‘Vicarious resilience’ means resilience that you have access to based on being in someone’s company.

I was Waiting to See the Fireworks

I was in Morden Park, London, on November the 5th, on a cold Autumn evening. I was about to watch the fireworks. I was with my flatmates, and my boyfriend of about three months. The first rocket went up, and there was a ‘thunk’ behind us. A woman had fallen over. Adrenaline took over, and I asked her husband what her name was. The woman was making a noise but not breathing. I shook her shoulders, saying her name repeatedly, but she didn’t respond. I took her pulse, which was present. Jason was calling an ambulance. An experienced nurse was in the crowd and took over. We watched as the ambulance came through the crowd, which parted. The collapsed woman was given chest compressions. Then St Johns ambulance staff got to her, and she was bag and masked. As you can imagine, we (and a lot of the surrounding public) were not watching the explosions in the sky. Once stabilised, she was put onto a stretcher and into the ambulance.*

Most midwives are not that experienced with adult resuscitation. Thankfully, it doesn’t come up a lot. But we receive training every year and have to prove we know how to make a start. Given a few more minutes, I think I would have started CPR myself.

I was glad to know the woman was looked after but had felt completely out of my depth. I wouldn’t have been able to put it into words, but it was then that I began to change direction. My lack of agency at that moment scared the shit out of me. I had been out of midwifery for four years. It was the beginning of my path back in.

A Confused Mess

Why the break from midwifery? Looking back at it now, it’s totally clear. But I shouldn’t get ahead of myself because, at the time, it was just a confused, roaring mess.

What I was sure about was that working nights were getting harder. It wasn’t so much the nights themselves but the after-effects. I’d get days where the world was unsteady. I had to resist the urge to ‘furniture walk’, i.e. hang on to the sofa or walls to get around. I felt sick, and I saw things that weren’t there out of the corners of my eyes. I remember drinking lots of electrolytes and lying on the floor listening to a Brené Brown audiobook about the power of vulnerability and thinking ‘you’re being a drama queen’. I didn’t get why I couldn’t just shake it off, as I’d pushed through in many situations when I was a student midwife.

At this point in my career, I had been a band 6 for years and felt confident in my practice. It was stressful, but I enjoyed my time at work. I had even started a blog about midwifery which was beginning to get some traction. 

The nights issue was dominating everything. I tested the water with my colleagues, and they agreed they were hard but I was told ‘they’re an essential part of midwifery care’. I felt like if I went to Occupational Health, I wouldn’t be able to explain what was going on. Besides, I didn’t want to take myself off nights as I’d let my team down. 

I Needed to Stop

I left midwifery in Aug 2014. I framed it as ‘wanting time off to write’. I didn’t have a clear idea of what came next, I just knew I needed to stop. The relief was intense. I concentrated on finishing my first book, then building up my blog and Facebook community.

I was building up my business and needed completely new skills. I didn’t even know how to put a spreadsheet together, and I had no idea how to approach a project as big as a book. I’d gone from a team I knew and loved, with lots of client interaction, to just me and a business partner. I lived in the mountains in Spain for a while because it was cheap. I read books about business and writing. I rented a house which was falling apart and ate lots of chickpeas and rice, and panicked about money. 

The spinning disappeared, mostly. So I got what I wanted, a job without nights. But on top of the challenge of business, I didn’t feel worthy of serving midwives online when I couldn’t hack it myself in the real world. I missed midwifery and felt horrendous about leaving the profession when it was under so much pressure. Once this energy was out in the world, it attracted others who agreed that I was a hypocrite, and were not subtle about letting me know it. 

Cut to a few years later. After much effort, my midwifery Facebook community had 30,000 people in it, and I’d had a midwifery novel published via a small publisher. I was incredibly proud of that, as I had always wanted to get something published before I turned 30. The novel came out two days before my 30th birthday.

But by this point, the spinning was back and getting worse. I had had week-long periods of labyrinthitis, which made the world spin but in a way that this time kept me lying down. One of these periods crossed over with my Grandad’s death and funeral. I remember sitting in the crematorium holding on to the pew, feeling like a worm that had been chopped in half and was trying to make the cut-away part move.

A Strong Streak of Denial

My GP thought that the symptoms were inflammation of the inner ear, probably caused by a virus. It was around this point that I came across the term ‘vestibular migraine’, which matched exactly what was going on. It’s hard to describe what a vestibular migraine feels like apart from ‘dizzy’, but imagine your brain is a snow globe that’s being shaken up or a cymbal that’s been hit. Will power will help you get things done, but you will feel unsteady and long for when you can sit still again.

My friends and family reckoned my symptoms were because of long-term exhaustion. I had worked hard as a midwife and then as a small business owner, so this was possible. After the steroids and anti-sickness tablets didn’t shift things, the GP gave me Sumatriptan, which helps constrict blood vessels in your brain. It didn’t get rid of the symptoms.

During this time, the thing with the fireworks and the CPR had also happened. I’d recently got together with Jason, and I don’t remember the exact phrase, but he basically said: you talk about midwifery all the time, do you think should go back to it?  

A dear friend of mine had been saying the same thing. Returning to midwifery was insane, really, considering my background health situation, but apparently, I have a strong streak of denial.

After two years of trying (and one university who rang me on the day of my interview to say they were no longer going to run the return to practice course that year), I was given an honorary contract at my local hospital. The only issue was that I wouldn’t be paid for the training period. I didn’t care about that. I had a very supportive head of midwifery who said I could come back without nights.

My Full Attention

Here’s something I wrote a few shifts into going back:

I looked up from putting a CTG on the other day and forgot I’ve had such a career gap. My brain had already joined this experience up with the last time I practised and presented it as a long unbroken road of fetal heart auscultation stretching out behind me like I’ve never been away.

Two things you might like to hear about.

The first cannula I’ve done in five years went in fine, and it was a tricky one. We can all agree that by rights, I should have missed it.

Two, I’ve been looking for the perfect pair of work shoes since 2007. 

I’ve now invested in a pair of Doc Martens (Maltbys, if you want to know) and I’m not looking back. Comfy and indestructible, which is also what I aim to be as a midwife.

My overall assessment of being back is that being with the women/clients and giving them my full attention is the best thing I could be doing for my mental health. 

Marching around trying to find a y-connector is the perfect complement to the intense community moderation I get up to in the other part of my life.

I really love this job. I always did.

Public Service Announcement

By this point, my midwifery community online was discussing things like anti-racism and trans rights and those things are important, but moderation was excruciatingly hard. So I booked business coaching from Mars Lord, who is a doula specialising in antiracism, and who sits on the RCOG equality board. Mars is a smart woman who worked on a plan to make things easier, and she is responsible for many things that make my business work.

 I also told her about the migraine situation, and she recommended I take a complete week off. This was awesome, something I hadn’t done in YEARS.

After this, I wrote this to my email list.

Public Service Announcement

I took a week off. Entirely, no moderating of the Secret Community for Midwives in the Making. No midwifery. No writing the book. No business stuff. Instead, I read and saw friends and ran and went swimming in Cambridge’s Lido.

And guess what, the vestibular migraines are gone. I mean, not completely, I can feel them lurking, and if I’ve had a busy day, they come back in the afternoon or evening. On the one hand, I’m thrilled that I don’t have to take amitriptyline, which is what your GP will suggest if your migraine has lasted four and a half weeks. On the other, this means I will somehow have to balance midwifery and writing with a low-stress life.

Wishful thinking. The second I sat down at my desk the next week to do some work, all the symptoms flooded back. On reflection, spending a lot of time horizontal during my week off was probably what helped. But that wasn’t a feasible solution in the long term.

In late 2020 I wrote to Mars: 

I don't think this is burnout. I've had days of near-complete rest and sleep and my symptoms are still very much there. The tablets help but they only take the symptoms of fullness away. The dizziness, lack of engagement, depersonalisation and weakness remain. But on top of this, I'm pleased because I got through the return course and my business is going well.  I want to go for runs and write my book. 

The issue I have with working nights is related. Lack of sleep puts me into a prodromal phase of migraine, with the real thing following soon after. This is incredibly obvious now things are worse. I didn't know what this meant when I was training as a midwife age 18/19. I just thought I was 'shit at nights'. 

The symptoms mean lack of balance, dizziness, hallucination at the edge of my vision at times and despair because my brain is telling me to stay still.  I don't have depression. I'm one of the most excited by life people I know. I get anxious about my performance but lots of people do and frankly, when this can hit you at any moment, I'm not surprised I get anxious.

In contrast to this is all the stuff I've done. Including throwing myself into 10 degree water, starting a business, being a midwife. Doesn't fit with being over-anxious and depressed? 

Mars’ advice was to go back to the GP to ask for further help, and not leave until I had an answer. 

I can remember thinking that it was odd I’d spent years learning to advocate for women but when it came to my own well-being, I couldn’t even describe my symptoms properly.

No Way Back

I went back to the GP, knowing full well that the next stage was amitriptyline. This is an SSRI used for nerve pain and as an antidepressant. At that point, I found a counsellor. Amanda happens to live around the corner from me, and I explained I wanted to do my due diligence before starting on medication. She took me on as a patient. Together, we got through the next few months, which were a blur of shifts and migraines. There were triumphs at work and the rawness and challenge of being a newly qualified midwife.

My counsellor and I talked about my childhood, my relationships, my work life and writing. We looked at the pros and cons of treatment versus no treatment. For some reason, amitriptyline was my Rubicon. I felt like if I started taking it I would always need medication to cope with life and there would be no way back. After weeks of pussyfooting around, I eventually asked her outright what she thought. She’s an older counsellor who is low on bullshit. She said ‘I think taking it could be a good thing’. I talked about the session with my brother, who’s a mental health social worker and he pointed out that my reluctance to take medication might just be common garden prejudice about mental illness. This was an uncomfortable mirror to have held up.

I rang the GP, who wrote the prescription. I cried as I picked up the tablets. Jason was coming back from squash and picked me up. He came and found me in Boots while I was waiting for it to be processed.

You’re supposed to take amitriptyline in the evening. The first tablet took a few hours to kick in, and then I got 2.5 seconds notice before falling asleep, and went under as if by an anaesthetist's needle. I was foggy the next day, with a migraine still underneath, but I made sure I did a cycling turbo session, pushing through the exhaustion and wanting to hit 170 bpm heart rate. Way too early to tell what was going to happen, but it helped me feel more in control. 

I had three weeks of being exhausted, sleeping for hours in the middle of the day. The migraines didn’t disappear, and it felt like bits of my brain were numb, like I’d injected lidocaine into them. The dizziness sometimes became much smaller. It wasn’t unpleasant. But I needed to keep taking the tablets for 6 weeks to see if they worked, which was a bitch with a book deadline due. Eventually, the side effects reduced, but I was still getting mild migraines, with the occasional day of severe ones. When you’ve had years of an illness getting worse, you assume nothing will help. I was terrified of putting myself through 6-8 weeks of intense tiredness and it not working and being back at square one.

Then there was a two-week period where I was still tired, but the migraines had gone. I remember being at a park with my nephews and telling my sister I should have taken the pills years ago. At the time, I wrote: ‘The drug I’m on seems to have smoothed the vertigo away like a giant hand brushing irritant crumbs out of my head.’

A Culture of Coping

A few weeks later I wrote this:

Return to Practice Reflection

The first birth I did as a newly qualified midwife was an intrauterine death. We ended up in theatre. The baby had been dead for some time. I was in a counselling session the other day and we talked about this. There were a few friends and family members I asked for support and the narrative of that newly qualified time period is studded with their reactions. One told me to forget about it and think about all the healthy babies I’d look after. Another told me I was too young to be doing that job. That situation and family pops into my head at least once a week.

I did my return to practice course in 2020, and my first birth was a healthy baby of the same sex as the child who died. The CTG was beautiful all the way through and it was an almost pain-free process. Birth is always hard but it was one of the most positive I’ve been at. This time my newly qualified process has been so much softer. I’m calmer. Being on shift without a migraine is a novelty. I have a new pencil case in which I put my ID and name badge, and pens so stuff doesn’t get lost in my bag and I can easily set my scrubs up when I get to work. I’m looking at it right now on my desk and I can hear the tick of my fob watch. My counsellor tells me I’ve created this wellbeing for myself but I feel like being happy and settled is somehow cheating. Not a sensible way of thinking. Instead what’s happening is the ghosts from my midwifery past have room to stretch out and tell their stories.

I am now a band 6 again. Quite the journey. 

As Professor Mavis Kirkham wrote in 1999, midwifery has a ‘culture of coping’. I was thoroughly immersed in that even before I started training. The odds are, you are too. But this culture cost me years of midwifery practice, and many hours of being miserable because I was getting more ill.

Rest is important but the real ‘Public Service Announcement’ should have said:

If you are struggling, this is no time for embarrassment: seek out all the help that is on offer. There is no such thing as ‘doing it on your own’. We all lean on each other. 

Going to Mars for help with my business made me able to ask for help with my health. Listening to my GP and being brave enough to start medication gave me my life back.

There are so many reasons I wanted to go back into midwifery. I missed it in my bones. I needed to get my internal self and who I am on the outside match. Without midwifery, I feel insubstantial, like smoke that’s going to blow away.

If I had found a professional I could trust and had been able to find the words back in 2014, I doubt I would have left midwifery. I was too proud to say ‘I think there’s something wrong here, could you take me off nights until I’ve figured it out?’I wouldn’t have had that experience in the park where someone needed CPR and I couldn’t remember what to do.

If you are at all considering you need help, do not be afraid to seek it out.

Vicarious Resilience

As I get older, I have more people in my life who are counsellors and therapists and they talk about something called ‘vicarious resilience’. Resilience has become something of a dirty word in healthcare because ‘you need to become more resilient’ is not an adequate answer to the current demands on service. ‘Vicarious resilience’ is different. It means resilience that you have access to based on being ins someone else’s company. I used to think about this concept well before I knew the term, as on particularly hard shifts, I used to imagine trying to climb onto the raft of certain midwives I loved.

It would be my honour and pleasure to offer you the resilience I have from being a midwife, along with ten years of business in this area. I can assure you that the same issues come up again and again.

There are things I share with my email list that I wouldn’t put up publicly on my website or social media.

If you’d like to hear more, consider signing up to my email list. You’ll get 5 small reassuring pieces of midwifery writing sent out to you over 5 days.

*I have changed identifiable features about this, like places and people, but the core story is real.