Stress and Burnout

 

I`ve been in denial, I denied that I had been suffering burnout prior to my decision not to return to LMC caseloading midwifery following my surgery in October but I can deny no longer.

I completed an assessment the Maslach Burnout Inventory. I scored 66 which is well above the score of 45 which is required to confirm burnout.

“Burnout is a psychological syndrome of emotional exhaustion,
depersonalization, and reduced personal accomplishment
that can occur among individuals who work with other
people in some capacity. A key aspect of the burnout syndrome
is increased feelings of emotional exhaustion; as emotional
resources are depleted, workers feel they are no longer
able to give of themselves at a psychological level. Another
aspect of the burnout syndrome is the development of depersonalization
(i.e., negative, cynical attitudes and feelings
about one's clients).” Maslach et al (1997)

It is only now after speaking to other midwives that I have begun to see it and recognise the symptoms in others.

Burnout is more likely to occur in midwives who

• are younger
• have more children
• Are relatively newly employed serving a high proportion of low socio-economic class families

Beaver et al (1986).

Whilst I can`t claim to be young, in relation to the average age of the midwife in New Zealand being 50 then at the start of my LMC career in New Zealand I was 36yrs old so younger in comparison. I also have young children who at the start of my LMC career were aged 3 and 4 respectively and so I had two of the predispositions towards burnout yet I never identified myself as being ‘at risk’ because I didn`t know about it. Would it have been useful to know?  I think that it is worthwhile considering that I may at least have made a more INFORMED CHOICE about entering into LMC caseloading and I possibly at least have been able to implement coping strategies but who can tell no one informed me of the risks and no one gave me the options of support instead I was often made to feel ‘guilty and selfish’ for needing to feel supported.

I am distressed now to hear of midwives still suffering ‘horizontal violence’ Friere (1972) Stories of ‘back stabbing’, medical staff shouting and admonishing midwives in font of the women under their care, undermining their practice and exulting in their parade of power. I am heart broken to hear of midwives struggling, compromising themselves to work in a broken system for which they are not responsible. Why should the midwife feel the stress when she is told that the woman has to have the epidural now, not because she wants to but because the anaesthetist is tired and if he/she goes home then he/she will not come back if the woman changes her mind later on. These elements work hard to drive the midwife to burnout.

This is another idea of how to work in more of a team it doesn`t mean that you have to lose the concept of LMC role and carrying a caseload it is about creating an environment to try and avoid stress and burnout,  trying to give people more time off and trying to avoid working dangerously long hours.

Name	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Midwife 1	COMMUNITY DAY BACK UP ON CALL	HOSPITAL DAY	OFF	community day on call	off	hospital day back up on call	Community Day back up on call
Midwife 2	hospital Day	OFF	Off Back up on call	Hospital day	community Day on call	Community day On call	Hospital Day On Call
Midwife 3	COMMUNITY DAY	COMMUNITY DAY BACK UP ON CALL	Hospital Day On call	Community day back up on call	hospital day	off	off
Midwife 4	OFF ON CALL	COMMUNITY DAY ON CALL	Community Day	Hospital day	hospital day Back up on call	off	off

1. HOSPITAL DAYS:- 8AM TILL 8PM LOOKS AFTER ALL OUR P/N AT THE HOSPITAL, TAKES CARE OF ANY HOSPITAL ASSESSMENTS NEEDED AND STARTS OFF INDUCTIONS.

ADVANTAGES INCLUDE NOT HAVING TO LEAVE CLINIC FOR CTGS, ABDO PAINS AND ALSO COORDINATES WITH HAVING ROOM FREE AND CTG MACHINES FREE AT THE HOSPITAL. SOMETIMES THERE IS A TENDENCY FOR AT LEAST TWO OF US TO NEED A CTG AT SAME TIME.

IT SAVES ALL FOUR OF US GOING UP TO THE HOSPITAL TO SEE OUR WOMEN.

IT ALSO MEANS THAT INDUCTIONS WOULD NOT BE SUCH A LONG PROCESS.

2. COMMUNITY DAYS:- SPEAK FOR THEMSELVES I TRIED TO GIVE EVERYONE THEIR CLINIC DAY AS A COMMUNITY DAY SO WE DO OUR OWN CLINICS AND WHOEVER ELSE ON COMMUNITY DOES COMMUNITY VISITS.

3. ON CALL GOES FROM 8PM TILL 8AM

THERE IS ENORMOUS DEGREE OF FLEXIBILITY, THE HOSPITAL DAY CAN HELP UP WITH COMMUNITY BUT HAS TO BE PREPARED TO GO UP TO THE HOSPITAL TO DO ASSESSMENTS.

OBVIOUSLY IF WE HAVE INDUCTIONS ON COMMUNITY DAYS WE CAN EITHER SWAP EVERYTHING WITH SOMEONE ELSE ON HOSPITAL DAY AND THE ON CALL OR JUST COME WHEN IN ESTABLISHED LABOUR AND THEN WORK AS BACK UP ON CALL.

I had to smile to myself when I read the list of things to do to avoid stress build up leading to burnout.

1. Increased self awareness of being stressed
2. Develop outside interests become a member of a social group
3. Regular exercise
4. Regular Vacations
5. Relaxation techniques, yoga, meditation.

How as an LMC are we supposed to find the time to do these things? I tried to be a member of a book club but found I couldn`t attend more than twice as I was always called out or in bed asleep. I tried to attend spin class but the instructor told me off for answering my phone in the middle of the session. Regular holidays aren`t enough unless you can take regular days off too. Relaxation techniques thats a laugh as soon as I took a deep breath in I was usually asleep!

Useful Website on stress and burnout

http://www.helpguide.org/mental/burnout_signs_symptoms.htm

References

Evaluating Stress, A book of Resources. Zalaquette, C.P. and Wood, R.J. (Eds) The Scarecrow Press, Inc Lanham, Md & London 1997

Supportive Care and Midwifery Rosemary Mander
Edition: illustrated Published by Wiley-Blackwell, 2001