clinical practice they actually enjoy their work much better. They feel that they are being a midwife; they have time to do the things they think are important for women. Not only do women feel more satisfied, but midwives feel more satisfied, and they feel safer because they’ re caring for a woman they actually really get to know.
clinical practice they actually enjoy their work much better. They feel that they are being a midwife; they have time to do the things they think are important for women. Not only do women feel more satisfied, but midwives feel more satisfied, and they feel safer because they’ re caring for a woman they actually really get to know.
Did the surveys reveal that any other stressors are at play? Perhaps any related to the personal or client domains? No, client domain scored very low. [ The domains ] asked items that particularly related to women; caring for women. Certainly in Australia, and I think overseas as well, midwives scored very low on that. There was no burnout in that client related.
There were some personal levels of burnout, but that’ s not surprising if you’ ve got work stressors. Some midwives have personal-related burnout, in terms of looking after family, kids, organising whatever they need to do.
What are some of the other consequences that burnout can bring about for a midwife, both professionally and personally? It’ s like anyone, I think that what happens is when you’ re suffering burnout you don’ t enjoy life. You don’ t enjoy life personally. What we know professionally, of course, is that you’ re not as empathetic, you can’ t provide the quality care because you can’ t engage effectively with clients. Your relationships with other colleagues suffer. Working in a complex and often chaotic health environment becomes much more difficult when you’ re feeling down and stressed and anxious and feeling like you don’ t want to be there.
The other big thing is that we need midwives. We need a healthy workforce going forward. It’ s costly for us to educate midwives, and we don’ t want to lose them from our profession. The average age of the midwife at the moment is around 49. We need younger midwives coming into the profession to want to stay in the profession. So it’ s really important that we start to look at reforming or redesigning or realigning how we do maternity care with the evidence, which means midwives really should be working to their full scope of practice, working within really supportive multidisciplinary teams – but having a caseload of women rather than just working in fragmented ways.
About a fifth of midwives surveyed reported anxiety, stress and moderate, severe or extreme levels of depression. Why might we being seeing those levels of anxiety, stress and depression? Are they all connected to burnout, or are there different elements at play? I haven’ t got it in front of me and we’ re still looking at all the different analysis. But certainly one goes with the other. I don’ t know which one comes first. What we did find that is when we did some particular psychometric testing of the different tools, what we were able to find out is we only have to actually give midwives the six items on the work-related burnout, and that tells us how depressed they are.
It all goes into the mix together. All those things are part of the same picture. I was somewhere the other day [ and someone ] said the heart’ s gone out of health, and I think midwives and our nursing colleagues are feeling that very much now. These large health services are very financially driven. Absolutely we have to provide cost-effective and good care, but I think for many midwives – and I would think that for some or many of my nursing colleagues – there’ s a real sense that the heart’ s gone out of health, that the vision for quality care seems to be left behind. People are struggling with that, those nurses and midwives, a sense of frustration and disappointment. I think there’ s a sense that the budget or the finances are the only thing that count. That plays into people feeling frustrated around how they can provide quality care. Certainly for midwives, busy, chaotic, understaffed environments cause them to feel stress because at the end of the day they go home and they think:“ I could have provided that woman with so much better care.” Something may have happened and they feel guilty or that it is their fault. All those kinds of feelings when we’ re talking about working with women and families in what is a very special time in their lives. So midwives particularly feel stressed and anxious when they can’ t provide the care that they know the woman deserves and should be getting.
Why is it important to continue to better understand and address the high prevalence of these issues in the profession from a workforce perspective? One of the reasons we did the work in the first place is we recognised that the emotional wellbeing of health professionals, or midwives particularly, is limited.
For the last so many numbers of years, often midwives have been, in a way, told to suck it up and get on with what they need to do. We come across a whole lot of different events; being with women and their families is fantastic but we do experience adverse outcomes where we need to work through those. That causes stress. That comes with the territory, not surprisingly.
I think we haven’ t paid attention to the emotional wellbeing, and I did see a study the other day that seemed to suggest suicide was very high in both the nursing and midwifery professions. Of course, this is really important from a personal perspective, but from an ongoing workforce perspective, we want our nurses and our midwives to love what they’ re doing and feel enjoyment out of that, and be emotionally well. We won’ t have a workforce if we don’ t pay attention to that.
We’ ve done the basic work that says:“ Look, things aren’ t good.” I think now we need to really say:“ Okay, what is it that we need to do? What do our organisations need to provide their health workers with to value them?” I think that’ s the bottom line now.
One of the things that we’ re investigating is clinical supervision. Perhaps another word for it is clinical reflection or structured clinical reflection. We think this might be an intervention that actually supports the emotional wellbeing of midwives professionally. It’ s not therapy, but it’ s a way of providing or valuing midwives and nurses. They get clinical supervision for an hour every month with a trained clinical supervisor. It’ s a safe space where they are given an opportunity to work through some of the things that they have to tackle on a day to day basis.
Most of the time when you think about what we do, everything we do really in nursing and midwifery is all about relationships. Most of the structured reflection gives clinicians time to talk about their relationships and unpick those and get some help with how they can do things better.
So it’ s really important that we address this. We haven’ t addressed it in the past, we just expect people to suck it up and get on with it, when really our organisations, our health organisations, need to say:“ We really value our clinicians and they’ re the resource.” Nurses and midwives are the biggest group of healthcare professionals providing that bedside care. [ But ] often we don’ t do things or put in place strategies that really value them, and say:“ We value this. We are going to provide you with opportunities to do reflection and feel that you’ ve got some way of working through the work-related issues that pop up on a day to day basis.” ■ nursingreview. com. au | 15