thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
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Ep 85 Jenny Patterson on Birth Trauma, Midwifery Burnout, Resilience and Healing
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Ep 85 (http://ibit.ly/Re5V) Jenny Patterson on Birth Trauma, Midwifery Burnout, Resilience and Healing
@PhDMidwives #research #midwifery @NHS_Education @ScotlandRCM @EdinburghNapier @CapacitarInter1 #PTSD #potatoes @Dianethemidwife
Research link - ibit.ly/KgViA
Ever wondered how a passion for midwifery can transform lives, not just for mothers but for the midwives themselves? Jenny Patterson, a trailblazer in the field, joins us to recount her unlikely journey from setting aside her childhood dream to embracing midwifery as a life mission. Discover how her personal experiences of giving birth at home rekindled her passion, leading her down a path of advocacy, independent practice, and eventually, groundbreaking research. Jenny's story is a testament to the power of resilience and the impact one person can make in the face of systemic challenges.
Join us as Jenny sheds light on her transition from independent midwifery to research, a narrative shaped by regulatory hurdles and the absence of insurance options. Her journey illustrates the delicate balance between clinical work and academia, revealing insights into PTSD and trauma related to childbirth. Jenny shares how her involvement in the Birth Project Group and collaborations with top researchers propelled her into a PhD that challenges the conventional understanding of birth trauma. This episode offers a profound look at the intersections of personal, professional, and academic pursuits, offering lessons in adaptability and courage.
As we wrap up, Jenny talks candidly about the realities of midwife burnout, the emotional toll on caregivers, and the urgent need for systemic reforms. She highlights the importance of support networks, both familial and professional, in overcoming self-doubt and achieving one’s aspirations. With a promising future ahead, including a lecturing role and an exciting book project on love in midwifery, Jenny’s narrative is a powerful reminder of the transformative power of passion and persistence. Tune in to learn from Jenny’s rich tapestry of experiences that continue to shape the field of midwifery today.
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Journey to Midwifery Practice
Speaker 1Thank you so much for joining me , as per usual . Can you introduce yourself , please ?
Speaker 2So I'm Dr Jenny Patterson . I'm a midwife based in Edinburgh Well , actually just outside Edinburgh now in Scotland , UK .
Speaker 1Fabulous . So let's start at the very beginning . How did you get into midwifery ?
Speaker 2Well , my journey into midwifery probably began when I was age 17 , but I didn't actually get there until I was 40 . So when , when I was 17 , my sister had some major um operation in the local sick children's hospital and when I visited there was all these little babies . And I remember thinking I want to work babies , I want to work with families , well , I could maybe become a midwife . And then I discovered that to become a midwife I had to become a nurse first at that point and I thought I can't do that because I just knew I couldn't work with people who were very sick or dying . I thought emotionally I don't think I'm cut out for that . So I put it to the back of my mind . I went on , I did a maths degree , partly because I didn't ever want to write an essay which is quite funny now , given what I have done . And then I had four children , two of them born at home . So my experience of birth was , you know , I was really inspired by all of that , still thinking , no , I can't do this . Until I'm .
Speaker 2A few weeks after my fourth son was born , I met a friend I hadn't heard from for about 10 years and we caught up with each other and in that meantime she'd become a midwife . And I said , oh , do you know ? I've thought about this over the years but I really don't think I'm cut out to do the nursing part first . And she said you don't have to , there's direct entry . And as soon as she said it it was like a wee thing dropped into my heart and I thought , oh , I could be a midwife Fabulous . But my youngest son was like seven weeks old , and I had four of them under the age of seven . I thought this is not the time to take on that training , but I had been .
Speaker 2When I was pregnant with my third son and because I was planning home births , I'd gone along to a local birth teachers birth preparation class , and just because I thought I better be prepared if I'm giving birth at home . So I did a lot of self-learning , which is obviously building towards my knowledge as well and they were running something called the Scottish Birth Teachers Association training and I thought , oh , I could do that and it was something I could easily do around my family . So I spent a year or two with that course . Within that course I discovered the role of a doula and I thought , oh , that's definitely something . I'd be around birth . I could be around families and support , but I don't have to do all that full intensive training . So I took that on and in the middle of that I thought actually I should check . I'm OK around other people's births . It's all right , having had my own births , but maybe I could be present at somebody else's and go . This isn't for me , and I was very , very lucky in Edinburgh to be given . It's not easy to do that now . This would have been in around 2000 .
Speaker 2I was given the opportunity to spend a day shadowing one of the senior midwives in the local hospital , which was just fantastic . I was really there . I witnessed lots of births . I was able to actually really support somebody in one of them very beautifully . I was given a great opportunity and I knew as I walked out that day that , yes , this is where I can be . So that was where I was . So at that point I thought , well , I'll carry on doing the doula work . This will be fine um , and that worked very easily around my family , but it did involve some on call and continuity and you know all of this um . So I worked that out .
Speaker 2And then towards the yeah , at one point I was at a home birth with a local midwife . I'm going to name her because she's so fantastic . She's a community midwife in Lothian in Scotland named Maureen Benson , and I went attended a birth with her . She was the midwife , I was the doula , and I was so inspired by what she was doing and her role and I came away thinking away , thinking you know , if I don't go and do that midwifery training , I'm going to be 61 day and regret it that I never did it . So it was through Maureen that I thought I'm going to apply . My youngest was about six at the time , so you know I'd given some time in preparation . So I did and I started my midwifery training at the age of 40 and that was me . I was in and I haven't looked back . So it's 20 years ago now since I started my training .
Speaker 1It goes fast , doesn't it ? It does , so where did you work then , after you first registered ?
Speaker 2Well , after I first registered , because I was really , really keen on the continuity side of things , having done that as a doula , and that I just knew that that sort of continuity path was the way I really wanted to go , and there was no easy way of doing that , um , locally , I couldn't leave where I was in Edinburgh because of my children all being at school , so I didn't have the option to travel and work elsewhere very easily . Um , but there was no continuity at that point and I thought the only way I can do this is to do independent midwifery . And there were two very good local independent midwives . In fact there were two in Edinburgh , one in Glasgow , which is on the west of Scotland , and one who worked more up in the slightly further north . And so I connected in with them and I aimed , when I finished , to work as an independent midwife . But for the first few months I worked on the local in the local hospital as a bank midwife . And being being a bank midwife meant that I could take shifts as and when . But I wasn wasn't tied in . So I thought if I end up doing independent , I can drop those shifts or pick them up . So it gave me flexibility .
Speaker 2So I did about six months working in the local hospital doing lots of shifts , and then I was given the opportunity to go and be second midwife to the midwife in Glasgow and that was just fantastic . And so her name is Alison Ewing and she's not practicing as a midwife now for lots of reasons , but she was so wonderful she'd been a midwife for 20-30 years so much experience that I learned I mean , she was my mentor . I learned so much from her and that first home birth I attended with her . I just came away from that and I remember sitting on a train coming away thinking I feel like a midwife today because there was something different about what we'd been able to provide in that home environment compared to the hospital . Um , so from then I started to pick up my own caseload as an independent midwife .
Speaker 2So I did do independent midwifery for I think it was about eight years which involved a lot of on-call for for my own , the women I came for , but also I was second on call for the other midwives locally and because there was so few of us it meant we were covering each other quite a lot and that was exhausting , but it was . You know , I really got a huge amount of experience . That the experience of being with somebody right from the beginning right through all their pregnancy journey and their birth and the postnatal journey and what you see and what you learn I think is so different because you don't just get a wee snippet of a journey , you get the whole journey , so you see how different parts of the journey impact on others . You see the fallout of decisions and choices and things that have occurred . And the other key thing I would say with the independent midwifery is that I became very aware of birth trauma Because , contrary to a lot of belief that I did , you know , I did come across some judgment and opinions from people that I was out there getting rich quick on , you know women's experiences and there's a free health care service in Scotland .
Speaker 2Why would people pay for independent midwives ? And it must just be wealthy people ? There's a bit of that rhetoric around but actually that's not what I experienced . But actually that's not what I experienced . What I experienced with many of the people that would come to an independent midwife were people who had either gone through a previous traumatic experience within the local service system or had an intense fear of childbirth with their first baby and they just wanted to trust that they had a midwife who was with them through that journey and they see the same person . They would have that continuity that we know all the evidence tells us is so valuable , um . So so that really opened my eyes , I think , to trauma and and to experience and the impact that we had , um , as midwives , the impact we have on people's experiences . So that's that's , yeah , that's what I did for a while .
Speaker 1So how ? What did you do ? You said you , you did that for eight
Transition From Independent Midwifery to Research
Speaker 1years . Where did you go after the independent practice then ? Or why did you stop ? Was it the tiredness and the family , or another opportunity ?
Speaker 2Well , to be honest , the the reason I stepped out of independent midwifery . There was several reasons and part of it was trauma for me and and I I wasn't traumatized by birth and people and their families and their experiences I was more , um , I developed a very intense anxiety . So I say about the regulatory processes the Nursing and Midwifery Council in the UK is there to regulate and protect and everything that it does , but there's a very heavy-handed action from them and if , as an independent , we had to transfer somebody into hospital which occasionally happened planned home birth for good reason we had to transfer somebody into hospital , which occasionally happened planned home birth for good reason . We have to transfer hospital care . That's , that's appropriate and and happens sometimes .
Speaker 2But it seemed that every time that happened there was some sort of oh , what's this independent midwife done ? Have they been practicing safely ? And there was a lot of , a lot of temporary investigate right , we're going to take all your notes and we're going to investigate you . And I just got so freaked out and it happened about three times and each time , after several weeks of putting me through a lot of anxiety , the local , it didn't even go as far as the NMC ever . They would come back and say oh , you've done a great job , your notes are exemplary . Nothing to answer here . But I kept getting put through this mill and every time I thought I don't know that , I can open myself up to that . I know that I'm , you know , doing this well . I know that I'm very well trained in obstetric emergencies , more so , possibly , than hospital midwives , because you know you've got to rely on yourself when you're out there . You can't just press a buzzer and have somebody come run in the room . That's right so . But but the stress of that was really intense and that really wore me down .
Speaker 2Um , and in the in the midst of all that , the other thing that there was , that was a feature , is that we had we weren't insured in any way . There was no insurance available and when I first began to do independent work , it wasn't a requirement . The NMC would say you don't have to be insured . What you have to do is make sure that the women and families you're working with know that you're not insured and they sign to say they've been made aware of that , which of course , we all have forms for that and everything .
Speaker 2But then they changed that and they required insurance and the process of getting that in place was very complex . It's been a long journey and there are groups of midwives across the uk who've worked that out . There's lots of pathways . It's a whole other story , but I think the fear of that , this constant sort of waiting to for you to trip up in some way and then check you out I couldn't live with it . Even talking about it now makes me go oh it , it just was too much for me and , um , I decided I I wasn't going to do that so .
Speaker 1I see more stories here too , sadly yeah , um .
Speaker 2So it wasn't the fear of birth , it was the , the fear of that . I didn't feel supported . I didn't feel safe or supported as a midwife in the role that I'd chosen . So therefore , I had this whole experience of being aware of women's trauma in childbirth . I had a sense of trauma from a different perspective . Birth I had a sense of trauma in it from a different perspective .
Speaker 2Um , and so what I found at that point ? I thought I still wanted to work as a midwife . I didn't want to do intrapartum care . I had about eight months of covering a post in the community where I did lots of antenatal and postnatal care and it was just fantastic and I wasn't required to do intrapartum or to be on call in that post . And then it changed and then they were saying we need you to go on call and I thought I can't , I can't do this at this point .
Speaker 2And at that stage breastfeeding clinics were . There were breastfeeding clinics running across Edinburgh that were absolutely fantastic . Sadly , they got disbanded after a big fight on our part , but anyway they got disbanded . So I started working in those and they were just fantastic . You know , we could just really sit and spend time with women and families and babies . I got a lot out of working for those . So that was where my clinical journey ended ultimately , because when I took on the PhD , I continued those a little bit and then I stepped away altogether . So I haven't done clinical work probably since about 2018 .
Speaker 1So what got you into the research ? Was it straight into the PhD , or did you do a stepping stone that got you into research first and then the pathway for the PhD ?
Speaker 2No well , no , it was a sort of stepping stone that got you into research first , and then the pathway for the PhD . No , well , no , it was a sort of stepping stone . So for a number of years , while I was doing the independent work , I was part of a local group called the Birth Project Group , which was a group made up of some lecturers , local lecturers , midwifery researchers and it was international as well joe murphy lawless , who's based in dublin she would come across uh , professor rosemary mander these are all sort of well-known names in the uk in terms of research and the . The place is right back to where I'd started , the place where I'd done the birth teachers training course . They were , they would , it was part of their network . Oh , cool
Embarking on PhD Research Journey
Speaker 2. So I started .
Speaker 2I got invited to go along so we would meet every two or three months , um , and discuss policy issues , things we could maybe campaign about , things we could research around . We've written some papers , um , but there was little bits of research . There was some surveys on midwives , experience in the workplace . There were different things that we got involved in , and that was really exciting and for me to be connecting with these other researchers who were very well respected and renowned , and to get a chance to do a bit of work with them . That was great . So I was doing that alongside the independent work for for a number of years . So I suppose that was my introduction to research and to exploring the impact we could maybe have as midwives in terms of what's out there in the world . And it was actually within that group . I we did a survey and then I think it was Joe who said Jenny , you should turn this into a PhD . I'm looking at her going . I cannot do me a PhD . I went and did maths to escape writing an essay .
Speaker 2And then I went to do midwifery and thought I have to write essays . And now you're thinking I should write . I mean , I barely scraped a pass in my English at school . You know me write an essay , a PhD no way . But you know , she got me thinking and I had a look . But it would all have to be self-funded . And I started reading around it and it was really complicated and financially we weren't . We weren't on a high income as a family at all . So , yeah , I wasn't getting rich as an independent midwife , we weren't in a strong position and I thought I'm not sure that I can do this . So I just that was I don't know . That would be about the January , probably January , of 2015 . I'd just lost my dad in December 2014 . And it was around that time and I thought thought no , this is too much , I can't take this on .
Speaker 2And then , about a month later , one of the lecturers who's part of that group and Nessa McHugh she's now a lecturer at Napier , where I work as well . She's been there for a long time , fantastic midwife as well , and she'd been an independent midwife for a period as well . So she came to me and said Jenny , they've got an advert at Napier for a funded PhD . Oh nice , yeah . And I and I said , oh really , do you think you should ? You should do this , you should look . So I looked at it and it was around PTSD and trauma . Oh , cool . And I'm thinking , gosh , okay , um , a funded PhD in trauma , which , of course , I had quite a deep knowledge about . Oh , I need to go back a step , because when I was struggling with midwifery myself personally , I came across an organization called Capacitar International and they're a trauma well-being organization that work across the world since 1988 . And they were starting some training locally for a year about wellbeing practices , ways of managing trauma and protecting , you know , taking care of yourself . So I'd gone to them , that's right . I did that for a year , thinking , right , I need to look after myself . And in the process of that , realised that a lot of what I was learning I could use with midwives , students , families , and I did spend a bit of time alongside the breastfeeding clinics . I was offering wellbeing sessions and trauma management . So I'd forgotten that wee bit of the story .
Speaker 2So I had got all this history around trauma and my background and this training and suddenly this PhD opportunity that was funded for three years , and you know , and so I looked at it , it was full time and I was really , you know , not sure and thinking can I do this ? And my eldest son , um , he'd been in his early 20s at the time I think I can't remember what age he was , but anyway I said to him he says what's this , mum ? Then I said I don't know . I don't know whether I should do this style . And he said well , but , mum , you've got um . Will you earn more than you're earning just now or less ? And I said , oh , more , the stipend is more than I'm bringing in just now . And he looked at me . He said it's a no-brainer , it's a job for three years . You know , just go and do it , okay . So I did .
Speaker 2So I applied , um , but one of the requirements was to have done a master's and I hadn't done a master's . But they said apply anyway . So I applied and I got some really good support um , locally , um , I've got a friend who did a PhD previously and she gave me some guidance I think I had . I think I had about a week to put in this application and that week included Easter weekend . So I spent Easter weekend , when everybody was on holiday , doing stuff , trying to write this application , um , but I got lots of support and I spoke to a couple of midwives . I got really good support , good advice .
Speaker 2I put the application in , I had the interview and then I sat there and one of the things that you learn in capacitors is our techniques to help build you know , keep you calm , build confidence , help you be able to to speak out and do so . Anyway , I was sitting in the waiting room before going in , practicing all these different acupressure things and positioning , standing and various things , getting myself psyched up , and I went in and I just went and I just talked really passionately about you know what , what was important here . And they all looked at me and anyway , and I said , but you know , at the end I said , but I don't have a master's . So you know I'm here , but I realize you require a master's . And they looked and they said , no , what we require more in the master's is passion , and you've got loads of that . Yeah , yeah , um . So I got , I was given the opportunity , which was fantastic , um , so that's how I got into doing the PhD .
Speaker 1So did you get to choose ? So if it was a funded , then your supervisor came with it . Did you know them ?
Speaker 2Supervisors . I didn't know them um well . One of them is a midwife , professor Holland Caroline Hollands-Martin , um , and I had heard her speak in the pre in events previously , so I knew of her and I knew some of her work and and , um , obviously , before going in , I knew the people that were going to interview me , so I'd done a lot of background about each of them and , yeah , so I learned quite a lot . And Professor Thanos Karatsias he's a professor in psychology , based at Napier in Edinburgh , and and he was and he was a fantastic supervisor as well . So I had a really good team . But that team was given to me .
Speaker 2The topic was given to me . So the topic was about PTSD , um , my application was about I wanted to research the use of the capacitor well-being practices in terms of supporting well-being around trauma , um , but they basically said , no , we we want you to do PhD , but we don't want you to do that one . So you could look at stillbirth or perinatal loss , or you can look at birth trauma . And I said , okay , well , birth trauma is something I have a lot of background awareness of , so in a sense , I did get to choose a little within a little set of parameters , so I chose to focus on post-traumatic stress disorder , post -childbirth , and that's where I started .
Speaker 1So when you think back to it now , because you finished in I think I was reading 2019 that you finished .
Speaker 2Yeah , I submitted in August 2018 and set my viva in January 2019 .
Speaker 1So what sticks in your mind now as something that surprised you when doing that PhD journey , either in your experiences or in the results and what you found In terms of doing a PhD .
Speaker 2One of the things that surprised me and was a relief right at the start was , you know that , my anxiety about being able to write at this level gosh . You know . I'd read my friend who's supporting me who'd done her PhD . I'd looked briefly her PhD and I just about fell over and thought I can't . I can't use those big words . What's that sentence saying ? I don't understand , um , so I was a little bit anxious
Balancing PhD Work and Sanity
Speaker 2about that .
Speaker 2But very early on we got a lot of training built into the PhD , which was fantastic . Um , and one of the early ones , uh , was a presentation and it was about writing for journals . I think and I remember what they said is big journals like the Lancet and Nature , these top , top journals . They're not looking for complex language , they're looking for something that's written in straightforward , plain English . If it's in English , in a way that people can pick up and read and make sense of and you should be able to explain it to your uncle , joe , you know , you should be able to make sense of it . And as soon as they said that , I thought I can write , that I can write straightforward English . I just can't write all this complicated high flute and stuff . So , um , so that was a relief . That was a surprise to me and a big relief because I thought right now I know what I can , I can sort of address this , um , I suppose surprising .
Speaker 2The other thing was the well , the amount of work with you know , you're told what it is um , and I sort of was prepared for that , but it was very intense . Um , and somebody once told me that PhD stands for persistence . I took it on and , um , I managed it . I managed it within the three years , but it , the intensity was , was exhausting . But don't regret it for a minute . I learned so much from doing it ?
Speaker 1how did you keep your sanity and how did you , did you balance it between doing it full-time in your family , even though your kids are a lot older now ? But how did you , kind of like , do that balance and not lose your mind ? Potatoes , potatoes , okay .
Speaker 2So please explain I , I've run and I've grown vegetables since 2001 . Okay , I had an allotment in Edinburgh for 20 years . Two years ago we moved out to a rural location and I'm now creating a garden here . But I had an allotment at the time of doing the PhD . I'd had it already for a number of years . That was my sanity , that was my escape place , so I would go down and I would get into the soil and plant and dig and weed and do stuff and , um potato , I grow potatoes , um , and so that was probably my core . I mean , I did spend time cycling , um , walking the dog , being with family , being with the boys . All of that , you know , obviously was really vital . But the allotment was such a key little space for me . It was like my little safe haven . I could go down there , switch the phone , have nothing , nobody , no supervisors , nobody could get at me . I could just be there and . But the reason I say potatoes is I had a sort of moment while I was planting potatoes , um , that made me realize that it's . It's a bit of moment while I was planting potatoes that made me realize that it's a bit .
Speaker 2Phd is a bit like planting potatoes , in that when I plant them , I gather . So the way I plant them is I dig . I don't dig big trenches . I dig a hole and I line it with a little bit of compost and some comfrey leaves , and then I put the potato on top and cover it over . So what I would do is I would prepare all the holes , get all the comfrey leaves , and then I put the potato on top and cover it over . So what I would do was I would prepare all the holes , get all the comfrey leaves and put them in , get all the compost and put them in and then plant the potatoes . And as I was doing , I was thinking gosh , it's the preparation . Put the preparation in place , prepare the holes , prepare the different things , then start building it . Yep , that's how a PhD works . Oh yeah , so that's , that's why I see potatoes beautiful analogy .
Speaker 1I like that because it is and then as you're the results of what sprouts and then kind of looking at how you kind of then put that together in the final product yeah , yeah , yeah yeah , cool . Yeah , so that was my sanity . So did you , did you kind of create your life around it being like a job nine to five job and then you switched off , or were you at it every single day ?
Speaker 2and then how did you craft your study time so I would say for the first year or so , right at the beginning , we have a whole induction day on how to do a PhD , what it's about . And I remember going to somebody and saying so I've been told this is manageable in in full-time hours , but I'm also anxious that it can bleed over and be all encompassing and the person said no , no , if you set aside a good 35 hours a week , you should be fine . So I did that and I was very diligent about doing that . So I did Monday to Friday , seven or eight hours a day . I set aside and I used it literally as a full-time job , as you say , and I had my evenings and weekends . I tried to keep clear .
Speaker 2Yeah , occasionally it bleated over if I had a bit of a deadline to submit something to a supervisor and you supervisor or whatever . Or sometimes I was really caught up in something and I couldn't take it a bit longer . So that was all fine , I would say . And also I tended to build that into four days really tightly , and then on the Friday morning I would go off and do a breastfeeding clinic and that was my little . That was another sanity thing , I suppose . There I was being a midwife still with mums and babies and and that was really lovely to do and I would cycle there and cycle back .
Speaker 2So I had a little valve built into the week , but I would say by the time it got to towards the end of the second year , I realized I was going to need more
Impact of Birth Experience on Trauma
Speaker 2time . Yeah , you know I I did choose to do a form of analysis which is incredibly time consuming . It was good to do , but it's called interpretive , interpretative phenomenal logical analysis , ipa . Yes , and it's really slow and in-depth and it takes hours your thesis is huge so I did tons .
Speaker 2So by the time I got to the end of second year I realized I'd have to stop doing the breastfeeding clinics and dedicate full-time . And then that full-time became six , seven days a week towards the end . So for the summer , I'd say , before I submitted , I was determined to submit within the three years . I submitted it two days before the end of the two years because I thought I can't afford to be running this without getting some income . So I knew I needed to do it , um , but that obviously the last six months or so were probably nearer six , seven days a week , very , very full time . But it was okay because I thought , right , I'm in the last stretch , you know . So psychologically I thought I can do this , I can just last stretch . So psychologically I thought I can do this . I can just put my head down and I can just do this . And still then I tried to do it within days and take a little bit of time around the edges , yeah .
Speaker 1So we'll go back to the second half of the question then . What was the most ? What thing sticks in your mind now that surprised you about the results ? Because we know that there's unfortunately too many women who have got traumatic birth experiences and it sits around . I think at the moment the latest results that I read was about 6% . I think it was a little bit less with the study that you found , but that was kind of a few years ago . But what surprised you in your results ?
Speaker 2so what ? I think it's hard to say this is so . Was that a surprise in some ways ? You know , one of the careful things you have to do about PhD while any research is , try and not bring in your presuppositions . You know what I expected , but from my experience as a midwife , and as an independent midwife , I knew that some of the trauma would come from not necessarily what happened but how that person had felt cared for in their journey . Yes , but I sort of had that , but I tried to . You know , I thought right , you know I'll have to put that aside because that might not be the main reason , um , but when I did my literature review , I came across some research that um had looked at this . Um , and you know , like loads of research , gosh , I was drowning and stuff , um , but what stood out was that , out of all the the aspects of a birth experience that can cause trauma , such as maybe the mother or the baby being very ill or the baby dying or premature you know the complexities that we can have there or the obstetric interventions and having emergency cesareans , having hemorrhages , all the things that can go wrong objectively like that , yes , of course they contribute to trauma , but actually , over and above that , the most significant contribution is the interaction with the care provider , and there was research supporting that and I didn't know that existed . So , while I'd been trying to put aside yes , yes , I was aware from working with women that that was something I was hearing there was then evidence to show in a couple of places that this was very significant . So that was probably the thing that surprised me and yet didn't yeah , if you know , but it was then . That was the stepping stone into .
Speaker 2Well , that's a literature review . That's where I want to focus . My research is around this interaction . What ? What is about this ? So I then I wanted to speak to women and I want to speak to women who had developed full PTSD post childbirth . But you can't put an advert out saying have you got PTSD ? You know . So the advert was did you find your childbirth experience distressing ? If so , would you like to speak to me ? Surprisingly , they went out on social media .
Speaker 2So I had lots of support groups and different groups put information out within 48 hours . I had over 20 people had written to me . I was only looking , I only needed I think I can't even remember how many , was it 10 ? I've completely forgotten how many participants I had , but anyway it wasn't because it's IPA . It wasn't a large number , um , but 20 , and so part of me as a researcher I was going way , lots of people as a midwife I was going . This is dreadful . Yeah , you know , all these people so quickly have come forward , so that was a surprising thing . I suppose I've lost the thread of what we were saying there that's okay , that's okay so I , yes , so I was talking about the interaction .
Speaker 2That's right . So I got the women and of course I was interviewing women . But I knew that I also needed to speak to midwives , because this is a two-sided situation , um , and I wanted to hear the story from both sides . I wanted to hear what the women . But it was really hard . I couldn't , couldn't easily go find those women and then find the midwives that had cared for those women . I couldn't then go to a midwife and say , by the way , you cared for somebody who's developed PTSD . I mean , can you imagine what that would do to the midwife ? No , and also it would be they might not remember that interaction and they couldn't describe it or explain it . So I couldn't do a paired thing . So what I just did was I then advertised and asked if I could speak to midwives about their experience of working with women . What's it like to interact with women ? What do they find and what was really came out really clear . So the women asked them what was distressing about your birth . So it could have been that they started telling me it was the cesarean or what happened to their babies . But and I did specifically say , how did you find your interaction with your care provider . So I built that in and so a lot of that came out and it backed up a lot of what had been read about or been written about previously . And then the midwife . So what ? What really struck me ? I think I wrote down .
Speaker 2So , with the findings , what struck me is there were complete parallels between both . So the woman talked about and I named it shattered expectations because they thought , right , I'm going to go in here , I'm going to be careful , I'm going to be safe . And then that wasn't how it was . Um , the midwives equally talked about I went in to be a midwife and I thought I would be doing this , but in the workplace I wasn't supported . This happened . It was overloading , I didn't have time with women , I couldn't build relationship , I couldn't . I couldn't be the midwife I want to be yes , and we hear that so much and that resonated obviously my own personal experience . So I had to reflect on all of that .
Speaker 2And the other thing was both midwives and women talked about relationship , talked about how fundamental it was to each of them and talked about how , actually , when that relationship either doesn't exist or is broken or separated , how traumatic that is for both . So the women would talk about , you know , I was giving birth and then the midwife just left . It's like I didn't matter anymore . Or they felt I talked about being abandoned and things matter anymore , um , or they felt I talked about being abandoned and things , so there was a lack of relationship . Or talked about midwives who just didn't connect with them , seemed disengaged , seemed to be bothered you know like you're a nuisance to me and and all of that .
Speaker 2But the midwives were then talking about how , when they've been with somebody a long time , been through the birth , and then the baby's born , placenta is delivered , so the midwife's job in terms of physical safety , the midwife's job is done . Yeah , and the midwives are there . Right , we need you in room six off . You go and the midwives are taken away . And the midwives are distressed by that . They don't , they've just been . And one of them describes it as oh , I just want to do those nice little bit of things after that sort of expression , to see them with their baby , to help them connect with their baby , to bring the tea and toast , to just talk about the initial breastfeeding , whatever it is , just to do that human thing . And yet they're taken away and the women are going . Oh so it was all right . Well , I was given birth , but now I don't count , you know , and who's the stranger coming in and giving me toast ? Who I've never seen ? I want the midwife I've just spent 10 hours with and bonded with , so that separation and I'm sort of going off track a wee bit here , but it's like one of the things I find and I talk about when I'm teaching and I talk about in various contexts is if we want to have psychological health , it is important . Obviously , physically we want people to be alive and well and baby . Of course we do . There's no question about that . But we need psychological health as well , as we've got all these people with trauma .
Speaker 2If we're , if we're , able to give the time to a woman . So a woman comes in and she takes two days to give birth to her baby , she will have a midwife with her for two days . If she comes in and she takes two days to give birth to her baby , she will have a midwife with her for two days . If she comes in and she takes two hours to give birth to her baby , she's got the midwife with her . We will allocate whatever time is needed until that baby's born and the placenta is delivered and we know that the woman's not having a hemorrhage , so we will give that time . Why do we not then also give that that extra two hours , say after the birth ? That that counts , because that's now the psychological safety of that mother and baby and midwife that we're taking care of . Um , and until we prioritize that , until we build that in , then you know , if that woman had taken another two hours to give birth , we'd have left the midwife with her . So yeah , um , yeah , it's bizarre anyway . So that was so .
Speaker 2Fundamentally , I think what I came out with is hearing from both sides told me that each person in this journey is a human being , absolutely , and we have human needs . We're not midwives , are not machines and robots . Women are not vessels that provide babies . We are humans and we need that respected on the journey for both sides , and if we do that we will reduce trauma . And so another part , if it's OK , if I just carry on here .
Speaker 2The other part that came out of this for me in my journey was that one of the conferences I went to was an IPA methodology conference and at that conference I met Dr Diane Menage , who I know you interviewed years ago and we met at that conference for the first time . We didn't know each other . We discovered we'd both been independent midwives . I had a camper van , she had a boat , we both grew vegetables , we'd both done this research and we both used ipa , so we had all this in common . So we , of course , we had big conversations . But what was most interesting was that her research was looking at women's experience of compassionate care . So she was coming from the complete other side , saying did you have an experience that you felt was compassionate ? I'm coming . Did you have an experience that was distressing ? But our findings were almost the same in terms of this human need and this human .
Speaker 1You know how we respond to the person as a human being , whether it's the care provider or the woman , and so we've been working together and we've written a couple of e-papers and we've presented together because your balance is is quite , is quite beautiful in that you're approaching from polar opposites and yet , sadly , complementary information and results kind of adds to that strength of the kind of the outcomes that you've both suggested and what we require because , as you said , we've got humans , we want holistic care , but we're working in an organizational system that is controlled by return on investment and data and banking account sheets yeah , it's a business model , it's not a care model and that's , and that's that's the way it has to be .
Speaker 2Um , with the systems that we have , your questions are what you know do we do in different systems ? But that's a whole other conversation . I think , um , yeah , and I think I think what was important for me , I gave a presentation at the royal college of Midwives in the UK
Impact of Midwife Trauma and Burnout
Speaker 2. They have annual conferences and I gave a presentation and I told , I presented a little bit about both sides of the story and unknown to me in the audience were two newspaper reporters for the local sort of the rags , as it were . The papers that are you , you know , just sensationalize the news .
Speaker 2And , um , the next day there were big um headlines and I was called into napier because the headlines were saying napier researcher says midwives give mothers ptsd . Oh yeah , can you imagine falling from that ? They didn't bother to quote any of the second part of my talk , which was about you know the midwives needs , and this is not about midwives being horrible , this is about you know . And but of course there was a backlash in social media with midwives going what you know . So it was horrible , horrible , um , anyway , we've , you know , we got past that , hopefully , but uh .
Speaker 2But then there's an event in Edinburghinburgh that they do every year which I came across another , you know , fun thing that I discovered as a while doing a phd called um the cabaret of dangerous ideas . Oh , and it's a stand-up comedy event and you are invited and it's for people doing research , so it's it's across the universities in Edinburgh , any topic of research , and you're invited to stand up and do like a I think it's a 30 minute presentation of your research in a way that's entertaining in some way . And I thought how do I make birth trauma entertaining ? But anyway , I decided to take part and you're supposed to have a five-word title . So my five-word title was neglecting midwives gives mothers PTSD . Nice , and so I was trying to talk about the fact that it's not nasty midwives , it's about we don't care for our midwives and they're just not able then to give the time , be present , stay for those extra bits of time , because we're not supporting the midwives to do that job .
Speaker 1Which you've kind of then gone on to in that stream of things . You've gone on to then talk about secondary traumatic stress from the midwife's point of view which is that counterbalance to what the women had with post-traumatic stress yes , yes , so I I haven't .
Speaker 2My focus , my research focus was on women's trauma in the phd um , but obviously , discovering what the midwives were saying to me , I have an interest in looking at . You know what's happening for midwives and how do midwives go ? Because midwives they were talking about because of their burnout or their exhaustion or the lack of support in the workplace for them , and which I was aware of , obviously as an independent um , they were sometimes just having to step back , disengage , protect themselves , and that's of course they do . They're human . We have to take care of ourselves . Um .
Speaker 2And then I did look around the research around the development of trauma , ptsd for midwives and and the numbers are shocking . They're shocking . And I gave a talk . There's an organization called , I think it's called Gold Learning . They do online talks and I gave a talk with them a couple of years ago and the focus was around midwife trauma . So I did a little bit more digging into the research and pulled together you know something there . And what was really interesting there was that I had a call a few days later from a woman in America , a midwife in America , who I think she phoned me or emailed me . She contacted me , I think maybe she emailed me to say I've just heard your , you know , I heard your talk and thank you , because I didn't realize this was something that affected other midwives .
Speaker 2I thought it was just me yeah you know , and it's so sad , there are midwives struggling thinking it's them , they're not capable , they're not strong enough , they've not got the thick neck or the brass neck or whatever , they've not got the resilience that they need to do the job .
Speaker 2Um , whereas it's not , it's it's systems and pressures and um and that . And I find that , with the students that I work with now , the passion when they come in . You know , I'm going to be a midwife , I'm going to do this , I'm going to support women , I'm going to be with women and then realizing that that's actually really challenging in our systems . And then the moral injury that that causes yes , in terms of I know what I should be doing here , I know what I want to do here , I know what the right thing is to do here as a midwife , but my hands are tied and I can't do it . Yeah , and going home at night thinking I wasn't able to care for that person , I wasn't able to be with them in the way I know I needed to be , and the trauma that that causes , over and above what they might witness in terms of outcomes and objective things which we witness as midwives , which we need to be able to be supported and cared for in as well able to be supported and cared for in as well .
Speaker 1And we have a lot of um , and when I say young , I don't mean chronologically , I mean professionally young midwives who are leaving the profession between three to five years . We're having a dearth of where there's this really big gap . That's a worry for the future because , as all of us oldies are kind of like reaching retirement age , then we've got this huge gap of . We're going to have an increasing pressure on the system and we know COVID blew away any bandages and any band-aids . That was on the system anyway . But we've got this kind of like perfect storm that we've known about . That just keeps getting worse and worse .
Speaker 2Yeah , yeah . I find it quite well distressing when I've worked with students who , as part of the education program , we have built-in reflection days where the students come in and we have , you know , I have . So I'm a personal development tutor for a group of students and would meet with them regularly , and last year , two students sat back at the end of that session and then they both started to cry and they were had been in placement for a few weeks . They hadn't been in placement too long , um , but they'd encountered stuff that was really challenging , not in terms of what we're witnessing in terms of birth , but in terms of the way they were treated and the way the culture was in that place , and and they were sobbing and they were saying I've wanted to be a midwife since I was 10 and I don't think I can do this . You know , really , really harsh , we're really hammering the people that we need , yeah , yeah .
Speaker 1Yeah , we've got similar issues here . We've had students who have started the course full of ideas and passion and energy and then by the third year , they've gone . I need to step away . I need to go part-time . I'm not sure I want to do this as a job or I'm going to finish this , but I'm never working as a clinical midwife . Yes , yes , so that potential wife . Yes , yes , so that potential . We've lost and potentially destroyed them to a degree . Well , not us , but the system has destroyed them to a degree that they don't want to come back into it , even though they know what they're capable of and what's needed . They're going , probably better than us , and protecting themselves . No , I'm not going to go back there .
Speaker 2Yeah , well , that is part of the reason I stepped out of medical care , because it was those experiences that were , and it was more acute as an independent midwife , because as soon as you walk into hospital place or something goes wrong which things do go wrong in birth , and things you know turn corners that we don't want them to turn . There was no sense of it's okay , we've got you and we're going to support you . It was , oh , so what were you doing then and why are you here ? And you know , yeah , it's not nice .
Speaker 1There is some good news . There is light on the horizon in that I think we've now got the World Health and now have put out about the importance of midwifery continuity of care . So we do have the research that we know we've had for 20-odd years , but that information is getting spread around , the importance of it , the critical need for midwifery continuity of care in particular . So we are having changes . We are going to continue to have changes . We just have to keep enough midwives in the system so that we can staff these changes .
Speaker 2Exactly , but also I think so , in the uk about 2015 and 2016 , there were government mandates to introduce , to transform our care systems into continuity care systems , um , and of course they were sort of up and running . They had challenges , and then COVID came along and changed those further as well , but some of the challenges continued to be that midwives were anxious about following those pathways , about their workload , about their time , about how they'd be supported , and actually some of the caseloading and continuity packages for some were too heavy and too much , so midwives didn't want to follow that path . And so there's loads of research going on to explore why , how , what midwives would need , but again we come back to how do we support our midwives would need , how . It was short , but again we come back to how do we support our midwives ?
Speaker 2Yes , if we set up a system I know this might be blue sky thinking , but if we set up a system where the the priority is getting something in place where midwives feel supported , um , supported in what they do , given a work-life balance that is realistic and healthy and and really enabled to be the midwives they want to be , if we can do that , then those midwives are going to stay exactly and they're going to get better care , um , or , I think many of them do give very good care , but a great cost to themselves . So I'm not suggesting midwives give poor care . They give fantastic care , but some of them are totally hammered by that because of their own cost , um . But if we optimize that , if we take care of those midwives , then we're going to have .
Speaker 2It's going to work absolutely we need to take care , and it's the wrong way . The priority is almost the wrong way around at the moment um , because we're not looking after our staff , and moment , because we're not looking after our staff and so therefore we're not providing us a care package that's appropriate no , and we need kind of governments that look further than the next election , that make changes so you're right , continuity is great and it is wonderful to see the evidence really being picked up and run with um , but there are challenges here , and financial challenges as well , and the governments need to put the money behind this and whatever .
Speaker 2And of course , we know that all of this is challenging for governments because they've got to put their money behind so many other things and yeah , and a lot of countries with different healthcare systems have got different priorities .
Speaker 1There are some countries that have actually made midwifery care a state of emergency so that they can actually implement changes in there's . Countries like bangladesh are doing just some amazing things with their changing to the system , where they're changing to education , formalizing education , but also then getting midwives back out into the rural areas and kind of having that care right on the doorstep . So there's a lot of countries that are doing amazing things . There is a lot of good stuff that's actually happening in areas that are working together . So , while we're celebrating some of the good stuff , how did you celebrate your PhD when you finally finished it ?
Speaker 2Well , I noticed that I was one of the questions you might be asking and I was thinking what did I do ? So I don't , you know , I didn't have any great big parties or anything . But what I did do on the day of the viva um , I finished and and Napier University , the the location of the university is very close to my mum's house , so I left after the vibe , because you find out straight away , of course , that , yes , you're OK . So I thought , great Phew , and I drove to my mum's .
Celebration, Transition, and Future Plans
Speaker 2Everybody else was working during the day on this day . So I thought , well , so we had a plan to maybe go out for a meal in the evening , hoping that it was all going to be okay . Um , so that was in place . But I went and picked up my mum and we went to , uh , marks and Spencer's cafe . Oh , brilliant , and partly , my mum has very limited mobility , so access is an important thing . Anyway , we went . I can't remember why we chose to go there , but I remember sitting up in this cafe having coffee with my mom and a cake and thinking , yay , it's done . And then , um , and then from there we went down and we joined my husband and my sons , um , and we had a meal out and they turned up with flowers and chocolate and bottle of port and nice things . So that was my celebration and I don't remember doing .
Speaker 2What else did I do ? I think actually , you know one of the other things I did I had a little tea ceremony . I'd forgotten about that . A good friend of mine spent time in China learning about tea . She's done lots of work , but one of the things she learned she worked in tea houses , oh nice . So we ran a little tea ceremony for myself and four of my friends and that was a really nice wee event .
Speaker 1Yeah , oh , that's a nice , calming little celebration . It was , it was good fun , meaningful . So what have you been doing since ? It was , it was good fun , meaningful .
Speaker 2So what have you been doing since ? Well , when I came , when I finished the PhD , my supervisors , my director of studies , caroline Shee , was right , you know , we want you working here at Napier , we'll get you in . But there was no lecturing job or anything at that point , but there was a wee research job , part-time research job , looking at perinatal loss and PTSD . So I started that job and that was fine . And alongside that , the NHS , the National Health Service in Scotland . They have an education branch called the NHS Education Scotland and they were looking for research , a literature review . They have a resource called the One Out of Four Online Learning Resource which is around sexual trauma particularly so it's for midwives , but it's our awareness of women who've had sexual trauma and care we might need to take into account . Of course , that's all part of that and that came up in my PhD as well . You know people not having that respected . So they were looking for somebody to do a literature review to refresh the knowledge so that they could update this . So I spent six months working freelance with them . That was a really interesting piece of work and I produced that literature review for them . I think that was pretty much it . So I did bits of research in Napier , did that and then a lecturing job came up at Napier and thankfully I got that . That was four years ago .
Speaker 2So I've been a lecturer in midwifery for the last four years and thankfully , the areas that I've been primarily given to teach allow me to focus on physiology , and right at the beginning of the training program , because I think that's you know , we need to understand physiology . If you know , if we don't have physiology and if we don't understand how the way we are , the the the psychological trauma we can cause , can actually impact on the physical journey of birth as well adrenaline oxytocin being reduced all that physiology as well . Adrenaline oxytocin being reduced , all that physiology . So I I get the chance to teach that , which is fantastic , and I'm also um building in a little bit more about trauma-informed care into the process now as well . Um , and other things , other things .
Speaker 2I was part of um the royal college midwives had a perinatal mental health forum for a couple of years . So I was able to be part of that , which was fantastic , and NHS Education Scotland produced as a in terms of the sexual trauma , one of the student midwives actually had written to the government to say you need this built in somewhere more in in the training for your midwives , um , and so they they funded nhs education scotland to have a working party to look at how that might go forward . So I was part of that for a little while . So you know , the phd opened doors into some really interesting projects and forums that I could be part of , um , which I hope have . You know , they've added to what's out there in the world and that's . That's been really good to be able to do that so what's next ?
Speaker 2aha . Next is a book . Oh , do tell so now . Now , this is a plug for a little book . So Diane and I oh , brilliant , yep are co-editing a book . We should have it submitted to the publisher Routledge by the end of this month , is the plan . It should come out early next year . Well , maybe around April , may next year . And Diane contacted me , probably just about two years ago , when we were chatting online like this , and she said I think , jenny , we should write a book . I've got an idea . I've got an idea for a book and I'm going OK , yeah , I'm up for that . She says it needs to be about love . Nice . So we have put a book . It might be called Love in Midwifery , midwifery and Love . We don't know the title yet , but the focus is around love in midwifery . What's its role ? What do we mean by that ? We've got some really good authors who have put chapters in for us , so that's been ongoing for the last couple of years .
Speaker 1Oh nice .
Speaker 2Almost there and that's been really exciting . So there's a wee plug . Watch out for the book to come out that Diane and I have edited , with some excellent authors built into the book .
Speaker 1So , on your bookshelves , well , if we still have bookshelves in 2025 . I can't believe . Next year is 2025 and it's not that far away .
Speaker 2Thank you so much for your time oh , thank you for inviting me and giving me the opportunity . Um , I picked up from the other uh programs that I've listened to , the other podcasts that you , you've run . Um , that part of this is about encouraging other people to do pfc's . Yes , and so if anybody wants to take from the fact that , look , I barely passed my English . I never wrote an essay . I hated writing essays . Then I discovered that you didn't have to write fancy , fancy language . Um , and , if I can do this honestly , it's really possible . Um , and , and just to give a wee heads up , I have a PhD student at the moment who's quite close to finishing . She is fantastic and I've already told her that I'm going to put it forward to you , but she said oh , wait till I finish , wait till I finish .
Speaker 1Yeah , six months after she's finished , because she needs recovery time , exactly exactly . She'll be happy to talk about it again .
Speaker 2So second half of next year absolutely more than happy . Yeah , I will let you know . So you know it's a great thing that you're doing here , and I think it's fantastic because the more research we have that comes from midwives on the ground , it's so valuable .
Speaker 1I think what's easy to forget and I've just spent I've got this week off at the moment and I've just spent , I've got this week off at the moment and I have literally gone through about 20 , 25 PhDs from midwives and I've looked through because I'm still kind of writing back to the last 12 months of mine and so I'm looking at a whole pile of things . But I think it's easy to forget it's a final product . The PhD and the published journal articles are the final product you haven't seen . Having just put an average in now , we've gone through seven or eight or nine drafts of improvements and changes and go through that , and then it goes back and forth to the publication to get changes as well .
Speaker 1So it's don't expect , when you're starting to be able to write as what you read , because it's a learned process you do get better at the writing process , um . But that's also why it's different to undergraduate is you're not doing it by yourself . You've actually got a team to support you . You've got supervisors to support you , um , and they make you better purely by the conversations , by asking you questions what do you mean here ? Or this is a bit confusing , or so that ? And having someone who's a non-midwife is an advantage , because you're then taking away all that assumed knowledge , because you then have to actually explain it out to them .
Speaker 2Yeah , yeah , from that point of view , my supervisors , my director , she literally would print out anything I'd submitted and use a red pen , yep , and it would come back covered in red pen and she would say Jan , you don't worry , this is for guidance , this is for learning . She taught me so much about how to write . I learned so much . Um and uh .
Speaker 2Thanos , he was , his approach was slightly different and he was . He was not a midwife , but he was really very hard to please . Yeah , you know , I put it in and be lots of criticism and , of course , course , he was teaching me , which was fantastic . But I remember my methodology . Or was it the history of PTSD chapter ? I think it was , which , of course , is his 40
Celebrating Writing Success and Future Plans
Speaker 2.
Speaker 2When I kept observations , it would come back to me and finally I put one in and he replied this is beautifully written , I have nothing to add . And at that point I thought you've done it , you've got me there . And it was like the man from Del Monte said yes , I was running around the living room going . Thanos said it was good , did you print that out and frame it ? But that's , you know , they do you learn ? Those people taught me . Both of them taught me so so much . I wouldn't be here , been able to write anything , even in simple language , without their help . So , yes , you do learn , it's fantastic . And now you're writing a book . Well , we've got lots of other people writing bits of the book , but yes , I look forward to seeing the book .
Speaker 1I'll keep my eye on it and look forward to reading it next year . Excellent , thanks very much , liz .