From MIDWIFERY MATTERS, Issue No.98, Autumn 2003
Tania McIntosh
IT WAS ONLY towards the end of my midwifery diploma course that a friend of mine commented that I never talked about "training to be a midwife" but always about "doing midwifery". At first I thought that her comment was irrelevant; after all did it really matter how I described what I was doing? Thinking about it more deeply, I did not believe her. After all, I had given up another career to retrain as a midwife after the birth of my own children had inspired me to want to become part of that amazing profession. I certainly did not want to "do midwifery" which implied something very mechanistic. I wanted to be a midwife; to be with women at every stage in the process of maternity and to be part of a profession which seemed to me, looking in from the outside soon after Changing Childbirth, to be clear-eyed and rigorous in debating what it was and where it wanted to go.
Now, five years after my initial application, three years after beginning my training, and three months after qualifying and beginning work, all I can think about are ways out of "doing midwifery". I trained on a direct entry course and undertook the whole of my clinical experience within the auspices of a large consultant led unit. I passed all my assignments and got consistently positive comments from mentors in my clinical assessments. Yet with every module that passed I felt myself losing sight of what it might mean to be a midwife. There has been much recent comment in the letters page of the RCM Midwives Journal about the experience of being a midwifery student at the present time. I would concur with virtually every comment expressed in every letter. No credit is given for previous life experience, or current work/study/life juggling acts, students often feel undervalued both at work and in the classroom. And yet my problems with seeing myself as a midwife were much broader than timetable glitches and patchy mentorship. Midwifery training can leave a student feeling very confused. With moves towards a graduate entry profession, we are increasingly encouraged to ask questions and to seek out our answers. Yet at a clinical level it is very much a case of doing as you are told; not just for students but for all staff who are led by protocols, guidelines and policies at local and national level, and by the fear of discipline and litigation, whether for something done, or left undone. My training therefore left me feeling pulled in two directions.
However, I also wondered increasingly what I was being trained for. It became clear that I was being trained to "do midwifery" rather than "to be a midwife". And the two phrases are, despite what I first thought, very different. "Doing midwifery" fits in perfectly with the busyness to which midwives subscribe. In the unit where I trained, staffing was inadequate, the birth rate high, and the pressures immense; yet many midwives who worked there commented that they would hate to work somewhere quieter and "be bored". The day is measured in numbers; how many labourers, how many inductions, how many sections, how many staff. Some midwives thrive in this atmosphere of constant bustle and near crisis, others manage and are caring and committed. Absorbing the ethos of perpetual motion is part of learning to "do midwifery".
Before I began my training I imagined that midwifery revolved around women and their families, but this does not seem to be the case. As well as the time element, "doing midwifery" revolves primarily, it often seems, around technology. I have been taught how to monitor CVP lines, how to recover women after a general anaesthetic, how to administer a fluid challenge. I have never been taught to use a Pinard. I have struggled with midwifery led care, which the unit I work in is attempting to introduce, because it is a challenge to leave the safety net of four hourly vaginal examinations, ranitidine-and-no-food-just-in-case, and always knowing that there is a doctor only a bleep away.
I want to trust myself and to trust the women that I care for; after all, I birthed my own children with no medical intervention, and trust seems to me to be the essence of being a midwife. But I have less confidence now than I ever did. My three years of training have taught me primarily to be afraid. Afraid of the unknowness of pregnancy, labour and birth; afraid of not being able to make everything right and perfect for mother, baby and Trust, despite careful adherence to guidelines and protocols. Again, to truly be a midwife I would want to be able to accept uncertainty, not to fight it. But "doing midwifery" means that every pregnancy is a problem to be wrestled with, not a road to be travelled.
Strangely enough, whilst I do not feel that I have become a midwife, neither do I feel that I am doing midwifery. Perhaps because I am direct entry and not nurse trained, I do not feel adequately prepared to look after women who need high dependency care or complex nursing input. Neither do I feel that in caring for such women I am providing midwifery care. Yet I do not feel like a midwife. In my uniform and badge I feel that I am playing a role rather than living a life. I do my best to be caring and to work effectively. I have even taught myself to use a Pinard. I am doing my small bit to keep an adequate maternity service running in this country, but I know very clearly that it is not a role that I would wish to fulfil for long. Maybe I have just fallen foul of the theory/practice gap, or the disillusionment of the newly qualified, and therefore newly exposed, member of staff. Except that my use of language made it clear that I felt like this during my training. Even if I could not admit it to myself, the fact that I referred to myself as "doing midwifery" rather than "becoming a midwife" expressed how I really felt, and still feel.
IK 21 September 2003