Chapter 15 Life skills for midwifery practice

Bronwen Pelvin

Learning objectives

Learning outcomes for this chapter are:

1. To explore the role of a midwife and the nature of midwifery practice

2. To identify and explore the essential qualities of a midwife

3. To identify and explore the life skills necessary to undertake the work of a midwife

4. To identify and explore concepts of ‘self-care’ and ‘work–life balance’ in relation to sustaining midwifery practice.

Key terms

autonomy

boldness

commitment

companionship

curiosity

decisiveness

empathy

friendliness

generosity

honesty

integrity

life skills

negotiating

organisational skills

positivity

practicality

reflectiveness

relationship

resilience

robustness

self-care

self-knowledge

self-responsibility

work–life balance

Chapter overview

This chapter identifies a number of ‘life skills’ that are required for midwives to fulfil their role in working ‘with’ women through the life experiences of pregnancy, birth and new mothering. These life skills include the development of personal attributes needed to be in relationships with women and of skills that assist midwives to sustain and maintain their midwifery practice.

This chapter is experiential, as it provides the personal perspective of one midwife with a long involvement in midwifery practice across all settings, and draws on knowledge derived from lived practice experience rather than theory. Unlike other chapters in this book, this chapter is not based on research or other evidence from current literature. Instead, the author offers guidance to midwives based on her knowledge and understandings and derived from reflective midwifery practice.

INTRODUCTION

Women rarely go through their childbearing experiences totally on their own. Each woman comes with not only her own personal context but also her social context. Each woman’s personal context is made up of her life stage, stage of personal development, educational background, spiritual beliefs, personal values that she holds, and the nature of her relationships with those in her immediate social circle. Her social context consists of the wider community, social group and/or ethnic or religious community that she lives within and the values and beliefs that those groups hold and how these influence the woman’s life.

Consequently, a midwife has to develop the ability to make an analysis of the total context of each woman and her family/whānau as well as the ability to develop a meaningful and purposeful working relationship with each woman as together they travel the journey of pregnancy, birth and the postnatal period. The way these working relationships develop will depend to a large extent on each individual midwife and where she is on her own professional and personal development journey. The learning she does as a midwifery student and the knowledge she gains through her practice experiences contributes to her journey of development as a professional midwife.

The nature of midwifery practice requires the development of skills and abilities within each midwife to support the work that she is required to do in her working relationships with each woman and her family/whānau. It is useful for a midwife to understand the personal attributes, qualities and abilities that will continue to develop as she builds practice wisdom through her experiences as a midwife.

Midwifery, centred as it is in human relationships and assisting an individual through a universal, yet highly personal and intimate life experience, requires practitioners who are able to bring sensitivity, support, compassion and generosity to those for whom they are providing care. The position of midwife is one of privilege—the intimate nature of the work places a midwife in a position of close proximity, learning, noticing and observing how a woman functions at a fundamental level and in her relationships with those nearest and dearest to her, as she experiences one of life’s pivotal events. Midwifery relationships, at their best, facilitate not only the physiological process of pregnancy, giving birth and the early mother–baby relationship, but also the growth and development of each woman and a deepening of her relationships with those in her family/whānau.

This chapter discusses the personal qualities and skills a midwife needs in order to be able to meet the demands of her profession. Midwifery education programs can assist individuals to prepare for the role of midwife by helping students begin to develop the necessary skills and abilities. This chapter will focus on identifying some of the life skills required to carry out, support and sustain the work of a practitioner of the art and science of midwifery.

THE NATURE OF MIDWIFERY AND THE ROLE OF THE MIDWIFE

Midwifery is concerned with the making of mothers. At the core of midwifery is the relationship between each mother and her baby. Midwives know that this relationship is critical for the baby’s physical, mental, emotional and spiritual survival. Midwives know that this relationship has a profound effect on the mother’s sense of her own power, her ability to give and nurture life, and her core sense of herself as a woman and as a human being. Midwives understand the intensity of the feelings attached to this experience and the need for the mother to allow herself the deepest sense of love that she may yet have experienced. Midwives know that it is critical for the baby to grow and develop in a world of love, understanding, attachment and generosity in order to lay the foundations for its ongoing development for the rest of its life.

There is also the nature of each woman’s relationships with the others in her immediate family/whānau/social network to consider. Midwives facilitate the development of the necessary support systems so that family and friends will support the mother in her primary role in ensuring the wellbeing of the baby. The midwife acts as a source of information and guidance; she acts as an educator of the wider family group and the community. As life has become more technologically advanced and complex, the midwife acts as holder of some fundamental truths of human existence, the things we can and must do to ensure that our lives have depth and meaning and that we are connected with one another. This is expressed around the universal act of giving birth; the truths evident here are applicable to the rest of our lives.

The role of the midwife is a large one in whichever society the midwife lives and works. It is a role into which the individuals who take up midwifery grow. Each midwife does not emerge from her educational program ‘fully formed’. As a new practitioner, each midwife cannot be expected to have the wisdom of the ages in her bones. It can be expected that she will have the competencies of a registered midwife and a willingness to go on learning through her experience.

Developing the role of the midwife

The ability to enact a particular role within a society requires development that occurs in a certain way. First, it requires integration of the individual’s own context and personal development with the requisite knowledge, skills and abilities of the role. Second, it requires acknowledgement that maturity and wisdom both develop over time. Therefore an individual who pursues midwifery will mature over time into a ‘self-actualised’ midwife, able to meet the obligations that the role and society demand.

Consequently, the focus is on developing each midwife’s ability to know herself as a person and as a professional practitioner. Midwifery will make certain demands on those who practise, demands that, in the main, will be a pleasure and a joy for the midwife to meet. However, some demands will challenge the midwife to the foundations of her own sense of herself and her belief in the purpose of life and the nature of meaningful work. Fortunately, a midwife’s experience takes place over many periods of time, as midwives take on different roles within the profession and move in and out of full- and part-time work depending on their personal life circumstances. There is an interesting synergy to an individual’s development as a midwife. To be a midwife requires a certain degree of personal development and maturity; but the practice of midwifery itself provides important opportunities for individuals to develop maturity and wisdom. Each midwife’s professional life can be viewed as a continuous stream of learning opportunities and challenges. Consequently it is useful to identify some of the qualities that will sustain each midwife in her ongoing midwifery life and keep her open to learning from the deep and rich experiences that midwifery practice offers.

Reflective exercise

Write down your reasons for wanting to become a midwife. Explain why the role of the midwife attracts you and what you think you will achieve personally by becoming a midwife. Consider how you becoming a midwife will contribute to the community in which you  live.

Qualities for midwives

Empathy

Empathy is the ability to sense and understand someone else’s feelings as if they were one’s own. It is necessary for midwives to develop this ability to a high degree in order that they can put themselves in each woman’s position and have a sense of what the experience is like for her. There is a potential danger in a midwife over-identifying with a woman, and this may lead to a desire to have the woman’s experience for her or to protect her from the experience that she is having. Empathy has to be tempered by the ability to set clear boundaries and have respect for each woman and her autonomy. The ability to empathise leads to acceptance of another and understanding of what their life is like for them.

Empathy is derived from communicating with each woman to discover what her feelings are about any given situation that arises in her experience. There is no room here for making assumptions about what a woman may or may not be experiencing. Whatever a midwife thinks a woman is experiencing needs to be checked out to ensure that the midwife is not projecting her own thoughts and feelings into the situation.

Companionship

The word ‘midwife’ is derived from the Old English mid, meaning ‘with’ and wif, meaning ‘woman’. At the core of the word is the concept of being a companion to a person, being alongside them, journeying together. Thus companionship is part of the midwife’s role. The nature of the work requires her or him to be able to assist a woman to make sense of her experience bit by bit and as a whole. But it is not just being a companion; it is being a companion in a certain way.

Midwifery companionship is based on midwifery knowledge, knowledge derived and distilled from centuries of attending women in childbirth. This includes knowledge of: the anatomy and physiology underlying the physical process of reproduction; human psychology, developmental psychology and the nature of human relationships; social, cultural and spiritual contexts of each woman; and women’s wellness, place in society and networks of support. Midwifery companionship is grounded in the belief of each woman’s ability to give birth—to grow and nurture a baby through pregnancy; to initiate, go through labour and give birth; and to nurture and care for a newborn infant and sustain its life in the first weeks after birth. Midwifery companionship is also grounded in respect for each woman, her life experience so far, and both the woman’s and the midwife’s own capacities to learn from experience.

Honesty

Honesty is the quality of being truthful and trustworthy. It can be applied to relationships where openness and sincerity characterise the interactions between the participants, who present themselves as they are.

In midwifery, honesty pertains to the ability of a midwife to present herself or himself, her way of working, her knowledge, beliefs, assessments, opinions and the available evidence about her choices for care to each woman truthfully so that meaningful discussions can occur about the care needed by each woman and her family/whānau. There is an art to presenting the midwifery ‘truth’ while still leaving room for a woman and her family/whānau to express the truth of the matter from their perspective. There is an art to being able to contain more truths than just one’s own and to work for a way forward if the truths are different or in conflict.

Commitment

Commitment is about honouring the intended purpose of each midwife/woman relationship, and a midwife is involved in providing services that meet the maternity needs of women and their families. A midwife has to develop the ability to be committed to the work and to each woman for whom she cares. She will do this in different ways, depending on the midwifery role she is in. One of the most binding commitments a midwife can make is to provide continuity of care to a woman throughout her childbearing experience. A midwife makes herself available to respond to a woman and the unpredictable nature of her experience, whenever and however it occurs.

Midwives working in other midwifery roles—shift work within a maternity facility, as a midwifery educator or advisor—also express commitment to their work by being available for the work at regular times, and being available to others during the times of work and often outside those times of work as well. When at work, these midwives express their commitment to the profession by engaging with the women for whom they care, the students they teach and the midwives and others they advise.

The law requires commitment from registered midwives. There are regulatory requirements that midwives have to meet and, depending on how maternity services are managed, contractual obligations for services to fulfil. The midwifery profession requires commitment from midwives. The profession expects them to provide midwifery care to a professional standard, and articulates what the professional standard of care is and what midwives need to do to provide it.

Integrity

Integrity implies consistency between the spoken word and the actions of an individual. It can be defined simply as honesty, the capacity for truthfulness, but there is an extra dimension connected to being united or whole. The word can be applied to a person’s functioning to describe the way in which their behaviour reflects their expressed belief system and their intentions. As a professional person, a midwife has an ethical responsibility to be consistent in what she says and does. This also applies to her words and actions being consistent with the professional expectations of her as reflected by professional regulatory requirements, codes of ethics and philosophical statements.

Robustness and resilience

Robustness carries the sense of being strong, healthy and vigorous in body and constitution, able to withstand what life presents to you. Resilience is the capacity to bounce back, to pick yourself up after being knocked over and carry on. The word ‘robust’ means strong, healthy, hardy, sturdily built, requiring and displaying physical strength. Resilience adds another dimension by describing the ability to withstand adversity and come back stronger than before. In the case of the midwife, these qualities describe the mental, emotional, physical and spiritual characteristics necessary to stand alongside women and their families through the experience of childbearing and the number of challenges that can occur in this as in any life experience.

Midwives deal with life ‘in the raw’, life as it is lived by women who rely on them for information, support and guidance. This means each midwife has to develop the ability to deal with what is happening in the ‘here and now’ and continue to work with each woman and her family to support them through their experiences. This requires stamina, fortitude and physical and emotional strength, as well as the ability to keep thinking, assessing and planning.

Decisiveness

The role of the midwife requires the ability to make decisions. She makes decisions in her everyday work about the advice she will give, the assessment she is making, the diagnosis required and whether referral to another professional colleague is needed.

Decision-making requires the midwife to take in all the information about a certain issue, practice or course of action, weigh up the information and determine what aspects of the issue are more critical or pressing, examine her own thoughts and beliefs about the information, and come to a decision about what is required or what advice to give the woman and her family. In most situations, this process can be leisurely and thoughtful, but there are also circumstances that require decisions to be made quickly because the life or wellbeing of the woman and/or her baby is at stake. This is decisiveness.

Curiosity

Pregnancy, labour, birth and the postnatal period are biological, physiological, mental, emotional and spiritual processes that a woman experiences. This means they are as dynamic and varied as each woman who experiences them. A midwife is involving herself in a life event and it is being lived forward, without the benefit of hindsight, until it is completed. A midwife will benefit from curiosity in her work—the eagerness to know or find out.

Despite her basic knowledge of the process of childbearing, each time a midwife encounters the experience it is with a different woman. Each time she encounters the childbearing experience with the same woman, the woman is in a different place on her developmental journey and the process is another singular event in her life—it is ‘this time’, not the last time or the next time. Nothing can be assumed or taken for granted.

Curiosity will enable a midwife to sustain her interest in the childbearing process. It will open her up to being responsive to what is in front of her, continuing to learn, assess and report on the event for the woman and her family/whānau.

Practicality

Midwives are often known and respected for their sense and practicality. Practicality is derived from experiences and actual use, rather than from theory. The involvement of midwives with women in their everyday lives affords them a wonderful opportunity to see women coming up with practical solutions to the management of pregnancy, labour and the care of the newborn. As women, many midwives have often had these experiences themselves and can report on what they have found helpful. They can also report on what they have noticed in other women’s childbearing experiences and contribute to the dissemination of knowledge. In this way midwives act as conduits of sensible, useful and effective responses to the situations women encounter as they journey through their childbirth experience.

Boldness

Courage, confidence and fearlessness typify the midwife’s functioning in the world and can be described in the attribute of boldness. This is not a profession for retiring, ‘shrinking violets’! When a midwife deals with all the possibilities and variations of a physiological life event and the potential for disappointment, grief, shock and trauma as well as enormous joy, elation, love and compassion, she must develop the capacity to be bold—to go where no one else has gone, to risk uncertainty and to respond to changing and unknown situations.

Women and their families/whānau can face their deepest fears as they approach childbirth in today’s risk-averse society. There is a strong drive for guarantees and perfect outcomes, not least because women have fewer babies than they have ever had before in the history of the human race. They want every baby, particularly their baby, to be perfect. The opportunity to learn about the nature of life from many different experiences is reduced, and maximum learning has to be derived from the experiences that each person does have. Medical dominance of the reproductive process and the reflection of that dominant view in the media has created a degree of fear in the community that the midwifery profession, coming as it does from a belief in a woman’s ability to grow, nurture, give birth to and feed her own baby, has to withstand.

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