Taking care of you:

Self-care for Midwives and healthcare professionals caring for bereaved families

Most midwives, obstetricians, and maternity support workers enter their profession to facilitate the start of a new life and care for families at a joyous time. Unfortunately, every day in the UK, fourteen babies die before, during, or shortly after birth. This means that in addition to caring for parents at a happy time, maternity staff must be able to provide practical and emotional support to families during a bereavement. So, there needs to be mechanisms in place to take care of staff wellbeing for those working within a maternity setting, as well as for those in the wider hospital and community settings 1

As a midwife caring for bereaved families, you are committed to providing the best possible care and support to families following the death of their baby. Caring for families during such a heartbreaking time can have a profound impact on healthcare professionals so why is it that those professionals on the frontline are so impacted yet so overlooked? 

photo of woman resting on the couch

It is not simply the act of caring for parents whose baby has died and managing the devastation it brings that is extremely challenging; it is the combination of trying to provide the best possible care whilst navigating inadequate staffing and a lack of available resources that causes extreme levels of stress and burnout. According to the most recent RCM staff survey, only 5.9% of midwives said that there are enough staff at their organisation. Chronic staff shortages, unrelenting workloads, extended shifts, missed breaks and poor culture – work-related stress issues can have a scarring effect to overall mental and physical health. It can also seriously affect the quality and safety of care that members strive to provide to women and families 3

During my time in post as a bereavement midwife, these pressures were evident and felt almost daily, and I regularly witnessed the effects of this amongst my more junior colleagues with very little recognition of the significance of this for the individual.  

Sian Ness – Bereavement Consultant & Relationship Manager, RM, BSc (Hons)

Winner of the RCM ‘Excellence in Bereavement Care’ Award 2021

The term ‘professional trauma and fatigue’, describes the risks that can be associated with working with other human beings who are in need of support and potentially affected by trauma. Stress, compassion fatigue, secondary trauma, burnout and vicarious trauma are all terms also used to describe this impact.2 Healthy and well rested midwives, maternity support workers and student midwives are at the heart of providing safe, high-quality care for women and their families

It is, however, common practice for a midwife working on the labour ward to be expected to provide care to a bereaved family whilst also caring for other women either in labour or undertaking routine inductions. This places a huge physical and emotional toll on the caregiver. 

worried young woman covering face with hand

The RCM 2022 staff survey showed ‘dangerously low levels of morale among midwives in England, with 71% of midwives saying they find their work emotionally exhausting – not far off double the national average of 38%. Similarly, 63.1% of respondents said they regularly feel burnt out because of their work, and 62% reported regularly feeling exhausted at the thought of another day/shift at work. Nearly four in every five respondents (77.7) said they often feel worn out at the end of their working day/shift’

These midwives are passionate and dedicated so they continue providing exceptional, kind, compassionate care for long twelve-hour shifts over and over again. The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as being able to walk through water without being wet 4. So, when they eventually break, as they all so often do, who cares for them? 

It’s not good enough that those whose role it is to support others, are not supported as a matter of course, in order to do their work safely, effectively and in good health 2. Without the ability to manage one’s grief, health care professionals may experience physical, emotional, cognitive, behaviour, or spiritual distress, which could have implications for their professional practice 5

Sian Ness – Bereavement Consultant & Relationship ManagSian Ness – Bereavement Consultant & Relationship Manager, RM, BSc (Hons)

Winner of the RCM ‘Excellence in Bereavement Care’ Award 2021
er

Sass Boucher developed a model to provide support to caregivers; this model is known as the pillars of protection. 

  • Awareness – Very simply, she states, we cannot work with or acknowledge any concept if we have no awareness of it, therefore, she recommends frontline staff should be trained in trauma and fatigue. Staff should be provided with an awareness and support for how it feels to be ‘in’ the job. 

Sadly, the RCM survey found that concerningly, just 48.4% of midwives reporting being able to access the right learning and development opportunities when they need to 36

At CuddleCot, we provide comprehensive clinician led bereavement care training. This does not only cover the fundamental aspects of providing gold standard bereavement care to families but also equips healthcare professionals with the tools to care for themselves too. 

  • Supervision – Supervision is recommended for any practitioner who is providing therapeutic support, or who works in roles that require regularly giving or receiving emotional support. Clinical supervision for nurses and midwives is increasingly becoming more widely used. This is mainly for two reasons: there is a search for support during what has been a challenging time for the profession and a recognition that a supportive, reflective and educational process (such as clinical supervision) has a decent evaluation literature, and we have people that have experienced it and continue to use it 7

Unfortunately, clinical supervision is not offered to all healthcare professionals routinely. Some bereavement specialists receive clinical supervision; however this is not a mandatory requirement for all specialist midwives caring for bereaved families. Midwives/nurses can seek alternative support through their line manager, professional midwifery/nursing advocates and staff therapy services. 

  • Peer Support – Healthcare professionals can find significant support from their relationships at work as a form of informal supervision. It’s well recognised that having colleagues to debrief with and offload to is vital in building practitioner resilience.

Debriefing is a process of communication that takes place between a team following adverse or upsetting events. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence as well as potential errors made. This helps improve staff confidence and learning as well as improving patient safety. It is vital that staff are provided with the time and space for debriefing and reflection following a particularly challenging event in order to feel supported and have their emotional responses acknowledged. 

  • Self Care – Practitioners need to be able to rest and recover from their professional roles. Physical and emotional exhaustion are often discussed when healthcare professionals talk about their work, typically using words such as fatigued and exhausted. There are a variety of ways self-care can be practised. 

Some ways healthcare professionals can look after their own mental wellbeing are detailed below:

  • Eating a healthy diet 
  • Making sure you are getting adequate sleep
  • Exercising such as walking or yoga
  • Getting outside for fresh air
  • Journalling
  • Mindfulness
  • Meditation 
  • Alternative therapies (reflexology, massage etc)
  • Spending time with family and friends
  • Painting/drawing
  • Reflective writing
  • Laughing 
  • Asserting your own personal boundaries (saying ‘no’ sometimes)

Prioritising yourself and your own mental wellbeing is essential to being the best version of yourself not only personally but professionally. Self-care is an essential part of life, not a luxury you can’t afford. We need to schedule self-care into our daily lives. This doesn’t have to be an expensive spa treatment or treat, but rather simply self-compassion by taking good care of yourself, allowing yourself to rest, to laugh and enjoy yourself, and spend time with friends and family. This is an unprecedented time which calls for unprecedented kindness, I know it is cliché, but it is so important in these times to be kind and not just to others, but to yourself. This is especially important for midwives since compassion is crucial for the provision of respectful maternity care. In the words of Pema Chodron, ‘Compassion for others begins with compassion for ourselves’ 8

Support Organisations and Information (UK)

Most NHS Trusts have their own employee wellbeing programme and access to counselling/support. We would suggest contacting your HR department to find out what support is available within your workplace. 

  • NHS England: If you need someone to talk to, NHS England have introduced a confidential text support service. You can access support by texting FRONTLINE to 85258 for support 24/7.  This service is available to all NHS staff who have had a tough day, who are feeling worried or overwhelmed, or who have a lot on their mind and need to talk it through. (NHS England)
  • Just B: Call 0300 303 4434 from 8am to 8pm, 7 days a week, for trauma and bereavement support from Just B
  • Samaritans: Call 0800 069 6222 from 7am to 11pm if you’re in England, or 116 123 any time or if you’re elsewhere in the UK, to talk to Samaritans.
  • You ok doc’ provides ‘Shout 85258’ – this is a free, confidential, 24/7 text message support service for any Doctors who are feeling overwhelmed or is struggling to cope. Text YOD to 85258. ‘The Shout service is staffed by trained volunteers who will work with you to take your next steps towards feeling better. We can help with issues such as stress, anxiety and depression and are here to talk at any time of day or night’. 

Support organisations (USA):

The Mental Health Hotline can connect you with professionals who are happy to listen and help with mental health crises. The services are free, and confidentiality is guaranteed.

📞 Call:866-903-3787

Find treatment in your area.

www.findtreatment.gov

References:

1. BLAW Blog, Kelly Williams, 2021

2 Boucher, S, Pillars of protection, BACP Workplace, January 2019, Issue 99

3  RCM ‘Caring for you’ charter’

4 Remen R. Kitchen table wisdom. New York: Riverhead Books; 2006

5 Behnke, M.L., Reiss, J., Neimeyer, G., & Bandstra, E.S. (1987). Grief responses of paediatric house officers to a patient’s death. Death Studies, 11, 169-176.

6  RCM Staff survey, Royal College of Midwives, March 2022

7  Nursing times, ‘What is clinical supervision and how can it be delivered in practice?’ January 2022

8 O’Connell, M, ‘Why does self-care matter for midwives’, All4Maternity, https://www.all4maternity.com/why-does-self-care-matter-for-midwives/

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