Fragmented care affects midwives too

It’s not just women who are impacted by the current maternity care system: midwives are unhappy and dissatisfied too. One of the main reasons why midwives consider leaving the profession is they feel they are unable to provide good care for women.

Here’s an example – read this powerful letter written by a midwife to the women she has provided care for: Sorry – A Midwife Speaks (Anonymous, 2017).

As you read, think about the main things preventing this midwife from doing her job the way she knows would be best for her and the women she works with.

Which of these elements are a result of fragmented care?

Midwives are struggling in the current system

In that poignant letter, you read the words of a midwife distressed by not being able to provide the kind of care she wants to. And it’s not just a personal preference for this one midwife: many midwives struggle to provide the woman-centered, compassionate, caring, and evidence-based care they aspire to. Why? Because their working environment doesn’t enable them to do so. Many factors are involved, such as:

• the way the maternity clinics are run
• the number of staff available vs the amount of work to be done
• how the health system is set up.

Midwives are really feeling the brunt of this disparity between care they know is right and the care they actually have the time and energy to provide. Studies show that between 30-80% of midwives experience some degree of burnout, and 1 in 5 experience work-related anxiety, stress or depression. (Creedy, et al, 2017.)

It’s easy to see how being a midwife can lead to burnout, as they cope with:

• long hours
• responsibility for the life and death of at least two people (usually many more, with midwives caring for large numbers of women at a time)
• often low pay

What we know is that when you lack a sense of connection with the woman you’re caring for, it’s easier to cope emotionally with not being able to provide the care you know is right. When you don’t feel you’re letting down someone that you actually know, detachment is easier. Unfortunately, this can lead to burnout.

Women, their families, and the midwives that care for them are all seeking the same goal – an optimal pregnancy, birth, and transition to parenthood for that woman and baby. However, with the way the current maternity system is set up, the foundational elements of midwifery care – the sense of rapport, familiarity and respect that has historically bound women and midwives – are at risk.

Demand better

The letter you read ends with a passionate plea for change:

We must demand change. We must demand our rights. We must demand better.

I will not stop talking about it, I will not stop fighting for it, and I will not let this system break me, no matter how close to the edge it pushes me.

And for that, I am NOT sorry.

Over to you

Having read the letter, first think back to any experiences you’ve had with the maternity care system in your area. Note any similarities or differences to what’s being written about in the article. Then answer this question for discussion:

Where do you see yourself in relation to this plea for something to change? Are there any ways that you can ‘demand better’ in your area?

References

1. Anonymous. (14 July, 2017). Sorry: A midwife speaks [weblog post]. Retrieved from https://thebirthhub.co.uk/2017/07/14/sorry-midwife-speaks/
2. Creedy, D., Sidebotham, M., Gamble, J., Pallant, J., & Fenwick, J. (2017). Prevalence of burnout, depression, anxiety and stress in Australian midwives: A cross-sectional survey. BMC Pregnancy and Childbirth, doi:10.1186/s12884-016-1212-5
3. Hunter, B., Fenwick, J., Sidebotham, M., & Henley, J. (2019) Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors. Midwifery (79), 1-12.