You're not imagining it, midwives really are disappearing and it has dangerous consequences.

In April 2022 I had an induced labour which led to an episiotomy after my baby’s heart rate started dropping. Fortunately, my beautiful baby girl arrived safely. However, in the hours that passed from her birth at 11:30pm until the next morning, I was left with a severe lack of support from hospital staff. 

I lay in the blood and vomit-stained sheets that I delivered in, as I tried to figure out breastfeeding on my own with a baby who would scream every time I placed her down. I called for help on the buzzer before frantic midwives would appear telling me I had to figure it out as they were extremely short-staffed and were managing a number of high-risk births. Having not slept for days, feeling the beginning pain of extreme nipple damage from incorrect attachment and not having a clue what I was doing — this was the beginning of my motherhood.

In the 14 months since I became a mother for the first time I have been doing a lot of reflecting. As part of my healing from birth trauma and postnatal depression, I’ve mentally had to return to that hospital room to try and figure out how I can make peace with what unfolded during my labour and the isolating hours that followed the birth of my daughter. Initially, I felt a lot of anger and resentment towards the midwives who were on shift that evening. Why didn’t they come and help me? Didn’t they know I was scared and alone and didn’t know how to care for my baby?

However, when unpacking those feelings, I realised the level of care I was provided was a direct result of extreme understaffing issues. It became clear that my anger was being pointed in the wrong direction. These midwives, coming out of the fog of COVID, were being stretched paper thin and being tasked with the agonising choice of dividing their time between multiple patients. Rushing from room to room, triaging on the fly and carrying the weight of the world on their shoulders. It’s no wonder I had the experience I did. And if that was what happened to me then surely it was happening to others.

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Over the past year, it has been widely reported that healthcare systems across the world are being confronted with mass healthcare staff shortages from midwives to nurses, doctors and aged care providers all leaving their professions due to burnout. It has been estimated by the World Health Organisation we are short around 900,000 midwives across the world.

In November 2022, the NSW government announced a $4.5 billion injection into the hospital and health service industries to boost dwindling staff numbers. Some seven months later and many working on the ground are yet to feel the effects of that funding and are shouting out for more help.

Mamamia spoke to *Anna, a midwife working at a hospital in Sydney’s Eastern suburbs who told me that understaffing has had a dire knock on effect to the working conditions for those in midwife departments. She and her colleagues are being worked to the bone, often required to breach baseline levels of safe care in order to juggle multiple patients. They’re working long shifts with no breaks and coming back in to cover additional shifts the next day.

“We work 12 and a half hours, but we only get paid 12,” said Anna. “So they're not paying us for our meal breaks. But then you're not even taking the meal break. Majority of your shifts, you'll stay an extra half an hour, 45 minutes, that's not paid.”

This kind of gruelling working environment means that inevitably things will fall through the cracks. Anna remembers a recent experience where she was given two high-risk labours to manage one evening. She was forced to run between two rooms as one patient was receiving an epidural and the other was struggling with bladder complications. She believes because of understaffing her patients' safety was completely compromised. “I was providing care that was half-assed and unsafe for both families,” she said.

Anna tells me that in recent months a lot of her former colleagues have quit, citing severe burnout for their departure. I spoke to one of those midwives who has taken extended leave from her midwifery role in a Sydney public hospital to go travelling. *Mary said the pressure became too much and her cries for help were falling on deaf ears.

“We feel extremely unsupported by both baseline management and higher management within our hospital,” said Mary. “Regardless of the number of letters and meetings we have written over the past six months, nothing has changed. We try to fight, but it feels like we are getting nowhere.”

And this seems to be the norm across the board for many midwives who are buckling under the pressure of a failing system, says Western Sydney University Professor of Midwifery, Hannah Dahlen AM. 

“You get this vicious cycle of not enough staff; overworked and burnt out midwives; midwives, who feel they're failing women because they're running all the time and not giving good care,” said Hannah. “Then they leave the profession and then the staffing is worse, the situation's worse.”

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When chatting to another midwife, *Dani, she said a true passion for providing a beautiful birth experience for patients is the only thing keeping her going, although the poor working conditions make it really difficult.

“You shouldn’t have to have the whole shift on your head for a lousy $34 per hour,” said Dani. “In the last week we’ve had several staff in tears, feeling broken. I’m sorry we don’t go to work for that. But we keep turning up because we don’t want to let down our women.”

These men and women are screaming out for help — so where is it? And more importantly, where do you even begin with figuring out how to repair this damaged industry. The more people I spoke to, the more cracks I discovered — the issues run deep. But a start is a start and something needs to change.

Last year the NSW Nurses and Midwives’ Association (NSWNMA) Assistant General Secretary and midwife, Michael Whaites said there’s one major change that could be implemented to help relieve stress across midwifery departments. Currently, the staffing ratios are around one midwife per five women and five babies — I’ve been told this can be pushed out to a bigger caseload when staffing is particularly low. 

“According to the latest available data, important aspects such as breastfeeding rates have continued to decline in NSW. We know breastfeeding rates would significantly improve if we had safe staffing ratios of one midwife to three women (1:3) and their babies on postnatal wards,” said Mr Whaites in an official statement released last year.

Indeed, *Mary doubled down on this when she shared her experience of poor ratios during her shifts.

“If you do a shift on the postnatal ward it means caring for 6 women and 6 babies,” said Mary. “This is 12 patients in any other health ward. But the system doesn’t recognise 'babies' as a number. Again this creates unsafe and poor care.”

But how do you begin to implement a new ratio system when the staff numbers are quite simply not there?

Professor Dahlen assured me that things are starting to take shape on a state government level with some of the assigned budget filtering through to education.

“One of the things that we're already seeing happening in New South Wales is a very strong push from the Ministry of Health to get more midwives trained,” said Professor Dahlen. “So this year, in particular, there's been a big increase in the number of midwives that we're taking through the programmes.”

In addition, she said there must be an increased emphasis on protecting and retaining the current midwives working across metro and regional hospitals.

“We need to pay midwives well and we need to make sure that we absolutely respond to staffing issues. We have to really look at how we support our midwives in the clinical place and we need to give midwives many more options of different models of care to practise in.”

It is clear there is work to be done. Institutional reform that spurs meaningful changes to the way midwives are supported in the workplace and the way patients are treated, is the only way forward. And it goes without saying, we need to significantly increase the amount we pay midwives — it’s a no brainer.

You only get one first birth experience and, unfortunately, mine is something I will have to reconcile with for the rest of my life. I want to make sure that no other midwife has to battle through a 12-hour shift without going to the bathroom and I want to make sure no other woman suffers birth trauma.

We must protect midwives at all costs. At this point, it really feels like a life-and-death situation.

*Real names have been omitted to protect privacy.

Image: Canva + Mamamia.