Midwives, Know Your Value!

Last week saw strike action from midwives here in Northern Ireland.

Their humble request: 

‘We’d like you to pay us the same as what you pay midwives in England!’

How come midwives in England earn more than those in Northern Ireland and how do you put a price on maternity services? How do you put a price on midwifery services? Whose contribution is most valuable? Is it the doctor’s or is it the midwife’s?  What about admin staff, domestic staff and support workers? And what about individual skill sets and motivation? There are typically people who take on more workload than others on a shift, should they get more? How is the worth of each individual contribution decided? How do we value when a practitioner adds extra skill to their repertoire voluntarily in their own time and out of their own pocket? How do you enumerate the worth of those midwives who only ever choose to work on the labour ward? Arguably they are at the acute end all the time and that comes with having to deal with acute situations more often than in antenatal clinics for example. What’s the likelihood of being involved in a coroner’s court case when you only ever practise in an induction ward versus practising in the antenatal education department? Is that measurable and should it be rewarded differently? And, why are doctors earning significantly more than midwives, does the extra investment in education at the start of one’s career justify an approximately threefold income for a lifetime? At this stage, when midwives have taken over many of the tasks that used to be carried out by doctors, should a midwife’s paycheck not be reflective of this? And should the extra funding come from the doctor's pay check given that they now technically don't have to do those things anymore or can we acknowledge that everyone is doing more today than ever before because of the enormous workload posed by ever increasing interventions and the associated paperwork?

This is a delicate topic. There's no denying that midwives are undervalued in more ways than one but will any kind of adjustment in pay address the more fundamental question of what a midwife is truly worth?

Many individual midwives feel personally undervalued. This sentiment is echoed in staff rooms. Bearing in mind that every single midwife will have been on shifts where she never got to step foot into those staff rooms it is easy to understand that midwives feel their employers don't value them. There will be shifts where you put your lunch into the staff fridge only to lift it back out at the end of the shift uneaten. Over the years this has been a more frequent occurrence and of course this has to do with underfunding services, so it is easy to deduct what midwifery services are worth to the state. Sadly midwives often also feel undervalued by 'management' and that's a much deeper and more complex issue. Management are operating in the same system as staff midwives and managers can only do so much, they can't save you. Look to those who lead midwifery forward instead of looking to your managers. We have some excellent leaders in our midwifery services in Northern Ireland, some of them are in management roles, and we also have managers who don't make for the best leaders and advocates for midwifery. Just accept that, it'll never change!

And I get it, management is not for everyone. 

I personally hated my management role. I resented the red tape involved in trying to advocate for midwifery and for midwives within a broken system. In the end I handed in the reigns. I ended up putting myself first, decided not to be a martyr. I was miserable. I couldn't see how we could fix this mess and I decided to leave it to people who still have fight and who still hold hope, people who don't have an issue with subjecting women to routine care pathways as much as I do. And I didn't want to respond to feeling like I couldn't do a midwife's job anymore by becoming jaded like I had seen some midwives and managers do. Anyone who is keeping on keeping on with total dedication and gusto during what I see as the most difficult time for midwives ever has my deepest admiration. There are some real warriors out there. It wasn't for me. I realised that I could do more for more women from outside the system which is why I founded Essentially Birth in 2019. I am better off advocating, educating, supporting mamas and help them get breech babies to flip or get rid of hip pain. 

Last week I heard that one of my clients who came to me on crutches for pelvic girdle pain ended up not needing them again after ONE session! Whaaaattttt? Sometimes I can't believe the outcomes my clients get! If you live local to Belfast or Dungannon or if you are willing to travel in order to work with me, shoot me an email at [email protected]. I offer individual sessions but I am particularly excited about my pregnancy packages. They provide you with regular massages and include free access to my R.O.A.D. To Birth online birth prep program. You see, I want you to be able to prioritise massages and sitll learn all you need to know about birth and current midwifery care. You also have me in the background answering your question on your journey through the program. I would love to have you on board! And if you are too far away, you can enrol in my program on its own and still get the benefit of being able to ask questions in the Q+A section. You can enrol as a virtual client here.

Having been on the entrepreneurial journey since 2019 I have learned A LOT about self worth. Claiming it is hard work and I do believe that midwives have never been very good at it. I know I wasn't and If you are like me, then truly owning your worth will be a journey. And once you embark on it, you might find - like I did - that you will have to leave the profession. There are no picket lines in my life anymore. I offer my service and my clients decide if its worth the investments. Simple but hard, too.

Midwives have a lot of unpacking to do. As a collective, they have historically positioned themselves as inferior to doctors. As soon as doctors came on the scene with their fancy instruments, midwives were prepared to step to the side not just in births where a doctor was truly needed. They wanted to be trained 'better' and they chose to become regulated themselves to be accepted by their medical colleagues. They appropriated themselves more and more to the medical model of birth and as a profession they have stopped providing a counter narrative to medicalised birth. They thought that playing ball would ensure their recognition in the long run, but, as I see it, it has done the opposite. 

I personally played a role in this, too, I didn’t stand up for midwifery when I was still busy being a midwife and sucking on ice cubes to stay hydrated during long shifts with no breaks. And I take full responsibility for being blind to the consequences of taking on more tasks (and therefore more responsibility) without appropriate remuneration. 

It happened so easily and it was encouraged by the Royal College of Midwives. Our representatives were fully on board with the midwifery 2020 project that was commissioned by the government in 2008 to 'deliver expectations'. In hindsight I can only see it as a step towards where we are now. At the time, I couldn't see why some of my colleagues resented the movement towards getting midwives to take over doctor’s tasks. ‘We are not getting paid for it’, they said and I just didn’t understand why that was an issue. 'Do you not take pride in your skills', I wondered. 

I was operating in a bubble, I was still to discover conveyor belt midwifery. When you take the relationship out of the equation, you are no longer working for each woman, you are working for your employer. But, for me, there was a time when I didn’t feel that I was ever ‘at work’ at all. I was living my dream. I had finally made it onto the caseload team, just as I had intended and being with woman was my vocation. Many mornings, on my commute to the hospital, I blasted a 'They Might Be Giants' song called ‘Seven Days Of The Week’ on the car stereo singing along ‘Oh no, no, I never go to work…’ and truly meaning it. 

I never went to work when I was part of that team. 

Not when the phone rang in the middle of the night to get me out of bed to a birth, not when I was still cruising around in the community at 6pm doing those postnatal calls that had to be put off until late in the day so that we could prioritise being at a birth and not even when fighting with the old sticker printer on labour ward; Never! 

So naturally, when I was offered to train in performing the final discharge check on babies that had previously been done by paediatricians I felt privileged and honoured. It meant I could ‘discharge my own babies’, so I took the opportunity with both hands. I wasn’t interested in getting more money, I was there only for the women, never for my employer. And when I was asked if I wanted to learn how to whizz a scanner probe over women’s bellies and make sense of whatever image appeared on the screen I said ‘Yes Please!’ even though I had always been one of those midwives who proclaimed that a scanner was NOT a midwife’s tool. I couldn’t resist the temptation. Of course I wanted to be the one who carried out that first initial scan, it meant I could truly be ‘with woman’ from the very start to the very end when I discharged that mama and baby from community midwifery care to the health visiting team. I was a caseload midwife after all, that was my job. I fell for the narrative that mastering these was indeed a required midwifery skill and, what’s worse, I didn't even think that I should be paid more for adapting what were historically doctor’s roles. Often I wonder if I would ever have changed my attitude had our team not been disbanded.

Now I know that in taking on these roles I was ultimately turning my back on authentic  midwifery and embracing medical midwifery. This revealed itself to me for the first time during the two (and a bit) years I was in the role of midwifery sister at a freestanding midwife led unit (stay tuned, that post's almost written!).

So what is the answer?

Is it another pay raise after the disappointing 3% granted about a year ago?

I personally don’t think so. It won’t fix the working conditions. It won’t fix maternity services. It won’t fix midwifery services. And while I truly hope my former colleagues get what they are asking for I don't think it'll make them feel more valued in the long run either. I think it takes more than that.

It takes for midwives to claim their worth every day. It takes for midwives to claim back midwifery, to stand up for pregnancy, birth and postpartum physiology even in complicated pregnancies. 

Look at statistics and get informed so that you can see that medical birth is not all that it's been made out to be, you'll undoubtedly find value in the more intuitive skills inherent in traditional midwifery practice if you study the intricacies of our physiology. It's magical! Do it in your own time, listen to podcasts on your way to work. Listen to audiobooks. Inform women of where to look for balanced information even when a ‘risk factor’ is present so that they ask for your midwifery skills.

Support doulas! Just like you, they want the best for the women they serve. They have filled the huge gap we have left when we dropped the ball and started serving systems rather than women. Doulas are an important part of the maternity landscape, respect them.

Support women who want you present at their homebirths but decline your routine observations. They know what they are doing, enjoy experiencing the unfolding of a birth without having to be in her space all the time. I've had the privilege a few times as a registered midwife, it is very enlightening.

Stand with women who choose to opt out of the system you are feeling trapped in. Support freebirth instead of taking offence at their choices. And please don't judge those women if they come to you for help if things didn't turn out the way they hoped. Supporting women who choose freebirth is not 'promoting freebirth' just like standing with women who want a caesarean isn't promoting C-sections. It's accepting women's choices regardless of your opinions, it's what a midwife does.

Normalise birth again.

When society recognises the value of respecting physiology and accepting those things that can't be controlled (evidently, looking at the recent MBRACE report that I discussed in last week's blog post 'The First Drive Through Maternity Hospital), then midwives will be valued. Value your colleagues, all of them. Don't speak ill of other midwives, doctors, managers, doulas and definitely not women. Celebrate them and celebrate each other. Be the leader you would like to see.

There was a very dramatic facebook post that was shared and reshared by midwives and supporters of midwives in Northern Ireland leading up to the strike. It was aimed at the government and it said that they couldn't decide a midwife's pay because of various (very dramatically worded) reasons. Stepping into drama won't achieve anything. We know this, because it hasn't so far. And the government does decide your worth even though they never do what you do, like it or not (that's for yet another post, also almost written).

If you want to shift this dynamic then you need to find a way to interact with women directly. You suggest your price and if the woman agrees, then she'll hire you. You know your value there and then, no picket line needed.

And if you feel that this isn’t possible for you because everyone's circumstances are different, then insist on the worth of midwifery. Apply midwifery wisdom with conviction. Support your continuity teams, go on call, be at home births, stand up for women and let the women validate you.

Owning your own value as a midwife shows that you value women and that is worth more than the prospect of a 5% pay rise because that doesn't even come close to reflecting what it takes to be a midwife today. 

Best case scenario, you get the pay rise as well!