Sustaining rural midwifery practice

When considering the issues of sustainability my colleague Sarah Stewart has been blogging about issues for midwives in sustaining practice. She has identified discontent amongst some midwives about the annual recertification process in New Zealand which has only been in place for the last three years. She also questions how midwives are supported and sees mentoring, particularly E-mentoring as a possible support for midwives to help to sustain them and enable them to continue in practice. She also mentions communities of practice as a possible support for midwives.

I was a rural Lead Maternity Care (LMC) midwife for around 15 years, from the start of our modern midwifery autonomy in New Zealand until I changed direction a little and ventured into the education field around 4 years ago. I still do a little rural LMC midwifery as a rural locum. I provide holiday relief or backup to several rural practices in my region and nearby. I have just completed my Master in Midwifery degree and my research looked at how midwives informed practice, finding that communities of practice had a strong influence on information sharing and supporting rural midwifery practice.

During my 15 years as a rural LMC I never had regular days off. I took days off when I had a quiet day but was still on call. I had holidays when I could and some years did not have a holiday at all. When I did take a holiday it was always for at least one month. I found it took me at leas two weeks to get my head out of the job and relax and probably took me at least twice as long as that to settle back into the job when I came back. This was during the years that my children were growing up and at times it was probably pretty tough on them and on my husband. None the less I loved the job and still do. It is my love of midwifery that sustains me most I think.

What I did not love was the continual battle that I felt I was fighting. When I worked with colleagues who shared my beliefs about childbirth I felt much more supported in my practice. Too often I felt that I continually had to justify my profession and myself with the world. With GPs who stated that homebirth was unsafe, with facility management who, rather than supporting often seemed to be trying to undermine what I was trying to achieve. With the media and public, whenever something happened in childbirth somewhere in the country and every midwife seemed to be blamed and had to justify there existence. This was not my usual experience but when it did happen it was very tiring and took most of my energy and enthusiasm for the job.

So my thoughts on how to sustain midwifery practice would be to make sure that you work with other midwives who share your beliefs about birth and work in a similar way to you. Let go and don’t believe you have to be all things to all people. It is women who are having babies not us. We should be able to prepare women so that they can do the job with or without us, as long as we know that our colleagues will support them as we would. Make sure you make the connections with other midwives who can sustain you and will share their knowledge with you as you will with them. Try to establish links with other midwives who can provide a locum service for you to have a break when you need it. If you do not have colleagues like this in close proximity to you then use online sources such as this to make connections with them and communicate regularly. Never lose that belief that this is a really important, satisfying, wonderful job that you do.

I am truly interested in what others think about this. How can we sustain midwives in practice? Our communities need midwives, how can we fill that need when it is not there or support midwives to continue in practice when it is there?