Midwives say they are missing almost a quarter of the staff needed to care for mothers and babies at Wollongong Hospital.
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In April, a new maternity staffing assessment - which is calculated using the number of babies born over a set period - identified that the Wollongong Maternity Service required 103 full-time positions.
This went up from 93, partly due to the high number of babies born in 2021.
However, the midwives said they had already been operating with 14 positions not filled, which now leaves them 24 positions short.
"We've been working since 2019 with a staff deficit," one midwife, who asked not to be named, said.
"And that's why midwives are distraught, because they can't provide the holistic care they want to."
Melissa* was once a proud midwife, who went into the profession to make a difference to women and babies and set them on a path that would have lasting positive results for the rest of their lives.
But now, working in the Wollongong's maternity service, she is ashamed to tell people what she does for a job
"I don't want people to know that I'm a midwife because I just feel like people say 'oh well when I had my baby, no midwives even helped me'," she said.
"It's soul-destroying."
Melissa, whose name has been changed to protect her job, this week joined a group of her colleagues to speak out about the chronic understaffing, which they fear is leading to post-birth trauma, less breastfeeding and the risk that something vital will be missed.
Gemma*, who has worked in Wollongong for almost four years, also said she had seen an "enormous decline" in that time.
"On an average shift, there's normally two midwives, or three if we're lucky, that are rostered on in the maternity ward," she said.
"We have a capacity of generally 28 women on the floor. So you're looking after between eight to 14 women [each], and sometimes there might be a [nurse] helping us."
What's being done about the staff shortage?
Wollongong Hospital Maternity Operations Manager Barbara Atkins acknowledged that it had been challenging to fill vacancies in the maternity service despite ongoing efforts.
"The District acknowledges that we do not currently have a full staff contingent in the Wollongong Maternity Service, but is committed to recruiting to vacant positions, with two permanent FTE staff due to commence in July," she said.
She said the service had rolling advertisements and interviews being conducted every two to three weeks, with recruitment being expanded to nursing and midwifery journals.
"[T]he District continues to explore other options to maximise recruitment opportunities," she said.
"Illawarra Shoalhaven Local Health District (ISLHD) is committed to providing safe, effective and collaborative maternity care that addresses each woman's specific needs and achieves desirable health outcomes for both mother and baby.
"We remain grateful for our committed staff and thank them for the valuable work they continue to do every day during this process."
With the midwives who spoke out feeling burnt out and considering other careers, they said they feared the staff issues would not get better unless there was more of an effort to improve the ratio of midwives to patients.
In its campaign for better condition and higher pay, NSW Australian Nurses and Midwives Association - of which the Wollongong midwives who spoke out are members - is seeking a guaranteed ratio of one midwife to three women in maternity wards.
What the staffing shortage means for new mums
Now, they said there was barely time to take patients' blood pressure and basic observations, let alone take their own meal breaks or have time to go to the toilet.
This left little time to observe breastfeeding or help educate women on correct bottle preparation, or pick up postpartum mental health concerns, they said.
They also said women who had caesareans were sometimes left waiting to get out bed until late in the morning, as one midwife with eight patients did not have time to attend to every woman as quickly as needed.
"With eight to 14 patients each, those basic things take up most of your shift and you don't have time to talk to women or ask how they are feeling," Gemma said.
"There might be people who had a birth that didn't go how they wanted and you don't have the chance just to sit with them.
"If something goes wrong and we're spending two hours of our shift looking after one mum or one baby, then you don't get to see the rest of them.
"We don't get to watch them feed, because we can't get there in time."
Melissa said this was "leading to massive issues".
"I see women in the community, postnatally, and I see a lot of trauma," she said.
"I see women who aren't able to breastfeed even though they want to, I see women who have lost faith in the maternity services, and I see a lot of disappointment."
With staffing gaps being plugged by nurses or support staff often working outside their specialty, the midwives said they were concerned that some maternity-specific issues were at risk of not being picked up.
"For example, a baby with low blood sugar doesn't tell you, they are just sleeping and look sweet and wrapped up in a blanket," midwife of several years, Justine* said.
"But it's actually a medical emergency - it can lead to long term brain abnormalities and issues if it is not treated.
"So having staff who can take blood pressure and answer buzzers if we can't get there is fine, but if they're not acknowledging these things that are not normal, then we can't treat it."
"I'm honestly surprised we have not had a worse outcome."
27-week pregnant woman went into labour on her own
As an example of the near misses, Melissa recounted a time where she was in charge of an "immensely busy" afternoon shift, when a woman in threatened premature labour came in to be observed.
"I had time to pop her in a bed and say here's your buzzer before I had to go again, and luckily her husband was with her," she said.
"Because a little while later he came out upset, and I followed him in, and she had locked herself in the bathroom where she was actively labouring. We got her transferred to Sydney and she birthed 20 minutes after they rolled her through the doors.
"If her husband hadn't been there, I don't know. She didn't speak much English and she was from a culture where typically she didn't want to cause too much trouble, so she would have had a 27 week gestation baby there in the maternity ward.
"I went home that night and I felt unwell, I felt sick. I nearly missed it. I was questioning what I did wrong. I should have, I should have, I should have, but I didn't. Because I didn't have time.
"If I'd missed it, it would have come back to me. And if you're looking after eight or 10 women, then everyday you are putting your registration at risk."
Justine said she felt that she and her colleagues were unable to fulfil their jobs as midwives.
"You're working with people in their rawest moments, they have just given birth and it's that start of life and women are really vulnerable in that time," she said.
"They need to be heard and nurtured through that space. Midwifery's role is about holistic care - and we are unable to fulfil our roles as midwives.
"We feel like we are letting down women, we are letting down babies. We only have time to do the very tip of our job.
A NSW Health spokesperson said the health department was "committed to the provision of safe, effective and collaborative maternity care that addresses each woman's specific needs and achieves desirable health outcomes for both mother and baby".
"This care is provided to women and their babies throughout pregnancy, birthing and postnatally," she said.
"All pregnant women are offered the most appropriate model of care related to their clinical circumstances and choice.
"NSW Health supports a range of options for maternity care, including access to midwives, obstetricians and shared care models that work in collaboration with a woman's GP."
The spokesperson said there was an evidence-based midwifery workforce planning methodology used to determine the staffing required in maternity services.
"The underlying principle of the methodology provides for a minimum of one-to-one care during labour and birth and calculates the number of maternity staff required to meet the needs of women for midwifery care throughout pregnancy, labour and the postnatal period," they said.
"The methodology also provides for babies with higher-than-average needs."