29.03.2024

Maternity staff facing extreme burnout over staff shortages

Professionals argued the coronavirus crisis will lead to a rise in doctors, nurses and midwives suffering post-traumatic stress disorder (PTSD) and other mental health issues – raising concerns staff exhaustion could curb patient safety and standards of care.

Maternity staff are facing extreme burnout during the pandemic as staff shortages and longer, busier shift patterns lead to the workforce becoming increasingly overwhelmed, healthcare leaders warned.

Senior figures working in pregnancy services told The Independent healthcare professionals are working longer hours, covering extra shifts around the clock, and spending more time on call to compensate for increasing numbers of employees taking time off work after getting coronavirus.

Staff say stress-related absences have reached “worryingly” high levels, with junior doctors and midwives “thrown into the deep end” due to having to fill in for colleagues.

The warnings come as a report by Make Birth Better, which was shared exclusively with The Independent, found 31 per cent of healthcare staff report having received no emotional support at all.

Michael Magro, a consultant obstetrician at Barking, Havering and Redbridge, said services were already “very stretched” – with only the minimum staff required working – due to workforce shortages before the Covid crisis hit.

Mr Magro, who is also vice chair of a multi-professional advisory panel for national charity Baby Lifeline, explained doctors at his trust were asked to take annual leave ahead of December to avoid burnout, but all their holiday days in January have now been cancelled to help cope with staffing shortfalls.

He said he had never seen this before as he warned staff are “demoralised and burnt out” and this will have long-term repercussions for both their mental and physical health.

Mr Magro added: “I’ve had midwives and junior doctors saying, ‘I’m going to have to call in sick because of exhaustion.’ Junior doctors are working in areas they would never have expected to work in. They are now working on Covid wards.

“It’s even more difficult for staff living alone. They are really struggling from anxiety, difficulty sleeping and concentrating, and anxiety about coming to work, due to fears of getting sick themselves.”

Recent research by the Royal College of Midwives argued the safety of maternity services is under “serious threat” – with eight out of 10 midwives reporting their NHS trust or board does not have sufficient staff to provide safe provision. Four in 10 say half of shifts are understaffed and seven in 10 have contemplated departing the profession.

Suzanne Tyler, executive director for services to members at the college, told The Independent: “Sickness absence due to stress and burnout has reached worryingly high levels in the profession and this has been further worsened by absences due to Covid-19 and for those left behind staffing already understaffed services the pressure is immense.

“A survey undertaken by the Royal College of Midwives showed that midwives are often unable to find the time to even go to the toilet on long, demanding shifts, working unpaid overtime, and this happens day after day. This is simply unacceptable.”

A study by the Royal College of Obstetricians and Gynaecologists, carried out before the coronavirus emergency last year, discovered two-thirds of a sample of its members and trainees reported having been exposed to traumatic work-related events. Of these, almost a fifth of both consultants and trainees said they had suffered clinically significant symptoms of PTSD.

Dr Pat O’Brien, consultant obstetrician and vice president at the professional association, noted a high proportion of maternity services staff were deployed to other areas of the hospital to fight on the frontlines of the Covid crisis during the first wave.

“It’s likely this would have been incredibly stressful for many of them who wouldn’t be used to treating critically ill patients on a daily basis,” he added. “Ultimately, a stressed workforce can have serious implications for patients, as we know burnout reduces patient satisfaction, safety and standards of care.”

Covid upheaval has resulted in women attending scans alone, giving birth alone without a partner, changing their childbirth plans and having less access to pain relief.

While new guidance sent to trusts in England in December stipulated pregnant women should be permitted to have one person accompanying them during scans, appointments, labour and actually giving birth, the growing severity of the pandemic means many trusts are not following the recommendations.

Leah Deutsch, a senior registrar in obstetrics and gynaecology at the Royal Free Hospital in north London, told The Independent the coronavirus crisis will trigger an increase in PTSD among staff in maternity services.

She added: “Pre-Covid, we joked maternity services were a war zone. I don’t think there is any preparation for the impact of highly charged traumatic situations. We are stepping in when things go wrong and are dealing with significant life-threatening haemorrhages and needing to get babies out in a matter of minutes.”

Dr Deutsch noted obstetrics has the highest dropout rate of any speciality within the medical profession – saying 30 per cent quit during the seven-year training.

She added: “It is so intense. It is a high-risk speciality where people bring legal cases against hospitals when adverse events happen – this leads to background anxiety.

“When you have dealt with horrific cases where mums and babies have died, you think I can’t do this. Some will have seen several cases during their career. People suffer burnout. I certainly did. After several back to back events, I had a year-long career break.”

Dr Emma Evans, honorary secretary-elect of the Obstetric Anaesthetists’ Association, told The Independent: “Unlike surgical specialities, there is no cancelling women having babies and lots of mothers are more complex and vulnerable than ever right now.”

Emily Pullan, a midwife who works for South London NHS Trust, said she has done lengthy shifts where there is no time to eat or drink – adding that she struggles to “switch off” in the evening as the day’s work remains on her mind.

She said: “When your sleep is interrupted, it adds anxiety, as you know you need to go and do another 13-hour shift, so you need sleep. Part of you really doesn’t want to go in, but you have to get up and do it again.”

Ms Pullan noted many of her colleagues are frightened about going into hospital because they are at risk from severe complications from Covid-19 or fear putting vulnerable family members at risk. She said neither her nor many of her co-workers watch the news as it exacerbates their anxiety.

“The one or two times I did watch the news, I felt very anxious to go into work – you think: I’m going into that germ factory tomorrow,” Ms Pullan added.

Georgie Haseldine, a newly qualified midwife who works in Rotherham hospital, said she had been “thrown in the deep end” and was having to be careful about cross-infection while looking after women who are Covid positive.

An NHS spokesperson said: “Despite the challenges of the pandemic, NHS staff worked tirelessly to ensure thousands of babies were born safely over the past year.

“Pressure on all staff has been intense and the pandemic has reinforced that we will need to ensure a resilient NHS workforce in the future, which is why the NHS has put a package of dedicated help and advice into place, including a confidential mental health and wellbeing advice line and 24/7 text support, backed by £15 million in investment.”

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