We are all aware that there are many forthcoming changes in midwifery recommended in government policies (Dunkley-Bent, 2016). So how do midwives feel about these, and how might they cope with further changes within the profession? There were some lively debates at the recent BJM conference, attended by a cross-section of midwives, from newly qualified to professors and government advisors. These discussions illustrated the continued enthusiasm and motivation that midwives have to drive the profession forward and ensure high standards. Proposed changes to supervision were also highlighted, raising the notion of experienced midwives acting as role models and clinical supervisors to protect the public through supporting and facilitating sound midwifery practice. Despite the uncertainty around these changes to statutory supervision, the audience responded positively to the fact that supervisors might be developed as leaders rather than tied up in investigatory processes.
Are future midwives likely to be different? Dunkley-Bent (2016) suggests supervision can help improve confidence, self-efficacy and stress management, leading to midwives who are compassionate, competent and resilient. Resilience is something we have heard a great deal about recently. Given increased workloads, staff shortages and the emotionally demanding role of the midwife, greater resilience could help achieve a healthy workforce who are not suffering from burnout. This, in turn, could help address the low morale and stress reported by midwives (Midwifery 2020, 2010). Lost days through sickness and absence are a real issue in the NHS, with 27.3 million days lost due to workplace illness and injury in 2014–15 (Health and Social Care Information Centre, 2015).
So what is resilience? There are many definitions, of which the simplest is that of Rutter (1999): an individual's, group's or community's resistance to adversity. This is usually a positive response. There are, of course, many reasons why this may be weakened: a poor work environment, complex and demanding roles, staff shortages, bullying, or working in stressful situations. These can all apply to midwifery and, although some exposure to adversity can help build resilience, there must be support and debriefing in place to make this a positive experience. This might be something the new model of supervision can assist with, as long as training is offered ensuring supervisors are well prepared for this role, with formal strategies in place.
Informally, midwives have always had mechanisms in place such as conversations with colleagues and a strong team spirit. Contemporary leaders need to see the value in such strategies and encourage more open and honest discussions in an environment that is safe and nonjudgemental. My recent conversations with midwives suggest they are scared of highlighting their own shortfalls for fear of disciplinary action. Midwives need to escalate concerns where real concerns exist, but also promote a supportive culture of sharing ideas and ideals. If the team witness individuals being supported and educated, as opposed to blamed and punished, this will encourage openness and personal accountability.
Workplace wellbeing reduces stress, increases motivation and productivity, and enhances patient care. Some companies provide good practice points for the NHS to emulate. One example is GlaxoSmithKline, which has introduced company-wide individual resilience programmes including support for smoking cessation and weight management. I think anyone could see the benefits to the NHS of such a programme. McDonald et al (2012) introduced an educational intervention for nurses and midwives including topics such as establishing positive nurturing relationships, achieving work–life balance, emotional intelligence and reflective/critical thinking. In these workshop-style meetings, people's skills and experiences were valued and respected, and honest airing of workplace concerns encouraged. It was positively evaluated by participants. This may not only promote increasing resilience but also support the skills required for revalidation—something I am sure supervisors of midwives will be actively involved in.
Perhaps the new model of supervision will have many added benefits to both midwives and families. As a profession, we need to ensure we use these changes to our own and women's benefit, building a happier, healthier and more resilient workforce.