Nonnatus house nurses and midwives are struggling with being able to meet the needs of the community, and Katie Moriarty says Modern Day Midwives still unfortunately feel this same stress.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 6 Episode 2

“The world was moving from a time of limits, of austerity into one which promised endless reinvention. We could change the homes we lived in and the clothes we wore. We could fly across the world, investigate new planets, begin to crack our own genetic code. But, no matter what science sought — our challenge remains the same — to accept what it meant to be human, to embrace our strengths, our weaknesses, our dreams.”

Episode 2 deals with facing our challenges and addressing our fears – all the while holding on to hope … even in the face of life and death. The show addressed the work environment from a safety standpoint but what this Modern Day Midwife would like to blog about within the particular story line is the topic of workload and efficiency and the conflict with engagement and being effective.

Sister Ursula stated that the nurses and midwives must alter their approach to care and how they organize their work. She states “there is to be no fat on the lamb” and that she wants them to be providers of efficient healthcare and midwifery services. There will be more patients, less staff and they should now be resources to be used sparingly, she warns. Sister Ursula also says that those who do not earn their place must find another or there would be professional consequences, and that statement felt like it loomed large and was very threatening.

Today we often enter the clinic with a room full of clients and families and see our list of bookings (along with double bookings) and we can often feel extremely overwhelmed. The acuity of our clients and the stressful challenges that many face need to be addressed. The healthcare system is not set up to foster and support clients, families or our community. How do we succeed in optimizing wellness within this system? Centering prenatal care (group prenatal care) can give us more time with our clients and allow us to address the mind, body and spirit. Also, having access to supportive services such as maternal child home visitors can be very helpful to address multiple challenges. However, as primary care givers we need to be able to connect all the dots and this is difficult when we do not have the needed time or the needed resources. We have a system of care that does not see what the true issues are and this does not support women and does not foster physiologic birth.

I just completed a national survey investigating how the work environment affects certified nurse-midwives and certified midwives by examining burnout, engagement, and clinical practice. The investigator, Brie Thumm, CNM, a Ph.D. student from the University of Colorado College of Nursing, noted that this information is important as provider burnout is associated with multiple ramifications such as increased patient mortality, provider absenteeism and staff turnover, and even leaving the profession. Burnout and work engagement are thought to be consequences of practice environment and can have significant personal and professional impacts. This is the first study of its type to begin to examine these relationships in the United States. I encourage all CNMs/CMs to participate in the survey.

After I participated in this survey, I reflected in my journal on why I entered the midwifery profession and why I still feel just (or maybe even more) committed and focused. I have worked with clients that face chronic and toxic stress and a clinical environment that is not supportive of midwifery care or in empowering the women that we serve. Actually, in the last few months the practice has systematically been deleting the midwifery positions. I have been reflecting on what this means for the community of women as we have the worst infant mortality in the nation and one of the worst maternal mortality rates. Medical and midwifery philosophy and care are very different. So the obstetricians remain and the midwives will be essentially gone.

As a midwife I have focused on evidence based care and a shared decision making model of care. There is an art and a science to being a provider. There is a difference of treating a symptom or a particular “diagnosis” versus engaging with a person. Why do we so often have to be in such a protective mode in protecting the whole person? We must protect women’s rights and their ability to share in all of their healthcare decisions.

In the face of all of these challenges we need to still retain our sense of nurturing and to feel empathy. One option that can help prevent feeling totally stressed is embracing self-care techniques. As a midwife I have truly engaged in integrative health care. I've found it is important to embrace utilizing many of these same techniques for yourself – it may help to sustain your vitality and sense of engagement as we try to survive the ups and downs of this crazy health care system. We need to remain present and we need to remain mindful.

With rapid developments in technology and the emphasis on diagnostic testing, we have an over-stressed care system that focuses on structure and standardized care. Less and less emphasis is on knowing your client or that individual or their specific blend of issues/concerns. Now, more than ever, I encourage midwives to embrace being “with woman” and to find the essence of why they entered this profession. Nonnatus house nurses and midwives are struggling with being able to meet the needs of the community—to meet those where they are needed. As Modern Day Midwives we still unfortunately feel this same stress.

I hope interested readers will check out this Mindfullness Training Opportunity — it is an chance to engage in Mind-Body Medicine training. I have found these techniques extremely helpful and they have helped transform my life and how I have clinically practiced. Hopefully the midwives at the Detroit Medical Center, Hutzel Women’s Hospital will be able to utilize their skills again soon to serve the community!

“However great the scale of injury or loss – our frailties and pains are made bearable by others: their thoughts, their deeds, their reaching out, their love and our endurance make us human and complete.”

Katie Moriarty, PhD, CNM, CAFCI, FACNM, RN is a professor on faculty at Frontier Nursing University and a Certified Nurse-Midwife with WSUPG CNM Service at Hutzel Women’s Hospital in Detroit, Michigan. Katie serves on the Board of Directors for the American College of Nurse-Midwives as the Region IV Representative. Previously she was the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.
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