Midwives and fear

A few weeks ago, Grumpy Midwife left her cosy office convenient to Costa yet within screaming distance of labour ward and ventured out once more to meet a real-life pregnant woman in her actual home. Her visit this time was at the request of an experienced community midwife who felt she needed the support of a supervisor of midwives to ensure her client understood the risks of the various care requests she was making for her forthcoming home birth,

Although perfectly happy to venture outdoors, Grumpy Midwife cannot help but be aware of a disturbing trend in the communication of risk to women. Not only must women be lectured on each and every risk however tenuous its link with whatever it is they are requesting outside of official guidance, but everybody else needs to know that this information has been imparted, a process requiring evidence and emails and special folders on labour ward.

Grumpy Midwife would not mind if this process (a) removed the necessity for all subsequent carers to reiterate all risks previously cited, and/or (b) led to more intelligent and respectful care, but it doesn’t – because at the heart of this is midwives’ fear of blame rather than women’s wellbeing.

Symptomatic of this fear is the roping in of others – consultant midwives, supervisors of midwives, anybody better paid – to explain or re-explain what any sensible midwife is already perfectly capable of explaining but lacks the confidence to do so, convinced that she will Say The Wrong Thing and be duly splattered when the s*** hits the fan and the unfortunate woman has a tricky second stage CS.

We are not alone in this feeling this fear. A brilliant essay in The BMJ (BMJ 2014; 349:g6123) describes how healthcare professionals are “required to consider an ever greater array of potential risks to the patient’s health, however well that patient might be feeling” and the “joy sapping consequences” of screening processes.

The tragedy for midwives – and for the women for whom we care – is the manner in which this fear is contributing to an erosion of professional confidence just when we need it most to meet the expectations of society. State of the World’s Midwifery 2014 describes midwives as “connective tissue for communities” whilst the Framework for Personalised Care and Population Health emphasises the lasting impact of midwifery care on the life of every mother and child.

A good midwife models and nurtures responsibility and resilience, self-confidence and self-belief. A good midwife helps women do the seemingly impossible in labour and afterwards. Succumbing to the fear of blame, and communicating this fear to women, diminishes us.

So what did the woman visited by Grumpy Midwife want from her carers? Nothing too scary; just assurance of peace and quiet in labour and lack of distraction at crucial moments, which may means that she declines the occasional auscultation of her baby’s heart if the moment is wrong. That’s all. How sad.