Exam challenges, personal circumstances, difficult colleagues or mentors, incidents...midwifery can be about as tough as life gets.

This post is on how to cope with midwifery knocks on the path to qualification and beyond and how to come back fighting. It's another piece of writing prompted by members of The Secret Community For Midwives In The Making.

Midwifery is about supporting the transition to motherhood and new life. This means it's a profession which comes with some of the most stressful and weighty (though amazing, privileged and enjoyable) situations.

The good news is that if you've hit a rough patch, you're not alone. Every midwife or other person I respect who I have got to know in any depth has faced catastrophic failure at some point.

It's just part of the life dance that we all do.

So considering midwifery knocks will happen to you at some point, you have to commit to being able to get through them in a constructive way*.

*NB: There are situations in which self-care needs to be your main consideration. If you are exhausted or burnt out, you need to see a personal tutor, supervisor or your GP to work out what the best plan is. For more information, see the Royal College of Midwives' 'Caring For You' Campaign.

For the times where things are tough but within the realms of normality, here are four strategies:

1. Make Turning Up Your Measure of Success

This sounds basic but it's been a profoundly important strategy for me.

Say you have a placement that you fear you may be failing, or you're struggling with a particular assignment or topic.

Or you have a challenge as a qualified midwife that's very difficult. For instance, in a certain staff midwife position, I used to hate early weekday shifts because I knew I'd have to balance memorising all the women on handover as well as trying to get elective caesarean patients admitted, cannulated, auscultated etc. It was a huge challenge for me and one I dreaded because if I failed at any of this (which happened regularly, knocking me back) my colleagues and the medical team would know as everyone was working together on the ward.

In this type of circumstance, I suggest you change the goal posts.

Don't aim for perfection.

Instead, make a mental shift so that turning up and authentically trying to be the best you can be is your measure of success.

No matter the outcome of a particular shift, lecture or assignment, you'll still be learning. Often you'll be absorbing far more than you realise. So turning up is often all you need to do to be successful in the end.

I used to wander round chanting 'I have no cherished outcome' in my head, over and over.

And of course, as soon as you decide that just having turned up makes it a successful day, you tend to relax and then everything goes better anyway.

2. Have a 'Tribe List'

This is a suggestion from one of my favourite researchers, Brené Brown. She studies difficult topics like shame. She also looks at healthcare research and how professionals keep functioning at a high level, with compassion and empathy at the forefront of their care.

Brené Brown suggests that you have a small piece of paper you keep in your purse with no more than four names on it. These four names are of loved ones that you know judge you fairly, with knowledge of your personal values and capabilities.

She suggests these should be the only people whose opinions really matter to you because otherwise you'll be swamped by trying to please everyone.

When you hit failure in practice, placement or at University, you can pop to the loo or another quiet place and look at your list. I had no idea how effective this was until I tried it.

To para-quote Alan Bennett: seeing those names in a time of struggle was like having a hand come out of the piece of paper and take mine.

When you're being given criticism you're finding hard, you can think to yourself 'I don't need to take this to heart because this person is not on my list'.

This doesn't mean you don't take constructive criticism. It just means that when you're struggling with something that's knocked you, you're able to put it into perspective and realise the person criticising you doesn't know you well enough to comment on you personally.

3. Know Your Story About Struggle Will Inspire Others

Three of my hardest, face down midwifery knocks have been:

• Taking the lead from a professional when I should have known better and putting a client somewhat at risk. Nothing bad happened but it still scared the life out of me and all my colleagues and my supervisor knew about it, which was mortifying
• Failing an OSCE on breech birth
• Crying because I was so exhausted and being sent home early from a shift

I swear I was still well thought of (I think!) by my colleagues at this hospital and I have also:

• Worked in a different country, adapting quickly and smoothly
• Never missed a cannula in an emergency
• Co-ordinated an exceptionally busy shift on labour ward with several emergencies, despite being fairly junior

Every midwife has stories like these. We need to keep learning and obviously keep striving for the best care possible.

But when you are feeling small because you've made a mistake or you're taking a knock, know that in future your story is likely to be exactly what another student or midwife needs to hear.

4. Hug Your Failure To You

I know this sounds bizarre, but it's likely that you will learn from the times in life when you have to be courageous.

I believe that taking knocks is a good sign. If you're putting enough of yourself into life and your career, you will face failure and challenging circumstances.

The only people who don't fear failure, feel terrible when they've done something wrong, or feel silly and ashamed sometimes, are sociopaths.

You don't want to be a sociopath!

The fact you are capable of feeling so deeply shows how much you care. One of the most important skills for a healthcare professional is the ability to get back up again and keep an open heart despite knocks.

That's why one of the 6Cs is 'courage'.

Your failures are hugely important. Imagine taking them round with you in your placement backpack or pocket of your uniform. Those stories are hard won.

Getting through these knocks is helping make you into the experienced, emotionally capable and valued professional that the NHS so desperately needs.

Before I sign off I also want to say that I don't think knocks and failures ever go away, no matter how experienced you get.

Even students and midwives you think are coping well or are highly experienced will still take knocks. The only difference between these professionals and those with less experience is that the seasoned midwives know that feeling lost and down is to be expected sometimes. They have been into the dark before and know that they need to keep going regardless.

Everything is constantly changing. All things pass. Even if it feels like you're going through the same old struggle, every day, it's just a matter of time before this circumstance changes into something else.

I'm sending all my very best wishes to you.

Do you have a story to share on midwifery knocks that you think could be useful to someone else?

Or a strategy to help get you through hard times?

Let me know in a comment! x