When midwives are broken - what can we do?
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It’s always a great pleasure to visit universities and meet enthusiastic student midwives. I also have the priviledge of speaking to scores of midwives at conferences and events. Social media is another way I connect with maternity workers, and I read blogs written by midwives about their work both in and out of the NHS. There are many heart soaring moments when I read about innovation, kindness, compassion and women centredness. But I am always alert to messages of distress, and when I hear accounts such as the one below, my heart well and truly sinks. I have written about the overwhelming and increasing pressures of being an NHS midwife, and midwifery manager, before.
I have chosen to share this midwife’s plight for many reasons. Firstly because she asked me to, and because her words represent the feelings of all the others who write to me almost on a weekly basis. And of course I want to add to the lobbying for much needed change in maternity services; how can midwives care and nurture others when they feel stressed, burnt out, and unable to do their work? The situation is intolerable, and needs action. By using a pseudonym below, I am protecting a midwife’s identity. But many midwives speak out reveal their names, when they don’t feel able to continue. Others reach out to tabloids annonymously to highlight their distress, and recently the mother of a midwife contacted the press. In 2015, the RCM revealed that 50% of midwives in England were stressed.
Julie is a newly qualified midwife, and like so many others, the NHS is in danger of loosing her.
It's with much sadness and desperation, that at only four months into my midwifery career, I am going off sick for the first time with stress/burnout. Working conditions, despite generally very good support from colleagues and amazing support from my SOM, are untenable. I am completely heartbroken at my inability to give the kind of quality care women deserve due to staffing issues and chronic overworking. And this is despite my unit having some of the highest levels of positive feedback in the country. The price to be paid for this appears to be the health and wellbeing of all staff (particularly midwives and registrars). I'm sharing this with you as you have all been so supportive of my transition to life as a newly qualified midwife. And I believe it is an outrage that four months of work as a midwife is enough to break me, someone who has sought every strategy possible to engage in maintaining resilience (yoga, meditation, peer support, Twitter, reflecting, conferences, self-care, etc), whose passion and love for midwifery is so strong and who has made it their life's work to reach the point of qualification. I have thought about leaving midwifery. In fact, I have thought it almost daily for the past three months. I had no idea working clinically as a midwife would be so distressing. The most profound problem is that there is no time. No time to create meaningful relationships, to properly support people in their journeys, to hold space, to be tender. I have done my very best every shift and believe I have given everything I could have to the families I have been with but that is not the same as it being as good as they deserve.
On the advice of my supervisor of midwives I'm going to my GP tomorrow to get signed off for two weeks. In this time I will be reviewing my finances to see how I can reduce my clinical hours as a midwife. As someone with a disability who already works 34.5 hours I don't know how I will survive financially. I may look for another part time job to make up the shortfall. My (retired) mother has spoken of giving me a monthly allowance. All this to enable me to practice midwifery. I am angry. I am angry for myself but I am angrier for the people we serve, that working conditions for midwives are so far from adequate and sustainable that they are unable to provide the care they deserve.
If you have any ideas as to how to come back to the vocation I truly love and an identity that shapes who I am, in a way that is healthy and productive then I would be so grateful. And if you can, in any way, publicly share what I have told you (anonymously, as I fear being open may negatively impact me) then I beg of you to please do so. Tell everybody what is happening. That conditions are now so bad they are beyond normal newly qualified midwife transition. That we are experiencing burnout in months. My unit is struggling to retain even the most committed staff. We are demoralised. Not by the wonderful women and families, not by our colleagues, but by the inability to provide truly compassionate, individualised, safe, holistic care and support. The 'workload' is relentless and the only thing left to give is ourselves. And I am broken.
Please share my story if you can.
In response to my supportive email to her, Julie later wrote:
It's reassuring to know I'm not the only one struggling! I really feel that the public deserve to know the real state of affairs. There seems to be an expectation for midwives to be virtuous and perfect (a mother-type complex?), able to carry all burdens without complaint, ever grateful for the 'privilege' and 'joy' of the job. That is not to say midwifery work is without these elements but I do not feel 'privileged' on most shifts! The stress is too great to even appreciate the beauty and wonder that exist. I live with a fellow (non-disabled) NQM, who is on the verge of breakdown too and she has had two two-week long absences from work from physical illnesses she attributes to internalised stress. Again, this is within a four month period of working clinically. I just wanted to let you know as it does affect my ability to earn extra income by managing the potential work-load of another part-time job in order to facilitate reduced clinical hours as a midwife and thus it makes me intensely financially vulnerable (I am 30, live independently with a housemate and all the associated costs). This on top of the stress of working in a busy, high risk obstetric unit with chronic understaffing, demoralised midwives and unmanageable workloads is just horrible. However, to temper this I would like to add that the labour ward co-ordinators, my incredible SOM and colleagues are doing their very best on a daily basis to support me and everyone else, however there is nothing they can do about the staffing and workload issues which underpin everything.
Thank you for taking time out to listen to me. I feel heard and understood which is so lovely in these trying times.
‘...if I'd known the realities I think I would have pursued doula-ing. It's a shame as midwifery is such a beautiful paradigm in its own right but enacting it authentically in the UK, particularly in a hospital setting, seems almost impossible’
If you have any ideas as to how to come back to the vocation I truly love and an identity that shapes who I am, in a way that is healthy and productive then I would be so grateful. And if you can, in any way, publicly share what I have told you (anonymously, as I fear being open may negatively impact me) then I beg of you to please do so. Tell everybody what is happening. That conditions are now so bad they are beyond normal NQM transition. That we are experiencing burnout in months. My unit is struggling to retain even the most committed staff. We are demoralised. Not by the wonderful women and families, not by our colleagues, but by the inability to provide truly compassionate, individualised, safe, holistic care and support. The 'workload' is relentless and the only thing left to give is ourselves. And I am broken. Please share my story if you can.
So what’s the solution? I offer some suggestions. Please comment below and add yours
Strategic
- WE ARE SHORT OF MIDWIVES, especially in England. The RCM’s calculation is that England needs 2,600 more midwives.
- The proposed NHS savings of £22bn by 2020 isn’t going to happen unless we work in different ways, and become more innovative and dexterous.
- The Better Births report tells us this too, and provides some solutions to improving the working lives of maternity care workers, by supporting the development of new models of care, increasing choice of place of birth, and proposing the exploration of no fault compensation.
Organisational
Heads of midwifery, consultant midwives and leaders do you:
- Meet regularly with your staff, seek opinion on pressures within your services, then lobby for change using quantitative and qualitative data, and benchmarking tools such as BirthRate Plus?
- Establish schedule of meeting with student midwives and newly qualified midwives? Their views will reflect the culture of your services.
- Know if your service offers women the full choice offer of place of birth, which gives midwives the opportunity to experience and use their full range of midwifery skills?
- Monitor your services’ continuity of midwifery care (r) levels, which evidence tells us improves outcomes and experience for mothers, and increases midwives job satisfaction?
- Carry in-depth analysis of sickness episodes/levels?
- Obtain regular feedback from service users via MSLCs or other forums, and frequent audit of views?
- Work closely with RCM and other union reps to seek opinion on working conditions and job satisfaction, and to share knowledge of your service?
Rewarding staff and showing appreciation, such as organising a celebration event where staff nominate peers is a great way of lifting morale, and increasing motivation.
Individual
- Look after yourself. You are your greatest asset, and listening to your body and mind then acting on signs of stress are crucial.
- Talk to someone you admire and trust, and ask for their guidance. This may be your supervisor of midwives, or a member of your team.
- Stay close to your positive role models.
- Exercise regularly, and eat well. Use relaxation aid such as Elly Copp’s The Relaxed Midwife - A meditation aid to pause, rest and recharge and Maggie Howell's Midwives Companion
- Join the Royal College of Midwives, and meet with your local representative
- Network with wider groups, such as closed Facebook groups, and seek positive support from others via social media sites such as Twitter.
- Read this Hannah Dahlen paper which highlights the importance of identifying real and manufactured fear.
- Read Chapter 17 in The Roar Behind the Silence – entitled Caring for Ourselves: the key to resilience by Hunter and Warren.
The Roar Behind the Silence: why kindness, compassion and respect matter in maternity care – has many examples and ideas for change in maternity care, for all levels.
It doesn’t have to be like this. Carmel McCalmont is an Associate Director of Nursing and Midwifery, and co-wrote a chapter for ROAR, about supporting student midwives in practice. She said:
We try to carry on the work we do with our student midwives into the NQM phase. I personally visit each clinical area every morning and talk to all staff. It is important to learn the names of new before they start working, to say ‘Hello’ and call them by name from day one. I speak to them during preceptorship at their formal programme, and advise them that I have an open door as do the matrons. It is vital to check their well being to empower and support them.
If we have an incident involving a NQM we try to wrap our arms around them to support, reassure and guide because we really can't afford to loose these amazing midwives who are the future of midwifery.
Carmel's contact details:
Twitter: @UHCW_Midwife