Anyway…. Before I was a midwife, I was an academic. I worked 0.8 whole time equivalent, meaning I worked 4 scheduled days, and like my academic colleagues who worked full-time, the work spilled over; an accepted aspect of the job. You write papers, you write grant applications – those things require time and space and thought, and don’t always fit neatly between teaching sessions, course admin, student supervision, pastoral support and marking. So I worked four days a week, starting at 8am so I could finish at 4.30pm, so I could collect my daughter from after-school club by 6pm (building in contingency time, since the trains I pick up once I get off the tube go every 15 minutes, and the cost of a late pick-up is £10 for every 5 minutes). My partner dropped my daughter off in the mornings and was home long after she went to bed; I left without seeing her for more than a few minutes every morning, but picked her up, fed her, bathed her and read her a story and snuggled her in bed every night. Then I went downstairs, washed up, made dinner for two, and felt guilty about the work that I was now too tired – and too disconnected from – to do. When she was five, I decided that without a partner who could take some of the evening burden off me, to allow me some evenings to stay in the office just to keep going with the work I was doing, rather than clock-watch from 4 and down-tools at 4.28; and maybe without a little more ambition, or drive, or energy, to mitigate the short days and fragmentation, I couldn’t be an academic any more. It wasn’t having a baby that interfered with my career; it was having a child.
So I retrained as a midwife, had a second baby during training, and started work in the NHS. I requested 0.6 whole time equivalent so I could see my kids as much as possible, limit the night shifts I worked, and try to make life feel a bit less unpredictable for them. Working full-time means working thirteen 11.5hour shifts a month – 3 weeks of 3 shifts and a week of four. As a newly qualified band 5 midwife in a rotational post (a few months in each part of the hospital maternity service), I expected to be a slave to my rota (difficulty putting in rota requests on time in the next area, difficulty getting annual leave in school holidays as it’s already been taken, no flexible working as you seem to have to earn that, by coming back from maternity leave, rather than arriving with a family) so I exerted what seemed to be the only choice available to me – working part-time enough to mitigate that (so, goodbye healthy salary and chunky pension contributions). 0.8wte means three shifts a week. Sounds manageable until you do it – up at 5.40am and home at 9.20pm three times a week is hard on the kids and exhausting for you. Throw in some night shifts randomly across the month and you have a disorientating life of never quite knowing where you are in the week and rarely feeling on top of things. (“But you’re only working 3 shifts a week! You’ve got four days off!”…. “Yeah, it doesn’t really work like that…”).
I enjoyed my preceptorship, for the most part. Some days and nights were scary, stressful, exhausting. Many days, I struggled to sleep long enough before or long enough after a night shift; but I enjoyed the work, enjoyed gaining competence and confidence, and enjoyed discovering I really liked Antenatal Ward, and I probably could work on Postnatal Ward (even if I was always barked at by the midwife in charge and some of the fathers for not discharging women early enough. Seriously, I just don’t know how you give good care and feeding support to 8 women and ~8 babies and write your notes and do the three meds rounds and discharge half the women before you get barked at). But on days I was out from 6.15am to 9.20pm, and on nights I left the kids eating dinner at 6.15pm and missed seeing them the next morning every time, as I got off the train at 9am as the school bell was ringing. And working two long days back-to-back meant putting them to bed one night and seeing them in the morning three days later.
As a full-time caseload midwife, however, I dropped my five-year-old to school every morning. I managed my own diary so that I saw my first client around 9.30, I was usually home for kids’ teatime at 5.15, I was able to take my 10 year old to swimming three times a week, I put them both to bed every night, and sometimes I got a call in the evening or the early hours and went out to a home assessment and/or birth. Occasionally I wasn’t home at breakfast time and had to send texts or make a call to remind the household of the things that mothers seem to keep track of so everyone else doesn’t bother; and occasionally I wasn’t home at teatime so I had to call or send a text to say ‘I’ll be late but I’ll make it for bedtime’, or very, very occasionally, ‘I’ll be late but I’ll see the kids in the morning’. Some days I had two appointments and was home in the middle of the afternoon. I was learning not to feel guilty about that – it mitigates the on-calls. Some days I had to call a client to say ‘I’m at a birth, I won’t make it to you today. Let’s rearrange, I’ll work around you.’ Some weeks I had to work at the weekend because some postnatal visits are non-negotiable, but I quite like driving on the quiet streets on a Sunday morning. Some weeks I chose to work weekends – it worked better for the woman, my partner would be at home so the kids wouldn’t feel short-changed and I quite like driving on the quiet streets on a Sunday morning.
All the midwives I’ve spoken to worry about work-life balance when providing care in a continuity model; caseloading meaning not seeing their kids; multiple on-calls meaning multiple call-outs. But for me, life is better this way. Better for my family, more manageable for me, better for the women, better for their families. It just means we might (in maternity services) have to review what work looks like when it’s focused around a caseload rather than around a hospital. But autonomous working for a salary is much more empowering than working for what amounts to an hourly wage, and makes you realise the other way is hierarchical, untrusting and maybe pretty infantilising. Of course there will be weeks where you’re working and working and working and feel like you need some help and a break – that’s where your team comes in, as well as the knowledge that not every week is like this. I don’t want to be able to have it all – it reeks of the greedy, selfish ’80s when the term was coined. But I do want to be able to do it all – do my best for women and for my family, and therefore, actually, also for me: I want to be a caseload midwife.