Hi, welcome to another Midwife Motivation Monday. This week I'm looking at a topic I get asked a lot about. Many midwives and student midwives experience stress as a result of coping with midwifery emergencies.
For me, there's always at least one day a week that makes midwifery worthwhile. Sometimes it's a brilliant week where no situation is too hard. Other weeks, the simplest midwifery skill is draining.
During harder weeks, it often feels to me like clearing a drive while it's still snowing. You can't tell whether you're getting slower at shovelling, or whether the snow is coming down faster!
Regardless of how you feel this week, I can guarantee the women value your care. In this post I'll tell you about a foundation for good decision making I use in emergencies. This will help you with the crucial midwifery skill of keeping your mental health intact!
Emergency situations can be put into two categories for me: 'Scary', and 'Twilight Zone'.
'Scary' situations are emergencies that I'm pretty sure I can cope with. There are enough staff, experience, and equipment, and I know we will have things under control soon. I go into autopilot, and the path is clear.
Coping with midwifery emergencies, especially this type, can be very stressful. The original title of this post was 'Midwifery and Bravery', because that's the crucial point. It takes bravery to make decisions within seconds, with the onus on you to act as a 'perfect' clinician, often with scared family members in the room looking to you for instant help.
Essentially, to make sure of your own mental wellbeing in an emergency, you need to make your decisions based on logic. You need to make sure you took the safest, most rational course you could at the time, even if you don't make 'perfect' decisions.
Here's what I think when a 'Twilight Zone' emergency rears its head:
1. What are the facts?
2. What else can I tell on consideration?
3. What's the best course of action?
To illustrate how useful this framework is, we'll use the example of what I'd be thinking with a mother suddenly shouting and threatening to hurt her partner, staff, and her baby who is in a cot:
1. What are the facts? 'My client has anger issues and a diagnosis of borderline personality disorder, she is usually well controlled, but is very agitated and now threatening towards her baby'
So after pulling the emergency buzzer for help:
2. What else can I tell on consideration: 'The baby is most at risk in this situation, we need to get the cot safely out of the room. It's important to remember many women die from suicide during childbearing due to being mentally ill, and puerperal psychosis cannot be ruled out. We shouldn't leave her alone and we should try and keep her calm and everyone else safe'
3. What's the best course of action 'After the baby and partner are outside, stay with this mother alongside another staff member until the psychiatric specialist arrives, have security in the room for the lady's protection and ours, speak calmly to her. Ask someone else to reassure the partner, and to document events.'
When I first qualified, I'd get my head round the emergency in the end, but after a lot of mental flapping. Then I'd spend the next week beating myself up about my (lack of) ability to cope.
The truth is, coping with midwifery emergencies get easier as you get more experienced, but..... the Twilight Zone will always crop up eventually, no matter how experienced you are.
It's really easy to just slide into 'flight or fight' - but you are a professional with a job to do, and even in the Twilight Zone, you need to think logically and calmly.
This philosophy is nothing new. Aristotle taught something similar 2000 years ago. It's just hard to apply in an emergency. But once you commit to staying calm and thinking logically in every situation, you will find you're less like to experience the 'post emergency hangover' - because you did your absolute best.
It would be naive to think we can avoid all stress by applying this philosophy. Midwifery is a job that comes with stressful situations, and sometimes you will need to debrief, reflect (in thought or writing), drink wine, have a bubble bath etc. Sometimes you will need a really good midwifery mate around to talk to about your experience.
However, you have to equip yourself with some kind of framework for coping with midwifery emergencies.
It's a bit like in sport. A gymnast will rehearse a jump hundreds of times before a competition. In the same way, midwives will mentally rehearse so when the emergency buzzer goes, they will be primed to do the right thing. Twilight Zone emergencies are just an exercise in thinking on your feet under stress. If you have a mental strategy like my philosophy, the odds are you'll cope better.
Oh, and make sure you get enough sleep if you've had a rough week with lots of emergencies. It's not always possible, but your brain needs to make sense of things by resting!
It's also important for me to tell you I'm not qualified to help anyone traumatised by a midwifery event. These are just suggestions and my own methods of coping with our privileged but stressful job.
So, how do you cope with emergencies when they happen? How do you avoid the 'post emergency hangover'? Is there anything else you would add?
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