Significant among the dispiriting catalogue of midwifery and obstetric issues that were identified in the review of 250 maternity services cases at the Shrewsbury and Telford Hospitals NHS Trust, is the revelation on page 11 that ‘[o]ne of the most disappointing and deeply worrying themes that has emerged is the reported lack of kindness and compassion from some members of the maternity team at the Trust’ (Ockenden report, 2020).
‘Disappointing and deeply worrying’ most certainly, and I sought refuge in the thought that this finding represented no more than an outlier. Yet we cannot ignore the warning from the World Health Organization ([WHO], 2014) that ‘[m]any women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care but can also threaten their rights to life, health, bodily integrity and freedom from discrimination’.
It is not my intention to comment on the Ockenden report but to consider instead the nature of kindness and compassion that the report highlights. One might assume that such concepts need no further elaboration in the context of midwifery but are central to the proper functioning of high quality maternity care. However, the documented experiences of childbearing women do not always support such assumptions.
For example, in a UK study of 10 new mothers, Pezaro et al (2018) reported that the mothers had observed midwives exchanging incivilities with each other and participating in undermining and bullying behaviours: ‘These new mothers perceived the consequences of work-related psychological distress in midwifery populations to be a lack of compassion, poor workplace behaviours, substandard care and demoralisation’ (Pezaro et al, 2018). And in a Turkish study of 78 midwives from six different hospitals, when Ergin et al (2020) applied a ‘compassion scale’ to estimate this emotion, they found that the midwives' total compassion scores were influenced adversely by factors like the number of patients and traumatic births, alternate shifts and work satisfaction. When midwives' kindness sub-scores were assessed, they fell according to shift work and the number of traumatic births, with midwives who expressed satisfaction with their work scoring higher kindness scores than those who were not satisfied.
To what extent can compassion be taught to midwives? This was addressed by Pearson (2018) who reminds us that it was the Francis report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry that provided the impetus for compassion to be taught, given that it was lacking in healthcare rather than being a central tenet of care delivery. Interestingly, while Pearson (2018) lists the main attributes of compassion – recognising vulnerability and suffering; relating to the needs of others; preserving integrity; and acknowledging the person behind the illness – she also highlights a possible shortcoming in applying such a definition in the context of midwifery. For example, although women giving birth may be vulnerable, and midwives relate to women's individual needs, ‘the words “illness”, and “suffering” do not easily resonate with midwifery care’ (Pearson, 2018), adding that pregnancy does not equate with illness, and that it is ‘women’, not ‘patients’, who access maternity care.
But notwithstanding the semantic challenges of an agreed definition of compassion, might there be a tension between a midwife's inclination to express compassion and the necessity to be resilient? A blogger to this journal commented that resilience has become a buzzword in midwifery, asking ‘who cares for midwives when resilience isn't enough?’ (Anonymous, 2018). Midwifery, asserts the anonymous correspondent, is a work of the heart; but when hearts get damaged ‘at times there is a tendency to answer that damage with a cry that we must teach resilience … [but] … I think more effective than resilience is kindness, patience and gentleness. In my worst moments, I had kindness poured over me from hearts steadier than my own’ (Anonymous, 2018).
In this respect, it is instructive for student midwives that Beaumont et al (2016) concluded that they ‘may find benefit from “being kinder to self” in times of suffering, which could potentially help them to prepare for the emotional demands of practice and study.’ Nevertheless, there is no escaping the conclusion of Ergin et al (2020) that midwives ‘should be reminded that compassionate midwifery care for women is a basic human right.’