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Mindfulness and Self-Care in Midwifery

As my main research interests are firmly rooted within supporting a positive staff experience for healthcare workers, especially midwives in work-related psychological distress, I am always looking for new opportunities to share knowledge with others in this area. …The Global Alliance for Nursing and Midwifery (GANM) is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Organization (WHO) Collaborating Center for Nursing Knowledge, Information Management & Sharing at the Johns Hopkins School of Nursing. This blog post provides an overview of a webinar session hosted by GANM entitled “Mindfulness and Self-Care in Midwifery:  Review of Current Evidence and Guided Mindfulness Practice.

For a preliminary introduction to this topic – check out an earlier blog post on this topic entitled “Midwife Burnout: A Brief Summary“.

downtimes

Erin Wright, DNP, CNM, APRN-BC, led the conversation…Participants were diverse, and originated from Canada, Peru, US (Baltimore, Urbana, Birmingham, Atlanta, Buffalo), Ireland, UK (Coventry University and School of Healthcare Sciences Cardiff), Brazil, Montserrat, and Trinidad.

The full webinar can be accessed here.

Much of the research covered, has also been captured within my earlier narrative review: Pezaro, Sally, et al. “‘Midwives Overboard!’Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.” Women and Birth 29.3 (2016): e59-e66.

However, there were some new and interesting comparisons made with more recent research here…

“Four common themes have been identified that traverse the different models of care. The NZ study provides insight into how case load midwifery can be sustainable enabling long term sustainability. The UK study highlights healthy resilient practices that enable practice. What remains uncertain is how models of care enable or disable sustainable long term practice and nurture healthy resilient behaviours within the different models of care”.

comparisons

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.”

Sources (Crowther, Susan, et al. “Sustainability and resilience in midwifery: A discussion paper.” Midwifery 40 (2016): 40-48.)

So we are now much enlightened as to how and why midwives are experiencing distress, we also have some insights into how they try to cope (or not)…and where this distress may affect maternity services…but what we are yet to learn, is what may be most effective in supporting midwives in work-related psychological distress…although a few clues are emerging….

Mindfulness is coming forward as a potential tool of support..stress management, education and clinical supervision may also be of benefit to midwives in distress…But how, why and how much is not yet clear.

After exploring the literature in relation to psychological distress in midwifery populations, we were all invited to join in some mindfulness practice..What is mindfulness?

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Feeling overwhelmed?…TRY….R.A.I.N

RRecognize What’s Going On

AAllowing: Taking a Life-Giving Pause

I—Investigating with Kindness

NNatural Loving Awareness

Source: Mindful.org

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Recommended further reading

Youtube presenters:

  • Jon Kabat Zinn
  • Elisha Goldstein
  • Tara Brach
  • Sharon Salzberg

Websites/Audio Links:

Books: 

  • A Mindfulness Based Stress Reduction Workbook (Goldstein and Stahl)
  • Everyday Catastrophe Living (Jon Kabat Zinn)
  • Wherever you go there you are (Jon Kabat Zinn)
  • Mindfulness for Beginners (Jon Kabat Zinn)
  • Real Happiness (Sharon Salzberg)
  • The Mindful Nurse (Carmel Sheridan)

For more mindfulness exercises, visit the UCLA Mindfulness Awareness Research Center.

book-mark

Thanks for a very insightful and informative session!

Until next time…Look after yourselves & each other 🦄💫🎓

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‘Making & Breaking the Maternity Experience’#Uclhmw2016 – A midwifery conference

Attending and presenting work on midwife wellbeing at , I was thrilled to see so much of one conference dedicated to supporting the midwife, as well as the mother. I was also keen to hear  Jacqui Dunkley-Bent update us all on the new plans for maternity services in 2017! – Bring it on!

-Improvement in Perinatal mental health in maternity services was highest on the agenda as we can see here – midwives were really responsive to making these a commitments a reality.

Yet we can see that NHS England is also looking to transform the workforce as part of this plan. There are so many ideas buzzing around my head at the moment that I am feeling dizzy… “so much to do and so little time” – As Willy Wonka would say.

We also saw how mothers are experiencing poor support in decision making…

Both  and  really must be heard by all midwives, everywhere, more often! Read more about these experiences here. …and here.

Women are roaring for change!

Christine Armstrong

There are so many great resources available from dignity in childbirth … We really need to challenge the way that women experience respect in maternity care.

And the #CaringForYou campaign?

Sadly, bullying still a real issue in midwifery, as  confirmed … punity, public shaming & undermining must stop.. We must be kinder to one another…remember why we became midwives in the first place and love each other for the critical safety of mothers and their babies.

…..more ❤️ is needed!

We must ‘Create a positive culture’ –   says at 

What can we do?

There is indeed much to be done. I wanted to personally thank , and @MaureenMcCabe15 (and their teams) for looking after me so well as a speaker at this conference myself. I have never been so well looked after at a conference 😘😍

And thank you to all of those who appreciated my presentation and engaged in this very important work. I love this particular image that people have been sending me (see below)…I believe it was created at the#BirthTrauma2016 conference & shares a powerful message 💜💙💚

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There really is so much to do and so little time!

Image result for so much to do and so little time willy wonka

As a last thought introduced to us by Sheena Byrom ‘Midwives are humming birds never too small to make a difference’

Until next time – Take care of yourselves & each other ❤💚💙💛

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Reflecting on the #MaternalDeath report from @mbrrace as a midwife…💜

During the December of 2016, everyone involved in the provision of care for childbearing women (and the women themselves) began to reflect upon the findings of the latest Confidential Enquiry into Maternal Death. As a midwife, I am dedicated to supporting, protecting and caring for other midwives, childbearing women, babies their families. There is no doubt in my mind that these deaths have affected all of these groups profoundly, and society as a whole. But before we begin to reflect, let’s remember that the mortality surrounding childbirth (in the UK) is thankfully rare 

    

 

When we lose mothers…we also tragically effect babies…The Stillbirth and Neonatal Deaths charity (Sands) responds to new MBRRACE maternity report here

There is no doubt that we must learn from all of these  as the president of the explains here. Clearly there is much learning to do and many improvements to make. These key messages should remind us all to ask the question…start the conversation…notice the subtle clinical cues which alert us all to danger, react to risk and remain emotionally intelligent to the needs of childbearing women.

However, what struck me most was the sheer number of women who die from mental health related causes. The MBRRACE report found that “one in seven of the women who died during the period of review died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action”.

Image result for maternal mental health related deaths mbrrace

You can read the ‘expert’ reaction to MBRRACE-UK report citing mental health as main cause of perinatal death here. Maternal mental health matters – toolkit now available from for those developing a community perinatal mental health service.

Learning to save maternal lives and making change happen will not only improve the lives of mothers, babies and families. It will also improve the lives of midwives, as they will be better equipped to give the care they would like to give as their job satisfaction improves. When the psychological wellbeing of midwives is left uncared for, maternity services may see less safe maternity care. When we care for midwives, the safety and quality of maternity care may also improve. This will in turn contribute to a reduction in maternal mortality rates. So when we are looking to improve maternity care for women, their families and their babies, lets make sure that we also look to support those who are caring for them. It really is two sides of the same coin.

What can we promote?

= That it’s “OK to ask”

How can we support women & midwives? = With trust, compassion & respect

How can we improve safety?

= Evidence based care & excellent communication

 

Preventable maternal morbidity and mortality is associated with the absence of timely access to quality care, defined as too little, too late (TLTL)—ie, inadequate access to services, resources, or evidence-based care—and too much, too soon (TMTS)—ie, over-medicalisation of normal antenatal, intrapartum, and postnatal care.

Although many structural factors affect quality care, adherence to evidence-based guidelines could help health-care providers to avoid TLTL and TMTS.

TLTL—historically associated with low-income countries—occurs everywhere there are disparities in socio-demographic variables, including, wealth, age, and migrant status. Often disparities in outcomes are due to inequitable application of timely evidence-based care.

TMTS—historically associated with high-income countries—is rapidly increasing everywhere, particularly as more women use facilities for childbirth. Increasing rates of potentially harmful practices, especially in the private sector, reflect weak regulatory capacity as well as little adherence to evidence-based guidelines.

Caesarean section is a globally recognised maternal health-care indicator, and an example of both TLTL and TMTS—with disparate rates between and within countries, and higher rates in private practice and higher wealth quintiles. Caesarean section rates are highest in middle-income countries and rising in most low-income countries. Although researchers partly attribute the increase and variable rates to a shortage of clear, clinical guidelines and little adherence to existing guidelines, multiple factors—economic, logistical, and cultural—affect caesarean section rates.

Quality clinical practice guidelines need to be developed that reflect consensus among guideline developers, using similar language, similar strengths of recommendation, and agreement on direction of recommendations.

Strategies for enhanced implementation and adherence to guidelines need multisectorial input and rigorous implementation science.

A global approach that supports effective and sustained implementation of respectful, evidence-based care for routine antenatal, intrapartum, and postnatal care is urgently needed.

There is much work to be done. Until next time, take care of yourselves and each other 💜💙💛

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Why we should welcome feedback and listen to those who raise concerns in both healthcare and research

Criticism and feedback can feel uncomfortable to both give and receive. It can be an awkward exchange, where both parties may be reluctant to let their guard down, concede to oversights, reveal any flaws and relinquish any feelings of responsibility. It can also be incredibly frustrating on both sides.

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But lets look at both sides of the coin rationally. Firstly, Why would someone offer feedback?

  • They want to make something better
  • They see an opportunity to improve something
  • They want to help you
  • They want something corrected
  • You, or someone else have asked them for feedback
  • They want to offer you their unique outsider/fresh eyes view of something that you may not be privy to.

These are all gifts, learning opportunities and avenues toward creating our best outputs. Here, we theorise that everyone who offers feedback has good intentions, which some may argue is unrealistic and naive. However, I am personally unwilling to lose out on the potentially invaluable gold dust of feedback for the sake of those who wish to meddle in mischief. The vast majority of those who enter both the healthcare and academic professions do so in order to contribute positively.

In order to feel valued and perform to the best of their abilities, healthcare staff must feel heard. This is the same for those in research. As such, whether we agree with the feedback we are given, it must be heard, examined, considered and then either acted upon or rebutted respectfully.

If you are doing your best, feel passionately about what you are trying to achieve and have worked hard to achieve something amazing, it can be hard to hear that there may be cracks in your work, despite all of your well intended efforts. You are also in the job to give your best and contribute positively. But you cannot know everything…so keep listening to those who have the ‘fresh eyes’ to see what you may not.

Image result for ICEBERG OF IGNORANCE

Denial only denies you an opportunity to do better.

Lets look outside the box:

What is going on here?

Restaurant owner:

  • Wants her food to be good
  • Believes she has done her best
  • Defensive and protective about her achievements

Customer & Gordon Ramsey:

  • Wants good food
  • Wants mistakes corrected
  • Wants things to be better
  • Wants to be helpful and constructive
  • Has a new ‘Fresh eyes’ perspective from outside the organisation

The negative response to this feedback could mean:

  • The customer probably won’t return to the restaurant
  • The customer will avoid offering any further feedback
  • A missed opportunity to make things better
  • The expert will at some point back away from offering further assistance
  • The restaurant may fail to reach its full potential

FYI – These restaurant owners always achieve great things for their restaurants once they listen and act upon feedback

Reflection: Can we apply these roles to some of the roles active healthcare and research? (Including our own)!

Don’t despair!… If you get everything right, all of the time, you miss new opportunities to learn

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Some of my early academic papers were really very terrible. Some of the work I do now is muddled at first. I make mistakes, everyone does. I am in no way perfect, nor do I alone have all of the skills to change the world. I need help. I welcome help and input from those who can fill in for the skills I do not have and the knowledge I cannot yet see. This is why I welcome feedback and listen to those who raise concerns. In fact I grab every opportunity to do so.

In exchange for this, my work improves, I see new opportunities to thrive, new ideas are generated and collective collaborations make our outputs much stronger. Success.

If I had been steadfast in feeling that because I was so passionate about the work I was doing, nothing could possibly be wrong with it, then I would have missed the chance to create something better. Yes, it used to be frustrating to hear criticism. But this frustration can be turned around.

Once you see that a criticism is not a personal attack, it becomes a welcome guest.

Image result for welcome

More recently, I had a paper accepted ‘No revisions required’. I was worried. I wanted feedback, I wanted changes made, I wanted other people to weigh in on my work and check for anything I may have missed. This is because I knew it would be a stronger paper having been ripped apart and then put back together again….made better.

Everything I have ever done has always been made better when others have offered their ‘fresh eyed’ feedback. Here are my top tips for making the most out of feedback.

  • Welcome and invite it
  • Listen to it, consider it and evaluate it
  • Let down your defenses (It is not an attack – people want to help)
  • Feedback on your feedback – Tell them how it was used
  • Actively search for those who can offer a ‘fresh eyed’ perspective on your project
  • Never attack those who offer you valuable feedback (They will avoid doing it again!)
  • Know that it is OK not to be perfect, you cannot do everything all of the time
  • Avoid blinkered approaches like ‘I know what is best’ & ‘Nothing can be wrong because I worked so hard for it not to be’.
  • Offer your own feedback to others – It will not only help them, but it will make you feel good and contribute toward the collective goal!

We all want to be the best we can be. We need to role-model and make things better for everyone. We need to lift each other up with support and praise.

Let go of your defenses and welcome new opportunities for success.

Free stock photo of typography, school, training, board

Until next time, look after yourselves and each other 💙💜💚

 

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Birth Rights & Attitudes Towards Autonomy in Maternity Care

This blog post shares some of my learnings from and reflections of a seminar I attended recently, hosted by the Birthrights group at University Hospitals Coventry and Warwickshire. I have always found medical law very challenging to understand, even having studied it at Masters level…I am still largely perplexed by the complexity of it all. Yet this session seemed to simplify things for me, offering case studies and easy to understand facts…for which I am very grateful! For further learning, please see more factsheets here.

Many of the topics under discussion were drawing from the work of the White Ribbon alliance, which I am highly drawn to in their quest to promote the wellbeing of midwives for the benefit of services around the world. Below I will discuss a few of the topics highlighted which have aroused my interest in relation to my own practice.

“Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk”. – (Lancet 2010).

This publication evoked moral discomfort within me immediately. Having previously practiced as a home birth midwife, I am used to challenging the notion that home birth is a less safe option where mothers put their babies at risk. As with many studies which examine the safety of various birth places, I often see biases where the skill of the birth attendant and other relevant factors are seemingly ignored to promote the argument that ‘It wouldn’t have happened if you had only been in hospital’…But the thought that women are putting their babies at risk (and choosing to do this) fundamentally goes against my own clinical knowledge and beliefs.

This paper has led to some women having forced cesarean sections…surely this is a path which nobody wishes to go down.

The discussion and debate around fetal rights has also led to mothers being prosecuted for drinking alcohol during pregnancy. This is a moral pathway which sees the woman become a vessel for a means to an end, rather than being an end in her own right. Again, do we really want to take this path? Having explored ethical arguments myself, I think there is a better way..

In this same vein, the issue of when a fetus has rights or not has also been debated and contextualized. Now that the 24 week limit upon abortions has been lifted (decriminalized), it is clear that the mother has more choice in her reproductive decision making abilities. For me, this can only be a good thing.

Human rights-based approaches guided by the World Health Organisation

  • Non-discrimination: The principle of non-discrimination seeks ‘…to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation’.
  • Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.
  • Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has 4 overlapping dimensions:
    • non-discrimination;
    • physical accessibility;
    • economical accessibility (affordability);
    • information accessibility.

Healthcare practices that violate human rights: Drawn from the Charter for Respectful Maternity Care

Physical Abuse: Episiotomy , non consensual force, restraint, unnecessary procedures, failure to provide pain relief

Disrespect: Verbal abuse, bullying, blaming, shaming and reprimanding

Non-confidential Care: Unauthorized revelations and psychical exposure

Non-consented Care: Anything performed without adequate information or dialogue to enable autonomous decision making, or with undue pressure

Misinformed Care: biased, non transparent information given, which inhibits a woman’s ability to make an informed choice

Depersonalized Care: Inflexible application of policies or guidance, which fail to take into account of a woman’s individual circumstances.

Discriminatory Care: Unequal treatment based upon personal attributes (age, race, religion).

Abandonment of Care: Refusal to provide care due to inability to pay or birth choices (or any reason)!

Check out the Birthrights info on human rights in childbirth here

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Attitudes to Autonomy

Lastly, the following statement from a paper published in 2013 had me thinking about the impact of blame cultures within our maternity services.

“Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions.”

The statement outlines how both midwives and doctors are happy to accept that the mother has the right to make any final decisions, yet they were under the impression that it was them a the practitioner who would be legally accountable for any adverse outcomes which occurred. This may be in part due to the nature of our regulatory and litigation systems, which can invoke a fear in practitioners that they will be ‘blamed’ in some way for any adverse outcomes.

Yet adverse outcomes occur all of the time, in any case, and sometimes cannot be controlled. This is of course very sad…yet it is also an inevitable reality of some women’s childbearing experience. Nobody’s fault.

When women have true autonomy and the power to make their own decisions around childbirth, they also have inherent accountabilities in relation to the choices they make.

That is why it is more important than ever to make sure that we are recording the conversational dialogue that we are exchanging with women. Consent forms really have no use unless the information can be recalled and maintained. The law dictates that we must be open, honest and avoid influence in open discussion with women.

I personally believe that these conversations would be best recorded in digital format. See my paper on this here.

As always, it is the relationships we build with women that will always be the key to building trust, opening dialogues and beginning advocatory conversations which support women’s ability to make truly informed decisions. We must work in partnership with women and the wider multidisciplinary team in order to ensure that women can make the right decisions for them, and in turn take accountability for the decisions they make. We can only do our best in managing any situation to the best of our abilities as midwives (and as any other clinician). That is what we are personally accountable for.

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(Image via http://hakam.org.my/wp/)

Until next time – Look after yourselves and each other  💛💙💜💚

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Why be a midwife?

As I recently watched lots of eager new midwifery students find their way through the first term of their midwifery courses, I found myself reflecting on why we all chose to be midwives in the first place. Not everybody can be a midwife of course, and we are all very lucky to have such wonderful training available here in the United Kingdom…But midwifery is not always an easy professional path to take.

‼️ 😎

It is wonderful to see so many eager new student midwives around, they are indeed precious diamonds who must be nurtured as the world tries to recruit and retain a high quality midwifery workforce in the face of global shortages..

The bravery that is required to be an NHS midwife cannot be exaggerated.

Why did you want to become a midwife?

✨🌟✨

(Comments welcome below!)

What is it like being a midwife? – ‘The Secret Community for Midwives in the Making’ is full of aspiring midwives wanting to join the profession. Some of whom are really struggling to. I applaud you all for your enthusiasm and efforts, and I wish you all the very best in your endeavors…. However, it is not always a bed of roses.

So you want to become a midwife?...Midwives all over the world experience work-related psychological distress. Causes of psychological distress can include hostile behaviour towards staff, either from other staff or patients, workplace bullying, toxic organisational cultures, medical errors, traumatic ‘never events’, critical incidents, occupational stress, workplace suspension, whistleblowing, investigations via professional regulatory bodies and employers, and/or pre-existing mental health conditions.

The consequences of psychological distress in midwifery populations can result in death by suicide, death anxiety, depression, burnout, depersonalisation, compassion fatigue, shame, guilt, substance abuse disorders, and symptomatic displays of self-destructive and unethical behaviour. This situation is highly significant as it is incompatible with safe, high quality maternity care.

This situation is further reflected in the following academic paper -> ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. This latest output was kindly co-authored by Wendy ClyneAndrew TurnerEmily A. Fulton, and Clare Gerada.

So as our new student midwives may well be facing this reality soon, why do they still want to sign up?

Hint -> It is certainly not for the cash!

“If nobody comes from the future to stop you, how bad can the decision really be?”

Midwives do not enter the midwifery profession to fail, overwhelmingly they pursue midwifery because they want to achieve, contribute and be of value to the maternity services (Spitz, Sermeus and Thomson 2013). If we can remember this, then we can be kinder to ourselves and each other as our maternity services become ever more challenging.

Why did you become a midwife?

I became a midwife because I have always been fascinated by pregnancy, birth and human biology. Think about it.. its amazing! When my brother was born (I was 4 years old), I read my mums pregnancy books from cover to cover..the midwifery profession was then the only profession in which I have ever really felt at home. I wanted to make the experience for everyone.. magical.

As I am now an academic midwife, doing less and less clinical work, I find myself wanting to contribute to the profession in a variety of new ways. I am now a part of the midwifery profession because I want to improve the psychological well being of midwives in a quest for safer and higher quality maternity services. This does not mean that my original reasons for joining the midwifery profession have changed or disappeared. However, it does mean that I now realise that both excellence in maternity care and joyful midwifery practice cannot happen unless the psychological well being of midwives is adequately supported. I believe that I am now a part of the midwifery profession so that I can help to create psychologically safe professional journeys for all midwives.

What is the best thing about being a midwife?

  1. For me, the best thing about being a midwife is that every day I have a new opportunity to do something meaningful, make a real difference to people’s lives and make a positive change in the world…

    (however big or small)!

✨🌟✨

Midwives enter the profession to shine and deliver great things. Lets not let their professional ‘sparkle’ fade out.

✨🌟✨

A photo by Morgan Sessions. unsplash.com/photos/YIN4xUBaqnk

Other research (2007) reports that ‘within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of ‘burnout’ as a consequence of their ideals and values being thwarted. This led to disillusionment, ‘job-hopping’ and, in some cases, a decision to leave the profession.’ – Let’s all ensure that the same does not happen within our midwifery profession.

Keep the midwifery profession’s spark alive!!!

 How?

  • Let’s be kind to ourselves and our colleagues.
  • Let’s remember why we joined the midwifery profession
  • Let’s remember that nobody joins the midwifery profession to fail
  • As failure remains unintentional, remember that punishment and blame serve no real purpose.
  • Let’s nurture new talent
  • Express gratitude whenever possible
  • Take every opportunity to learn, mentor, share knowledge and lead with courage.
  • Listen.

Also see this blog post -> 20 Ways to Create a Thriving #NHS workforce

Join the midwifery profession because it is fabulous…. (The midwife diaries can help you with your application)… Then look after yourself because it can be a challenging ride. Stay because you want to, and then care because your fellow midwives need caring for. When we are all cared for, we can work effectively in partnership with women and each other to achieve excellence within the maternity services..

..(excellence for midwives as well as for mothers and babies!)..

Until next time, be kind to yourselves, and each other 💛💙💜💚

References:

Maben, Jill, Sue Latter, and Jill Macleod Clark. “The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study.” Nursing Inquiry 14.2 (2007): 99-113.

Spitz, Bernard, Walter Sermeus, and Ann M. Thomson. “Student midwives’ views on maternity care just before their graduation.” Journal of advanced nursing 69.3 (2013): 600-609.

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Midwives can change the world…what is your superpower?

As I read the latest Executive Summary on Global Maternal Health  from The Lancet’s Series, I (as I am sure all other midwives did) wondered how we could improve the health of women around the world.

Countdown to 2030 Officially Launches

There is indeed a countdown to 2030 to improve reproductive, maternal, newborn, child, and adolescent health and nutrition around the world. #IC2030. I have been working toward the Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) through research and by supporting midwives to be the very best they can be. Yet I am well aware that there is still so much work to be done, and midwives are in the very best position to do it.

@Countdown2030

The current challenges to address:

  • Lack of evidence-based guidelines
  • Lack of equipment, supplies, and medicines
  • Inadequate numbers of skilled providers
  • Women delivering alone
  • Lack of emergency medical services and delayed interfacility referrals Too much, too soon
  • Unnecessary caesarean section
  • Routine induced or augmented labour
  • Routine continuous electronic fetal monitoring
  • Routine episiotomy
  • Routine antibiotics postpartum

Women often left out of good quality care:

  • Adolescents and unmarried women
  • Immigrants
  • Refugees and internally displaced women
  • Indigenous women and ethnic or religious minorities
  • Women living in poverty
  • Women living in informal urban settlements
  • Women living in fragile states
  • Women affected by humanitarian crises

Whilst reading the reports, I saw that a number of global experts had been invited to share, build and deliver new innovations. This is wonderful. However, we as midwives are right at the mouth piece of change. We are there at the beginning of new life. This is a time where the opportunities for change are most prevalent. People are looking to bring new life into a better world, and we are a part of that. How amazing!

And so looking at the challenges listed, what will you tackle or address? Women and their babies trust us, they are ready to be led toward a brighter future…they look up to us..Being able to influence change at the very start of human life is a both a gift and a super power.

Midwives are superheros…what is your superpower?

With Fab Change Day coming up on the 19th October 2016…there has never been a better time to make your pledge for change (however big or small)!

(Please note that although this post is predominantly about midwives, obstetricians and other birth attendants are also a huge part of the superhero team!)

You may think that you are a small fish in a small pond, but I am telling you that there is a global pond where you, as either a small or big fish, can make a real difference!

One charity (close to my heart) is really making a difference to mothers and babies around the world ->> Maternity Worldwide. I often give them a shout out, because they really are awesome (and a fun bunch too!)…#GetInvolved with them here and here -> @maternityww.

I will continue to contribute towards evidence based guidelines and research in my quest to improve the well-being of women, babies and midwives around the world. So until next time, be the superheros I always knew you were 💛💙💜💚.