Tuesday, December 18, 2007

Midwifery and sustainability

Sustainability appears to be a big theme in all walks of life. For me as a midwife, sustainability is all about how I maintain my practice in a way that provides quality of care to the woman I am responsible for, at the same time as maintaining a personal and family life. Sustainability is about maintaining job satisfaction by providing total midwifery care, yet avoiding stress and burnout. This has been one of the themes of this blog, and clearly it is an issue that is affecting the midwifery profession globally.

The New Zealand College of Midwives has responded to the issue of sustainability in its latest edition of the 'Midwifery News'. Karen Guilliland has written an article entitled ' Supporting and sustaining ourselves' in which she exhorts midwives not to focus on the negative aspects of midwifery practice but rather to continue to fight to guard our autonomy and be steadfast in the knowledge that women want midwives to work with them to achieve normal birth.

Karen is right to remind us that midwives in New Zealand have wonderful opportunities to practice autonomously and we are very privileged compared to a number of countries such as Australia. We have our own statutory/regulatory body - The Midwifery Council of New Zealand - which is quite different from the UK and Australia, where midwifery is overseen by nursing. We have the ability to be self-employed and be totally responsible for the care we provide without being overseen by other health professionals. We have an extensive scope of practice in which we can order medical investigations, refer directly to secondary services and prescribe medication. But this is not enough if the midwife shortage and discontent amongst midwives is anything to go by.

I have to admit that after reviewing some of the posts of this blog, I could be accused of some of the things that Karen talks about - focusing on the negatives such as workload, blaming women for not doing their part to achieve normal birth, losing hope that normal birth is achievable. So I must take responsibility for how I contribute to the sustainability of midwifery, and I see my role as lecturer as a vital part of that. I also see my endeavors to explore alternative means of supporting each other by online communities of practice and e-mentoring as another approach to sustainability.

Every midwife must look at how she can contribute to the sustainability of midwifery so that the profession maintains its autonomy and isn't re-consumed by medicine and nursing. Midwives are hugely responsible for the way the maternity system runs, so you are not happy with it, you must ask yourself how you can work to change it.

Having said all that, I also believe it is vital that we listen to what midwives are saying about the realities of practice in today's world. As Karen said, it is a journey we are on, and we are not in the same place that we were in nearly 20 years ago when midwives in New Zealand first gained their autonomy. It is not enough to blame midwives' discontent on the mis-management of their caseloads.

What is the reality of midwifery practice for you? What do you feel the profession can do to encourage its sustainability?

Guilliland, K. (2007). Supporting and sustaining each other. Midwifery News. No 47, December, 6-7.

Image: 'Sustainability Without Compromise' Richard Eriksson www.flickr.com/photos/35034348378@N01/146872543


Carolyn McIntosh said...

Yes there are a lot of components to the recertification programme, However I think most practicing midwives do these updates and study days anyway the only additional thing really is documenting and reflecting on learning goals that arise form these. It looks big but is not really so terribly difficult to achieve in practice. I think it is more challenging for those who are not working in an LMC capacity, those who work in a particular area, postnatal, antenatal clinic etc. Or those like you and me who are outside direct practice, those in administrative or teaching positions. For us many of these activities are extra to the already very busy jobs we do.

I would love to hear some positive stories about midwives who are loving what they do and are happy doing it. We do seem to hear an awful lot of the negatives.

I think one of the big issues about the recertification process is that midwives do not want to do anything unless they will get points towards their recertification. We used to have some really good study days in Otago which do not happen now as there were no points attached and so they are not valued or attended.

Sarah Stewart said...

I agree, Carolyn. To be honest, I think its the points system that I am not too sure about. I wonder if a better to have done it was to have made it an hours allocation rather than points. But then again, how do you prove how many hours you have spent on an activity?

Leigh Blackall said...

Well, I'm a reader but I'm not a midwife or a woman... am I welcome here? I read this blog in an effort to get to know issues and concerns facing midwifes and midwifery training.

While I think the sustainability of your sector and the culture it enjoys is important, I can't help thinking that sustainability runs a lot further than that and would like to see you explore sustainability in the broader sense as it relates to midwifery practice and parenting generally.

Perhaps you will need to look further than midwifery. Here's a link to Samuel Mann's blog. He is a software engineering letcurer at Otago Polytechnic. His blog focuses on sustainability in the broader sense and how it affects his practice. I find it heavy reading though.

Why do I want to read about sustainability and midwifery.. well, it is becoming a topical issue at the Polytech (along with everything else!) and I would like to start seeing how midwifery relates to the world around us more broadly.

Sarah Stewart said...

You are extremely welcome here, Leigh. Your comments always challenge and motivate me. I think it is just as important to get your view as it is to get those of pregnant women and/or midwives. And I am extremely interested to hear from an outsider looking into the world of midwifery.

As for your comment here, I know you are right - it is time that I start to think outside the 'midwifery square'. Midwifery does tend to be insular. We have spent so long battling to become an autonomous profession that we sometimes forget there is a wider world out there.

As I have said before, we tend to think of sustainability as how we keep ourselves afloat. But you're right when you say that sustainability is more than that. But sometimes I am so tired with trying to keep all my balls in the air that I do not have the energy to think any wider...and I believe that is a very serious problem for midwives.

Carolyn McIntosh said...

I have been thinking a lot more about sustainability of midwifery practice spurred on by you. I am going to write some posts on this when i get a moment to clear my thoughts and do so. So thanks for challenging again.

Leigh Blackall said...

yes, I know the feeling. Its not just a problem in midwifery. Its just as much of a problem in Educational Development (my area). Hopefully blogging will offer us the opportunity to get outside our insulation from time to time. Every now and then we might find an ah ha moment that we can bring back to our work and transform something for the better - or worse...