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