Hello from dark but not so cold Alaska! Last year in January it was below 0 degrees for almost the entire month. We did have a day last week that was so cold that the icicles had icicles – that doesn’t happen too often. Our days are getting shorter now that the solstice passed…but the sun still rises at 10:00am and sets at 4:30pm. It’s such a beautiful and strange place to live.
Today we’re chatting burnout. I think that everyone felt burnout in 2020. Most of us still feel burnout.
It’s imperative we talk about burnout in healthcare – especially nursing and midwifery – because our patients depend on our care and expertise regardless of what mental or physical state we are in. Patients choose to trust health professionals when they are the most vulnerable and weakened states of themselves and if we are not mentally and physically strong, it’s difficult to offer strength to others (sometimes referred to as compassion fatigue)!
It’s also important to maintain a strong midwifery force. If there is a constant stream of midwives leaving the profession, it makes it very difficult to grow and nurture the profession, as well as continue to offer midwifery services to women and families. (I talked a lot more about this in the State of Midwifery posts last year…here, here and here.)
Burnout in midwifery has been the focus of a number of articles published internationally and studies have found high rates of burnout globally in midwives:
- In Canada, Stoll & Gallagher (2019) surveyed 158 midwives and found that midwives are at high risk for burnout and occupational stress. The study found:
- 35% of midwives surveyed seriously considered leaving the profession
- Midwives most at risk for burnout had small children, higher caseloads and fewer days off
- In the United Kingdom, a study by Hunter, Fenwick, Sidebotham & Henley (2019) showed high personal and work burnout in midwives. The study sent a survey to the entire Royal College of Midwives (approximately 31,000 midwives) in 2017 to survey their levels of anxiety, depression, stress and burnout. 1997 midwives responded – about 16% if the College’s membership.
- 83% reported moderate personal burnout
- 67% reported moderate work-related burnout
- Client burn out was reported by only 15% of respondents
- Midwives were more likely to report stressors is they were aged 40 years or younger, had a disability, worked in a hospital/rotation setting or had less than 10 years experience
- In Sweden, a study by Hildingsson, Westlund, & Wiklund (2013) found:
- One third of midwives had considered leaving the profession
- 40% of respondents reported high personal burnout
- Only 15% reported client burnout
- Midwives that were less than age 40 or had work experience less than a decade demonstrated the highest rates of burnout
Similar to the studies, I personally look at burnout through two different lenses: personal and professional. I think you can feel burnout in one area or both, but often times we’re burning the candle on both ends. In midwifery, so much of our care overlaps between our work and personal lives that it’s often very hard to separate personal life from work life.
This scoping review on burnout from Europe published the following table for factors associated with burnout:
Do any of these resonate with you? Some definitely resonated with me – ahem, many small children.
In that vein, I thought a lot about what keeps me going as a midwife and excited to go to work, see patients, catch babies, answer the same emails, check labs results, etc…over and over and still really love midwifery. Here are the habits that I think would help prevent burnout, strengthen midwives and the midwifery workforce, and instill resiliency.
- Focus on prevention first. Try to accomplish these three things everyday to strengthen your foundation mentally and physically. These are simple but powerful over the long term. Think of these three as a frozen pond in the winter that you have to walk across – you don’t want to worry about if the ice is going to crack when you walk on it – instead, your focus is on maintaining the thickness of the ice so you don’t have to worry about walking across the pond.
- Get proper rest. Go to bed early. Get adequate hours of sleep. Practice good sleep habits. Turn off the screens. Put your phone downstairs or across the room from your bed. Get a sound machine or use an eye mask.
- Eat nourishing meals and snacks. I like to use the guideline from food writer Michael Pollen: If your grandma wouldn’t recognize something as food, you shouldn’t eat it.
- Move your body. All you have to do is go out for a 20-30 minute walk. Daily. Don’t think you need to train for a marathon or start CrossFit. Just try to move every single day. Closing out the stress cycle in midwifery is imperative for long term mental health and well-being!
- Set boundaries at home and at work. Similar to prevention – this is just a different form of prevention. Boundaries look different for everyone but boundaries can change your life personally and professionally. For example, I find a lot of people like to leave “work at work.” I think a lot of nurses and healthcare workers are able to do this but some aren’t. For those that are, that means that at work you’re giving it 100%, but when you walk out of work, anything you were thinking or doing at work, stays at work. However, if you’re on call 24/7, leaving work at work isn’t an option. Offering clear expectations with your clients are a great way to offer yourself some boundaries for those on call 24/7. In short, boundaries help prevent things from piling into your life that might otherwise wear you down over the long term. For example, about four years ago I decided not to attend baby or wedding showers anymore. It always conflicted with some quality time at home with my spouse or kids, or, I was post-call and somewhat delirious from sleep but was determined to sit through a round of baby games. Now, I send a greta gift and a card full on congrats and that’s it – the boundary allows me to celebrate the event or new baby but also allows for family time (or sleep). Set boundaries where you can! (If boundaries are new to you and haven’t read the book <a rel="noreferrer noopener" href="http://<a target="_blank" href="https://www.amazon.com/gp/product/0310351804/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0310351804&linkCode=as2&tag=amidwifenat0c-20&linkId=4b3a568a246d78f64550fbe2931b1f8b">Boundaries Updated and Expanded Edition: When to Say Yes, How to Say No To Take Control of Your Life</a>
Boundaries by Henry Cloud, I highly recommend starting with his book!).
- Prevent a rut! Find ways to challenge yourself personally and professionally. One of my favorite reasons for blogging is it forces me to look at issues or topics I’ve known for years in other lenses and to challenge those thoughts. Challenging our brains and bodies to do new things is beneficial and we need to do this at work and at home regularly! Consider challenging yourself with one of these tips:
- Find a new hobby. Or, dust off an old hobby!
- Learn a new language.
- Listen to a new podcast (check out BOOKS & MORE for recommendations).
- Participate or start a journal club!
- Read a book or books! (suggestions are in abundance HERE! and are often in the Friday Fives!)
- Join a book club!
- Start a book club.
- Precept a student.
- Scroll through your phone with your non-dominant hand or stir your dinner with the opposite hand while cooking.
- Put together a puzzle.
- Play a game – chess, checkers, Catan…pick your favorite!
- Sign up for a new webinar on a topic you want to learn about.
- Find a new work out to try!
- Learn a new craft – sewing, crochet, painting…take a trip to your local craft store and get inspired.
- Learn a new skill at work – IUDs, colposcopy, biopsies, billing?! – something that makes you stronger as a midwife and brightens up your resume!
- Sign up for a conference in 2021 that you’ve been wanting to attend!
- Maximize your routines and make the most of your time. Routines make you more efficient and can help prevent burnout. What does a current day look like for you? Take a good look at your routines at home and/or at work and ask what makes you happy, excited, frustrated or mad? Are your routines productive? Or unnecessary? Do you get more work done in the morning, afternoon or evening? What are your biggest time drains? The answers to these questions tell you about your habits. For example, I know I work better in the morning and the after dinner hours. If I try to do a lot of work in the middle of the day it’s very slow and mentally painful. In the morning time, I’m more alert and focused and I tend to complete tasks in almost triple the time. Habits are so powerful in our daily lives and build strong patterns in our lives both day to day and year to year. Take time to write down your entire day on paper and assess where things can change to prevent burnout and maximize your time. One of the best book’s I’ve read on time management from a midwife, mama and family perspective was Laura Vanderkam’s I Know How She Does It: How Successful Women Make the Most of Their Time. It was great on audio too (I listened to it a few years back while we were driving through Canada to Alaska).
- Reflect. Make reflection a habit once a year or a few times a year. What’s working in your life and what’s not – professionally and personally? Did something work well in one phase of your life but doesn’t anymore? For example, when I have a newborn, morning workouts just don’t happen for me. I’m too tired from being awake all night long for nursing. But, around 9 months or so, my babes are usually on more predictable schedules and working out first thing in the morning is much more feasible! I think it’s also important to reflect on our experiences as midwives. Did you have a stillbirth, shoulder dystocia or hemorrhage situation that was mentally and physically emotional? Did you always have a student with you? For me, I love teaching midwifery, but I also need days where I don’t have a student to recharge my own batteries. When we schedule students in our practice, we try to ensure that the student works with all the midwives while ensuring that midwife has a break from teaching as well. Here’s my challenge to you: Look at what 2020 was for you as a midwife. Where did you experience exhaustion, depletion, extraction, disconnection, confusion, or lack in 2020? Take some time to reflect on why you experienced those and how that can change for you in 2021.
- Find your circle of mentors and use them as sound boards often. Do you have someone in your life that would tell you “You’re headed towards burnout?” or “I think you’re experiencing burnout?” Do you have someone that could listen to your journey and talk to you about future goals? Do you have someone that inspires you? I have a little circles of midwives that I touch base and chat with on a regular basis. They are my people. But I also have some mentors outside of the circle that I consider to be some of the wisest, intelligent, and compassionate people I’ve ever worked with. Find your people and try to connect with them regularly. Try to put seasoned and novices in your circle too – you’ll be amazed at the wide range of perspectives it offers you to grow.
- Ask for help, support or a hug. We all get to a crossroad as a midwife – sometimes it’s a physical move to another city or another practice. Sometimes it’s a bad outcome or a challenging patient. Midwifery is really, really hard and asking for help is not a question of it, but when.
Whew! That’s a heavy list – but there it is. Those are the tips I think help me to stay on top of burnout. What do you guys think? Anything else that helps you in particular or could help the midwifery force? I read the book Burnout (below) about a year ago and definitely recommend it. The first 30% of the book is really eye opening and talks about the stress cycle. It’s definitely worth a read if you ever think “I am stressed out.”
If you’re interested in more, these are some other articles, podcasts and books on burnout that I came across:
- This article from Harvard Medical School: Challenge your mind and body to sharpen your thinking skills has examples of little activities to new hobbies to keep your mind sharp!
- 13 exercises to keep your brain sharp
- Top tips from nurses on dealing with burnout
- This 2019 bulletin by the Joint Commission: Developing resilience to combat nurse burnout
- Nine strategies for alleviating nurse burnout
- The Brene Brown podcast – Brene interviewed the Burnout authors here but in general she talks about so many important aspects of taking care of ourselves and our family. She’s easily one of my favorite podcasts to listen to.
Lastly, something to bring some cheer. I found this instagram account last week and love the colorful, positive posts – check her out at @blessingsmanifesting:
I hope you’re not experiencing burnout. If you are, please know that it’s not the end of your career and that you are blessed to be a midwife. Reach out to people, take care of yourself, and make renewing your mind and taking care of your physical body a priority every day.
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Hildingsson, I., Westlund, K., & Wiklund, I. (2013). Burnout in Swedish midwives. Sexual & Reproductive Healthcare, 4(3), 87-91. https://www.sciencedirect.com/science/article/abs/pii/S1877575613000323
Hunter, B., Fenwick, J., Sidebotham, M., & Henley, J. (2019). Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors. Midwifery, 79, 102526. https://www.sciencedirect.com/science/article/abs/pii/S0266613819302128
Sidu, R., Bowen, S., Shapiro, K., & Stoll, K. (2020). Prevalence of and factors associated with burnout in midwifery: A scoping review. European Journal of Midwifery, 4. https://doi.org/10.18332/ejm/115983
Stoll, K., & Gallagher, J. (2019). A survey of burnout and intentions to leave the profession among Western Canadian midwives. Women & Birth, 32(4), e441-e449. https://www.sciencedirect.com/science/article/pii/S1871519218303196