In last month's Birthwrite column, Louise Silverton (2019) encouraged midwives and other interested parties to respond to the Nursing and Midwifery Council (NMC) consultation on the draft standards and proficiencies for the future midwife (NMC 2019)—a sentiment I would echo.
As the draft standards formed an unwieldy document, I had only skimmed the main themes, but the article prompted me to look at them in much more detail. Some of those suggested in Domain 5 caught my eye. These related to midwives being able to demonstrate at the point of registration that they have the strength and resourcefulness to work in stressful and difficult situations, that they are able to recognise the signs of vulnerability in themselves or colleagues, and that they can incorporate self-care into their personal and professional lives. Similarly, I recently noticed a thread on social media related to making midwifery colleagues feel valued in the workplace and increasing their wellbeing. Ideas to do this included a selection of goodies to keep them going over the working day or an inspirational quote. This might have been prompted because someone has identified a need in others or in response to a particularly challenging day—a great idea that hopefully links to compassionate care.
However, throughout my career, I have seen health professionals taking on the responsibility and cost of supporting others while employers are not required to put the necessary support in place. In these draft documents I did not see anything related to the new professional midwifery advocate (PMA) role or clinical supervision, both of which would ensure that employers have some supportive networks in place. This might take the form of midwives being required to meet with the PMA at least annually or to have a set number of hours of clinical supervision, as is the case for other professionals.
‘Think of it like when you are flying and asked asked to put on your own oxygen mask before helping others’
The NMC consultation documents reinforce the changing and expanding role of the midwife, particularly with regards to challenging and emotionally charged situations. Dealing with vulnerable women and families is common and yet the support is not in place that might be for counsellors, for example. Feeling tired, irritated or unsupported would surely affect our relationships with others and the standard of care we are able to provide. Websites such as Mumsnet have many examples of women who feel that midwives have communicated poorly, highlighting the long-term effects of these exchanges.
What is compassionate self-care? We are all aware of healthy strategies to ensure wellbeing (and perhaps more unhealthy ones that usually provide a quick fix but not longer-term benefits). Looking after yourself as well as others might ensure that midwives are in a better emotional and physical state to provide high standards of care. Think of it like when you are flying and asked to put on your own oxygen mask before helping others: it seems like a selfish act, but if you didn't do so, you might not have the ability to assist others.
I feel that midwives have often struggled with the concept of making their own psychological needs a priority. Working extra hours, with the ensuing anxiety and stress overlapping into personal lives, is common, even though we are working at full capacity. We need to learn to understand that saying no is not a weakness, but a way to ensure our own wellbeing, while providing an insight into what is achievable. Employers have to acknowledge this and take an equal responsibility.
One strategy I have learnt while researching restorative clinical supervision is the checking in and out process, where you aim to understand how you and your colleagues are feeling each day—a simple but effective start and end to the day. Doncaster and Bassetlaw NHS Foundation Trust (2019) recently tweeted a great example of their checklist. It included taking time to think about the day, consider what went well and what was challenging, taking time to notice if your colleagues are OK and giving yourself permission to go home, rest and recharge. This is not resource-intensive and can be built into any work environment. If you work alone, you might have a ‘buddy’ to text after shifts, to express how you are feeling.
As more changes to the role are on the horizon, midwives need emotional support as well as guidance and policies to make the profession appealing and future-proof.