Monday, December 10, 2007
Blaming the midwife
The recent death of a baby following its early discharge from hospital brings midwives' practice to the fore again. I have no intention of commenting on this particular case but it does have the effect of making one's heart sink because "there but for the grace of God go I".
The lead maternity carer midwife carries a tremendous responsibility and when something goes wrong, she is the one who ultimately carries the can. The midwife in this case will be feeling sick because of the death of the baby and its effect on the family. But the midwife also knows she will be undergoing trial by media in the ensuing weeks as well as facing considerable pressure from the investigation that will now be carried out. This will impact on her personal and professional life; her health, her financial security and the peace of her family.
Now, I am not saying that when midwives make mistakes, they should not be held accountable. Indeed, midwives who perform poorly outside prescribed professional standards and guidelines should be made to account for their decisions and actions. Midwives in New Zealand undergo a rigorous undergraduate three-year midwifery education program in order to be able to deal with the responsibilities they carry. Once midwives are qualified, they are legally required to participate in a program that ensures ongoing competence. They also have a framework(Section 88 Maternity Notice) that clearly spells out the services they must provide.
But there are times when even the most experienced and well-meaning midwife has an error of judgment and makes a mistake. Midwives are no more perfect than doctors or any other health professional. Granted, midwives cannot afford to make the sort of mistakes that put mothers and babies' lives at risk but at the same time, midwives' actions have to be put into context. In this case I have been talking about, the context is a very busy tertiary hospital and we do not know at this stage what else impacted on the midwife's decision to send the family home.
To be honest, I am not totally sure where I am going with this post. I guess what I want to have acknowledged is that the midwife's job is far from an easy one, although there are a number of professional processes in place to support her, and we should not be quick to judge. I also think we need to acknowledge that there is additional stress in the midwife's job knowing that she cannot afford to err in judgment because even the smallest slip can have severe repercussions.
What I question is: do midwives do enough to support each other in this world where even the smallest error can impact hugely on one's professional standing? Is the stress of this which hangs over midwives all of the time acknowledged by the profession, or am I just blowing one incident out of proportion? I would also like to know how much of what I have been talking about is a serious issue for midwives? Anecdotally, I have been told that it is an issue that midwives consider and may have an impact of retention. But as far as I know, there has been no research in New Zealand to really look at this.
What I am suggesting is that it is time for us to carry out national research that looks at midwives' recruitment and retention and seriously take on board what midwives say about the issues of being a midwife. In these days of increasing midwife shortages, we cannot afford to ignore what midwives say as being just the rantings of a few dissatisfied midwives who cannot manage their workload.
I would be very interested to hear from anyone who has an opinion about this post, either as a midwife, parent or by-stander. Please feel free to comment anonymously.
Image: 'I9m not keen to shift the blame' John Goodridge