Maternity care providers – exhausted and overwhelmed

The demands of midwifery often feel unrelenting: the lives of not just one person, but two, in their hands, often long hours, and little time to debrief their experiences.

In an era of economic health policies governed by cost-cutting, midwives are being asked to do more in less time. Something has to give.

How bad can it really be?

Pretty bad, actually. We just heard from a midwife who deeply cares about the women and families she works with – but she simply doesn’t have the time or connection to give the quality of care she wants to.

Here, another midwife speaks about her experience, from a 2012 study called ‘How can we go on caring when nobody here cares about us?’.

No sooner have you got an empty bed and … there’s three women down in emergency needing to be assessed and only one bed to do it on. You know. I mean the whole thing is they’re all working their butts off, they’re like a hamster running round inside a thing, like crazy … but it just doesn’t, you know, they couldn’t work any harder. And I’m talking from the team leaders down, they couldn’t work any harder. It’s just a nightmare. (Reiger & Lane, 2013, p.136)

• almost 30%-80% of midwives globally are experiencing moderate to high levels of burnout (Creedy, et al, 2017)
• one in five midwives are experiencing work-related stress, depression and anxiety (Creedy, et al, 2017)
• almost 20% of midwives fit the criteria for probable post-traumatic stress disorder (Leinweber, et al, 2016).

I come to work the next day thinking, I can finish what I started and then you don’t get to it, and that impacts on how you feel about your standard of care, impacts on how you feel as a midwife, impacts on how you’re feeling emotionally, impacts on how you’re feeling… And you think you might be doing a really good job and that’s your standard, you want to do a very good job. Sometimes that standard is decreased, and I struggle with that because I know I always want to do a good job. (Mollart et al, 2009, p.85)

One of the common complaints about midwives (amongst the flood of gratitude and appreciation expressed at the lengths midwives will go to care for women) is something you heard Janet mention in the video earlier this week – there wasn’t enough time to answer her questions, to care for her. The midwives were always rushed. Janet – felt treated like the next number in a long line. And this is true for women the world over.

Who can blame midwives for this? With too much to do, too little time, and no guarantee a midwife will ever see this woman again, it can become easier to align with the institution and the policies than the women and families being cared for.

Fragmented care affects all maternity care, providers

It’s not just midwives who are affected by a fragmented maternity care system: other maternity care providers suffer too. High levels of burnout and stress are found amongst obstetricians and obstetric residents, with studies showing that somewhere around 50% are experiencing some degree of professional burnout. (Smith, 2017.)

The reasons are similar to midwives: too much to do and too little time, paired with high levels of responsibility. It’s no wonder so many health professionals are exhausted and overwhelmed.

We’re reminded of the aeroplane oxygen mask analogy. Health professionals – especially those involved in maternity care where there’s more than one life at stake and the work is always unpredictable – need to take care of themselves. Without putting the oxygen mask on the caregiver first, everyone’s at higher risk.

References

1. Reiger, K., & Lane, K. (2013). ‘How can we go on caring when nobody here cares about us?’ Australian public maternity units as contested care sites. Women and Birth, 26(2), 133-137. doi:10.1016/j.wombi.2012.11.003
2. Mollart, L., Newing, C., & Foureur, M. (2009). Midwives’ Emotional Wellbeing: Impact of Conducting a Structured Antenatal Psychosocial Assessment (Sapsa). Women and Birth, 22(3), 82-88. doi: 10.1016/j.wombi.2009.02.001
3. 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
4. Leinweber, J., Creedy, D., Rowe, H., & Gamble, J. (2016). Responses to birth trauma and prevalence of posttraumatic stress among Australian midwives. Women and Birth, http://dx.doi.org/10.1016/j.wombi.2016.06.006
5. Smith, R. P. (2017). Burnout in obstetricians and gynecologists. Obstetrics and Gynecology Clinics of North America, 44(2), 297-310. doi:10.1016/j.ogc.2017.02.006
6. 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.