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To: Sajid Javid
Open letter to Sajid Javid regarding the Mental Health impact of the UK Midwife Shortages
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Dear Mr Javid
As a Clinical Psychologist specialising in perinatal health and birth trauma, I am writing this letter to raise urgent concerns about the impact of the current midwifery staffing crisis on maternal mental and infant mental health and the mental health of the midwives themselves.
I am aware that the government are working to halve the rates of still births and infant deaths by 2025. Together with the launch of Maternal Mental Health Services across the country, we welcome these strategies and the positive impact they are likely to have. However, the current deficit of 2500 midwives means that mothers are experiencing unnecessary levels of birth trauma.
As mental health professionals, we are experiencing a sharp increase in mothers accessing mental health services for birth trauma. Their presentations include PTSD, Post Natal Depression, Post Natal Anxiety and Peurperal Psychosis. We are hearing that in a maternity system that is stretched way beyond capacity, emotional wellbeing does not appear to be on the agenda. Women are not blaming the midwives they have, but the fact that there aren’t enough of them to be able to prioritise their emotional experience of childbirth.
Women are telling us that they have not been able to have a midwife attend their homebirth, because community midwives are being called in to the hospitals to back fill the staffing crisis. This is leaving a proportion of women to unexpectantly have to ‘free birth’ at home. This is often resulting in trauma for the mother, any supporting partner and any children who may also be present. There is also obviously a higher risk of physical birth injury to mother and baby, which can also lead to long-term psychological trauma response.
We are hearing that women are being left on labour wards for long periods of time without being able to access a midwife. Women aren’t receiving any medical assistance until much later in their labours, meaning there is far higher likelihood for the need for emergency intervention. Stress and adversity during labour can increase adrenaline and reduce oxytocin levels (oxytocin being a neurochemical essential for labour to progress, for the mother to bond with the baby and for milk production). This scenario again gives rise to the need for higher levels of intervention and injuries.
We are hearing that many women are being subject to procedures such as episiotomies without consent. This induces as a sense of violation and can again cause a long-term psychological trauma response. Birth injuries to mother or child can have far reaching mental health implications for all involved.
When mothers experience psychological trauma, postnatal depression etc, they are less emotionally available to their babies. Babies are very sensitive to maternal distress and this can cause them to become chronically hypervigilant. The long-term impact of early insecure attachment relationships is very well documented and can have far reaching consequences for the child’s long-term mental health and wellbeing.
After birth, women are telling us that there has been no support available to them. They are transferred to a ward, their birthing partners being sent home relatively quickly and there has been no breast feeding support. This can lead to latching difficulties, crying babies and depressed mothers. For those who have had caesarean sections, there are no midwives available to pass their babies to them from their cribs or to return them after feeding. This leads to babies being left crying for long periods and/or staying in bed with their exhausted mothers with risk of accidental smothering.
We ask you to act urgently to increase staffing levels across all maternity services to a level where the emotional wellbeing of all mothers, babies and maternity staff can be prioritised. Without this, we predict a sharp increase in maternal and infant mental health difficulties. We also predict a high level of staff burn out, mental health conditions and turnover should those staff who remain be expected to continue under present conditions. Human connection is essential at the point in which a mother gives birth. Providing compassion and support that is supportive to mother and baby is critical and not something that we can afford to omit.
If we are to retain any newly recruited midwives, there needs to be substantial change in how they are supported to manage the psychological impact of their challenging role. As was the case with the Family Nurse Partnership initiative (a specialist intervention for young mums), supervision structures and compassion focused models that are utilised in psychology professions would enable midwives themselves to have a safe, nurturing environment that supports their own wellbeing and development. This in turn enables them to consistently provide a safe base for the women in their care.
Yours Sincerely
Dr Jennifer Wilson (nee Greenwood)
Clinical Psychologist and Birth Trauma Specialist
As a Clinical Psychologist specialising in perinatal health and birth trauma, I am writing this letter to raise urgent concerns about the impact of the current midwifery staffing crisis on maternal mental and infant mental health and the mental health of the midwives themselves.
I am aware that the government are working to halve the rates of still births and infant deaths by 2025. Together with the launch of Maternal Mental Health Services across the country, we welcome these strategies and the positive impact they are likely to have. However, the current deficit of 2500 midwives means that mothers are experiencing unnecessary levels of birth trauma.
As mental health professionals, we are experiencing a sharp increase in mothers accessing mental health services for birth trauma. Their presentations include PTSD, Post Natal Depression, Post Natal Anxiety and Peurperal Psychosis. We are hearing that in a maternity system that is stretched way beyond capacity, emotional wellbeing does not appear to be on the agenda. Women are not blaming the midwives they have, but the fact that there aren’t enough of them to be able to prioritise their emotional experience of childbirth.
Women are telling us that they have not been able to have a midwife attend their homebirth, because community midwives are being called in to the hospitals to back fill the staffing crisis. This is leaving a proportion of women to unexpectantly have to ‘free birth’ at home. This is often resulting in trauma for the mother, any supporting partner and any children who may also be present. There is also obviously a higher risk of physical birth injury to mother and baby, which can also lead to long-term psychological trauma response.
We are hearing that women are being left on labour wards for long periods of time without being able to access a midwife. Women aren’t receiving any medical assistance until much later in their labours, meaning there is far higher likelihood for the need for emergency intervention. Stress and adversity during labour can increase adrenaline and reduce oxytocin levels (oxytocin being a neurochemical essential for labour to progress, for the mother to bond with the baby and for milk production). This scenario again gives rise to the need for higher levels of intervention and injuries.
We are hearing that many women are being subject to procedures such as episiotomies without consent. This induces as a sense of violation and can again cause a long-term psychological trauma response. Birth injuries to mother or child can have far reaching mental health implications for all involved.
When mothers experience psychological trauma, postnatal depression etc, they are less emotionally available to their babies. Babies are very sensitive to maternal distress and this can cause them to become chronically hypervigilant. The long-term impact of early insecure attachment relationships is very well documented and can have far reaching consequences for the child’s long-term mental health and wellbeing.
After birth, women are telling us that there has been no support available to them. They are transferred to a ward, their birthing partners being sent home relatively quickly and there has been no breast feeding support. This can lead to latching difficulties, crying babies and depressed mothers. For those who have had caesarean sections, there are no midwives available to pass their babies to them from their cribs or to return them after feeding. This leads to babies being left crying for long periods and/or staying in bed with their exhausted mothers with risk of accidental smothering.
We ask you to act urgently to increase staffing levels across all maternity services to a level where the emotional wellbeing of all mothers, babies and maternity staff can be prioritised. Without this, we predict a sharp increase in maternal and infant mental health difficulties. We also predict a high level of staff burn out, mental health conditions and turnover should those staff who remain be expected to continue under present conditions. Human connection is essential at the point in which a mother gives birth. Providing compassion and support that is supportive to mother and baby is critical and not something that we can afford to omit.
If we are to retain any newly recruited midwives, there needs to be substantial change in how they are supported to manage the psychological impact of their challenging role. As was the case with the Family Nurse Partnership initiative (a specialist intervention for young mums), supervision structures and compassion focused models that are utilised in psychology professions would enable midwives themselves to have a safe, nurturing environment that supports their own wellbeing and development. This in turn enables them to consistently provide a safe base for the women in their care.
Yours Sincerely
Dr Jennifer Wilson (nee Greenwood)
Clinical Psychologist and Birth Trauma Specialist
Why is this important?
It is not currently safe for women to give birth in the UK. Our services are very under funded and under staffed. Those midwifes who remain feel burnt out, unappreciated and are underpaid. The role of midwife needs to change and be better supported if we are ever going to be able to train, recruit and retain the 2500 additional midwives that are so desperately needed.
