Midwives, resilience and sustainability

selfcare1Discussion of midwives and resilience seems to be happening everywhere at the moment. And a discussion paper on sustainability and resilience in midwifery has highlighted the importance of self-care, self-determination, relationship and passion in midwifery (Crowther et al 2016).

The research was led by a team of authors who have worked on past and current research in these areas in New Zealand and the UK,  and the intention was to explore the notions of resilience and sustainability by comparing two key studies. One of these (Hunter and Warren 2014) looked at resilience in the UK, and the other (McAra-Couper et al 2014) looked at sustainability within the context of New Zealand midwifery.

One thing I love about papers like this one is the way in which the authors have dived into an exploration of what these terms actually mean and explored the extent to which they may or may not be helpful. And these are important questions, because it’s important to step back and look at what is happening.

From Mavis Kirkham’s germinal work on Why Midwives Stay to more recent research on sustainability and resistance, the studies discussed in this paper have all added to our understanding of what it is like to practice an ancient art in a modern world.

But there is a concern – as the authors highlight – that “the notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.” (Crother et al 2016).

I must admit that that’s something which has bothered me a bit, so I was really happy to read this analysis, which makes some really important points.


The similarities between the two studies highlight some of the core tenets of midwifery:

  • “Love, passion and joy for midwifery …Making a difference to the lives of women, their families and the wider community and society is what sustains midwives in their practice.”
  • “Self-care seems crucial in sustaining the joy and passion for practice and contributes to healthy resilience when midwives are working in difficult situations.”
  • Self-determination is important, but “there were differences between the two studies regarding the potential for midwives to be self-determining. These were largely the result of the differing models of care in which midwives worked.”
  • “Relationships with women, families and colleagues contribute to both midwifery resilience and sustainability.” (Crowther et al 2016)


And rather than glossing over the issues or seeking simple solutions, the authors highlight, “the extent to which control by midwives over their immediate working environment (whatever the employment relations that enable that to happen) is significant in relation to the array of strategies that midwives are able to use to support themselves in making their practice durable over a number of years if not decades. Resolving current professional, economic and infrastructural issues in midwifery is crucial in all settings. The notions of sustainability and resilience may potentially provide an opportunity to examine ways of achieving systems and processes that would benefit both the maternity organisations and individual midwives. However it is important that these notions are understood properly by midwifery leaders and maternity policy makers to avoid exploitation.” (Crowther et al 2016)

Quite. And I can’t better their conclusion, either:

“What is apparent from the comparative emergent themes in this paper is that self-determination, ability to self-care, cultivation of relationships both professionally and with women/families, and a passion, joy and love for midwifery transcends models of care. This paper points to the need to foster practice and models of care that allow these qualities to flourish. The focus needs to turn from systems that may appear to cope with continual crisis demonstrating persistence despite personal costs, to one that brings into focus the importance of the themes highlighted in this paper. This is vital if midwives and the care they provide to families is to be sustainable long term.” (Crowther et al 2016).


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Crowther C, Hunter B, McAra-Couper J et al (2016). Sustainability and Resilience in Midwifery: A discussion paper. Midwifery, in press doi:10.1016/j.midw.2016.06.005

Hunter B and Warren L (2014) Midwives׳ experiences of workplace resilience. Midwifery 30:926–934. http://dx.doi.org/10.1016/j.midw.2014.03.010

McAra-Couper J, Gilkison A, Crowther S et al (2014). Partnership and reciprocity with women sustain Lead Maternity Carer midwives in practice. New Zealand College of Midwives Journal, 49: 29–33



The Research

Background: Midwifery workforce issues are of international concern. Sustainable midwifery practice, and how resilience is a required quality for midwives, have begun to be researched. How these concepts are helpful to midwifery continues to be debated. It is important that such debates are framed so they can be empowering for midwives. Care is required not to conceptually label matters concerning the midwifery workforce without judicious scrutiny and diligence.

Aim: The aim of this discussion paper is to explore the concepts of sustainability and resilience now being suggested in midwifery workforce literature. Whether sustainability and resilience are concepts useful in midwifery workforce development is questioned.

Method: Using published primary midwifery research from United Kingdom and New Zealand the concepts of sustainability and resilience are compared, contrasted and explored.

Findings: There are obvious differences in models of midwifery care in the United Kingdom and New Zealand. Despite these differences, the concepts of resilience and sustainability emerge as overlapping themes from the respective studies’ findings. Comparison between studies provides evidence of what is crucial in sustaining healthy resilient midwifery practice. Four common themes have been identified that traverse the different models of care; Self-determination, ability to self-care, cultivation of relationships both professionally and with women/families, and a passion, joy and love for midwifery.

Conclusions: The impact that midwifery models of care may have on sustainable practice and nurturing healthy resilient behaviors remains uncertain. The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking. Resilience may be interpreted as expecting midwives ‘to toughen up’ in a workplace setting that is socially, economically and culturally challenging. Sustainability calls for examination of the reciprocity between environments of working and the individual midwife. The findings invite further examination of contextual influences that affect the wellbeing of midwives across different models of care.