's story is not only a testament to midwives' strength and resilience but also a reminder of how valuable they are to society, helping women through one of the most overwhelming, difficult and empowering moments of their lives.
We spoke to Hazard about her career, the myths about midwifery, and finding moments of joy and laughter in a high pressure job, while surviving in a system on the brink.
How long have you been a midwife?
In a few months’ time, I will have been a qualified midwife for six years.
How many babies have you delivered?
I’m not actually sure, but it definitely runs into the hundreds! I stopped counting after I finished my training. As a student, I was required to deliver (or 'catch') at least 40 babies but I trained in a very busy hospital, so I managed to catch 76 by the time I qualified. It’s about quality, not quantity, though – women are so much more than numbers in a log book.
I’m not sure how many babies I've delivered but it definitely runs into the hundreds!
You used to work in television – going from that to midwifery is a big leap! What drew you to midwifery?
I’ve always been fascinated by women’s health. My first birth was quite difficult and nothing like I expected, which prompted me to ask some serious questions about why the system seemed so stacked against a positive experience. I began to find my job in television less and less fulfilling, and the prospect of making a difference to women during pregnancy and birth became increasingly compelling. I left my job and made the leap gradually, first working for six years as a doula, then retraining in midwifery.
Do you have any favourite births?
My own! My first daughter’s birth, although difficult, inspired me to make a change. I probably wouldn’t have gone on to study midwifery if I hadn’t had such a rough time of it. And my second daughter was born in a really empowering home birth, so I feel like I can empathise with women who’ve had very differing experiences too. I couldn’t possibly choose a favourite birth in the context of my midwifery practice – they’re all special.
What is the hardest birth you’ve ever assisted in?
The most difficult births are the ones where there is an immediate threat to the life of mother and/or baby. Birth is usually a straightforward physiological process but midwives see all kinds of emergencies over the course of their careers, and these are the really testing times. With every birth, we’re looking after two lives and trying to keep two people safe. That is the ultimate goal.
What is your favourite aspect of the job?
Definitely the connection that can be made between midwives and the women in their care. It’s not all about that peak moment of birth. In fact, like most midwives, I don’t work in the labour ward, and most of the care I give is geared towards the nine months leading up to birth, and up to six weeks afterwards. I find joy in those moments when I know I’ve helped someone feel safe, empowered and appreciated, and that can happen during a quick antenatal check, or when providing urgent treatment for sepsis, or listening to the story of a woman who’s been trafficked. My job is so varied that I’m lucky to find these moments of joy in so many different scenarios.
What are the hardest aspects of the job?
Providing effective, compassionate, woman-centred care in a system that’s often understaffed and under-resourced. Unfortunately, this is a running theme across the NHS at the moment. We’re all trained to provide world-class, gold-standard care, and it’s incredibly frustrating when the system that surrounds you won’t allow you to utilise your skills to the best of your ability. Some days, the best you can hope for is to keep everyone safe, but that should be a given. It can be exhausting trying to do your best within a framework at breaking point.
How do you deal with the long hours?
You just grind on and get through it. As students, we know that 12-hour shifts are likely to be the norm, so it’s a pattern I’ve grown accustomed to since I started my training nearly nine years ago. Time management and self-care are important.
Have you ever thought about quitting?
Without wishing to sound overly negative, I think many midwives in the modern NHS think about quitting, even if only fleetingly, more often than the public might imagine. Burnout is real. Midwifery within today’s system is physically and emotionally demanding, and everyone has their limits. Hardly a day goes by when I don’t wonder if I’ve reached mine.
What is going through your head when you’re delivering a baby?
Birth is such an intense time. When a baby is on the way, I’m completely focused on the moment: what I can see and feel, what sounds the woman is making, how her body is working, what might happen next and how I can respond to that. She has put enormous trust in me, and deserves my full attention.
Are there any myths about midwifery you’d like to bust?
The cliché idea of midwifery is that we spend all our time holding hands, delivering babies and cuddling newborns…very warm and fuzzy. In actual fact, while emotional support is important and some midwives do work in the labour ward, I can’t remember the last time I cuddled a newborn. Modern midwives perform an extremely complex and highly skilled role within an intensely pressurised system. Nowadays, we have to be experts in the normal and the unusual, and everything in between. We coordinate women’s care from start to finish, we manage social needs as well as physical ones, and we work in a variety of settings, from clinics to triage units to wards and research labs and beyond. Things have changed a lot since Call The Midwife, but many people still have an outdated understanding of the breadth and complexity of our role.
Are there aspects of the job no one talks about?
People often don’t understand how frequently midwives encounter pregnancy loss, by which I mean miscarriage and stillbirth. These things happen much more often than the general public is led to believe, and although awareness of this issue is growing, the topic is still fairly taboo. As midwives, we know that not all pregnancies have a happy ending and we are often the ones to diagnose and manage a tragic outcome. We accept from the earliest days of our training that this will be part of our job, but it never gets any easier.
What has the job taught you about women?
Women are stronger than they think, and this applies to both pregnant women and midwives (who are, with the exception of a small but growing number of men, mostly women).
What has your career as a midwife taught you about fertility, and the way we talk about it?
We talk about fertility a lot more than we talk about loss, but the two subjects are intertwined. I didn’t realise until I became a midwife how many women struggle to conceive and carry a full-term, healthy pregnancy. If you don’t know how common this is, it’s easy to imagine that everyone around you is breeding away quite blissfully, yet nothing could be further from the truth. Fortunately, assisted conception is a fantastic growth area for technology, and I’ve looked after women who have had amazing, successful treatments that would not have been possible in years past.
What is the most bizarre thing that has happened while you were on call?
I once inadvertently soaked myself in a woman’s urine by forgetting to close the tap on her catheter bag. I was a student at the time and felt completely mortified, but my mentor found the whole thing hilarious. Midwifery has a tendency to take itself quite seriously – and so it should – but I’ve also laughed harder in this job than I could ever have imagined at the outset. Midwives are hilarious people. We have to be, to relieve some of the pressures of the job, and birth also has its funny moments. We have to be able to laugh at ourselves on occasion, and over the years, any midwife becomes pretty unembarrassable.
...and the worst thing?
Undoubtedly, the worst thing is when a baby has died. There is no sadder time in a woman’s life, and as the mother of two children myself, it grieves me every time I encounter a woman in that position.
What’s it like developing a relationship with the mothers?
As with life, there will always be people you connect with and people you don’t. I’m not naturally a very extroverted person, so developing a quick rapport with women is a skill that I’ve had to learn (and am still developing), but I hope that the women in my care feel relaxed, appreciated and safe. 'Liking' a patient is neither here nor there – every woman deserves compassion and respect.
Are there any patients you’ve kept in touch with?
Keeping in touch with patients can be a tricky issue; we have to respect the boundaries of our role and maintain professional behaviour at all times. The nicest thing is when a woman I’ve looked after before returns to the maternity unit in her subsequent pregnancy – it’s always a great surprise, and so nice to catch up on all her family news.
As someone who has given birth, does it help to have experienced having a baby firsthand?
I don’t think a good midwife necessarily needs to have had children of their own, but I would like to think that my two very different birth experiences have given me an insight into how some of the women in my care might feel. Women often ask whether I’ve had children of my own, and for better or for worse, I think sometimes they do like to know that I’ve been down that road myself.
Is there anything else you’d like to tell us about midwifery?
I would love it if my book could, in some way, transform public understanding of the modern midwife’s role. There are so few accurate representations of what we do nowadays, and I think that if people could see how complex and challenging our role really is, and how much we can contribute to public health and wellbeing, our profession would benefit enormously. In turn, that newfound respect would benefit the ones who really matter: the women embarking on their journey to motherhood.
Hard Pushed: A Midwife’s Story (£16.99, published by Hutchinson) is out on 2nd May