From MIDWIFERY MATTERS, Issue No.106, Autumn 2005
TODAY is the Summer Solstice. It is a beautiful, clear and sunny evening and
I would love to be wandering on top of the hills which I can walk to through
the fields at the back of my house in rural mid-Wales. Instead I am on call
and confined if not to my house then certainly to within mobile reception and
suitable travelling distance should the multip who has rapid labours and is
now due call to tell me she is having contractions.
This may sound like complaining. It is not. I have chosen this way of life -
and it does frequently feel to be a way of life rather than just a job of work
because the rest of my life so often ends up fitting in around midwifery. Whilst
I have had a quite delightful late afternoon and early evening eating my dinner
outside and pottering around the garden, I am also aware that I feel the hills
calling me and I am hoping that this good weather will hold until the weekend
when I have a few days off.
Many midwives' lives mould around our commitment to supporting women at all
times of day and night 365 days a year. When I first started being on call as
a student doing caseload midwifery, it felt incredibly exciting to always be
carrying my pager and knowing that at any moment I could be dashing off to attend
a birth. I lived in the city then and was quite successful at still going out;
to the cinema, visiting friends, going to parties and walks along the river.
I knew my pager would pick up and the most I would have to drive for a home
birth would be about eight miles. I also had a very supportive partner who would
cook me delicious meals if I had been out and about for hours and tuck me up
in bed after I'd been out in the middle of the night.
He was still around when I started working independently and along with my colleagues
was my confidante listening to my de-briefings after differing births, concerns
about particular situations and rants about endless frustrations with the obstetric
hospital system. He, again along with my dear colleagues, was a gentle reminder
that 'Rome wasn't built in a day', that I wasn't responsible for what other
people chose to do and most importantly that I couldn't be all that I wanted
to be as a midwife unless I seriously took care of myself first of all.
A few years on, I am working in a tiny stand alone Birth Centre on the Welsh
borders. I am very lucky to work as part of a small, tight-knit team of just
three midwives who, whilst different in our personalities and lifestyles are
incredibly supportive of each other and our different needs. We have taken it
in turn to listen to each other's stories and worries, to debrief after exciting
or difficult births and have worked together to weave creative solutions to
difficult management decisions.
Last summer though, a series of events led to my being off work for a significant
period of time. During that time I reflected a lot about how critical it is
to really nurture and nourish ourselves as midwives and to make sure that we
are truly fulfilled in our own lives in order to be able to be fully there for
the women we support. It is perhaps a cliché that we all know, but I
have now learnt it through painful experience: if we don't look after ourselves
properly and ensure that our own needs are met then we do not have a hope of
truly supporting the needs of women. I remember advice from my own mother when
I left home at 18; to "be a good mother to yourself". Sound advice,
but easy to forget in the throes of daily life and in our work as midwives.
I am reminded of one of the readings in The Tao of Motherhood which talks about
the importance of self care for effective and loving parenting:
It is said:
"She who values her body more than dominion over the empire can be given
custody of the empire." Taking care of yourself is your right and your
responsibility.
If a mother values herself, her children value her. She teaches self-esteem
by her example. Her peaceful demeanor communicates love to all who come in contact
with her.
Knowing when to sacrifice the self and when to nurture the self comes with daily
mindfulness. Pay attention to your body's signals. Observing your feelings each
day, eventually you will be able to take time for yourself before it becomes
an angry demand. This enables you to give of yourself appropriately, without
resentment.
(McClure, 1994)
Such sentiments are also applicable to us as midwives. If we do not nurture our bodies, hearts and souls appropriately we will not be able to support and encourage and empower women to do the same. Unless we look after our own basic human needs first, we cannot be there for women and are likely to eventually end up resenting the work that we do. Resentment is usually a sure sign that something is missing in our lives and that we need to look after ourselves and ensure our own needs are met more fully.
Modern physics now agrees with what many of the great spiritual traditions have
been saying for thousands of years: that we are all connected and that what
happens to one of us happens to and effects us all (Sheldrake, 1990). Women
and midwives have a deeply connected relationship during the journey through
pregnancy and birth. Midwives are the gatekeepers of birth. It is a great privilege
to be with women at this life-changing time and with that comes a responsibility
not to abuse power. The midwife as gatekeeper accompanies the woman in her journey
through birth and keeps a protective, watchful eye for the well-being of both
the woman and her baby. However, she cannot make the journey for her, nor can
she tell her which route to take. As midwives, we need to be centred enough
in ourselves, to be sure footed on our own journey, to take responsibility for
our 'stuff' so that we don't, albeit unintentionally, adversely affect women
and interfere with their own path rather than facilitate it's unique route.
Self love or care is something which seems to be little recognised in modern
western culture which is focused on external goals and achievements. I believe
it is a critical part of life and needs to be incorporated into all parts of
education, starting in childhood. Imagine if midwifery education and ongoing
post-registration programmes included self care and self awareness as a fundamental
part of their syllabus. Imagine how more supportive a work culture we might
create if in order to be truly 'with-woman' it is stressed that we first need
to be truly 'with ourselves'.
You may feel that you already do plenty to look after yourself. However, if
like me you sometimes find stress, frustration and anger rearing their heads
then you may like to explore some of the reminders below to help relax, nourish
and strengthen yourself.
Get up slowly
Be gentle with your body each morning. Set the alarm just a few minutes earlier
and give yourself a few moments in bed before jumping up. Explore how your body
is feeling. See what emotions are waking up. Let your body stretch and move
in whatever way it needs to before you start the day. Try meditation, yoga or
t'ai chi to centre yourself before facing the world.
Honour your body
Firstly by eating good food. Make sure you have breakfast. Make something nourishing
for lunch. Have some healthy snacks in your bag or car for those inevitable
times when you can't stop for a proper meal. Drink plenty of water.
Secondly, get enough exercise! We know we need to yet somehow so often manage
to find excuses for why we aren't doing what we know makes us feel good! Figure
out what it is you like to do; swimming, walking, dancing, kick boxing and make
sure you do it at least once a week.
Spend at least five to ten minutes outside in nature each day.
You don't need to do anything in particular, just be. See how you are feeling
inside and recognise what is reflected back to you in nature. Keep a journal
to put your feelings onto paper or to see more clearly what is going on in your
head.
Do something special for yourself at least once a week
Make a list of all the things you would like to do, from the mundane to the
absurd. Give yourself time to do at least one of these things once a week and
start exploring how you can do the more crazy things!
Spend time with people you like!
It sounds obvious, but sometimes at the end of a week we have been so busy doing
things we 'ought' to do and seeing people who 'need' to see us that we haven't
spent time with our nearest and dearest and those people who understand and
nurture who we really are.
Protect yourself
If you are finding particular situations or people difficult, work out ways
to protect yourself emotionally and spiritually. This may be putting yourself
in an invisible bubble or somehow wrapping yourself up to protect yourself from
things you are finding difficult. It is also important to protect ourselves
energetically when we are with women so that at the end of a long labour we
don't feel that we have given birth ourselves. Work out what works for you so
that you can give and be fully present without getting burnt out.
Let stuff go!
Ensuring that you don't get burnt out also involves learning how to let go -
of the energy, emotion and involvement you've put into whatever you've been
doing. I find a long, warm bath or shower critical after having been with a
woman in labour in order to let go of whatever has happened so that I can go
to bed without the labour replaying itself in my head! Washing your hands between
for example, antenatal appointments, is not only good practice for infection
control but can also act as a way of letting go of the energy from one woman
to be more fully present with the next. If there are situations at work that
you are finding stressful, find a colleague or friend who will really listen,
work out a plan of action about the issue and then put it to bed.
Stress is known to be increasing in all walks of life today. The Department
of Health has identified stress as being one of the key reasons for ill health
and absence from work. More than 20% of workers in the UK admit to feeling stressed
at work and 12.8 million working days a year are lost through stress related
absence (HSE, 2003). Pressure is arguably a normal aspect of work at times,
certainly within midwifery and it typically causes an adrenaline surge which
can help to get things done. Stress is defined as "the adverse reaction
a person has to excessive pressure or other types of demand placed upon them"
(International Stress Management Association, 2004). Stress is when the scales
of balance have tipped and we are not functioning at an optimal level. This
is critical in midwifery as it has obvious implications for clinical safety.
Nurturing ourselves is critical in order to minimise our own stress levels.
We also need to reach out to others around us and support those we work alongside.
ARM has been doing this for many years through its regular caring and sharing
sessions. Midwifery managers have a vital role to play in ensuring stress levels
are minimised for employees. All managers have a legal duty to carry out regular
risk assessments and this includes assessing stress levels for staff. HSE Management
Standards highlight six risk factors of work related stress; the demands of
the job; the control over your work; the support you receive from managers and
colleagues; relationships at work; your role in the organisation and how change
is managed (HSE, 2003). Resources have been produced aimed primarily at managers
to help them develop effective solutions to prevent or reduce work-related stress.
It can be difficult working as a midwife within an institution such as the NHS
since our task is to support women through a process which is wholly uninstitutional.
I believe that this can be part of the conflict that can cause some of the dissatisfaction
and stress as both women and midwives are so often expected to fit the needs
of a service rather than developing a service which is both women and (therefore
also!) midwife centred. In order to be strong enough to help be part of that
change, we need to make sure that we are making the necessary changes in our
own lives to support ourselves. As Goethe said: Whatever you can do or dream
you can, begin it. Boldness has genius, magic and power in it. Begin it now.
REFERENCES
Health and Safety Executive (2003). Real Solutions, real people: A manager's
guide to tackling work-related stress, HMSO, London.
Management of Health and Safety at Work Regulations (1999). HMSO, London.
International Stress Management Association, (2004). Working Together to Reduce
Stress at Work: A guide for employees, ISMA, UK.
McClure, V (1994). The Tao of Motherhood, New World Library, Novato, Ca.
Sheldrake, R (1990). The Rebirth of Nature: The Greening of Science and God,
Rider, London.
Emily Fuller trained at Bournemouth University and worked as an
Independent Midwife in the South West of England before moving to the Welsh
borders where she now works as a community midwife based at a small birth centre.
Updated LW November 30, 2006