Birth should be empowering for women. And an empowered midwife empowers women. But when we are forced to justify a decision we have made by our colleagues, our knowledge, experience and skills can be undermined. As can our respect for each other.
Now a little challenge is good. It encourages us to reflect on the situation from different perspectives, to consider the various ‘what if?' scenarios and to be able to think through the evidence that supports our decisions. But the way in which this challenge takes place is all important. A challenge can easily become negative, especially when colleagues question our decisions because they are uncomfortable or threatened by them. They may even believe that by doing things differently we are ourselves making a comment on their practice.
Supervisors need to provide support
Even if your colleagues won't support you, you should have the support of your supervisor of midwives. In situations where your professional judgment is in doubt, she is meant to take on the role of a supportive professional friend. This does not mean that she will always agree with what you have done, but she should try to understand why you have done it.
Your supervisor should also provide an opportunity for you to discuss your decision making process, and to talk about the evidence or research on which to based your decision. Part of her role is to explore, question, understand or challenge the basis your clinical judgement.
When trust breaks down
When colleagues do not support each other it is often because they feel anxious and perhaps even insecure. This may be due to the unsettling effect of organisational change, or because they don't feel secure within the organisation's culture, or even because they have recently had a near miss or critical incident themselves.
Research suggests that bullying is embedded in the NHS culture and that many midwives feel unappreciated and undervalued. We may be overwhelmed by the culture and magnitude of the NHS but we need to believe that each individual, along with the collective of midwives, can have a significant effect on the whole. It is really up to us to work for a better future - if we don't, we will allow the problems of the present to continue unchallenged.
The key to rebuilding solidarity is to focus on the positives in each other's practice, and not to dwell on the negatives. Lessons need to be learned from mistakes, but this can be done without encouraging blame. There is no 'right' way to practise - what constitutes excellent midwifery will be different in different situations and for different midwives. Tolerating each other's differences in values and approach, as well as celebrating those that are shared, helps to create a more understanding and supportive culture.
Open and honest communication, motivated by friendship and appreciation, makes it possible for midwives to create an environment where everyone feels supported and constructively challenged and where new ideas and practices can be discussed and tried without opposition and suspicion.
Tips and tricks
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Make time to discuss your practice with your colleagues - share your experiences and your decision making processes. Do you share the same philosophy? Do you know what each others' philosophies are? Try to understand how others have come to believe what they do, and what is good about their beliefs.
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Avoid apportioning blame - when someone makes a mistake, think about what could have been done differently and try to help everyone move on. Separate the practices from the person: what they did may have been wrong or inappropriate, but that doesn't make them a bad practitioner.
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Work towards building solidarity – it only takes one person to model positive attitudes for a whole organisation to begin to change. Support and nuture openenss and constructive attitudes wherever you come across them and be accepting towards colleagues, however different their beliefs.
Further reading
Ball L, Curtis P, Kirkham M (2002)
Why do midwives leave? Royal College of Midwives, London
Furedi F (1997)
Culture of fear: risk-taking and the morality of low expectation Cassell, London
Kirkham M Communications in midwifery. In:
Midwifery Practice: A Research Based Approach. Alexander J, Levy V, Roche S (eds) (1993). Macmillan, London
Price A (1995) Making professional midwifery decisions. Sound choices: Part 1: principles and process
Modern Midwife 5 (6): 14-18
