Editorial

Article Outline

• ‘Getting involved’: positive strategies that generate change
• Copyright

As I sit pondering what to write for my first editorial I am gripped with fear. Writers block takes hold and I silently curse the fact that life as a midwife continues to create the conditions where I feel fear. Fear often arises in situations of uncertainty. In reality midwifery is all about living and dealing with uncertainty without allowing fear to take control. Uncertainty presents challenges and if we are to believe the educational theorists is the space in which we learn and grow. In daily practice finding ways to feel at ease with uncertainty is the midwives lot. Fear is also part of life and therefore serves a purpose. It is an emotion, a strange and unique concept that is meant to keep us safe. Fear potentially galvanises us into action. For pregnant women some level of fear about labour and birth fosters motivation—to learn about the journey ahead and be prepared. For midwives too, fear can bestow on us positive lessons – teaching us to be silent and vigilant – waiting and watchful—whilst simultaneously basking in the strength and power of women's bodies. Like so many things in life it is the balance that is important.

But what happens when fear drives the woman or the system—as it can so easily do in our ‘risk-based’ approach to maternity care. In the dominant medical model of birth, fear casts dark shadows on and over the normal rhythms of uncertainty. When birth talk is coated in the language of damage and death, then the concept of risk takes on a twisted meaning reshaping the normality of childbirth; turning the possible into the impossible. Fear in this form has the potential to render women helpless and powerless by subtly coercing them to hand over control and responsibility. Fear can then paralyse women. There would not be many of use who have not been witness to the havoc wrecked on a woman's normal biological functioning when she attempts to birth within a bubble of fear.

And what of the midwife? The woman's companion and guide. What happens when midwives see, act and respond through a veil of fear? …

Over the last few years our team's research into childbirth fear from both a woman's and midwife's perspective has confirmed that some midwives, like women, construct birth to be potentially unsafe and unachievable. The findings of our work clearly demonstrate the destructive nature of constantly working within an environment that is driven by fear. Perceptions about what is ‘normal’ and ‘abnormal’ became increasingly blurred when midwives work for long periods of time only in a busy tertiary referral centre, and only in one area. While fragmented care has been deemed detrimental to women our work indicates that it is also incredibly damaging to midwives and ultimately the profession.

While there is a growing body of knowledge on how to ensure the sustainability of woman-centred models we have failed perhaps to ask what the benefit of ‘knowing’ the woman is to the midwife. I believe that ‘knowing’ the woman has a powerful positive effect on clinical practice. Knowing the woman provides a window through which the midwife gains an understanding of how the physical, emotional, social and spiritual dimension of the woman ‘fit’ together. Knowing her makes the woman visible to the midwife increasing the midwife's ability to both provide ‘safe’ care and feel safe in doing so. Working in this way, of course, does not protect one from experiencing the sadness and grief that may accompany an adverse outcome, but it does restore balance; facilitating perspective and healthy growth.

There is increasing momentum around the country as midwives at all levels seek to work more fully in partnership with women and each other. Together, woman and midwives are seeking ways to keep birth normal and nurture the journey. Continuity of midwifery carer is now a prominent strategy in many of the health reform agendas around the country. Care of this nature situates the pregnant women within the relationships of her life and provides an opportunity to restore women's cultural knowledge of birth. This enhances a woman's feeling of confidence, competence and control and ultimately assists her to feel safe.

As we continue to move in this positive direction leadership is the key. Being a midwife can be about being a leader or a follower. Both are important but it is how we enact them that will make a difference. Each of us must choose our path and consider the role we must play in enhancing maternity services so that they truly become woman-centred. We each need to reflect and consider what drives, motivates and scares us. Confidence and optimism will facilitate positive change whereas focussing obsessively on risks allows fear to distort and stifle—driving negative change. Strength and courage come from sharing the journey together with women and each other. Yes there are many barriers; and yes it is uncomfortable when we take those first steps outside our current and limited space into uncertainty. Yes we are not always going to make the right decision or say the right thing; and yes not everyone is going to agree with us; but the greatest mistake is to let a chance to make a positive difference pass us by.

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‘Getting involved’: positive strategies that generate change