C is for confidence
My current rotation as a newly-qualified midwife is leaving me feeling as though I'm trying to practise midwifery inside a glass box with one eye closed and my hands tied behind my back. I feel as though I'm meant to be measuring things that are largely immeasurable using something akin to a steel ruler and a set square. Limits, thresholds, time scales, progress, guidelines, technology, drip stands, drugs, stages, charts, more technology. Labour and birth are twisty-turny and don't stick to the trajectories that have been set out, women and their bodies do weird (unexpected) and wonderful things. It's hard to sense what's going on when labour is induced, when epidural analgesia is in place, when I'm meant to measure rather than intuit. I know I frustrate women when they ask how long until their baby is born and I shrug. I don't know, that's not how it works, but that's how we want to make it. Let's time you, let's measure, let's micro-manage, let's take away your instincts.
This week I got some feedback from one of the coordinating midwives: “You just need to be more confident”, which unfortunately wasn't accompanied by a guidebook as to how to achieve this confidence. Being confident is easier said than done when many of the so-called soft skills that I have are seemingly being eroded or overruled, undervalued or unappreciated by the systems, processes, hierarchy. How can I be more confident when the things I thought I understood have changed and shifted, when I spend shifts almost waiting to make a mistake because I'm not entirely convinced where the parameters are any more. Induction of labour for maternal age, section for breech presentation, twins being birthed in theatre, central monitoring. Maybe I don't feel confident as I don't feel part of that world and I don't feel I'm making a difference. I'm learning lots and it's valuable, but not more valuable than things I have learnt on other rotations. I'm not even managing to tick off skills that I should be achieving because the ward is busy and time is scarce. It's quicker for someone else to do it than for them to teach me to do it.
Don't misunderstand me, had it not been for monitoring, interventions, induction, scans, my own babies may not be sleeping soundly in their beds as I write this. I'm not denouncing obstetric-led care, it probably saved my babies' lives, but it's not a system of care that I relish being part of (apart from the team, which I love). I value the care provided when it's necessary, but it's someone else's midwifery, it's not better or worse, it's just not the version of midwifery that I want to be in the midst of.
Be more confident. I felt confident (ish) until another midwife stepped into the room to be the second midwife at a birth. She began directing, instructing, commanding, both myself and the woman. I'd asked her to document, but she ploughed in until I felt as though three years of training had been completely wiped away. I don't know whether she thought I was rubbish or whether I lacked confidence or whether she lacked confidence, but the woman was doing exactly what she wanted and needed to be doing, and I followed her lead. Spontaneous labour, intermittent auscultation, a baby, being with woman. I could do all of that. I didn't need another midwife to rally me into a frenzy and make me doubt myself more than I already do.
Be more confident. Last week I discussed the transition from student to NQM with one of the life gurus. She suggested that NQMs need time to pursue normality in order to gain confidence in and retain enthusiasm for a profession that we've worked so hard for. If my confidence in my abilities is lacking, maybe there's a gap between what I've got and what I need. For example, there's little point in attempting to suture at the end of a night shift when my brain is nearing the end of its capacity for new information, or when the only person to teach me is barely more qualified or more confident than I am. I was floundering and wanted to cry as I sat staring at a woman's perineum that made no sense to my very tired eyes, and the other midwife was probably very frustrated (quite rightly) by my lack of ability. That bashes confidence rather than builds it.
Be more confident. I felt an almost overwhelming desire to tell the coordinating midwife that this version of me is much more confident than previous versions. I no longer walk into labour ward wanting to die before I reach the office for handover; I put my uniform on and am no longer torn apart by anxiety; I hold my head up high and engage with the team; I ask for help when I need it. Confidence is turning up to work and being a midwife when my inner self tried to convince me that I am a worthless person and didn't deserve to be alive. Confidence is walking away from bad people intent on injuring you. Telling me to be more confident has actually been detrimental as it has made me analyse my behaviour, my abilities, my knowledge, demeanour, character. Maybe everyone has realised that I am a complete fraud and shouldn't be a midwife. When every single teacher, school report, lecturer, has told me the same – be more confident – it has left me wondering whether this is a fundamental flaw in my personality. Some people have mistaken the things I have done for confidence. In my second year at university I spoke at the European Midwifery Association conference, I have organised study days, I have had articles published, I was course rep and then academic president at university, and I will always advocate for others. Each of these things is a superhuman feat, each takes its toll, each pushes me out of my comfort zone, each requires me to step away from fears and anxieties, each makes me feel alive and scares me half to death all at once. That's not confidence, it's a fear that life will otherwise pass me by and I won't be taking part.
Be more confident. I'm left wondering where this confidence is going to come from. I've built a tribe of incredible women who remind me why I'm a midwife and what I love about midwifery and about life in general. They've built my confidence, but I may always fall into the trap of thinking I'm not good enough. Maybe that is a character flaw, maybe it's not. Maybe there is a wider issue of how preceptorship programmes for NQMs can build confidence as well as skills, and whether there's a lack of confidence in certain areas because there's actually a lack of exposure to teaching and workplace support. While I'm pondering that, I am going to be more confident (heavy eye rolling). Maybe they should add confidence as one of our skills to be signed off. Maybe not.
