A Veteran Midwife of 29 Years Speaks Out on the New Reality of Childbirth

What I’ve Seen Change in Maternity

I’ve been a midwife for more than two decades — hospital wards, community rounds, home births. When I stepped back into clinical practice a couple of years ago after a period away, I expected to find a workforce stretched thin. Some of what I found in the birthing suites was also unexpected.

Here is what I’ve observed.

The babies are smaller. The rate of small-for-gestational-age babies has increased noticeably. It used to be something you flagged as an outlier.

Bleeding is more frequent. Post-partum haemorrhage has always been a risk we managed, but I’m seeing it more often, along with bleeding in early pregnancy. I’ve made the personal decision to step back from home deliveries because I’m no longer comfortable with the risk of unexpected haemorrhage in that setting. The obstetric doctors have adjusted too — anti-bleeding agents are used earlier and more readily than they used to be.

Placental abnormalities are more common. I’m seeing more placentas that are abnormally shaped, calcified, or showing signs of early aging. Radiologists are more frequently noting “mature placenta” on late-pregnancy ultrasounds — a finding that warrants attention when it appears earlier than expected.

Hypertension in pregnancy has increased. I’m seeing more severe pre-eclampsia, and magnesium sulphate during labour — once uncommon in my experience — is now something I has seen often in the last 2-3 years. ICU admissions for sepsis and haemorrhage, appear more frequent than they were earlier in my career.

The miscarriage rate appears higher. Late miscarriages are occurring more often than I’d expect based on prior experience. Stillbirths also seem more frequent — though I want to be careful here, as this is my clinical impression rather than a figure I can verify precisely. The neonatal unit has been consistently busy, and more babies are being placed on HIE brain assessment protocol following fetal distress during delivery.

The caesarean rate has crossed 30%. Induction rates are also climbing, in part as a response to concerns about perinatal outcomes. These are significant shifts from where things stood earlier in my career.

The workforce is under strain. Staff are tired. Colleagues note, in general terms, that patients seem less healthy than they used to be. Several colleagues have been diagnosed with serious illness and subsequent death – turbo cancers – a new term to me have been the cause. I don’t draw conclusions from that — I simply note it.

An official obstetric report has recently been released, and the data in it is consistent with at least some of what I’ve been observing clinically.

I can’t offer a controlled study. What I can offer is more than twenty-nine years of experience, and an awareness that the patterns I’m seeing now are different from what came before — different enough that they deserve proper examination.