'A dent in my armour' - Building resilience in Midwifery

That is what it felt like a few days after the event. A dent in my armour. A dent in my belief pattern of childbirth being a happy and exciting experience for families and for myself as a student midwife.

For confidentiality purposes I will be changing some facts of the events but remaining honest in my feelings and opinions.

At my university before you head into second year you are taught the theory of obstetric emergencies. What to do if a woman has a spontaneous rupture of membranes and the cord prolapses, the positions and techniques to use for a shoulder dystocia, the medications used to treat an eclamptic fit.
Theory.
Unfortunately in my opinion only a small section of that really prepares you when you encounter with an obstetric emergency in real life.
I completely understand why obstetric emergencies are not discussed in depth during first year training, we need to understand normal to identify abnormal, but labour ward and childbirth doesn't discriminate based on your experience and for some, seeing these emergencies can impact upon their emotional resilience and training for the rest of their career.

I was prompted to write about this after being on my labour ward placement and experiencing second hand the emergencies we had been taught. I was not looking after these women but was on shift during the events.
For me, just being in the labour ward when a woman had a cord prolapse, diagnosis of an IUD, placental abruption and an eclampic fit occurred really opened my eyes to management of obstetric emergencies and the resilience of the labour ward midwives. Especially when it came to managing their own emotions and actions before and after the event.

The one event that made me question my own emotional resilience was a stillbirth. Again, I was not looking after the woman but was on shift. The emotions within the entire labour ward were hard to ignore, yet an air of extreme professionalism remained.

An article shared by Hannah Dahlen on twitter (@hannahdahlen) by Rakime Elmir, Jackie Pangas, Hannah Dahlen and Virginia Schmied 'A meta-ethnographic synthesis of midwives’ and nurses’ experiences of adverse labour and birth event' highlights a few important areas of focus for midwives after a obstetric emergency. I would advise reading it.

In the article midwives and nurses noted feeling relatively unprepared due to the rapid unfolding of the event. They themed this as 'Feeling the chaos' - having to respond quickly both practically but also emotionally. Facing different emotions including, fear, disbelief, shock and anxiety. 

Many midwives noted that they are continually learning from these experience and I believe this is where the resilience grows.They see it as part of becoming a midwife, professional growth and understanding emergencies better. By using positive debriefing and reflection, continually developing skills and practice for any future events.

But I also think it is important that the culture in which midwives practice in is support after events. Debriefing is used, reflection is championed, for example writing a statement, to ensure midwives are not left with emotional trauma.

Unfortunately some events can cause midwives to change their view of midwifery, to start practising defensively, increase risk management and even vigilance which sometimes can be downfall for promoting normal physiological birth. 

The resilience of midwives should be highlighted as an important skill as this can impact upon the core belief of a midwife to build a caring relationship with the mother and family and then when an emergency occurs, how to deal with this both personally and professionally.

I agree with a lot of the finding of this article and believe it is important for midwifery services to be aware of midwives experiences of adverse labour and birth outcomes. This will effect different aspects of staff moral, and needs to be highlighted as an important area for compassion and care within maternity services and to provide midwives with the emotional support needed after these events. 

Training courses such as PROMPT can help reduce that emotional burden, by practising emergency routines in a safe environment with colleagues. I myself have contributed to PROMPT training by acting as a woman having an obstetric emergency (PPH) and it was invaluable to see how midwives reacted honestly to an emergency situation outwith their control.

But for me I still wasn't prepared for the feelings of sorrow, fear, anxiety and doubt I had surrounding labour and childbirth after being secondary to an emergency. But by reflecting, writing this post and discussing it with my mentor I feel this experience is only a small dent in my midwifery armour, and will make me a better midwife for emotionally facing it.


Midwives need support within the work place as well as outside of it. RCM Campaign 'Caring for You' aims to support midwives health, safety and well-being at work. More information can be found at https://www.rcm.org.uk/caring-for-you-campaign

I hope this has helped, and give you a little more insight into a student midwife's perspective on midwifery resilience in obstetric emergencies.

Until next time,
Ruth x

twitter: @ruth_stmw


References
Elmir, R., Pangas, J., Dahlen, H. and Schmied, V., 2017. A meta‐ethnographic synthesis of midwives’ and nurses’ experiences of adverse labour and birth events. Journal of Clinical Nursing.