At the time of writing, Maternal Mental Health Awareness Week (29 April–3 May 2019) was being discussed and shared across social media and the press. Statistics about how childbearing women are vulnerable to mental health issues, how it affects 1 in 10 women and how it can range from mild to severe, were widely distributed. Mental health does not discriminate; it can affect anyone at any stage of life and from any background. I was one of those people and it was a very difficult experience.
Among the mass of the tweets about this, I then discovered the tragic news of the suicide of a student nurse. In the aftermath, Nursing Times reported that, in the past 7 years, there have been more than 300 reported suicides of nurses in the UK (Mitchell, 2019). It is well known that wards are under increasing pressure, and the number of nursing vacancies in the UK is a testament to how understaffed some hospitals are. Suicide among doctors is all too common; these bright energetic minds driven to drastic means. It says something when those who care for us are actually the most needing of care.
What does this mean for midwifery? One study of suicide trends placed midwives and nurses in the top 30 occupations for high risk of suicide (Roberts et al, 2013), and another showed that midwives and nurses had a suicide rate that was almost triple the rate of those in non-health professions (Williams, 2018). A study performed by the Royal College of Midwives (RCM) in 2016 demonstrated that stress and burnout were evident in midwifery (Shallow, 2018). We have an aging workforce and a population whose comorbidities are making pregnancy more complex. Many times I have cared for someone, and thought, ‘This is edging the limits of my training here.’ This situation is not helped by the issues that have affected nursing and midwifery training; getting rid of the bursary has not helped us to attract new students. Student retention is down in England; however, in Scotland (where the bursary was kept) numbers of nursing students have increased.
There is evidence that traumatic births can affect the midwife just as much as the mother (Patterson, 2019). Midwives are experts at bonding with those in our care, forming lines of communication quickly and easily. It's a gift that can also be a curse: I had an experience in my first year as a student midwife that will probably stay with me for the rest of my career. Trauma rewires the brain; it puts those it affects on high alert and unable to regulate their emotions as normal (Bremmer, 2006). Putting this person, who has not had a chance to heal and talk, onto a shift where there is another trauma, only exacerbates the problem.
It is not surprising that in this cooking pot of issues, those in the profession can end up struggling with their mental health. Many workplaces have resources to help support staff when they are struggling, and there are publications with ideas on how to self-nurture, set self-care practices and build resilience (Anderson-Whalley and Goodwin, 2018). However, I feel that even with all the best resilience and self-care in the world, sometimes it just gets to a person. We can not give more with less, and this means that we are spreading ourselves too thin and our care becomes stretched and disjointed.
This trend is rife in the medical community and I do not see it ending. It is a question to which I do not have an answer, as it is complex and multi–level. There is no single magic solution, and it will probably require a combination of systematic change—where attitudes towards mental health change on individual and corporate levels—and initiatives for better staff wellbeing and welfare.
Perhaps, however, we can just start with each other. Create kind working environments where it is OK to not be OK, have ears that listen and hearts that are open to others' struggles. Small acts of kindness create greater change: that cup of tea you make might not be life-changing for you, but for another, it's a signal of caring and thoughtfulness that can get them through the shift.