Midwives roles are dedicated to their profession, their patients, and giving their time to help women during their pregnancy, childbirth and post-partum period. This job can be taxing on the health professional, causing possible stress and burnout. When a person constantly gives so much of themselves to their clients with nothing in return, their emotional and physical wellbeing can become compromised.
‘Midwifery is a demanding profession carrying high levels of professional responsibility and, increasingly, public performance accountability. Midwives are accountable to the women they care for, to their employers, and to their regulatory body, the Nursing and Midwifery Council (NMC)’ (Martin et al, 2018). In a recent study by Mollart et al (2013), 152 registered midwives working within two different hospital maternity units were tasked with taking the Maslach Burnout Inventory Human Services survey and another demographic survey that analysed their care model, shift work, lifestyle data and their exercise level.
‘There was a response rate of 36.8% with 56 out of 152 midwives completing the surveys. Almost two thirds (60.7%) of midwives in this sample experienced moderate to high levels of emotional exhaustion, a third (30.3%) scoring low personal accomplishment and a third (30.3%) experiencing depersonalisation related to burnout’ (Mollart et al, 2013). The response rate shows how midwives experience a lot of emotional exhaustion in their field, along with depersonalisation which can cause mental health deterioration. Midwives become so consumed with the wellbeing of their patients that they lose sight of their own mental health and need extra support along the way.
Starting in England and slowly making its way around the world, a relatively new study has emerged into the medical field, the professional midwifery advocate (PMA). This position allows for senior midwives to become consultants to those below them, giving their coworkers a chance to seek professional support. It is a newer model that allows for midwives to get the support they need in their careers, limiting their chance of burnout and mental health problems.
‘The role of a PMA is to support and guide midwives so that they can deliver consistent, high quality, safe maternity care and also to support the women and families who journey through the maternity unit at Western Sussex Hospitals NHS Foundation Trust. By listening to women and supporting the choices that they make, PMAs ensure that the maternity care provided is responsive and caters to their needs’ (Western Sussex County Council, 2020).
This new profession is a way for younger midwives to get support with their professional development, education and preparing for appraisals. It has been made as a role for support towards those working in the medical field. Midwives have to be mentally and physically there for their patients as a way to calm their anxieties and nerves, and give them the best care possible. Which is why the new PMA title will give midwives a better chance for success within their industry. It is a way to protect them and derive them from burnout.
In an article by Midwives magazine (2017), the author talks about how midwives will be allowed to talk one-on-one with a professional, allowing them to slow down and reflect. ‘In England, this new employer-led professional model is “A-EQUIP”—or advocating for education and quality improvement. It brings into being the PMA, a new role replacing the statutory supervision of midwives (SoM)’ (Midwives magazine, 2017).
One of the key elements in the A-EQUIP model is the restorative clinical supervision in midwifery practices. ‘Restorative supervision is widely used in other professions, such as health visiting and social care work, and the initial challenge for the new PMA role will be the successful introduction of this innovative model into NHS maternity services as a resource within the new local maternity system transformation project’ (Sterry, 2018).
The SoM was a role that supported the protection of childbearing women and was recently transformed into something more positive for midwives. Kim Housham, a SoM who completed the four-day module to become a PMA, discusses in the article how the programme is beneficial to all midwives (Midwives magazine, 2017). ‘It is purely support; an opportunity to talk to somebody, where everything said is confidential—unless there is a safeguarding issue or unsafe practice’ (Midwives magazine, 2017).
The SoM existed to protect women who are pregnant but it did not protect the midwives within its medical field. This ensued the change to a different role that helped not only the pregnant women but also the midwife. ‘The King's Fund review (Baird et al, 2015) and the Kirkup (2015) report made recommendations that the supervision and regulation of midwives should be separated, and that the NMC (2017) should be in direct control of all regulatory activity’ (Wain, 2018).
‘The SoM existed to protect women who are pregnant but it did not protect the midwives within its medical field’
This change encouraged the chief nursing officer of England to create a new model that would still focus on supervision but would also enforce support within the community, introducing the PMA role (Wain, 2018).
Each PMA needs to undergo training to deliver restorative clinical supervision to their patients which is a model designed to support professionals that work in roles with significant emotional demand. But there were aspects of the SoM that were not brought into the new role, such as PMAs will not be on call 24/7, only during working hours and they will have a specific group of supervisees (Midwives magazine, 2017). Although the changes have been made, the idea to help other midwives has grown stronger.
‘It has delivered substantial reductions in the stress and burnout levels of over 2 500 staff while supporting their compassion satisfaction (the pleasure they derive from their job) and increasing the attachment they have to their organisations. The programme currently offers a training day, followed by six individual sessions and two group sessions of restorative supervision’ (Wallbank, 2013).
The programme to become a PMA focuses on the attendee's skills, clinical leadership, restorative clinical supervision, normative function and personal action for quality improvement. ‘A small-scale study of six high-level managerial nurses revealed that after six months of clinical supervision, nurses viewed it as positive as they had been able to debrief, reflect and share stressors in their work environment’ (Wallbank, 2013).
This study shows how nurses and midwives are affected in a positive manner towards the restorative clinical supervision that is associated with the PMA title. As a result, numerous workers within the healthcare sector have experienced a relief in their stressors since they are given the option to rely on someone else in confidentially which, in turn, makes them a better worker.