Normal pregnancy and labour are at the heart of the midwife's skill and expertise. And we are the only profession to have this as our focus of attention. As a result, we like to see ourselves as autonomous practitioners, respected for what we do and accountable for our own actions.
Stifled in the workplace
However, the environment in some maternity units can mean that we are unable to provide women with the type of care our role prepares us for. Even if we want to practice midwifery in the true sense of the word, we may find ourselves restricted by our organisations' policies and procedures.
Rigid adherence to procedure prevents the development of a more sensitive approach to care, and stifles innovation. It's a symptom of an organisational dis-ease that often also results in constraining structures and poor support systems.
We may believe in woman-centred care, informed choice and the often-repeated mantra of autonomous practitioner but we often have very little choice about the way we deliver care. Many midwives complain of feeling under-valued by colleagues and unsupported by senior management. And the demoralisation this produces affects those we are tasked to care for. It often means that we are not good at supporting colleagues who try to provide care in innovative ways that benefit women and reflect the true nature of midwifery.
We are caught in a dilemma between our obligations to our employers and our responsibilities to the women in our care.
Finding a way through the obstacles
Some midwives try to find a way through some of these obstacles and make changes by stealth. But such strategies do not always achieve permanent change. To make a lasting difference, we have to learn to negotiate with our colleagues, supervisors and managers.
The first step in negotation is finding common ground and a staring point. A good idea is to begin with an unthreatening practice, identifying supportive colleagues who share your values and vision of midwifery. Encourage them to see the bigger context in which it sits, promoting woman-centred care and the incorporation of policies and procedures that support normal birth.
There has never been a better time to do this, with social attitudes increasingly in favour of empowering women and research increasingly validating practices that encourage normality. Furthermore, Government policy favours midwife-led care and a reduction in rates of bio-medical interventions.
Winning friends and influencing people
If we are going to be able to empower women, helping them to have the confidence to give birth normally, we too need to be empowered and be confident. This requires a fundamental shift in professional relationships such as trust, support and respect. Give positive feedback and praise to colleagues - and be prepared to receive feedback. Even when what comes back is critical, use it as a learning opportunity.
Negotiation in isolation can be lonely. You will need emotional resilience and creative thinking if you are to persuade others to your way of thinking. Choose your tactic - is this one-to-one negotiation or team-to-team? Also be inclusive. Draw on the skills and expertise of others, and value their positve input. Recognising everyone's contribution fosters an open and collaborative working environment. But don't assume that everyone shares your enthusiasm for change, even if they share your values.
Tips and tricks
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Introduce new ideas or topics in a neutral environment - negotiation is best when there is a series of smooth structured steps which avoid becoming bogged-down in trivial issues.
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Choose the right language and behaviour - looking for ways of talking about what you want that your opponents will find persuasive. Evidence can make a powerful argument, but only if it is in the language and style of the person you are aiming to influence.
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Identify the expectations of your opponents - if they feel there is something to gain, you are more likely to achieve a win-win situation. But avoid direct confrontation, considering a wide range of options and counter-proposals instead.
Further reading
Ball I, Curtis P, Kirkham M (2002)
Why do midwives leave? Royal College of Midwives, London
Hoban V (2003) How to … communicate with your colleagues.
Nursing Times 99 (7)
Hunt J (1992)
Managing People at Work: a manager's guide to behaviour in organisations (3rd edition). McGraw-Hill International UK, London
Kirkham M (1999) The culture of midwifery in the National Health Service in England.
Journal of Advanced Nursing 30 (3): 732-739
Mander R (2004) The B-word in midwifery. MIDIRS
Midwifery Digest 14 (3): 320-322
