One thing that I have found particularly challenging over the past couple of months of working as a preceptee midwife is the number of postnatal women, or women in the early stages of labour, whom the midwives are allocated to care for at one time. This was something that I experienced during my first week on the delivery suite.
It was an extremely busy day and I was allocated four women to care for. Three were at various stages of the early postpartum period, and one woman was in the early stages of labour. All of the women had their own—very different—needs, such as requiring extra support during the latent phase of labour, talking about their birth experiences, discussing care after caesarean section, assistance with breastfeeding, or just that little bit of extra reassurance for first-time mothers that everything they were experiencing was normal. I wanted to spend more time with these women, discussing their hopes and fears, but I found myself saying, ‘I'm sorry I haven't been around much, but I have other women to look after,’ and, ‘I've got to transfer you to the ward now—they are brilliant over there and they will help you.’ I found this extremely disheartening because I wanted to give all the women the attention they needed. I wanted more time to talk to the first-time mother about her birth experience; I wanted all the time it took to help a woman with breastfeeding her new baby. But in the real world, with the pressures of the unit and the demand for delivery rooms, this is virtually impossible.
I know this is a normal occurrence in many other hospitals; it just comes down to the lack of midwives, the increasing workload, the fact that we can't stop time and that we are unable to chop ourselves into several pieces. This is one of those things that I find incredibly frustrating—being unable to give the time that all the women I am caring for need. However, I also recognise that I am new to this solo juggling act, and many experienced midwives have reassured me that I will learn to ‘talk and do’ at the same time. I will become quicker at assessing a woman while talking things through with her—apparently, it soon becomes second nature, with documentation becoming more concise and straight to the point—I will get quicker on the computer and I will find time to go to the toilet at some point during the day! I am positive that I will become more efficient over time; however, at this stage of my preceptorship, it sometimes seems a long way off.
I know that most of the midwives I work with, even the most experienced, find it challenging to prioritise their own basic needs with the needs of the women. They feel stretched psychologically, emotionally and physically the majority of the time, and basic things like going to the toilet have become a ‘treat’ in the midwifery world. Most of my colleagues eat on the go, grabbing snacks while popping out of the delivery room for 5 minutes, eating lunch outside the normal lunchtimes and, on particularly busy days, never actually having a proper break in the whole 12.5-hour shift.
I am under no illusion that the pressure of the midwifery profession is ever going to change. For this reason, I am becoming increasingly aware that I need to be mindful and look after myself, as well as being there for the women who need my support. I have realised over these first couple of months that I need to take a step back, as I can feel myself slowly slipping into the spiral of neglecting my own physical, emotional and psychological needs at the expense of the women for whom I am caring, and I am mindful that poor health can lead to an increase in errors (Harrison et al, 2014)—which is not compatible with safe and effective patient care (Pezaro et al, 2016).
Midwifery care aims to support optimal outcomes in childbearing (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010), so all midwives need to make sure we are also caring for ourselves in order to provide the quality and safety of care that is essential in the maternity services.
Stress, anxiety, depression and burnout account for a quarter of all episodes of sickness absence in the NHS (Boorman, 2009; 2010; NHS Employers, 2014). Therefore, it is important to invest in our mental health and wellbeing so that the maternity service may reap the rewards of improved care, staff experience and safer services (Pezaro et al, 2016). With this in mind, we all need to encourage one another to start putting our own needs first. It's just like when you get on a plane and the cabin crew's safety speech says, ‘Ensure you put your own oxygen mask on before helping others’—we will be of no use to any women if we are not considering our own health and wellbeing. Poor wellbeing among midwives could lead to exhaustion and mistakes, preventing us from providing the high-quality care that is required for all women and their families (Royal College of Midwives, 2016).