Time to Act for Midwives

There have been some fantastic conversations taking place on the MatExp Facebook group, with lots of ACTION threads being posted to generate discussion. The aim of these discussions is to identify ways that we can ACT to improve maternity experiences. Big, long-term actions that might require system change or a change in culture. And small, immediate actions, that professionals and individuals can take today to improve the maternity experience of those around them.

One of the subjects we started to tackle early on was Birth Trauma. This was an insightful discussion about parental experiences, but it was mentioned that midwives can also be traumatised by their experiences of birth. We started a thread specifically to discuss this issue and for me it got to the heart of some of the problems facing maternity care today.

I was at a user group at Salford University in May where a group of parents discussed the midwifery curriculum with some of the lecturers. We talked about all of the things that parents want – compassionate care, informed consent, skin to skin, optimal cord clamping, breastfeeding support – the usual topics. One of the lecturers commented that they had been teaching all of these things for years, why were the same complaints and comments still coming back from parents?

I really feel that midwives’ experiences and the way that these are dealt with is one of the answers.

A comment that particularly resonated with the group was from a third year student midwife and I would like to share it here in full:

“I agree, that the trauma for me is cumulative. Often a singular ‘traumatic birth’ is easier to process as the necessity for intervention is usually clearer, staff involvement/support is higher and women/families are offered enhanced care/debrief/support. It is the ‘routine’, less critical ‘procedures’ that affect me over time. The ‘heroic’ ARM, the VEs by doctors with inadequate consent, instrumental deliveries without compassion or the ignoring of important birth wishes (OCC for example). It calls into question your very notions of love, kindness and compassion. It hurts personally to see these violations of women, often by doctors. Usually it is not the ‘act’ itself but instead the loss of autonomy and consent that causes me so much pain. I also have noticed, how frequently these things are not noticed by women, because they don’t know it could be any different. And I feel that in that alone ‘we’, the system, have let her down. It took me a very long time to establish why I found the delivery suite so challenging. Now I understand that witnessing, sometimes being part of, repeated human rights violations is of course going to be distressing. It would be to anyone. The fact that this job is integral to my sense of self, identity, world view and beliefs makes the impact even greater. But I do think that without adequate support birthworkers (midwives, doctors, doulas, etc) may become detached or choose to leave the hospital setting to protect themselves. This has been my biggest challenge throughout my training and I know will continue to be as a NQM. I believe all birthworkers need nourishing support to continue to provide compassionate care. I have received this from a community of feminist birthworkers spread across the country but whose shared values inspire, support and encourage me. Having space held for me as a student midwife by fellow birthworkers has taught me more about how to provide loving care than almost anything else.”

A retired midwife commented “I’m old hand in some respects and you basically brushed yourself down and moved forward. The difficulty occurs I think in the future as over time as you find that the coping mechanisms aren’t working as well and you exist with a high level of adrenaline running around your body; it becomes more and more challenging to cope.”

Birth workers discussed crying in the toilets whilst at work, fire-fighting from one emergency situation to another, feeling vulnerable, angry and frustrated. Cutting costs and box ticking were mentioned and a lack of compassion amongst the management system, with policies slowly eroding midwives’ scope of practice.

“As a student, I have found morale amongst midwives one of the hardest things to deal with. The majority dislike their jobs for many reasons (too many to list but management and politics play a huge part) and are unresponsive to students enthusiasm. I have even been told by mentors that they don’t like having student? This obviously has an impact on learning and emotions. When experiencing birth trauma with a midwife that shows no emotion, even after the event, it is hard for a student to deal with and can have a huge impact on students emotional/mental well being. That being said, there are some fantastic mentors. However, students leaving training due to lack of support is unacceptable.”

Immediate, short term actions:

Find out if your Trust has guidelines about supporting families AND staff after difficult births
If anyone has good guidelines from their Trust that they are able to share please let us know
Midwives at all levels to reassure one another that it is acceptable to have difficulties coping with some of the births that they witness, and to talk about coping strategies that they have found helpful.
Mindfulness classes to be offered to staff
Read The Roar Behind The Silence (and encourage colleagues and managers to read it) – many of these issues are discussed in the book and action points suggested
Use Random Acts of Kindness and Paying It Forward in your workplace to support colleagues

Long term actions:

Consideration to be given to what will replace supervision of midwives if it is to be dismantled, in terms of who midwives are going to go to for support
Explore the model of Restorative Supervision
“We need a powerhouse of strong and courageous managers, midwives and students who are able to steer midwifery towards kinder more humane care keeping in mind our goal for physically safe and emotionally satisfying outcomes for women.” (midwifery student)

“The emotional investment of midwifery takes its toll”