‘You can drop dead’: Midwives bullying women
Section snippets
Introduction and background
This paper reports on a very unexpected finding from a larger research study which explored forty-two women's experiences of having to move away from their rural and remote communities in NSW, Australia to birth. When sharing their experiences in the larger study, five (four women and one partner) of those interviewed described incidents which they reported as uncaring, cold, callous, abusive and aggressive behaviour by a small number of midwives. During the process of thematic analysis this
Literature review
Bullying is a universal phenomenon but there is no universally accepted definition.2 The definition of bullying used in this paper has been inferred from the data and relates to midwifery behaviour that is perceived as uncaring, cold, callous, threatening, abusive and/or aggressive; the midwife, in a position of authority, abuses and exerts power over the woman who is in the more vulnerable position. Bullying is the antithesis to woman-centred care and the midwifery partnership deemed as an
Participants and methods
The study was funded by the Nurses and Midwives Board of NSW. Participants self-selected and were recruited following media coverage of the study and consequent promotion by the Country Women's Association of Australia. Women who had been forced to travel at least one hour from their rural and remote communities to birth in the previous two years were eligible to participate in the study. Forty-two participants (six of whom identified as Aboriginal) were interviewed in 2007 and 2008 from all
Ethical considerations
The larger study informing this paper received Charles Sturt University ethics committee approval (2006/307). Safeguards were built into the design of the project to minimise the risks of harm and burden to participants. These safeguards included the giving of information about the nature, advantages and potential disadvantages of the project so that informed choice could be exercised. Written consent was obtained and copies of the consent form and information sheet were given to each
Findings
The core definition of bullying emerged from data analysis and subsequent member checking. It relates to a midwife, in a position of authority, abusing and exerting power over a woman through uncaring, cold, callous, threatening, abusive and/or aggressive behaviour. This behaviour which came to be labelled as bullying was not perceived as unusual but as part of an endemic culture of negativity:
And it wasn’t just one nurse [sic] … They come down and they was swearing in my face (Sarah).
I was
Case study: Jemma
To illustrate the extent of bullying described by some of the participants, Jemma's story is provided as a case study. Jemma was a young Aboriginal woman from a small town. She was transferred with a severe urinary tract infection by Air Ambulance to a hospital, at term. She travelled alone and was extremely frightened. Her partner, Henry was unable to be with her due to there being no room in the aeroplane and then extenuating circumstances prevented him from being with Jemma and their baby
Discussion
Compared with the non-Indigenous population, perinatal mortality rates are up to five times higher and the percentage of low birth weight babies are double in the Indigenous population.21, 22, 23 There is evidence equating maternal stress and anxiety with both prematurity and low birth weight babies24, 25; stressors imposed by a medicalised obstetric system and experienced by Aboriginal women during pregnancy, labour and birthing need urgent consideration.26
Sonn and Fisher27 argue that
Recommendations
The Code of Ethics30 clearly states ‘Midwives value respect and kindness for self and others’ (Value Statement 2). However, midwifery education and practice are skewed in the direction of technical competence and away from valuing human kindness and compassion.30 This imbalance requires redressing as a matter of urgency so that kindness, empathy, cooperation, encouragement and a willingness to share knowledge in a respectful way are as highly valued as ensuring physical safety.30, 31 All
Conclusion
Emotional safety for women accessing midwifery services needs to be as highly valued as physical safety. Participants in this study exposed a previously hidden form of abuse, that is, midwives bullying women. The bullying behaviour of what is believed to be a very small minority of midwives requires further research to determine its extent and impact. More importantly, it requires immediate redress and the recommendations outlined in this paper need to be adopted as a matter of urgency if
Acknowledgments
The Nurses and Midwives Board of NSW provided financial support to enable this study to take place. We also wish to thank the women who gave so much of their time and themselves in sharing their stories so courageously with us.
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Cited by (25)
Midwifery students’ experiences of bullying and workplace violence: A systematic review.
2020, MidwiferyCitation Excerpt :Hospitals and healthcare settings, in general, exemplify such structures (Vessey et al., 2009) combining historically entrenched hierarchies with a closed environment and high levels of workplace stress (Birks et al., 2017). Over the last few decades research has emerged that explored workplace violence in the maternity setting (Dietsch et al., 2010; Farrell and Shafiei, 2012; Gillen et al., 2008) with scholars identifying workplace violence as a cause for midwives becoming burnt out (Yoshida and Sandall, 2013) and deciding to leave the profession (Ball et al., 2002). Considering the significant organisational and financial investment in midwifery education, loss of students early in their program through bullying should be a policy priority.
Cultural security in the perinatal period for Indigenous women in urban areas: a scoping review
2019, Women and BirthCitation Excerpt :Other examples were: staff being abrupt and women feeling like they were wasting peoples time30; inadequate communication between hospital staff and mothers24; problems related to alienation and racism24; and, impersonal care and lack of connection with hospital staff28. One of the ten was a case study on care provided to a young Indigenous woman she discussed the inappropriate, threatening and ‘bullying’ care she received during her time in hospital.22 One study referred to birthing on country principles for the adaptability of these to urban contexts.
Remote dwelling Aboriginal Australian women and birthing: A critical review of literature
2019, Women and BirthCitation Excerpt :The majority of the scholarly literature reviewed has been authored by midwives who are currently working, or who have worked, in a remote setting or provided maternity services to women evacuated from their remote communities to birth in regional or urban centres. Nine of the 19 articles clearly articulated the first author status as midwives11–19 and six were assumed to be first authored by midwives based on the information provided within the article.20–24 Of the nineteen articles reviewed, only one article was written by an Aboriginal author25 who clearly identified as being Aboriginal (Indigenous health academic but not a midwife).
Models of midwifery care for Indigenous women and babies: A meta-synthesis
2017, Women and BirthCitation Excerpt :This phenomena reported in qualitative research give some indication of the reasons why Indigenous people do not access health care and why the standard of health of Indigenous people is lower than the rest of the population. Experiences of racism are widespread and well documented.10,36–38 This needs to be addressed to fundamentally improve access to health care.
Midwifery student exposure to workplace violence in clinical settings: An exploratory study
2016, Nurse Education in PracticeCitation Excerpt :Midwives have been reported to be perpetrators of bullying. In their Australian study, Dietsch et al. (2010) reported a small number of midwives exerting “uncaring, cold, callous, abusive and aggressive behaviour” towards women that served to instil fear. In a large UK study exploring why midwives left the profession, it was found that midwives without previous nursing education and those without degrees or diplomas found themselves more likely to be bullied.
Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence
2014, Women and BirthCitation Excerpt :Although most women had positive experiences with the midwives, a few participants reported negative experiences.25–27 Especially, Dietsch et al.27 reported that “a midwife, in a position of authority, abusing and exerting power over a woman through uncaring, cold, callous, threatening, abusive and/or aggressive behaviour”. The authors labelled this behaviour as bullying targeted specifically towards Aboriginal women, which was not perceived as “unusual but as part of an endemic culture of negativity.”27