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


Carolyn McIntosh said...

What a joy it is to be a midwife. To work with women and their families through this truly special time in their lives. Now that I am teaching student midwives and only doing a little midwifery cover for others I really miss that special relationship that midwives have with women and their families. The downside is that a bad day at the office for a midwife is something that is never forgotten. Women never forget if the midwife does not come up to their expectations. If things really go badly wrong the midwife can expect to see her name in lights all over New Zealand. She will face years of investigations through ACC, Health and Disability Commissioner, Midwifery Council and Coroners court.
I have to say that this is something that is often somewhere at the back of my mind when I am practicing. I do not worry about myself. I can look after myself, and I may after all deserve the censure. What I really worry about is how it would affect those close to me. How would my family cope with seeing their mother, sister, wife, aunt, being dragged through the media mill? How would they respond when challenged by others? This is a huge burden that I think all midwives bear. I know other health professionals have similar issues but I do think that midwives are somewhat unique in the amount of vitriol that is cast their way when things go wrong. Yes I do believe that this has an impact on midwifery recruitment and retention. I think this may well also play a part in the reluctance that friends a family sometimes express when hearing of the intention to become a midwife.

Sarah Stewart said...

Thank you, Carolyn. You have been a lot more articulate than I have and nailed the question on the head. And I must admit, the pressure of being a midwife was certainly on my mind when I counseled my daughter about being a midwife. I also agree that there are many joys in our job and it is important not to lose sight of those. As I look back on more than 20 years as a midwife, I know I have made a difference in many women's lives. But as the saying goes, you're only as good as your last birth!

Myra said...

I think the issue is compounded when you consider the extra scrutiny midwives are under in comparison to other birth professionals. The midwife must not only look after the health and wellbeing of her clients, but also the wellbeing and reputation of her profession as a whole. And, in many areas, the midwifery profession is in a very tenuous state.

(PS, I added you to my blogroll)

Sarah Stewart said...

Thank you, Myra. Your point is extremely valid and the reason we must stick together and listen to each other, both nationally and internationally.