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I recently came across an article when researching another blog post. The title grabbed me straight away “Am I too emotional for this job?” - An exploration of student midwives' experiences of coping with traumatic events in the labour ward (Coldridge and Davies 2017). I was interested because of a few experiences I'd reflected on recently and the articles coming out in the news last year about change from normal birth and the reduction in nursing and midwifery applications and more midwives leaving than joining the profession (see here and here).

What is happening? Is it case of the profession not being appealing to young people, the politics of the NHS budget, the pay cap (read more from the RCM here) or simply the removal of the bursary in England and Wales?

For those who are studying and coming to the end of our student midwife journey - it is important that we continue to be well supported and encouraged when studying and in clinical practice in order to sustain the demand for passionate and empowered midwives needed across the UK.

New UCAS data has revealed the number of students applying for midwifery and nursing degrees are down by 8%. (RCM)

So back to the article. Coldridge and Davies look at students experiences of coping with traumatic experiences in a labour ward in a consultant led hospital in the North West of England. Focusing on a psychotheraputic perspective of a study undertaken by Davies and Coldridge in 2015. Here they examine the psychological tensions and anxieties that students face.

A few key points that stood out for me when reading this article include

The awareness that student midwives are more vulnerable to psychological distress due to having a more empathetic relationship with woman and the unpredictable nature of birth itself
In many instances students are left to make sense of experiences alone
Which can lead to feelings of being unsupported, traumatised, uncertain of their abilities and even questioning their abilities to be a midwife.
Students often flip between role of observer and practitioner and this can be uncomfortable when discovering how to best advocate for the woman - they feel uncomfortable discussing the best versus safest options.
Lack a feeling of belonging between the space of the woman and the midwife ('No mans land' Coldridge and Davies 2017)
Students are often disillusioned by reality of working in a busy labour ward
More often the student has a higher personal investment in labouring woman

Unbelievably a few of these points were sounding familiar to what I had read in regard to midwives leaving the profession - so why are students being left with a feeling of uncertainty and a loss of their 'Midwifery spirit?'

Overall the article looks to mentors to recognise the students need to talk, discuss and debrief from difficult and traumatic events. They need to creatively think about student midwives anxieties and make sense of them in order to mentor and work together appropriately.

Student midwives also need to be encouraged to reflect and focus on self care when experiencing adverse outcomes in clinical placement settings.

Great article, and really made me think of how I will reflect on my experiences to come - with a new found awareness that psychological distress and upset is natural, normal and need to be managed in order to practice effectively.

Have you read this article? What are your views on students exposure to traumatic events?
Are we really in danger of losing our 'Midwifery spirit' if this is not managed correctly?

I hope not. Until next time,

Ruth x

twitter: @ruth_stmw
#GetYourTweetOn

Links to news articles are click through in the blog post.

Article reference:
Coldridge, L. and Davies, S., 2017. “Am I too emotional for this job?” An exploration of student midwives' experiences of coping with traumatic events in the labour ward. Midwifery, 45, pp.1-6.

On the 12th September 2017, the RCM introduced into the Parliament a series of short films and images related to the illegal practice of FGM, or Female Genital Mutilation. This is being put forward to help highlight misconceptions about FGM and the UK, cultural practices and awareness of the consequences of FGM.

My first experience with FGM was at a Midwifery conference held by my University the year before I started studying there. I had accepted my place and was keen to visit, so attended their student run International Day of the Midwife conference. There during the second half of the day was a lecture on FGM.
This was the first time I had seen first hand images of FGM. The first time I had really connected the practice with Midwifery. However it was not going to be the last time I heard about it, or encountered it.

In July 2017 new statistics showed that there had been 5391 new cases of FGM in England alone.

112 of these were Women and Girls born in the UK, and of then 57 procedures we actually performed in the UK.

The RCM remain concerned that there is a lack of access to FGM community support, lack of resources and lack of education by health professionals surrounding FGM.

As a future midwife I am not as naive to think that I may not one day met a woman or girl who has suffered FGM. In fact my plan is to mentally and educationally prepare for that day.

FGM, also known as female cutting or female circumcision is usually performed by a traditional cutting practitioner usually a family member, with a blade. Usually a razor blade.

It is conducted from birth, to puberty and beyond and is prevalent in countries in Africa, Asia and the Middle East.

FGM is culturally practised to ensure a woman or girls maintain their 'innocence' or 'purity' in an attempt to control their sexuality. Many families see it as an honour, with fear that if their daughter is not 'cut' she will be socially excluded.

Call The Midwife, the BBC drama about Midwives in 1960s portrayed FGM in their last season. The woman was pregnant and had been circumcised and then sewn, also known infibulation. This is where the vulva are joined and sometimes a small hole is left for urine or menstrual fluid to leak and for sexual penetration but no visible vaginal opening. The show portrayed sensitively the cultural aspect of FGM in the 1960s and also the difficulties and health problems that it causes women. Not just pregnant women.

Please watch it if you haven't and are more interested in FGM. (I am aware this is a dramatisation but it was a great source of awareness of FGM).

Since 1970s it has been of great effort to try and persuade practitioners to stop performing FGM. Many countries made it illegal, but rules were not enforced. In countries like the UK - women and girls are flown back to countries where the practice is not illegal to have the procedure.

The procedure, as mentioned is performed by non-medical practitioner, often using the same blade for many girls. Infections and sometimes urinary issues arose, haematoma and considerable pain for the women and girls.

In regards to women's rights, it was only in 1993 that the United Nations added FGM to the Deceleration on the Elimination of Violence to Women. In 2003 it joined and sponsored the International Day of Zero Tolerance for Female Genital Mutilation.

But how and why did we wait so long?

Practising of FGM has been known since the 1960/70s yet organisations such as the UN have not declared zero tolerance to FGM until 1990s.

Perhaps because FGM was not seen as prevalent in UK or Western society that many healthcare practitioners and organisations felt it was not an issue to deal with. Perhaps it is just another case of female health being ignored for other health matters. (My own Opinion)

I have read a few pieces on the opposition of making FGM illegal on the basis of cultural significance, potential social exclusion, women's choice and hygiene.

In one article a pro-FGM supporter noted that female circumcision is carried out to avoid bacteria and clitoral adhesion occurring due to having extra labia and not being able to clean themselves properly.

I will one hundred percent admit that as a white woman in a western society this does not make sense to me, but perhaps through traditions women are taught to see circumcision as beautiful and 'clean'.

Perhaps also however, we should also be focusing on hygiene education in these countries.

In the UK I cannot see the same issue arising except for social cultural acceptance.

This particular author also noted how the term 'mutilation' is offensive and demeaning. But surely having to have parts of your genitals cut with a razor blade with no pain relief is more demeaning to that woman than not allowing herself to have the right to choose.

As a feminist and future midwife I am encouraged to educate, bring awareness to and #EndFGM

Follow the RCM's Campaign on Facebook and Twitter - if tweeting use hashtag #EndFGM

Ruth x

twitter: @ruth_stmw

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