Overdue: Birth, burnout and a blueprint for a better NHS

by Amity Reed

Amity Reed became a midwife to serve women, but the reality of working in over-stretched and underfunded NHS maternity services soon shattered her illusions. She's not alone - for every 30 midwives that train, 29 will leave the profession. Overdue is both the devastating personal story behind the statistics, and a call for change in the NHS. Real-life stories capture the moments at the heart of midwifery: life, death, birth, tragedy and joy, and are embedded in a clear-sighted examination of what is working and what isn't in maternity services.

The result is a book that asks - and tries to answer - questions that are at the heart of many people's working lives: how can we follow our calling, provide for our families and keep ourselves healthy, if the workplace and its systems are working against us?

Genres: Nonfiction, Memoir

224 pages, Paperback

Published October 1, 2020

About the author

Amity Reed is a feminist midwife campaigning for better maternity care and the wellbeing of NHS workers. Prior to entering midwifery, she was a doula, freelance journalist and editor. Her first book, 'Overdue: Birth, burnout and a blueprint for a better NHS' is published in October 2020 by Pinter & Martin. Amity lives in London with her husband and two children.

https://www.pinterandmartin.com/overdue

Agent: Emily Sweet Associates
https://www.emilysweetassociates.com/

Reviews

[books4chess · Rating 3 out of 5]

"Like mothering, the work midwives do is idolised in words of praise the world over. And like mothering, midwifery is often underpaid, undervalued and unsupported... We shouldn't have to go through such darkness to carry the light for others."

Amity Reed delivered a painful, raw look into the world of midwifery in the UK, as experienced in the public sector. The book is an all-in-one, offering anecdotes, personal thoughts, recommendations of possible and necessary change, as well as an intersectional approach and understanding of the short-comings. Her passion is clear. Whilst the intended readership perhaps shifts throughout the various sections, the book offers a fly on the wall experience for every stage.

By the end of the memoir, I felt that I had accompanied Amity on a long, arduous road that spanned at least 10 years. I was shocked by how long she had actually held the role and the variety of experiences and troubles she had been exposed to in such a short period of time. I feel passionately for the NHS and shared her sorrow, her pain and her frustration by the excessive underfunding. Areas that only focus on birth and only half of the population, unsurprisingly, feel more neglected.

I adored that it wasn't a scathing 'expose' but a book filled with hope. Unlikely Adam Kaye's humorous look into the downfalls of the birthing department in general, Amity takes a more sentimental approach.

My heart bled for Shanthi and Alisha, who won't have been the first nor the last patients to fall victims to prejudice, racism and unequal treatment. The book hopefully has the potential to raise questions in how we support people who give birth, especially with current events encouraging more people to have more babies.

Thank you NetGalley for the ARC.

[Caroline · Rating 2 out of 5]

Unsure of the audience intended for this book. If it was meant as a memoir in the vain of Adam Kay it missed the mark by a mile. The occasional birth story and personal anecdote are included but not enough to satisfy.
And if it was aimed at creating awareness of the issues faced by midwives today then I'm fairly sure the government and officials required to read this in order to begin making changes will never happen either.
The author seems self indulgent and whiny tbh. Everyone feels tired after doing a set of nights. Nobody likes the all seeing eye of managers on days. For example But it seems this profession from the get go was not for her.
Not my kind of book at all I'm afraid (and I work in the industry so have read a lot of books on maternal health)

[Bekah B · Rating 4 out of 5]

I thought that maybe Overdue would be a straight forward midwifery memoir but it was actually a great mix of cases Amity worked on and an analysis of the NHS system and policies. The cases discussed were used to point out and prove certain areas of discussion and I thought the author did an excellent job of showing us how the policies actually work in practice. The book started with some very sobering facts about the current state of nursing and midwifery in general and continued in an open and honest way throughout, pointing out the failings of both staff on the frontline and the policies/policy makers showing that it's not going to be an easy job to make changes for the better.
I really enjoyed how Amity wove her own story of becoming a midwife, her health, and her ambitions in to the book and used those experiences to further facilitate discussions on the system. She was very raw when explaining how she struggled and I really felt for her and all the staff struggling through the same situations. As a former NHS Nurse I can completely empathise with Amity and can relate to experiences she spoke about, from not having the time to even go to the toilet during a shift to witnessing colleagues speaking about a patient in a derogatory way. I'm pretty sure that feeling of fighting a never ending battle and feeling like you are providing just the basics is prevalent in many areas of Nursing.
If you are looking for a book full of cute/funny/unusual stories of babies being born then this is not the book for you. If you are looking for a brutally honest account of midwifery in the UK and an indepth discussion of the failings and changes needed then here you go, this is it. I would say that the book is definitely more suitable for medical professionals either working in the field of midwifery/obstetrics or those with an interest in those areas rather than the general reader.
Trigger warnings for racism and still birth.
Thank you to NetGalley and the publishers for a copy of this book in return for an honest opinion.

[Bex · Rating 4 out of 5]

An honest and gritty personal account of Amity's experiences as a midwife in the NHS. The book is part anecdotal and part a critical essay about what needs to change within the NHS and midwifery practice. In parts it reads like a journal and the author is very honest about the real and serious impact that her job had on her mental health.

I would recommend this widely, and I hope that it is a wake up call to those with decision-making power within the NHS.

Thank you to Amity Reed, Pinter & Martin and NetGalley for an ARC in exchange for an honest review.

[Kelly · Rating 3 out of 5]

Thank you to NetGalley and the publisher for providing this book in exchange for an honest review.
I have mixed feelings about this book. I was most interested in this book because of the midwifery topic and the NHS. As a US citizen, reading about the NHS is always interesting. I felt like parts of this book were more of a tangent than informative but overall the hope and dreams for positive change in women's rights and health were inspirational.

[Deanna Pilcher · Rating 3 out of 5]

I would really recommend this book to anyone. It really gives a good insight as to the role of the midwife and the pressures Midwifery is facing currently. It’s so sad to know that the most important part of someone’s life, is completely underfunded and understaffed. However I did find, as a midwife who is currently really loving their job, it was a bit negative for me and where I am right now. I could completely relate to a lot of it, but I know I’m in the minority when I say I am not experiencing many of these issues faced.

[Jules · Rating 5 out of 5]

Overdue is also a love story to people who give birth, to midwives and other birthing professionals, and - despite its substantial failings - to the NHS as well. And ultimately, it's a love story Amity wrote for herself, allowing her to put on her own oxygen mask first so she can be "with women" in ways she never planned the day she decided to enter the birthing profession.

Overdue is not just a much-needed analysis of the realities of midwifery, maternity care, and birthing within the NHS. It is an extremely honest, sometimes heart-wrenching, and deeply touching memoir by a woman whose calling to be "with women" as an NHS midwife landed her in a dark place due to systemic problems plaguing the national health service. The issues plaguing the system as outlined by Amity include how austerity measures and poor management not only prevent healthcare professionals from properly caring for their patients, but for themselves too.

Amity is a powerful writer. Her prose pulls at your heart in a visceral way, providing a glimpse into the joys and the burdens of working in the birthing world during times of austerity and chaos. Overdue is witty and dry where levity and eye rolling is called for most – which is often in the birthing world. Overdue is also intensely moving and pain-filled in moments were compassion and outrage are needed most.

This book has something for everyone....including some wonderful birth stories of course, but a whole lot more. It's a must read for anyone working in Healthcare or birthing, but also for parents-to-be, birth parents who've used the service before, and women who are struggling to keep it all together personally while pursuing their dream vocation.

My advice: buy a copy, read it, share it with your friends….. and then instead of putting it on a shelf to gather dust, or donating to the local charity shop, send it to your MP, your local hospital administrators, or donate it a local library. We need to get this call-for-change in front of the right people, and quickly. You can be part of making that happen.

[Sandra "Jeanz" · Rating 5 out of 5]

I enjoy reading non-fiction and am quite interested in maternity services and how they have changed over the years. I really like the book cover, the bird cage with the door open, maybe it is symbolic and represents those midwives flying away from the NHS, which after reading this book and having witnessed how short staffed and overworked they can be at first hand I honestly can’t say I blame them!

Amity talks about problems that occurred in certain hospitals years ago and how the national nursing strategy called ‘COMPASSION IN PRACTICE ’ was introduced.
The key values are: CARE, COMPASSION, COMPETENCE, COMMUNICATION , COURAGE and COMMITMENT. Amity rightfully says that when maternity/midwifery services suffer, women suffer, and babies can potentially die, meaning families are destroyed and for the midwive’s careers may be ruined or lost.

Amity tells us, the reader her own story of how she became a midwife herself. Amity already had children herself, she had also been a doula before going into midwifery herself. Though she loved being a doula, after three years she began to want more. Amity studied to become a midwife, it took 3 years of hard work, but Amity achieved a first-class degree.
I’ll be honest other than watching a TV programme a few years about Doula’s I didn’t have a clue who they were. A simple description is an independent birth partner and advocate for you when you are going through your pregnancy and the birth of your baby, and they often offer support after the birth too. I didn’t think doulas existed in the UK until I recently read a book called, Why Baby Loss Matters by Kay King who is in Yorkshire and is a doula herself.
Amity also gives an insight on what it is that keeps herself and other midwives on the daily grind of the treadmill, despite their working conditions being hard, pressure from those in charge and the pressures and sometimes the poor treatment and lack of thanks they receive from service users. We also see an American’s view of our free maternity services.
Amity reveals that though it is the hardest part of midwifery she loves the post-natal part of her job. Amity explains that she has to make sure of eating something substantial before her shift as it is a regular occurrence for it to be so busy that the midwives hardly have the chance for a drink let alone to sit down and eat. Amity also reveals how those you are working with can make a great shift or bad one. Amity also talks of understaffing. In the specific ward she talks about it can care for 21 mothers and babies, and it is considered as fully staffed with 3 midwives, 2 maternity assistants and just one infant feeding specialist on the floor for a day shift. Despite these numbers considered as “fully staffed” it is not uncommon for there to be just two midwives and one maternity assistant. This understaffing can be because of staff sicknesses or lack of budget, or that one of the midwives has been called over to the labour ward, as women in labour always take priority of those who have given birth. The labour ward is seen as where “all the action is” but the post-natal ward also has its own important needs. The post-natal ward is often called the “Cinderella” part of the Maternity services. Amity has spoken to many women about maternity services who have said that they felt alone and uncared for after they had given birth.
Amity reveals herself and many other midwives often say the job isn’t worth it, they could go get a job in a supermarket and it would mean at least the same money but a lot loss stress. So why do these midwives stay? Because they want to help the women, the new mothers, those with difficult birth, or those going through baby loss.
On TV fictional midwives either present day or in the days gone by such as Call The Midwife are portrayed as there always been enough staff, beds for mother and baby as well as having lots of time to sit and help the new mums etc. In reality the real maternity service has a heck of a lot of tests, measurements to be done repeatedly as well and reams and reams of paperwork that takes hours to be done. Which I honestly cannot blame the midwife feeling resentful to paperwork when it is stopping them from doing the caring which they originally signed up to do when they became midwives.
As with most inspectorate bodies, when the CQC turns up on a maternity ward they don’t see the shifts where there are only 2 midwives on a post-natal ward with 20 mother & babies to be cared for. They simply don’t see the stress the midwives are under, whether it’s from urgently sending for a doctor to check a baby’s heartbeat and as the Doctors are also short staffed the midwife is worried, they won’t get there in time. They do not see the midwife working way past the end of her shift to fill in her paperwork which means by the time she gets home she won’t get time with her own children as they will already be in bed. They don’t see the midwives going the extra mile trying to source clothes and baby equipment for a mum who has nothing.

So how would Amity changes things? Amity would propose a further set of “6 C’s” be brought into action, Choice, Consent, Creativity, Connection, Collaboration and most important of all and the ultimate goal, Change.




Having said the negatives about being a midwife and the current maternity services please don’t go into the book thinking it may be all negative as the author, Amity Reed does cover how bad things can be, but she also puts forward a solution to every problem she raises.
I found it interesting to read how things seem to be going full circle with less births being in hospitals and more of a push towards birth centres and/or home births. I could go on and on about this book, it’s a subject I find fascinating after two pregnancies myself, the first one in 1993 ending at 22.5 weeks in a “silent miscarriage” on 15/03/93 in a hospital side room, with me confused, scared, no explanations, uninformed, given drugs to bring on a “natural” birth. Eventually giving birth to my son on a commode that had been brought in when I asked to use the toilet. Then the next morning listening to all the other mum rightly so talking about their healthy babies. Then another pregnancy in 1996 that resulted in me giving birth a baby girl on the 29/02/96 with the help of an amazing midwife who stayed well past her shift as the labour ward was so under staffed. She even came in early for her next shift and made a point of dropping in on me to ask how myself & my daughter were.

To sum up I truly found the book interesting, informative, and enlightening. I wholeheartedly hope the changes Amity talks of in this book come sooner rather than later. I hope our NHS remains what it was set up as, a free care to all, whenever it is needed and not sold off becoming privately owned. I also understand that those in the NHS deserve fair pay and fair working conditions. Why do those in power not speak to and work with those who work the front line on the wards to create an even better service for everyone?

[Soo · Rating 2 out of 5]

I was left with a strong impression that Amity Reed is highly inauthentic. Nauseating and sickly prose, self promoting and patronising. I do not recommend this book. Far better midwifery authors than her.

[Agirlandabook · Rating 4 out of 5]

“For every 30 midwives trained, 29 leave”

“Mother’s are the resistance. Underground, invisible, forgotten. But I’d like to invite you to think, for just a moment, about where we’d be without them”

I gave birth to my son in 2008 and the experience is etched in my memory. I wish I could say the strongest memories were the first time I saw my baby boy, heard his cry and became a mummy but it isn’t. I remember the fear, the condescending attitude of medical professionals, physical and mental trauma and a deep loss of identity. But I had a healthy baby boy so this was an acceptable price to pay.

Reed (a midwife) writes with refreshing honesty about her personal experiences, frustrations and hope for women during pregnancy, labour and motherhood. This reminded me of Adam Kay’s This is Going to Hurt with a little less comedic back bone (although there are some very funny parts). She is extremely passionate about protecting the rights and wellbeing of women during the process and giving back a voice to women everywhere who appear to be viewed as nothing more than a vessel for delivering babies. A passion so strong it impacts all aspects of her life both positive and negative and there are some brave personal stories included. Tear were shed on a number of occasions.

I resonated so much with her words and it lead me to review and discuss amongst friends my own experience, which I have to say was extremely therapeutic.

This book will not only be of interest to anyone working within Obstetrics but anyone who has given birth, plans to in the future or wishes to support and understand someone that has.

[Kathleen · Rating 5 out of 5]

Overdue, by midwife and journalist Amity Reed, takes a hard look at the NHS and the ways its policies, while well meaning, have failed mothers in England.

Amity Reed was raised in Texas and, as an American used to the USA’s arcane system of health insurance, was initially amazed by the NHS. The extra fees Americans are used to being charged after health insurance has paid for some of the cost do not exist under the NHS. After the births of her two children and a bout with post partum depression, Amity trains to be a midwife. She anticipates that Better Births, a report promoting midwives as primary caregivers during a woman's pregnancy and postnatal care, will make a positive difference in her field. Over the next several years, she grapples with disappointment as she sees the reality of hospital care. Midwives are overworked and so unable to provide the care they know is need. Prejudices are shown to the poor and foreign. Burnout is common, Reed suffers from it herself.

In conclusion, Reed lays out the changes she would like to see made to the practice of midwifery. These are well thought out and thoroughly explained. I hope they are put to use. 5 stars.

Thank you to NetGalley, Pinter & Martin and Amity Reed for this ARC.

[Esther · Rating 3 out of 5]

When I finished this book it was unclear to me what exactly the author hopes to achieve with it. It is way too muddled for the professional audience the author states she's trying to reach, which is the leadership in midwifery and NHS as a whole. I expect them to quickly lose interest in the book, because it lacks a necessary structure and it needs more breadth and depth in research.
The research itself absolutely needs more attention. References to (mostly) articles should not count as a full source in this case. A more academical approach is needed here.

The same applies to the author's recommendations and suggestions at the end of the book. In order to reach the leadership she wants to reach and to be really taken seriously by them, this part needs to be approached in a much more professional way. It reads too much like the approach of an idealistic first-year student.

The author describes herself as an activist and states that she really wants to make change happen. Throughout the book she comes across as an idealistic and slightly naive person, quickly disappointed by setbacks and people not applauding and appreciating her every attempt and move. If she wishes to become a serious partner at the discussion table with the people she is trying to reach, she will need to understand that the road ahead will not only be very tough and full of challenges, but also a minefield of politics and many different interests.
The rant that is this book will probably not reach that coveted table. However, more study, better research, a tough skin, and a balanced way of communicating will be helpful and might push her in the direction of achieving her goals.

For the general public interested in the world of midwifery this book will offer great insights, a lot of birth stories and a pleasant writing style. I really enjoyed that. However, I got put off by the self pity, the rants, the way the author dealt with her expectations not being met and her describing herself (not literary, but I got the feeling strongly) as the examplary midwife, student and colleague, only the halo was missing.

I received this book as an ARC from Netgalley and the publisher.

[Kimberly Barnes · Rating 3 out of 5]

Overdue by Amity Reed is a review of the challenges of being a midwife in the UK. This is a realistic account of the successes and challenges faced by midwives working in the NHS system. This book follows her journey through many situations, where she faced with gut wrenching birth stories as well as, positive birth stories. Also presented, are the challenges faced by working on the birthing wards, including lack of staff, lack of budget, lack of supplies, and increased work responsibilities. Not only does Amity Reed present the difficulties or deficiencies in this system, but also, some solutions to the presented problems. I recommend this book to anyone working in the fields of maternal fetal medicine.

[Meredith · Rating 2 out of 5]

**I received and voluntarily read an e-ARC from NetGalley in exchange for an honest review. All thoughts and opinions are my own.**

I appreciate the true stories found within the book, but I just couldn't sympathize with the author. I would have preferred more mother/child stories instead of rants about the NHS.

I understand wanting to change a system such as the NHS, but midwifery isn't the only part of the system that's broken, it's the system as a whole. Fixing one part isn't going to fix the entire thing, and usually trying to fix one section of healthcare means that another sector will suffer.

Overall, more stories and less discussion about the system would have improved the book and made it more accessible for a global audience.

[Mimi · Rating 4 out of 5]

I never really know what to rate non-fiction books like these. As a low rating feels like a personal attack on someone’s life experience. Overall this was an enjoyable read. I found Amity’s experience within the NHS to be an interesting and informative read as this isn’t something I usually seek out it was interesting to hear how working within the NHS can affect you as a person mentally and physically. Her recommendation for a better NHS where I feel not groundbreaking or revolutionary but still very good things to highlight. Often simplicity is key. As a midwife ground-breaking innovation is not necessarily her job so I do feel her suggestions are still valid even if they only touch the surface which she acknowledges.

[Kat McKenzie · Rating 4 out of 5]

This was a really gripping read. Reed reflects on her time as a midwife, including fascinating details around specific memorable cases. Her dedication to helping others is admirable. I particularly enjoyed her calls to action at the end of this book, in which she lays out exactly what she believes needs to change to improve standards of care both for staff and the patients they support.

At times, it felt as though all management was cast as the villain that did not understand what needed to be done, which I'm not sure is always completely true. However, it is clear from Reed's account that change does need to happen.

Working in employment advice in the NHS, I can recall countless stories from our clients of toxic workplaces that suffer from the same lack of drive for positive change. I could not agree more that investment in staff well-being will only lead to increased productivity and standards of work. Would love to read more about what Reed went on to do next.

[Bethany · Rating 3 out of 5]

As a birth doula who has worked in the obstetrical field for many years, the stories of burnout shared in Overdue were unfortunately all too familiar. That being said, the awe-inspiring tales of success surrounding the birth work done at the NHS are also familiar. I think Overdue falls just shy of being accessible to a global audience, though I do appreciate the specificity that the author has in her mission and vision for the book. I hope she is able to create enough waves with Overdue to begin to see some change in the NHS.

**I received an electronic ARC from the publisher via NetGalley in exchange for an honest review.

[Reader · Rating 1 out of 5]

I was opening the book with good expectations as I had read the reviews, however as I read through it more and more I realised that this book is just awful. I made it half way through before just giving up, it was honestly the worst 10 pounds I have ever spent it doesn’t keep you hooked it’s just flat terrible. If I could leave a 0 star then I would. I would advise doing deep research before reading this. I even tried to send it back but they said no so I just threw it away. Good luck to whoever reads this book, you’ll need it.

[Beth Russell · Rating 5 out of 5]

An incredible book that beautifully puts into words the utter joy and absolute heartbreak that working as an NHS midwife brings. After one of the most difficult years working in the NHS, struggling not only through a pandemic but through the moral dilemmas and mental health challenges that this work brings, ‘Overdue’ resonated more than I could have imagined. Thank you Amity for articulating so beautifully both the wonder and the darkness of this complicated world of midwifery.

[Hannah · Rating 5 out of 5]

A beautifully and powerfully written book which both validated my experiences as an ex NHS midwife, and made me sad that despite the decade since I left, the situation has in no way improved. Like Amity, I long for the day when one of the most intimate, beautiful, and privileged of jobs can also be one where staff are well supported and able to offer the best of themselves to women in their care.

[Emma Glover · Rating 5 out of 5]

Brilliant book! As a newly qualified midwife it was very relatable. The honesty and passion put into the writing showed throughout! Definitely recommend!

[Susie · Rating 5 out of 5]

I really enjoyed this, my kind of book that intrigues me.

Thank you NetGalley for my complimentary copy in return for my honest review.

[Isabel Sarson · Rating 4 out of 5]

This honestly describes the NHS and the life of a midwife SO SO well. I read it before becoming a midwife, and it is the only book I've found that gives true honesty of how difficult it is to work within the NHS.

[Bethany · Rating 5 out of 5]

What an important book for anyone who is in the birth world. While Amity discusses the NHS her words are not only necessary for the UK. Her story would resonate with anyone in the world working in Maternity. As a doula I found myself thankful for hearing the many sides of a maternity ward. It is not simply midwife and birthing person. As she so beautifully describes, the hierarchy of management, with no actual knowledge of what happens on the maternity floor, is who makes all the decisions on how labor and birth are managed. A midwife, who wants with all her heart only to support and fully care for women is, like so many midwives today, forced to work in a conflicting atmosphere of surviving and caring. An impossible way to live. I do hope this book gets the attention it deserves and change moves forward. So often change feels stagnant in the birth world.

[Shelley · Rating 4 out of 5]

As someone without children this book was incredibly insightful about what to expect if I am ever lucky enough to have children.

Amity’s heartbreaking account of working for the NHS and the toll it took on her health was such a brave thing to write about.
Her open and honest observations and accounts of what really takes place on a maternity ward is something that everyone should read and educate themselves further on if they, or anyone they love, ever intends to have kids.

I really hope the higher ups read this and made the needed changes to improve everything regarding maternity for staff and mothers.