Women supporting women... continuity counts
Continuity of carer is undoubtedly the gold standard of care that we should all strive for, and women who experience continuity of carer have more favourable outcomes and increased satisfaction. Continuity has given me the most incredible backdrop to my midwifery training, and has enabled me to carry on, qualify, become a midwife. Continuity of mentor and tutors has been important throughout my own midwifery journey, although 'journey' is too tame a word... 'voyage' may be more apt. A voyage conjures up rough seas, hidden icebergs, pirates attempting to throw you overboard, discovery, stormy weather, privation, walking the plank. It's been a voyage of three years and it's set to continue, yet continuity has made this voyage bearable and removed some of the fear.
Continuity is linked to mentorship. While working with a variety of midwives has given me the opportunity to observe different practices, having one mentor as a constant backdrop to my turbulent life enabled me to feel safe and protected. She saw me struggle and flounder, she knew how to challenge me and how far to push me, she understood my fears and helped me overcome them, and at times she felt my hopes and dreams as keenly as if they were her own. The same mentor saw me cower in fear behind her at the beginning, and then happily stepped aside towards the end because she knew I could do it. She trusted me because we had worked closely together since my first year, and I trusted her for the very same reason. I began to believe her when she said I could do it. When one thing in practice seemed insurmountable, she knew why, and she was able to comprehend the magnitude of my achievement when I no longer tortured myself when it cropped up. Each time I make small gains, she is the first person I want to call, she's the person I want to high five. That's continuity at its best, and she is the absolute embodiment of the phrase 'women supporting women'.
After three years of training, she still can't get rid of me because I am working in the same community team as her and she is overseeing my year as a newly-qualified midwife. Being in the same team as the one in which I trained means that I feel as though I have returned home. This continuity has made the transition from student to midwife less daunting, and it has given me a base and a safe space. The team know my strengths and weaknesses, they already know the challenges I face, they've seen me at my best and my worst. Continuity isn't allowing me to hide or shy away from challenges, it makes me feel nurtured and guided. Continuity means women can support women to the best of our abilities, it means not having to open up and divulge your deepest, darkest secrets to perfect strangers, not having to disclose sensitive information time and again, not having to utter the words “I'm having a bad day, I want to die”, because they already know. They can already tell by the look on your face and your body language, because they already know you.
The last fortnight has seen me welcome 'new' women onto my caseload. I had the privilege of caring for some of these women with my mentor when I was a student. While this is providing continuity for the women, it is also providing continuity for me, which will hopefully give us all a positive experience of care. This week I held a baby while his mum went to do a urine sample during her booking appointment. I'd palpated that baby during her first pregnancy last year, and I'd carried out his day five check. Now I'm getting the opportunity to do the same with his little brother or sister, and it's made me feel like the luckiest person alive. Caring for a woman once is special, but caring for her in a subsequent pregnancy and meeting her family again as it grows and changes and develops may be even more so.
In the same vein, I am now working as a midwife alongside midwives who have watched me grow and change and develop across three years. Equally, there are tutors and lecturers who have sailed this tempestuous voyage with me. Continuity meant that during a mental health study day, it was ok (ish) that I had a breakdown and sobbed while a lecturer quite literally held my hand. Continuity meant she knew I would find it hard, it meant she didn't panic when I told her I couldn't “do life” any more, and it meant she knew that holding my hand was the safety net I needed that day. Women can support women without that continuity, but it made it so much easier and it felt safer.
As incredible as continuity is, however, there can be a dark side. That is, when it is over. While continuity promotes trust and confers all sorts of other amazing benefits, it must also facilitate self-efficacy so that when it ends we are not left bereft. Our university tutors promised us self-efficacy: we were told in no uncertain terms that we would inevitably move from the fluffy-feathered hatchlings unsteady on our wobbly legs, to self-sufficient third years ready to qualify. At the beginning of our three years, our surrogate mums were taking us under their wings and simultaneously planning for us to fly the nest. It felt like a brutal prophecy, but it was actually a natural progression. Continuity has meant that a small team, focused around two tutors who have been by our side from the outset, have seen us thrive because they have fought for us, but not because they have done it for us. Fortunately, we are now able to renegotiate the boundaries that once limited the student-lecturer relationship and this summer they will watch us graduate, as friends.
We will, unfortunately, have to say goodbye to people who we hoped might remain in our midst for the foreseeable future. So few of our cohort have moved away for their first posts, that the loss of the few is perhaps felt more keenly. Similarly, we are having to bid farewell to one of our tutors. A year ago, I would have been unable to see how I could possibly get to the end of my training without the absolute safety net of the woman who has been the ultimate surrogate mum. She has seen me go from having my world fall apart to holding it all together and qualifying, and I'm sure there were many times that she questioned whether I was strong enough, whether I'd get to where I wanted to be. The benefits that the continuous presence of this woman had on my life are almost impossible to put into words because she went above and beyond what she needed to do. Women supporting women can have such a tremendous impact on someone's life, it can remind them of their sense of self-worth, reassure them that they matter, that they should be alive, that they can continue, that they made a good decision, that the dark days will get better.
The continuity I have experienced as a student and as an NQM has given me a stable grounding and a security blanket when I needed it. It means that I have approached my new role with a quiet confidence that would have evaded me a year ago. That confidence is not in my own abilities, but rather in myself as a person. I am confident in my resilience and my strength of character and my resolve. This continuity that has allowed me to thrive means that I will never underestimate the importance of providing women with continuity of carer. It also means that I will always appreciate the significance for students of having a constant, a person who provides continuity throughout their training, a safety net for when things get rocky. Continuity has provided me with trust, confidence, self-efficacy, development, understanding, support, belief, friendship, and places to go when I want to run away. Although, as I pointed out this week, that is a dangerous offer because I often pose a significant flight risk.
