While it is true that doctors carry a burden of care, the people at the coal-face are the nurses and midwives, writes Barbara Hanrahan of the University of the Witwatersrand, in response to last week’s article in MedicalBrief on burnout and stress.
Hanrahan, women’s health co-ordinator and midwifery lecturer in the department of nursing education, University of the Witwatersrand Faculty of Health Sciences, writes in response to the article carried in MedicalBrief – SA’s silence over high stress and burnout among medical professionals:
I read the coverage on burnout and stress in medicine. Your focus however is on doctors and yes, I agree that doctors carry a burden of care. But the people at the coal-face are the nurses and midwives.
My current research shows that many midwives working independently in a midwives obstetric unit (MOU) work under very difficult circumstances. In Johannesburg approximately 50 % of the population are from other provinces or countries presenting language and cultural challenges. The MOU facilities are not well maintained – some do not have toilet seats, only one hot water tap working, the roof leaks and maintenance repairs take a long time to come to fruition.
Then there is overcrowding, putting pressure on the midwife patient ratio. The supply of commodities is unreliable – for example: linen savers / incontinent sheets – there are days, weeks when midwives do not have a linen saver for each birth and some put newspaper under the mother to protect what little linen stock they have.
Many MOU midwives are frustrated with their managers – midwives perceptions are that management do not support them or are not proactive in solving problems. Imagine working in a busy MOU (2 midwives/shift) and one labouring woman presents with pre-eclampsia – both midwives are needed to get this woman’s blood pressure controlled and to transfer her timeously to the nearest hospital. What then of all the other women who are labouring and birthing? This is when the student midwives have to step up – knock on effect of understaffing and increasing stress levels.
Many midwives report compassion fatigue, burn out, high stress levels and frustration. Quite a few request a transfer to an antenatal or postnatal clinic where the stress is significantly reduced or to a totally different field of nursing. Sadly – it has been shown, in the literature, to contribute significantly to disrespect and abuse of woman in labour and birth.
This is an issue that can no longer be pushed into a corner. In order for midwives to provide high quality comprehensive midwifery care, issues such as stock outs, facility maintenance and adequate staffing have to be attended to URGENTLY. South Africa has too few midwives in the public sector – we cannot afford to lose the midwives we do have.