The Challenges Midwives Face Day-to-Day

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The Challenges Midwives Face Day-to-Day

Midwives face many different challenges as part of their jobs, and must be able to adapt whenever new problems arise. Not only must midwives deal with a wide range of issues, but they have to work with many different people, each with their own unique set of circumstances, health issues, opinions and attitudes.

To highlight the scale and variety of work that needs to be undertaken in midwifery practice, we have created an infographic that highlights some of the key challenges midwives face day-to-day. Our research is based on experience and insight into the profession, and sheds light on some (but by no means all) of the central factors that go into the provision of high-quality midwifery care.

Click on the image below or follow this link to view the complete infographic, or read on to explore the key points in greater detail.

Key Challenges During Pregnancy

  • Provide advice, care and support to the expectant mother and family: midwives are essential in offering personalised maternity care and support throughout the pregnancy journey. This involves educating the family on the importance of maternal and child health, addressing any concerns they may have, and ensuring the mother feels supported. This role is critical in improving maternal health care and ensuring the family is well-prepared for the arrival of the new baby.
  • Offer information on a range of matters, including health issues and parenting: midwives play a crucial role in public health by providing information that covers a wide array of topics such as nutrition, exercise, mental health problems, childbirth options and pain relief. Effective education can significantly impact maternal and child health, and empower expectant mothers to make informed decisions that contribute to better health outcomes.
  • Monitor, examine and diagnose the expectant mother and unborn child: regular monitoring and examination by midwives are vital in ensuring the health and wellbeing of both the mother and the unborn child. This includes measuring maternal blood pressure, monitoring foetal growth and movements, and identifying any abnormalities early on. This ongoing assessment is crucial in the early detection of potential health issues and contributes to the provision of quality midwifery care.
  • Detect and investigate any complications, making referrals to medical specialists when required: midwives are trained to recognise the signs of complications, such as pre-eclampsia, gestational diabetes or foetal distress. Detecting these early is essential for the timely referral to medical specialists, ensuring that both mother and child receive the necessary medical attention. This is a critical aspect of midwifery practice that helps in maintaining maternal and child health and reducing maternal mortality.
  • Conduct screening tests and provide information before and after these tests: screening tests are a fundamental part of prenatal care, as they allow for the early detection of potential health problems. Midwives are responsible for conducting, or making referrals for, these tests and providing comprehensive counselling to help expectant mothers understand the purpose, process and implications of the results. This supports informed decision-making and prepares the mother for any further actions that may be needed.
  • Develop individual programmes of care for every patient: personalised care plans are essential in meeting the unique needs of each expectant mother. Midwives develop these plans by considering the mother's health history, current health status and any specific risks associated with the pregnancy. Tailoring care in this way ensures that each person receives the most appropriate and effective support throughout their pregnancy, which contributes to better maternal healthcare outcomes.
  • Review the mother's history and assess whether the pregnancy is high or low riskunderstanding the medical and pregnancy history of the mother is crucial for assessing the level of risk associated with the current pregnancy. This involves a thorough review of past and present health issues, previous pregnancies and their outcomes, and any hereditary conditions. By accurately assessing these risks, midwives can refer the mother for doctor-led care if needed, implement preventive measures, provide targeted advice, and ensure each mother receives the most suitable care for their specific needs.

Key Challenges During Labour

  • Assist with the delivery of the baby: midwives are central figures in assisting with natural births. They provide hands-on support, and aim to ensure the safety and wellbeing of both the mother and the newborn. Midwifery care helps to guide the mother through the birthing process, employing techniques that promote a safe  delivery and support the mother's preferences for childbirth.
  • Assist with drugs administration and pain management: effective pain management is crucial during labour. Midwives administer medications and utilise various pain relief methods, such as drugs, , gas and air, or natural techniques like water therapy and massage. They can also organise for an anaesthetist to provide an epidural if the mother requests one. They ensure that pain management strategies are applied safely and effectively, aligning with the expectant mother's birth plan and medical needs as much as is safely possible.
  • Monitor the health of the mother and baby throughout: continuous monitoring during labour is essential to identify and respond to any issues promptly. Midwives monitor vital signs, contractions, and the baby's heartbeat to ensure that labour is progressing well and both patients remain healthy. This constant vigilance helps in the early detection of complications, contributing to safer deliveries and better maternal and child health outcomes.
  • Support and reassure the mother-to-be and her family throughout the labour: emotional support and reassurance are also important factors during childbirth. Midwives should provide constant encouragement, answer questions and help maintain a calm and positive environment. They should also support the family, keeping them informed and involved in the process, which is crucial for a positive childbirth experience.
  • Make sure the mother is comfortable throughout the labour: comfort during labour can significantly impact the mother's experience and the birth outcome. Midwives can take various measures to enhance comfort, such as adjusting the room's lighting and temperature, offering positions that ease labour pains, and ensuring privacy and dignity throughout the birthing process.
  • Refer to, and work with, other medical professionals when required: collaboration with obstetricians, paediatricians and other healthcare professionals is crucial when complications arise that go beyond the scope of midwifery practice. Good midwifery practice provides a seamless transition and coordination of care, advocating for the mother's and baby's health needs throughout the labour and delivery process.
  • Provide lifesaving care in emergency situations: in emergencies, midwives are often the first responders, providing critical interventions to safeguard the lives of mothers and newborns. They are trained to manage emergencies such as haemorrhage, neonatal resuscitation and eclampsia, underscoring their vital role in maternal and newborn healthcare, particularly in settings with limited access to medical specialists.

Key Challenges After Labour

  • Provide ongoing care for the mother and baby in the postnatal period: after labour, midwives continue to play a crucial role in providing postnatal care to maintain the well-being of the mother and the newborn. This includes monitoring the mother’s recovery from childbirth, observing the baby and taking readings such as their temperature, checking the baby is feeding, addressing any complications, and offering support for emotional and physical adjustments post-birth. This care is vital for promoting maternal and child health and ensuring that both mother and baby are progressing well during this critical period.
  • Offer advice regarding daily care of the baby: midwives provide essential advice and education on newborn care, including bathing, feeding, and sleeping patterns. This support is crucial for first-time parents and contributes significantly to the quality of midwifery care. By equipping parents with the knowledge and confidence to care for their newborns, midwives play a fundamental role in improving maternal healthcare and child health outcomes.
  • Visit mother, baby, and family for ongoing heath checks: home visits by midwives in the postnatal period are vital to check that the baby is not suffering from any illnesses and is feeding well. They are also vital so that the mother’s healing from tears and caesarean sections can be adequately monitored. These visits are a key aspect of community midwifery and help in providing personalised care, reinforcing the importance of maternal and child health in the community setting.
  • Ensure continuity of care by liaising with relevant health and social care professionals: midwives coordinate with a range of professionals, including paediatricians, health visitors, and social workers, to ensure a holistic approach to postnatal care. This interdisciplinary collaboration is crucial for addressing the comprehensive needs of the mother and baby, contributing to the overall effectiveness of the healthcare system in supporting maternal and child health.
  • Monitor the health and development of the baby: regular monitoring of the baby’s growth, development, and general health is a key responsibility of midwives in the postnatal period. This includes conducting newborn screenings, immunisations, and providing guidance on developmental milestones. Through ongoing assessment, midwives contribute to early detection and intervention for any health issues, aligning with the goals of improving maternal health care and child health.
  • Feeding support: breastfeeding advice, for those who choose to feed this way, as well as help with formula feeding, is a critical aspect of newborn care. Midwives provide vital support for breastfeeding, including by teaching techniques for proper latch, positions for breastfeeding, and solutions for common challenges. They can also provide advice on how to safely make up bottles and how to store baby milk. 

Other Key Responsibilities

  • Supervise and train junior colleagues: senior midwives play a critical role in the professional development of student midwives and newly qualified midwives. By supervising and training junior colleagues, they prepare the next generation of midwives to provide quality midwifery care.
  • Complete contemporaneous record-keeping: accurate and timely record-keeping is essential in midwifery practice, for both continuity of care and legal compliance. Midwives should meticulously document all aspects of the care provided, including maternal and child health observations, decisions made, and care plans implemented. This contemporaneous record-keeping is vital for effective healthcare system operations and supports the provision of safe midwifery care.
  • Act as an advocate for women: midwives can be key advocates for women's rights and needs within the healthcare system. They can try to ensure that women's preferences and concerns are heard and respected during maternity care, labour and postnatal care. 
  • Offer support for families during and following complications with the pregnancy, such as a miscarriage or stillbirth: midwives should provide critical emotional and psychological support to families experiencing the challenges of pregnancy complications, miscarriages or stillbirths. They should offer compassionate care and guidance during these difficult times, to help families to cope and find the support they need. This aspect of midwifery care is essential for addressing mental health problems and supporting families through the grieving process.
  • Develop on a professional level to meet post-registration education and practice (PREP) requirements: continuous professional development is crucial for midwives to keep up-to-date with the latest practices, research, and technologies in maternal and child health. By engaging in further education and meeting PREP requirements, midwives enhance their skills and knowledge, and contribute to the advancement of the midwifery profession and the improvement of maternal healthcare services.

Why Midwives Require Greater Support

This breakdown of responsibilities demonstrates the pivotal role that midwives play in upholding the essential health systems that new mothers rely upon for their own safety and the safety of their children. Despite this overwhelming importance, however, midwifery practice is often undermined by various practical barriers caused by under-resourcing, which impacts their ability to safe, high-quality midwifery care.

The challenges midwives face include a high volume of patients, poor working conditions and a lack of necessary time and budget, all of which can lead to decreased health worker motivation and increased stress levels. An international study published in 2022 showed that midwives reported having to deal with high levels of burnout, insufficient work resources and low job satisfaction, despite their own belief that the work they do is very meaningful. The World Health Organization has also emphasised that midwives "are essential to the provision of quality of care, in all settings" - but also notes a "startling lack of investment in quality midwifery education, despite the evidence of impact".

A significant factor contributing to the pressure on midwives is a shortage in the midwifery workforce. Newly qualified midwives and student midwives often enter the profession only to find themselves overwhelmed by the demands and insufficient mentorship from more experienced midwives. This can lead to high turnover rates and a cycle of understaffing that further strains the system. Additionally, the lack of professional development opportunities and supportive supervision undermines midwives' ability to grow in their roles and improve maternal health care.

These challenges not only affect midwives' mental and physical health but also prevents consistently safe midwifery care, potentially compromising maternal and child health outcomes. Addressing these issues requires comprehensive human resource management intervention, and a commitment from healthcare system leaders to empower and support midwives. Managers and senior midwives must work together to create an environment where all midwives, especially those who are newly qualified or working in community settings, feel valued, supported and equipped to provide the best possible care.

Steps to support these essential health workers should include:

  • Increasing investment in midwifery education and resources: enhancing midwifery education programmes and ensuring that midwives have access to the necessary tools and facilities are essential steps to take. Investing in healthcare facilities can significantly improve the quality of maternity services provided.
  • Implementing HR interventions: developing strategies to address staffing issues, improve working conditions, and provide adequate personal protective equipment can all help to reduce the workload on individual midwives, while offering the support they need to perform their duties safely and effectively.
  • Promoting professional development: offering continuous learning opportunities and further education for midwives to advance their skills and knowledge. This includes providing supportive supervision and mentorship programmes that help integrate newly qualified midwives into the workforce smoothly.
  • Enhancing support systems: establishing strong support networks within the healthcare system can help midwives cope with the mental and emotional demands of their work. This could involve providing access to counselling services, peer support groups, and initiatives aimed at improving mental health and wellbeing among healthcare professionals.
  • Advocating for the midwifery profession: raising public awareness about the vital role of midwives and the challenges they face can lead to greater support and recognition from the wider community and policymakers. Advocacy efforts should highlight the link between well-supported midwives and improved maternal and child health outcomes.

By addressing these key areas, healthcare systems in the UK and beyond can ensure that midwives receive the support they need to provide quality care. This will ultimately lead to better health outcomes for mothers and babies. It is essential for healthcare leaders, policymakers, and the community at large to recognise and act on the need for greater support for midwives, as they are fundamental to making sure that every new child gets the best possible start in life.

To learn more about how JMW can help when failures in midwifery practice occur, call us on 0345 872 6666 or complete our online enquiry form.

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