Grumpy Midwife is at her grumpiest when faced with a clinical shift. She spends most of her working time teaching and training, moaning in meetings, writing reports, and putting money in the swear box in her office. Then, once a week (less if she can get out of it) she pulls on unflattering scrubs, sticks a pen in her pocket, and stomps off to labour ward.
Why is Grumpy Midwife so particularly grumpy at these times? Because she has many more important things to do (like updating the training database and cleaning her keyboard) – and is secretly just a teeny-weeny bit nervous that she may get caught up (and shown up) in some hideous obstetric emergency.
But when she gets to labour ward, has a cup of tea and makes people laugh in handover, she starts to feel better. This has a lot to do with the folks with whom she works: the dramatists and divas, the thrill-seekers and the timid, the unflappable care assistants, the scary ward clerks. The gossip! (“Have you heard? No! How awful!”) The stories! (“I had a woman who …”) And aren’t SHOs fun? (Just like GM’s sons’ friends, except with stethoscopes.) And registrars so generous with their knowledge. And consultants so, well, grumpy …
Which is all very encouraging because, as a study reported in the Harvard Business Review concluded, it’s the energy and engagement of workers outside formal meetings that builds teams, and the NHS managers who recognises and facilitates this are wise indeed.
Then there’s the women and their families.
As followers of Grumpy Midwife on Twitter will know, she likes to work in labour ward triage. She takes peculiar satisfaction, first thing in the morning, in lining up the monitors, stocking up the specula, and preparing paperwork – and is actually quite peeved when patients arrive to mess up her beds. But not for long.
GM is no saint; she is therefore genuinely surprised each week anew to rediscover how incredibly rewarding is contact with women and their partners, mothers, fathers, friends (but not their toddlers; GM draws the line at toddlers). For it is one thing to speed-read 800 pages of NICE’s draft guidance on Intrapartum Care and quite another to actually start thinking about what this would mean to the woman sitting in front of you.
It is easy, for example, to write a nicely referenced guideline on latent labour with the correct emphasis on encouraging women to stay at home for as long as possible, bouncing on balls, eating oat cakes and timing contractions on their smartphones; far harder when a woman is crying down the phone after a few hours of niggling labour pains.
Similarly, when a girl staggers into the ward, red-faced and tearful, it may look like established labour, sound like labour, feel like labour but, if her cervix isn’t four centimetres dilated, it’s not supposed to be labour.
Away from the bedside, midwifery becomes technical and scientific; it is only with women that the full artistry becomes apparent.
A recent personal piece in The BMJ attacked competency-based medical training as a box-ticking exercise that reduces doctoring to “the mechanics of procedures”; an absurd situation akin to an artist being assessed on how they hold a paintbrush rather than use colour and form, depth and perspective to produce a picture.
It is only with women that midwives can see the whole picture – messy, moving, disturbing, inspirational – and this is why the busiest manager, the smartest lecturer, the grumpiest midwife should jolly well get out there, once a week, to palpate bellies, take pulses, test urine, wipe tears and put the humanity into those damn policies we spend the rest of the time writing.
And those real-life obstetric emergencies? Needless to say, Grumpy Midwife has long since mastered the tick of walking purposefully and confidently, but very slowly. To give other midwives a chance to shine. Obv.