NHS midwives say unsustainable shift patterns and chronic under-staffing are putting the safety of mothers and babies at risk, and are calling for stricter legal protections on their working hours.
Last week Valerie Amos, who is leading the government’s national review of maternity care, said in an interim report that families are receiving “unacceptable care” and that the situation was “much worse” than she had anticipated.
Midwives supporting the campaign say a “put up or shut up” culture in the NHS is leaving them so exhausted that they make mistakes. They say that, unlike other safety-critical roles such as bus or HGV drivers, midwives don’t have specific regulations mandating their breaks and rest.
Alice (not her real name) is a practising community midwife in north-west England. She said that at least once a week she works “unsafe hours” because of shift patterns and her workload.
“We’re expected to work during the day, then attend a home birth or go into the [maternity] unit if we’re on call, and then work again the next day or we have our pay taken off us for the second working day,” she said.
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Alice said that in one instance she was called in to cover a hospital unit at 2am after already working the previous day: “I then worked until 4.30pm. I had 3.5 hours sleep in 32 hours”.
‘I was up all night and all day at work. When I got home, I drove into someone’s car. It was really scary’
Sadie Holland, ex-midwife
Although midwifery is covered by the UK’s working time regulations, meaning employees shouldn’t work more than 48 hours a week, many midwives say they have felt pressured by NHS managers, including those responsible for rotas, to opt out of that regulation. Workers in the UK also have the legal right to 11 hours rest between working days, but due to the nature of their on-call shifts, some midwives claim that rule is regularly flouted.
NHS staff survey findings show that 78.8% of midwives work additional unpaid hours. The national average for NHS staff is 52.7%.
Surveys conducted by the Royal College of Midwives, which represents more than 50,000 midwives in the UK, have shown that 45% of midwives report burnout often or always, and only 16% feel there are enough staff for them to do their job properly.
Sadie Holland, 58, left her job as a community midwife in 2023 after she was told by NHS management, “Iʼd leave if I could, I donʼt blame you”, when raising concerns about her working hours.
According to Holland, after the Covid-19 pandemic her working conditions changed significantly, and she was often called in to cover staff shortages or illness on hospital units while continuing to support women on her existing caseload.
“I came home one day having been up all night as well as all day. I only lived two miles away from the hospital … but when I got home, I drove into somebody elseʼs car,” Holland said. “It was really scary, but it just shows the exhaustion level. I feel terrible that all of this is going on in maternity. I am a person who could easily be out there helping and Iʼm not. I really didnʼt intend to leave, but at the same time, I just think, do you know what? Iʼm much happier.”
Leah Hazard, a practising midwife and author who is leading the campaign for further legal limits on midwivesʼ working hours, said that although midwives have tried to escalate their concerns about the impact on quality of care to management and unions, many are often reprimanded or disciplined for speaking up.
“So many midwives have contacted me saying that they know their fatigue and exhaustion have led to them also making mistakes in care,” Hazard said. “That is a very clear and present risk, but it is also an entirely preventable risk.”
Gill Walton, chief executive of the Royal College of Midwives, said: “The fundamental issue is that you cannot deliver safe maternity care with exhausted and overstretched staff. Well-rested midwives who have manageable workloads provide better, safer care.”
A Department for Health spokesperson said: “There are legal limits to working hours to protect staff and their patients, and any circumstance where employers are contravening this is unacceptable.
“The secretary of state has ordered a rapid, independent investigation into maternity and neonatal services to understand deep-rooted issues. It will seek to understand the experiences of staff and healthcare professionals working across maternity, and how they can be better supported to provide high-quality, safe and compassionate care.”
Photograph by Andy Hall for The Observer