Midwifery continuity of carer and the fallacy of multitasking

I was pondering on some of the things in our modern maternity services that impede genuine connections to others. The ability to create, cultivate and build authentic relationships with others lies at the heart of midwifery practice. It is relational continuity and the myriad associated better outcomes for women, families and midwives that inspires continuity of carer models of care. This blog is not about providing more of that evidence, but professional and personal observation of what is going on.

Continuity of carer demands that we do not simply fall into autopilot in practice, to follow blindly all institutional dictates, but instead follow women. To do this we need to be open to learning about the other and be willing to cultivate bespoke care pathways in partnership with women. This requires mindful practice to nurture relationships and not blind adherence to what we have been told to do! Being mindful helps our ability to connect with others. I have found that this alleviates stress and tenseness and replaces it with a feeling of relaxed practice. Trying to please the institution and a woman right there in front of you is often really challenging and can trigger our amygdala and initiate a possible flight or fight response. In such a situation the dialogue we are having can become quickly impersonal, emotionally charged, reactive, and defensive. When this occurs, we tend to take a position that makes for a dis-empowering experience for us all there in that moment. In such a situation I would always take a breath, pause and become aware of my own judgements, own up to them and explore them with the woman who has come to me for midwifery care. An example of this could be when a woman at 42 weeks gestation declines induction of labour or a woman decides that a home birth is the best option for her despite a previous caesarean section. For some these situations could be challenging when clinics are busy and/or when we know that we will not be the intrapartum midwife and/or our practice partners do not share the same philosophy of care as me.  Challenging for many of us I’m sure.

When such occasions arise, I find that a healthy skepticism about institutional dictates helps inform better relational practice. Nurturing discernment around technology and guidelines and being vigilant that they are not owning and taking away the possibility of connection in any moment of practice is key. This is not about bucking the system in a reactive way but concerned with taking responsibility and being accountable for the actions taken in each moment of practice. Most of the time this aware mindful approach to practice creates an opening for honest communication that improves the partnership between us. Through this process I am often brought back into presence with the woman in front of me. In that moment relational continuity flows so much easier and that moment of practice is so much more enjoyable! When we start worrying what the institution or/and others may be thinking of me and the type of care I am providing I can quickly feel tension within me arising again. This is not to promote poor practice, quite the contrary, this is about reinforcing the evidence based relational continuity we aspire to nowadays that consistently demonstrates optimal outcomes! It is about being honest where you are with care, skills and understanding in each individual encounter and doing what is best for the woman, her infant(s) whilst honouring that as midwives we are part of that partnership.

For me and many colleagues I speak to, being with women in this way is made so much easier when working within a continuity of carer model. Yet there are seemingly so many obstacles to this occurring. One is the expectation that the ability to multitask is seen as a sign of good midwifery practice and a virtue worth aspiring to. Firstly, there is no such thing as multitasking. Secondly, to attempt to multitask, especially complex multitasking (e.g. several women in labour at once in your care) is a recipe for not doing anything really well! Would you consider crossing a busy road whilst texting a friend and helping a young child to cross good practice? Would that be considered safe? Who is getting the best of your caring aware attention, the child, NO, the person at the end of the text, NO, the drivers and their passengers on the road around you, NO, your own health and wellbeing NO. Yet many maternity units expect professional resilience and capacity to do this level of complex multitasking. Some services expect their continuity of carer, caseload midwives to do this, e.g. manage a busy caseload and be called in to the acute area to help out. This is neither desirable or sustainable. These demands are often driven by staffing and fiscal issues constructed in a world in which maternity services are construed as an industry with ‘outputs’ and ‘products’, these of course are contrary to any idea of relational care. One has to ask who is benefiting from multitasking?

Multitasking does not improve care, does not make you a great midwife! It certainly does not prove to you and others that you are a resilient midwife worthy of praise. Neither is it associated with better outcomes!

What multitasking does do is:

  • Emotionally and physically drain us,
  • Reduces our ability to practice safely, higher chance of missing something important
  • Leads to standardised care because too much variety is challenging to work with at one time
  • Inhibits our capacity to nurture relationships because we are always divided among many tasks at once,
  • Takes away our ability to be fully present at a moment of practice
  • Diminishes our joy of practice because we simply have too much going on at one time (our heads are full of complex dilemmas to resolve/attend to)
  • Lessens our ability to provide the tactful, compassionate and sensitive care that we all wish to provide each woman
  • Overshadows our sense of meaning and purpose in our midwifery practice leading to spiritual distress in which our values and what matters most to us in practice becomes impossible to actualise

This is not to say that at times we can do simple multitasking (e.g. eat a packet of crisps while walking the dog in the park), but not complex tasks – so we must remain vigilant that we never truly multitask and be aware that constantly trying to do so depletes us emotionally, physically and psychologically, even spiritually.

We are never actually multitasking, what we are actually doing is rapidly switching attention from one thing to the other. This itself takes energy to do constantly. Each time we switch attention we are obviously not completely focused on the other – i.e. Moving between birthing women on a shift – who are we truly with completely in any given moment of practice?  The outcomes of continuous attempts of multitasking, that is to say, rapid attention switching, in our maternity services leads to burnout, dissatisfaction (of everyone involved) and I would contend, lead to detrimental outcomes in childbirth. Being a multitasking midwife is not the panacea! Being a multitasking midwife does not prove your worth as a good resilient midwife! Being a multitasking midwife is the antithesis of relational continuity.

As a phenomenologist and midwife I find the idea of multitasking difficult to comprehend. To be elsewhere in our thoughts and actions means we loose the precious moments in front of us; are we in those times of being absent in our midwifery care missing something special? How can we find our way back to authentic connections when we are constantly interrupted by competing demands? How can we be full participants in the meaningful story of that woman’s childbirth year when constantly distracted by the needs of others and institutions? The magic unfolding when two or more people come into relationship is threatened in our overly busy worlds. Allowing this busyness to enter our moments of midwifery practice is to deny the precious gifts shared and available in our woman-midwife relational encounters.

Multitasking in midwifery is a fallacy. There is no evidence to support it, it causes stress, impacts negatively on relationships and takes away our joy of doing what we love to do. Most of us love to be with one woman at a time, be able to be present and fully engaged and give our caring aware attention to her needs. I know this energizes me in practice. In addition, we need to nurture and attend to the needs emerging throughout our unique woman-midwife professional partnership with woman. This requires us to turn up fully and be ‘there’ in each moment of practice. I would urge you all to challenge this pernicious idea of multitasking in the midwifery profession and be a lot kinder to yourselves and others.

Some further reading

Kalisch, B. J., & Aebersold, M. (2010). Interruptions and multitasking in nursing care. The joint commission journal on quality and patient safety, 36(3), 126-132Paridon, H. M., &

Kaufmann, M. (2010). Multitasking in work-related situations and its relevance for occupational health and safety: Effects on performance, subjective strain and physiological parameters. Europe’s Journal of Psychology, 6(4), 110-124.Laarni, J.,

Karvonen, H., Pakarinen, S., & Torniainen, J. (2016, July). Multitasking and interruption management in control room operator work during simulated accidents. In International Conference on Engineering Psychology and Cognitive Ergonomics (pp. 301-310). Springer, Cham.

Loukopoulos, L. D., Dismukes, R. K., & Barshi, I. (2016). The multitasking myth: Handling complexity in real-world operations. Routledge.

Rosen, C. (2008). The myth of multitasking. The New Atlantis, (20), 105-110.

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