Posted Thursday 5th May 2022 for the International Day of the Midwife 2022.
Dr Patricia Gillen, Head of Research and Development for Nurses, Midwives and AHPs, Southern HSC Trust & Reader, School of Nursing and Institute of Nursing and Health Research, Ulster University.
‘I realised I wasn’t safe in Midwifery!’
Today on the International Day of the Midwife, we mark the 100th Anniversary of the International Confederation of Midwives (ICM) which works to support, represent, and strengthen professional midwifery associations throughout the world.
On this auspicious day, we continue to be encouraged to advocate for midwives and midwifery as we have for the last 100 years. While rightly we seek further investment in maternity services and celebrate the many positive intergenerational impacts of midwifery worldwide, I suggest, we must also acknowledge the pervasive culture of bullying that exists within our profession. Bullying in Midwifery is not new; it exists in academia and practice, it has been discussed for many years often in private and only sometimes in public with workplace unions such as the Royal College of Midwives highlighting the existence of bullying in midwifery and Ball, Curtis and Kirkham reporting a large minority of midwives leaving their jobs or profession because of bullying.
More than twenty years on, we have copious anecdotal and research evidence of bullying in midwifery, from student midwives, newly qualified midwives, experienced midwives and pregnant, labouring and postnatal women. Bullying has three key attributes: the behaviour/s is repeated, it has a negative impact on the targeted individual and it is difficult to defend against, usually due to an imbalance of power (3). Bullies are often supported, encouraged and promoted within our profession. From a human resources perspective, it is rarely the bully that leaves as often they are protected by the hierarchical and power-based systems within which many midwives work.
Workplace conflict is a normal part of working life. Being surrounded by colleagues who will always agree or on the contrary, always disagree with the person in charge is not healthy. Constructive debate and challenge is needed for innovation and optimal care for women and babies. We can all have bad days, be a little short tempered or gruff with a colleague. That type of behaviour is usually sorted a with a quick acknowledgement and apology. Learning to work with colleagues who we would not choose as friends, is all part of working as a midwife.
Midwifery has its social order and, in those places where bullies thrive, as a student midwife or midwife, you fit in, learn to fit in or if you don’t, you are constantly watching your back. If you fit in, there are many advantages bestowed on you, including (but not limited to) better work rotas, training and development opportunities, you are included and invited to feed into important decisions. If you don’t fit in or bring challenge that doesn’t align with the bully or bullies, you may find yourself a target.
Don’t be in any doubt, the culture of bullying that pervades our profession comes from the top. It is used to keep midwives in their place. Those midwives who have a different perspective to bring or disagree with the ‘way things are done around here’, are quickly put in their place. We can blame others and our work circumstances if we wish. However, where bullying is not tolerated, it either does not happen or if it does, it is dealt with swiftly and damage is minimised- both for the bully and the target of the bully. If it is not dealt with, the bully quickly learns what works and will continue to behave in that way and may begin to bully others. The target will most certainly suffer, often becoming ostracised by colleagues and will leave if they can, as they no longer feel safe. They will work somewhere else or leave the profession altogether further adding to the problems with retention of midwives and the maintenance of optimum staffing levels for the provision of high-quality care for women and their babies.
Midwives including those who lead the midwifery profession work to a Code of Conduct (4) that sets standards of professional practice including prioritising people and promoting professionalism and trust. These standards encourage midwives to raise concerns about care or practice and expect that midwives do not bully each other or indeed women in their care and yet, the evidence continues to tell us that bullying is a pervasive aspect of the midwifery culture with the recent Ockenden report highlighting the role that bullying can play in workplace culture.
Today, of all days, it is incumbent on leaders at all levels in the Midwifery profession, each midwife and student midwife to consider if they tolerate bullying in their place of work- do they include or exclude, do they show favouritism to some and do they accept bullying behaviour from colleagues using spurious justifications such as they are a ‘good midwife’ and ‘its just their way’! We need to change how we behave towards each other and stop relying on our cliques and being in with the right people to get us through our working day! Doing the same thing and expecting a different outcome, will get us nowhere and waiting until we have the right staffing levels and working conditions, until we do something, is not acceptable. The time for change is now! Each of us must play our part!
1. Royal College of Midwives (1996) In Place of Fear: Recognising and confronting the problem
of bullying in midwifery London: RCM
2. Curtis, P. Ball, L. and Kirkham, M. (2002) Why do midwives leave? Talking to Managers London: RCM
3. Gillen, P. Sinclair, M. & Kernohan, WG. (2008) The Nature and Manifestations of Bullying in Midwifery Belfast: Ulster University
4. Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for nurses, midwives and nursing associates London: NMC
5. Ockenden Report (2022) Final Report of the Ockenden Review Findings, conclusions and essential actions from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust.