Midwife to midwife – embracing connections

Midwives have the potential to be a strong network of support for each other – or a source of tension and conflict. Creating a supportive environment built on a foundation of mutual trust between colleagues is essential for working together. No midwife practises on her or his own, and a midwife’s best source of support are other midwives. At the basis of this support?

Relationships.

Midwives working in partnerships with other midwives are in the unique position of having direct insight into what their colleague is going through. Emotional or practical support from someone who understands is invaluable. It may also help prevent the high incidence of burnout, stress and depression that we are seeing in midwives globally.

Midwife-to-midwife relationships are a cornerstone of safe practice

Continuity may be equally important with colleagues as it is in midwife-woman relationships. Forming long-term collegial relationships with other midwives can help create a network of trust and respect for each other’s skills and expertise. This trust carries countless benefits. For example, a midwife is more likely to make a call to discuss a difficult case with a trusted colleague than someone she doesn’t know. That call may make a key difference in a woman’s outcome, as having the perspective of another midwife may be just what’s required to determine the best way forward. From a place of mutual trust, midwives can depend on each other, allowing sharing of best practice and keeping the woman’s needs at the forefront of care.

Where there is distrust or a culture of competition and conflict, midwives may be reluctant to call on other midwives for support, and this creates further isolation. Reluctance to seek support from colleagues is understandable: fear of rejection or ridicule may make it easier to pretend to be ok. Within midwifery, bullying, disrespect and silencing the voices of those with less power or different opinions occurs more commonly than you’d think, especially in groups dominated by one person or in small cliques. This is often called ‘horizontal violence’, and happens when midwives internalise the attitudes of those in power and direct their criticism inward toward their own profession. (Leap, 1997)

Within this culture, we see experienced midwives bullying new graduates, and new graduates inflicting the same on student midwives, in a continuing cycle. This has the potential for serious consequences for mother and babies. If a midwife feels unsafe and under scrutiny from her colleagues, she is more likely to make mistakes and less likely to ask for help in challenging situations – placing mothers and babies at risk.

Collegial relationships are vital for midwives

Positive collegial relationships may make a foundational difference in how midwives experience their working lives. For midwives that work within fragmented care systems, the relationships with other midwives may be the most important relationships they have – these are the people they see every day. Midwives also rely on this network for support to cope with feeling unable to provide the best care they can, as we saw in Week 1. For midwives working in continuity of care, the relationships with the midwives they work with are what sustains their practice and allows a work-life balance to occur.

Regardless of the context of care, the relationship of midwives with each other are a cornerstone of safe maternity care.

Over to you

Can you think of examples of how care can be compromised if a midwife is afraid to ask for help? In contrast, what benefits come from relationships between midwives – in both fragmented care and continuity of care models?

If you’re a health care professional, what strategies have you seen in your practice that have worked to create a positive culture?

References

1. Catling, C., Reid, F., & Hunter, B. (2017; 2016;). Australian midwives’ experiences of their workplace culture. Women and Birth, 30(2), 137-145. doi:10.1016/j.wombi.2016.10.001
2. Leap, N. (1997). Making sense of ‘horizontal violence’ in midwifery. British Journal of Midwifery, 5(11), 689-689. doi:10.12968/bjom.1997.5.11.689
3. Curtis, P., Ball, L., & Kirkham, M. (2006). Bullying and horizontal violence: Cultural or individual phenomena? British Journal of Midwifery, 14(4), 218-221. doi:10.12968/bjom.2006.14.4.20790