Bullying, Poor Care, And Struggling Leaders

It’s been a while now, years in fact, but I can remember it like it was yesterday, I found myself weeping, sobbing actually, sure, I was feeling a little tired and I did have a cold coming, but what had prompted my tears was a BBC Radio 4 interview, a midwife was talking about her long career working in the NHS (through an actress due to a fear of being bullied).

In the stilted words of the actress I could feel my own experience of of working in the NHS as a midwife, over 15 years of working in an environment that often seemed over managed by deeply flawed managers. People who were no doubt doing their best, but due to poor preparation for leadership true embodiments of the Peter Principle. Great midwives who have been promoted beyond their level of competence, desperately struggling to keep their heads above water as the rising tide of audit paper threatens to drown them.

Over the years I have been told that things will get better, there will be more midwives (nurses etc) they say? The working environment will improve for the professionals who work within the NHS. But in truth, as I look back over the 20 years plus that I have been in involved with professional birth work nothing really seems to have changed. Where are all the new midwives that we need?

So often the Governments response seems to be to inspect more, audit more and investigate more. None of these activities are bad, but sadly they can end up being just pseudo actions. It looks like the Government is doing stuff, but nothing actually gets done.

When will we, midwives and other birth professionals actually wake up and realise that the culture we are working in can not be transformed by top down reform, nor can our morale be managed from the out side in ( Having said that Government investment would definitely help).

The values that took most of us midwives into the work are a long way from the profit driven motives of the market. We didn’t chose to train as midwives for the money and we still don’t, we just want to make a difference to the experience of those women we are with as they are pregnant and give birth.

Yet I have heard midwives speak in horrendous ways to labouring women, I have seen managers seem to turn a blind eye to desperate staff shortages, I have talked to newly qualified staff who are leaving within a year of graduation to pursue different work. Something is desperately wrong and appointing a new hospital head of ‘Inspectors’ is definitely not the way forward.

We need more midwives, our NHS needs more investment from Central Government, I think we would all agree with that very loudly. The mad thing is there is no shortage of people who want to train as midwives, each intake of student midwives is oversubscribed by many 100’s of applications from people who are passionate about serving pregnant women.

It’s time to take another look at how our academic institutions whittle down those numbers to include a far broader range of people, a variety of ages, personality types and social and ethnic backgrounds. It feels like a risky thing to suggest and in no way is it a comment on all the fantastic student midwives who are currently training to work as midwives now.

I remember a conversation I had recently with a University Admissions Tutor, she told me that her university screened their applicants for the midwifery course with a maths test, the pass mark was 90%!

That got me thinking, maybe we have created methods for selecting from the thousands of applicants who apply for midwifery training that are unwittingly excluding large numbers of people who possess in abundance the empathic skills required to be with woman?

Don’t get me wrong, I know that the academic demands of the course are rigorous, and those who are going to succeed will be stretched in that area. But, a 90% pass mark on a maths test before you even have a chance of an interview!? And don't forget every candidate that gets to this pre interview stage has already achieved the academic standards stated by the University to even apply in the first place.

Here are my suggestions of where we could make start in order to achieve the kind of shift I think we need when it comes to broadening our recruitment strategy for student midwives:

  • First ask those who applied because of watching ‘call the midwife’, get rid of those who raise their hand.
  • Then the the follow up question, who thinks ‘one born every minute’ shows good levels of communication skills and care? Those who say yes, we say goodbye to.
  • And finally any one who gets over 80% in the maths test are on their bike as well.

I know you know, that I had my tongue in my cheek as I wrote those, forgive me. One thing I feel sure about, all those applicants who have the stated academic requirements already, should not be filtered by extra testing.

I think Dr Odent is being extreme when he suggests that only women who have had a good experience of the birthing process should be midwives and obstetricians, but who really knows? He could have a point. A discussion is long overdue regarding where midwifery training positions itself with in our academic institutions, in my opinion it fits nicely within the Arts, and is currently being forcibly shoe horned into the Sciences.

Can we at least start to talk about how we can attract and recruit compassionate people with the values that underpin our age old commitment to be with women as they birth?

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