Elsevier

Women and Birth

Volume 23, Issue 2, June 2010, Pages 53-59
Women and Birth

You can drop dead’: Midwives bullying women

https://doi.org/10.1016/j.wombi.2009.07.002Get rights and content

Summary

Background

This paper describes how women experienced what came to be labelled as ‘bullying’ by a small number of midwives when they were evacuated from their rural and remote areas of NSW, Australia to a maternity unit to birth.

Research question

What is the experience of women who are required to travel away from their NSW rural/remote communities to birth?

Participants and methods

Forty-two participants together with a number of their partners/support people were interviewed indepth for this qualitative, exploratory study. Upon thematic analysis of the transcribed interviews, an unexpected finding was that four participants (plus one partner) described experiences which were interpreted as bullying, by a small number of midwives working with them. Women identifying as Aboriginal were especially likely to share stories of midwifery bullying.

Results, discussion and conclusion

Emotional and cultural safety of women must be a prime consideration of midwives. Strategies to reverse power differentials between midwives and women are urgently required to eradicate bullying by any midwife.

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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