Dr Diane Menage

Compassionate midwifery makes a difference to women, but it is just as important to midwives.

These are difficult times for the midwifery workforce. The WHELM Study was commissioned by the RCM and carried out by a team from Cardiff University, led by Professor Billie Hunter, to explore the relationship between the emotional wellbeing of UK midwives and their work environment. It was a serious effort to find out more about what factors contribute to the ever growing problem of low morale and attrition. The results, from around 2000 midwives surveyed, indicated worrying levels of emotional distress and burnout. Those in the greatest need of support had the highest levels of burnout. Younger and less experienced midwives and also midwives with a disability seemed to be particularly at risk.There is more, and if you have not read it yet then please click on the link above and take a look.

The RCM Conference in Manchester last October was a great success in many ways. BUT I was expecting the RCM to discuss the WHELM Report and respond with a way forward. As the only trade union and professional organisation dedicated to serving midwifery, I (and many others) thought that the RCM would want to address this in some way, but it didn’t happen. Many people were baffled by this. I wrote a blog expressing my disappointment that Gill Walton (RCM CEO) had not used the conference to highlight and respond to the study findings. One thing led to another and Gill Walton invited me to meet up with her. She seemed interested in my research on compassion in midwifery and how I believed it linked to the WHELM Report. It took a while to plan our meeting, as Gill is very busy in her RCM role. During that time I had discussed this subject with lot of midwives to find out more about what their views were on WHELM. I wanted to make sure that I was able to represent, not just my opinion, but that of other midwives.

Anyway, on Thursday it happened! I went to London to see Gill in person at RCM HQ.

I was made to feel very welcome and Gill was clearly keen to hear what I had to say. I talked to her about the findings of my research: Women’s Lived Experience of Compassionate Midwifery and how it has shone a light on the importance and impact of compassionate midwifery, for women. Then I turned to the WHELM Report. It became apparent that Gill wants the RCM to respond but the question she was taking time to consider, is how? She talked about how the recommendations from WHELM link with The RCM Caring for You Campaign and how this could be a constructive way forward. I agreed, I think it should reinforce Caring for You and take it to a new level. I was impressed by the way that Gill was really listening and considering the best way forward now, given the really very concerning findings from WHELM.

I invited Gill to consider a compassionate response to WHELM. Compassion involves the recognition of another’s suffering and the emotional connection, motivation and actions aimed at relieving that suffering (Menage et al 2017). I explained that, as I see it, WHELM is evidence of midwives suffering as a result of their workplace experiences and conditions. Therefore a compassionate response must start with recognition and acknowledgement of that suffering. This should, of course be followed up with an action plan but the recognition has to come first. We know that this is true when we show compassion for women who are very frightened, in emotional or physical pain, depressed or distressed for any reason. As midwives we know that we have to recognise what is happening first and acknowledge it. Only then can we work with the woman to try to find ways of relieving it. As human beings, we know that when others ignore or disregard our own suffering, it is a painful experience in itself. Recognition of others’ suffering and standing with them in that suffering is a compassionate human approach, and what is more, it helps!

I was heartened by Gill’s response. Clearly the RCM do not have all the answers to a seriously over-stretched and under-resourced NHS, and midwives do get that. But Gill was very open to considering what the RCM could do. She seemed genuinely enthusiastic about a compassionate way forward.

Only time will tell if the RCM can demonstrate their compassion effectively for midwives who are clearly suffering. I believe they can. I left London feeling optimistic that my suggestions were heard, understood and will be seriously considered.

Thank you so much for listening Gill Walton.

Reference

Ménage, D., Bailey, E., Lees, S., and Coad, J. (2017) ‘A Concept Analysis of Compassionate Midwifery’. Journal of Advanced Nursing 73 (3), 558-573

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It’s has been an inspiring and thought provoking day for me attending the first day of the RCM conference in Manchester. The day started with such a buzz as midwives piled into the Manchester Central Convention Complex. It was good to see so many midwives from all over the UK today and talking to midwives I have never met before as well as those I haven’t seen for a while is a big part of Getting the most from a conference like this.

There have been some great speakers and sessions but the first session in the Main Programme: Conversation with Gill Walton, the RCM CE has stayed with me. It was a great start with the RCM CE up on stage outlining the last year of RCM work to a packed hall. Better sill with the conference app delegates were able to pose questions to her. This was a brave move and she competently dealt with a number of issues including a new report about prevalence of domestic abuse for HC workers and the impact of changes in student midwifery funding. However, I was disappointed with her response to a question about The WHELM report https://www.rcm.org.uk/sites/default/files/UK%20WHELM%20REPORT%20final%20180418-May.pdf. This study by Cardiff University has highlighted staggering levels of stress, burnout and depression amongst UK midwives. But Gill Walton tackled this topic by advocating positivity towards midwifery. She called for midwives to focus on the good things about the job and difference it can make. I am afraid I think she missed the point here. Midwives generally know that they are in a fantastic job and that they have an opportunity to make a huge difference to women. That is not the problem. We don’t have a problem with enough people being attracted to the profession (yet) but we have a very big problem keeping qualified midwives in the profession without them getting burnt out. It’s not the true nature of the job that is the problem, it is the culture. It is the frustrating organisational systems, the onerous record keeping, the fear and blame, the bullying, the impossible workload which prevents midwives from having basic breaks. Above all it is something to do with the lack of support in their role which makes huge emotional and physical demands on them.

The response The WHELM Study must be one of compassion. Compassion is a response to suffering and what WHELM tells us is that many midwives in the UK are suffering. This is a serious threat to the profession and must be acknowledged and addressed. Compassion is a process which involves recognition of another’s suffering and the motivation and will to relieve that suffering. This is what midwives need now. Positivity has a place but it cannot relieve suffering. When women are suffering because they are exhausted, frightened, feeling vulnerable or in pain, positivity has limited effect. So we listen to women and notice how it is for them and this way we try to understand what would help them and provide it. Compassionate midwifery must apply to midwives too. The response to WHELM starts with compassion.

The last day of the congress and I want to reflect on how despite the difficulties that midwives have to work in they grow from strength-to-strength by finding ways to overcome these difficulties. Yesterday my blog focussed on the terrible suffering of FGM but today my first thoughts are on overcoming the distresss caused by difficulties that midwives sometimes endure in their work.

On Wednesday Sally Pezaro from Coventry University presented her work on midwive’s workplace distress. Midwifery is highly emotional and sensitive work and yet we often work in high stress environments. Sadly fear and bullying can also be a problem in our profession. Sally reminded us that fearful, stressed midwives do not provide best care and suffer from poor physical and mental health. She proposes an online intervention for midwives experiencing workplace distress. A one-stop-shop where midwives can gain support at any time, wherever they are. Her PhD research project has been testing the feasibility for such an intervention.

Midwives throughout the world are finding ways to overcome women’s  sufferring. On our last ICM morning there were many presentations and workshop including sessions on: Tackling gender barriers to education fo females in Ethiopia, Promoting autonomous, family centred care in a over medicalised environment in Switzerland, addressing women’s rights in Rwanda and caring for pregnant women who are displaced or seeking asylum.

And so to our closing ceremony. Once again a moving and powerful occasion. All 4200 of us came together again to reflect on this inspirational 31st ICM Triennial Congress hosted by The Canadian Midwives Association, which by any standards has been a huge success. The retiring ICM President Francis Day-Stirk handed over to the the new incoming President Franka Cadee.

We thanked the Canadian Midwives Association for their excellent hosting and were addressed by The Malaysian Midwives Association President and members, in national dress, who invited us all to attend the 32nd ICM Triennial Conference which they will host in Bali in 2020.

Our new ICM President reminded us that most of the problems in maternity care throughout the world relate to care being too little too late or too much too soon.. She emphasised that throughout the world midwives make a difference to women and their families and represent a low risk, high yield investment in maternity care.  Therefore all women in all countries should be able to access midwifery care.  Finally to enthusiastic applause she said:

We are midwives, we know when to breath and when to push,  and it’s time to push!

As we leave Toronto there were many heartfelt goodbyes, some exchanging contact details and many photos!

Midwives from Peru and Brazil leaving

Goodbye Toronto. 

Stay connected

You can keep in touch and find out about my midwifery interests and research at http://www.compassionatemidwifery.com

email me diane@compassionatemidwifery.com 

Follow me on Twitter @ Dianethemidwife​​

It has been a difficult day. Thought provoking yes, informative yes but still a difficult one. For those of you who know my work (http://www.compassionatemidwifery.com) or who came to my presentation on Tuesday you will know that I study compassion in midwifery and that compassion, by definition is a response to suffering. Today I attended sessions which highlighted suffering of different sorts and explored responses to it.

I attended three linked presentations on female  genital mutilation (FGM), the first of which was delivered by Elinor Clarke from Coventry University. Elinor gave an clear and useful introduction to the topic and explored the midwife dilemma regarding the mandatory requirement to report FGM and the issues around confidentiality. 

Elinor Clarke, Senior Lecturer in Midwifery at Coventry University and Chair in the FGM National Clinical Group in UK

Later I attended a workshop called Maternity Rights: Making a Difference for Circumcised Women also facilitated by Elinor and other midwives, health workers and activists. Nancy McKenna, a film maker and founder of Safe Hands for Mothers played a key part in this Worksop. See their website

http://www.safehands.org/

During the workshop clips from her films were shown, highlighting personal accounts from girls who have been through FGM and are still suffering the consequences as well as the stories of those who do the cutting – women – and from men in the communities. We worked in groups to try to generate ideas about how FGM which is so deeply entrenched in the culture of  the communities where it is practised can be stopped. It became apparent what a complex problem it is. I wept as I watched the film clips. It is so barbaric and causes so much suffering. Yet 200 million women and girls are living to day with the effects of FGM and 3.6 million are at risk each year. 

I met Hibo Wardere who is part of The Orchid Project who is an activist.  Her book: Cut, One Woman’s Fight Against FGM in Britain Today gives a personal account of her FGM story. 

http://www.simonandschuster.co.uk/books/Cut-One-Womans-Fight-Against-FGM-in-Britain-Today/Hibo-Wardere/9781471153983 

She agrees that the problem is a stubborn one and sometimes seems very difficult to make any impact but little by little their work of raising the profile, gaining an understanding the issues in different communities, education, activism, campaigning, communicating and advocating, little by little it is changing but my goodness there is such a long way to go.

Hibo Wardere

I also met Janet Fyle MBE the RCM Professional Policy Advisor. She really challenged my thinking as we went through the workshop excercises and the enormity of the problem revealed itself. My ideas on how FGM might be stopped were naive and simplistic and would not work in the communities where FGM is the norm.  She is in for the long hall and I am thankful for her understanding and work on eradicating FGM. I urge anyone who can support this work in any way to do so. Watch Nacy’s films, and look at the Safe Hands for Mothers Website, read Hibo’s book, get in touch with the Orchid Project, donate, volunteer, do what you can.  http://www.safehands.org/ 

Janet  Wardere

I have other things I would like to report on from the day but I don’t think I can do them justice after attending this workshop. I will include them in tomorrow’s blog instead. 

Thank you for reading, especially as this is such an uncomfortable subject. Let’s work together in whatever way we feel we can to end FGM and the suffering it brings. This is fundamental to compassionate midwifery.

All over the world midwives enter into women’s lives to support them through pregnancy, birth and early adaptation to motherhood. All the sessions I attended today reflected this, starting with the session entitled ‘Socially Complex Lives’ in which three separate presenters described their projects with vulnerable women. Presenters from London and Rotterdam gave interesting talks on their research and practice  first. But the highlight was Dr Liz Bailey and Carmel McCalmomt presenting and sharing the iBumps project: a special service for teenagers in Coventry. The iBumps Midwives (Sam Nightingale and Tracy Standbridge-Boyle) were unable to attend the ICM because of other commitments so Liz gave a very clear and engaging account of their experience of setting up this successful project which offers young mothers enhanced personalised support from specialist midwives. Feedback from a young mother was shown in a film , she gave a personal account of the benefits of this compassionate and much valued service. iBumps clearly makes a difference.

At coffee time I went to see more posters and the Coventry University and UHCW posters seemed to be attracting a lot of interest. These included Sally Pezzaro’s poster on Workplace compassion for staff in the NHS a subject dear to my heart. Also the Midwifery Lecturers project on parent education in partnership and research on protected quiet time for new mothers and babies in the hour following birth.

After coffee I was spoilt for choice again! There was so much on offer including a session about midwifery care in disaster areas and another on the ways midwifery students can be supported with accounts from USA, Canada, Germany and Afghanistan. In the end I chose a session on Midwifery Leadership. There were three excellent presentations. My take home message from presenter Susan Calvert: ‘The biggest challenge is getting all midwives to realise that leadership is their role’. I reflected on this as I left the session. It’s true, if midwives are to make a difference they have to see themselves as the leaders and have the courage and skills to say when things are not right and to lead improvements in care whenever they can, rather than wait for others to lead it. 

During the afternoon I felt excited and nervous. Today was the day for my presentation: The Concept of Compassionate Midwifery. For more information on this see my website    

http://www.compassionatemidwifery.com

I was the third and last presenter in a session entitles Giving Voice to Respectful Care. The first two speakers were excellent, presenting research from North America and Jamaica so I felt a bit daunted. I took a deep breath.  I knew my work was unique and relevant and I was practically bursting to share it with midwives from around the world.

I was so hoppy with how it went and the response I got. The audience were engaged and attentive and seemed to really get it! I had lots of questions from them in the allotted question time and many coming to speak to me afterwards. I could not have wished for more.

No time to hang around though, it was the ICM Gala Dinner starting at 6.30pm and  we needed to get our posh frocks on! 

I heard there were over 1000 midwives at the ICM Gala Dinner. So more networking and learning about midwives far and near but this time with a relaxed party atmosphere.  What I can confirm is that when 1000 midwives get together with food, drink and dancing they certainly know how to party – enough said 😊

More tomorrow. Thank you for reading.

http://www.compassionatemidwifery.com

Twitter @Dianethemidwife 

It’s been a totally different day. The pomp and ceremony is over. The flags stand like silent, still soldiers in their position. The singing, drumming and dancing seems a long time ago because this morning the scientific programme commenced and all the delegates have been getting down to the serious business of listening, questioning and learning. 


To say it is an impressive programme is an understatement. There are plenary sessions, concurrent sessions which each consist of three presentations, workshops and symposiums which have several speakers with a common focus. There are also the poster displays containing more than 500 posters and the exhibition. All this needs to be tightly managed as the conference centre is vast and you might be in one part of the building for one session and the other side of the building for the next and at some point a coffee and a loo visit will have to be included. So arriving at the right sessions on time requires forward planning, time management and a fast walking pace! 

So what were my highlights today? Well there have been many excellent sessions on a range of  subjects including human rights, accessing antenatal care in different parts of the world and cultural safety as well as midwife-led birth centres, managing breech birth and perineal care. My favourite session was Marie Lewis presenting her PhD research on Women’s Experiences of Trust within the Woman/ Midwife Relationship. Marie noted that the word trust is being used frequently in relation to midwifery but with no concencus on what it means within the woman/midwife relationship. She carried out a concept analysis initially and then interviewed 10 women several times during their pregnancies and after their births. She found that trust built during the pregnancy and was reciprocal. Women had a need to trust midwives but midwives also need to be able to trust women to make their own decisions . I loved this research because it has links with my research on compassion . Marie gave a flawless presentation and there were lots of questions from the audience.

I also enjoyed the exhibition hall with its many stands. This stand displaying beautiful birth art certainly brings in the crowds

The  Kangaroo Mother Care (KMC) Challenge is drawing a lot of attention. Premature birth is now the leading cause of death for young children worldwide. KMC is an effective way to meet a premature baby’s basic needs for warmth, nutrition, stimulation an protection from infection.  It is thought that this sort of care has the potential to save hundreds of thousands of babies’ lives and yet it is not widely utilised. Many of the ICM delegates are taking up the challenge to try out kangaroo care with a premature baby doll for 24 hours to raise awareness and generate more discussion and debate on KMC. Here is Dr Luz Bailey taking up the challenge. 

What a stimulating day. Tomorrow there is lots more and  the 4pm session in Rm there is a session entitled Giving Voices to Respectful Care when I will be one of the three presenters . I will be presenting my work on The Concept of Compassionate Midwifery. Do you have thoughts about what Compassionate Midwifery is? I would love to hear them. Come along and hear my session and contribute to the discussion.

Www.compassionatemidwifery.com

Twitter @DianetheMidwife 

Today I attended the opening ceremony of the 31st ICM Congress in Toronto. I had certainly been looking forward to it but I was unprepared for the impact it had on me. 

I had been to the multi-faith event earlier in the afternoon which welcomed midwives of all faiths, and none, to come together and reflect on Midwifery and to respect our differences in beliefs, culture and traditions and  celebrate our strong midwifery connection.  I don’t have a particular faith but I understand and appreciate that others do and that it may play a meaningful part in their lives. I loved the idea of coming together in this respectful way. There was beautiful singing and music and drumming! Four midwives each gave a short talk on how their faith impacted on their life and work as midwives. It was heart-warming to see. Christian, Muslim, Hindu and Jewish midwives together in this way.  At a time when we are constantly reminded  of examples of discrimination and even hate based on differences, it was a powerful reminder that we all have more in common than we have differences

A key message from the session for me was from the words of one of the songs that were sung. I think it sums up how we are inextricably linked, whatever our beliefs and backgrounds.. From memory ( which can be a bit iffy) I think it is a song by Peter, Paul and Mary and goes something like this:

There’s only one river, there’s only one sea. I’m flowing through you and you’re flowing through me.

The is only one river. There is only one sea. 

And it flows through you, and it flows through me. 

There is only one people. We are one and the same. 

We are all one spirit. We are all one name.…
Soon after the multi-faith service we assembled outside the Plenary Hall for the opening ceremony. The atmosphere was buzzing with energy and anticipation. Some midwives were dressed in costumes that reflected their countries and cultures. Some countries co-ordinated their look which made it easy for them to be identified and easy for them to identify each other amongst over 4000 other midwives. The Australian contingency had the best hats for sure! The British Midwives had no such accessory but we waved our union jacks high in the air to be identified and gradually all the British Midwives gravitated towards each other. We all entered the Hall and took our seats. The excitement was palpable. 

The ceremony was one of the most moving occasions I have ever attended. I was moved to tears several times and know that I was the only one. There were extordinary, inspiring speeches and there was a wide variety of artistic and traditionally inspired performances of music and dancing. All of these were fascinating and we were all mesmerised by the the world champion hoop dancer and the Inuit throats singers to name just two of the more unusual acts. But the traditional flag ceremony was the absolute highlight for me. Every country had a big flag on a flagpole which was carried by a midwife representative from that country. Our flag was carried by our wonderful Lesley Page who was our President of the RCM until very recently. In alphabetical order each flag was carried up to the stage. This parade of flags from 144 countries has been likened to the Olympic Games of midwifery! It was the most inspirational and moving experience and I think everyone in the room felt it.

It was absolutely fabulous. I have never felt so proud to be a part of this profession which has been around in some form since the beginning of human civilisation in the world and has developed into something that has such a huge impact on women, babies, families and the whole of humanity. Midwives making a difference in the world.

Yesterday I had the opportunity to go beyond the idea of midwifery in the context of something that happens in a particular maternity setting or place and really saw the midwifery of the entire planet. We all get a little blinkered by what we are used.  I don’t want to underestimate the differences in different countries. One of the most obvious is the economic, social and political differences. Many midwives had left their countries for the first time and had difficult journeys. Some midwives work heroically in their own countries to provide care with so little in the way of resources or in areas of conflict or civil unrest. But fundamentally we are the same. We are one. One midwifery.

Thank you for reading. More tomorrow.

Yesterday I made the journey from my home in Warwick, England to Toronto, Canada to join other midwives from all over the world for the International Confederation of Midwives (ICM) Triennial Congress. From the start I was linking up with other midwives. I sat next to Regina from Zimbabwe on the plane and shared my train journey from Toronto airport into the city centre with these two lovely midwives Octavia and Teresa from London. Both will be presenting and I am hoping to see more of them over the next few days. 

I arrived at my hotel and put some cooler clothes on as it was hot, humid weather. I found my travel kettle and tea bags and made a quick cuppa. I can’t do without tea! So I have set up the essentials in my room. I had  rememberd that hotels only supply coffee makers in these parts. Ah, there  is only a disposable cup in the room!  I must buy something more substantial to make my cuppa in today. I guess I like my home comforts.

Then with map in hand I headed straight for the Start of the March for Midwives and arrived just to as around 4000 midwives were setting off from Roundhouse Park. It was a wonderful coming-together with midwives from all parts of the world. We bought Toronto to a standstill. Thank to the Toronto Police for their organisation and support. 

We marched through the city and sang,  waved our flags and chanted our message: that the world desperately needs more midwives. I caught up with some of the UK contingency. 

I also talked to midwives from Canada, Australia, Jamaica, Belgium, Brazil and Laos (https://en.m.wikipedia.org/wiki/Laos) to name just a few. 

Midwives save lives. In places where women have free access to midwifery care and where midwives are valued and free to practise autonomously within a healthcare system, maternal and neonatal outcomes improve. See the Lancet series on Midwifery for the evidence for this http://www.thelancet.com/series/midwifery . This will be a key theme over the conference. But there is so much going on and so many midwives sharing their learning from their research, practise and education.

Over the next few days I want to give a flavour of what is happening at this conference. I want midwives and others who cannot attend to feel part of this community and share in the learning.  I aim to blog at the end of each day to report highlights.

Thank you for reading.