The pandemic is pummelling the healthcare system on all fronts, testing the limits of already exhausted staff across the board. But, to paraphrase Anna Karenina, every over-worked, over-stressed area is over-worked and over-stressed in its own way.
At the heart of the current pressures being felt by many midwives are a number of issues: COVID furloughing, redeployment, EFT vacancies, parental leave and increases in personal leave, as well as the lockdown baby boom. Combined, they are increasing workload and stretching capacities further than ever.
In October, ANMF (Vic Branch) held three more well-attended maternity wellbeing forums, at which members overwhelmingly expressed their fatigue, but also how they have been able to hold onto the essence of midwifery and the strength they get from their colleagues. Midwives were also able to discuss the Andrews Government’s $13.2 million maternity workforce funding initiative and the accelerated implementation of the student midwife employment model (Registered Undergraduate Students of Midwifery – RUSOMs), which was widely acknowledged as a positive.
Double the work, half the time
‘It’s a very overwhelming time for everyone, mothers and midwives,’ says midwife Hailee Love, a Job Rep at Joan Kirner Women’s and Children’s Hospital. ‘The biggest stress that we’ve had is the baby boom. No one really thought this would be a side result of the pandemic. We’re doing almost double the amount of births with the same amount of staff – or less, as that’s obviously led to a significant amount of burnout, which has led to an increase in staff calling in sick or needing time off, which means we’re even more short staffed.’
Over at Box Hill Hospital, midwife Kate Mason and her colleagues are also seeing workloads double. Kate, a Job Rep and ANMF Branch Councillor, says that has led to women being discharged earlier. ‘The workload has effectively doubled, while the women’s lengths of stay have effectively halved.’
‘It means the quality of care we can offer has been significantly impacted,’ Hailee adds.
‘Maternity has been at a breaking point for a long time, but now it feels like we’ve reached the limit of what we can cope with. Our resilience is all used up.’ – Kate Mason
This situation is adding to the pressures on the mothers, and many midwives have become a ‘first-line of punching bag’ for scared, stressed women, says Melissa Manson, a midwife and Job Rep at Monash Health Clayton. ‘On top of our own frustrations, we’re having to deal with the frustrations coming from women – many of whom, culturally, are used to having a lot of family support around them when they bring a baby into the world. Being told that they can’t have that support can be very upsetting for them, and that backlash often falls onto maternity staff.’ (The pandemic’s impact on new parents is at the heart of a new $6.89 million Andrews Government investment in perinatal mental health services.)
Kate concurs: ‘It’s been particularly hard on the women. That rule about visitors into the hospital is changing on a regular basis, and that is stressing out the women a lot. In turn that’s stressing out the midwives because we’re trying to support the women, who are coming to us for answers. But we don’t have the answers.’
The lack of answers is also mentioned by registered nurse and midwife Seda Kiroglu, a Job Rep at the Northern Hospital. ‘One of the biggest issues is the confusion,’ she says. ‘The ambiguity of everything. We’ve got minimum guidance, because everything’s changing so much, but the work is full throttle.’
This is leading to staff burnout, Seda says. ‘We have limited resources with maximum commitment, and maximum expectations.’
‘Everyone just needs a break.’ – Hailee Love
In addition to the baby boom, other familiar COVID-related stressors are taking a profound physical and mental toll. The prolonged use of uncomfortable PPE not only makes it difficult to create rapport and trust with women, it’s leaving staff with acne scarring. Colleagues being furloughed or redeployed has been creating staff shortages, in already short-staffed birthing suites and wards. Taking much-needed leave then comes riddled with guilt. The rollout of telehealth has created a whole new set of challenges. Parenting children through the pandemic while helping to bring other people’s children into a virus-weary world has brought its own worries. As has potentially bringing the disease into the home after working with COVID-positive women.
‘It’s a horrible cycle at the moment,’ says Hailee. ‘Everyone just needs a break.’
‘Maternity has been at a breaking point for a long time’ Kate elaborates, ‘but now it feels like we’ve reached the limit of what we can cope with. Our resilience is all used up, and for a workforce that’s already feeling very disenfranchised and un-acknowledged, it’s just next level.’
Melissa notes that there have been some positives during this time. ‘The International Confederation of Midwives has put out a study that has said more women are actually establishing their lactation before they leave hospital because they don’t have the interruptions of excessive visitors,’ she notes.
She also acknowledges ANMF (Vic Branch) successes in securing from government much-needed funding boosts, and in particular mentions the rollout of RUSOMs. ‘We’re hoping and praying that if that is successful, it becomes a long-standing thing.’
‘It’s going to take time, but Rome wasn’t built in a day. We just have to hang in there.’ – Seda Kiroglu
Seda notes that getting RUSOMs into birthing suites and onto wards is a positive for her staff as well as for the students – perhaps even more than usual. ‘They’ve been so restricted for the last two years, so this in an invaluable opportunity.’
Implementation of the government’s maternity surge funding initiatives has frustratingly been delayed by the latest COVID-19 outbreak so the full benefits for all are yet to be felt. But Seda is pragmatic: ‘It’s going to take time, but Rome wasn’t built in a day. We just have to hang in there.’
Kate agrees. The funding is going some way to address some of the issues, she says, but it’s ‘slow to trickle onto the floor’.
She and her colleagues get through each day, she says, because ‘midwives generally love supporting women, which also means that we love supporting each other as it’s primarily a female-dominated profession. And as much as we care for the women, we care for each other.’ It’s a sentiment echoed by all.