Tag Archive | fear

Compassion in midwifery, maternity and childbirth

Last week I had the wonderful opportunity to be part of an interactive event in Dundee. It was the 2nd Scottish Improvement Science Collaborating Centre (SISCC). A wonderful liberating and inspiring day. I just want to share some insights that came during the day which focused on care and compassion.
I was confronted by a series of questions that arose both within myself and in communication with others: 

  • What is compassion? 
  • Where does it come from? 
  • Does it dwell within us or outside of us? 
  • Can compassion be taught and learnt? 
  • Is compassion an innate human quality?
  • How can compassionate care be spread to places where it may not yet be realised?

My personal life experience is that compassion is a quality and energy that manifests, and awakens between us within relationship. Such relationship is born of communications both silent and spoken. It is in the richness of a reciprocal dialogue that the possibility of empathy and compassion awakens. For me it is a way of being in the world and being with others. 

Following last week I am left wondering how do institutions and organisations in which we work enable and disable the potential for compassion to be revealed? Do our organisations ensure relationships can flourish? I am thinking of organisational structures that resonate at a particular tone or mood of fear and control that may not value human connection in which compassion can thrive. 

What does the organisation you work for value most? I’m not speaking of written policy, guidelines and organisational rhetoric but coalface interactions between and through all layers of an organisation. Does the context you work for allow the magic between people to unfold and energise compassion? Are the the conversations we have with colleagues and users of services based on a democratic dialogue, that is to say, does our use of language create a level playing field between us? 

For compassion to thrive and inform our connections with others a particular mood is required. A mood of congeniality, openness, transparency, care and tenderness. If we understand that we have to be in one mood or another and that we cannot be without a mood then the mood of a places and persons are significant. If a mood permeating your place of work is largely fear based then that is how that environment comes to be understood and how all interactions in that environment become interpreted. I would contend that in that mood a maternity (or any health environment) unfolds into a risk orientated experience. That can feel threatening and stressful.

I remember transferring a women into a hospital from community. I was happy to see an old colleague on duty in the hospital yet the communication between us was uneasy. I was confused and disoriented. I was met by a host of questions about the care I had provided prior to admission. This was all necessary yet it was the tone of the communication that left me feeling uneasy. The obstetrician then entered and the mood drifted into antagonism which translated into a barrage of risk discourse that awakened anxiety both for me and the family I was working with. I remember becoming overly judgemental of my own decision making, second guessing myself and feeling defensive. I was on guard and felt no sense of connection between the staff and myself. I went quiet. 

My relationship with the mother and partner became challenging as they too were being pulled into this new mood since being admitted. Suddenly everything became dangerous and risky. We transferred in for slow progress of labour and maternal request for analgesia. It felt we had arrived just in time to stop a terrible outcome! I felt that no one was having a good day in that environment. 

On the other hand I have admitted from a homebirth with a woman having a retained placenta and been met with congeniality, respect and a listening ear. The admitting midwife made me a coffee whilst I admitted the woman and spoke to the doctor. The admitting doctor was friendly and professional. The mood on both occasions was startlingly different. Although the outcomes both times were positive for mother and baby in terms of physical needs there was a tangible felt difference postnatal in my relationships with the mothers. In the first story I went home exhausted, questioning my abilities and feeling frustrated. The postnatal care did not flow easily in the way I had hoped. In the second story I felt connected to my colleagues and went home feeling part of a team and that I had done a good job. The compassion in the second story left me sustained and nourished my relationship with the mother throughout the postnatal period.

Compassion is a quality awaiting a fertile ground to awaken and grow. Once compassion and care takes root it can nurture the possibility of compassionate connections in each moment. So for me compassion requires the right ground, a freeing type of resonance. Once the mood of an organisation shifts from one that narrows potential, for example when fearful, to one that opens to possibility something enlightening between us awakens. A spark of compassion, once a spark of a potential flame awakens it can be fanned into a roaring fire warming and bringing brightness to all our encounters.

Let us think about how our leadership is attuned? Our colleagues? Our policy makers? Our researches? Our educators? Our new graduates? 

Maternity and midwifery have been shown repeatedly to be based on relationships. Indeed it is the relationships that keep care safe. Midwives are the ambassadors of maternity care and have a responsibility to safeguard what is precious in childbirth and ensure its continuance is holistically orientated. Facilitating and turning to moods that enable compassion to flourish between us is therefore worthy of our efforts. We may or may not have innate compassion, in a certain sense that does not matter. However we can be accountable to the moods which we contribute to and choose to awaken and we can also decide the moods we choose to turn away from. We just need to be aware of moods and take notice of the affects certain moods have on ourselves and others.

For me the good news is that compassion awaits us all. It is not dependent on whether you or your colleague next to you has a good amount of innate compassion! The notion of compassion being inside or outside creates a kind of false objective -subjective dichotomy that is antithetical to compassion. Compassion wants to gift us all those wonderful experiences that come from giving and yielding to each other. Compassion is thus realised and expressed in our relational encounters. Compassion for me is thus unfolding moments between us in the reciprocal play of our interactions. Without the play between us compassion finds no ground to take root and grow. Compassion only asks for a fertile ground to grow and come forth. The delight of feeling compassion once awakened between us reminds us of our shared human needs of wanting to be understood to feel loved and to feel safe.

It may only take a kindly moment of eye contact, perhaps a smile and some gentle verbal acknowledgement of the others you meet and work with. Such moments can be the fan that ignites the flame of compassion between us.

taken from collective notes board at SISCC in Dundee 2016:Sept

Feeling safe being free

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Safe and free

Focus on safety safety safety breeds fear,

fear then attunes us to more fear and then

the situations we find ourselves in, like childbirth,

become coloured by more fearful feelings ….

then it all feels even less safe!

Being constantly fearful is an unsafe place to dwell, function and be human,

we are simply not free when we are fearful!

Needing to feel safe is a human need yet it need not imprison us

let us not cover over what it means to be human in the pursuit of safety;

find ways of being and doing that awaken our potential to

flourish and feel safe and free

Susan Crowther 2016

What are we protecting? Midwives and other professionals

This is a short blog to garner a dialogue I hope. I am curious about how midwives feel the need to feel in someway “other” to colleagues in the maternity team. I have been guilty at times of feeling the need to safeguard the sanctity of midwifery from others that I perceive don’t understand. Or feel a need to protect and shelter what is precious in midwifery from those I believe will overpower my own professional position, stand, opinion and indeterminate knowing that directs my art of practice.

Yet is such positioning helpful, constructive and empowering? I am proud to stand as a midwife within my community. I live and work in a community of practice with lay as well as registered medical colleagues. I know my skill set, my scope of practice and have a knowing that stirs within me and bubbles up into action when needed. Such intuitive knowing is a wellspring of knowledge issuing forth just beyond my visual awareness; an historical and cultural embodied knowing. A knowing that brings deep awareness of how I stand on the shoulders of giants. Of a vast history. I need not be intimidated and lash out, avoid, do good by stealth, aggressively reject what I disagree with or even passionately accept what fits my present knowing – others may feel awkward in hearing my over zealous self righteousness. They perhaps have a different knowing. They may feel attacked, unacknowledged and grow uneasy around me. These encounters of difference, of divergent ideas are merely an opportunity to explore more of the complexity that is childbirth.

The knowledge and embodied knowing about birth does not belong to an individual group, time, place or person.

It is not feasible that anyone person or professional Group can hold all there is to know. Surely no one would claim this?

What matters most to us all is – being safe, feeling safe, being loved, being seen, being with-others respectfully. What matters is that we all engage in miracles daily. We, those privileged to be at birth, get to be at the time of an exquisite specialness. A time which is the greatest of equalises. A time when we can gather in awe at the mysteriousness of life! Surely that transcends any professional differences and conflict; surely within this living kairos time the silent voices of our collective inner selves are permitted to sing out in unison? We can transcend, just for a moment, the divergent discourses that serve us little when what matters most arrives as a message in a bottle from beyond the horizon. This is a celebration of our diversity and differing ways of coming to our knowing. Then we see there is nothing to protect. Then we become still and silenced.

What do you feel?

 

Embracing the Dionysian Apollonian paradox in maternity care research

“Rachel was born at home, unplanned. In the lounge of course, right in the middle of winter. She came on hard and fast. I just woke up about 9.30 with feeling uncomfortable again nothing really, just niggles. Went back to bed I rang Sam [midwife] at about 10.30, said “I’ve had a couple of contractions, nothing regular”. She said “Do you want me to come around”. We’d just had a snowfall that weekend the roads were quite dodgy so needed to make the decision to travel or not. It can take a good hour and a half, two hours to the rural unit depending on conditions and up to 4 hours to the hospital. So it was a bit scarier especially at night time. The gorge passes can be quite treacherous with ice and snow on the roads. I cracked on – the road trip was not happening, they’d all decided for me but the decision had to be mine. I wasn’t frightening at all. It was horrible outside, cold and the roads were really bad. I had visions of getting stuck on top of the gorge and having the baby out side with my bare bum out in the middle of the snow. I was not leaving even if others wanted me to, not with that length of time travelling and the terrible weather conditions. I was comfortable here at home, it was really lovely. The fire was roaring, put the jug on, and had a cup of tea. Sam called her second midwife and popped home and got her home birth bag. We had a cup of tea and settled in basically, parked up, and let things progress – just did what I needed to do”

Things are certainly not as straight forward as we would often believe them to be as Lynn’s story narrates. I am now dwelling amongst pages upon pages of post doc gathered data. The data is brimming with stories of maternity care lived experienced descriptions from a wonderful host of participants as the one above. I am always bemused and delighted when I come to the part of qualitative research that involves ‘letting arrive what needs to arrive’ from the data. Amidst the seemingly overwhelming complexity of life rendered in these gifted stories are the shared meanings that gesture towards our together humanness! In this is the possibility of transformative understandings and how to go forward. At the end of day I’m a swirling energy of interpretive images and words punctuated by my exclamations of “yes”, “perhaps”, “oh I feel that”,” I see what that means”, “where is my note pad and pen” “oh wait there is more”. No-one warns one of the insomnia that can plague a qualitative researcher once immersed in stories about life.complx

To be fully engrossed in the process is to be witness to the Dionysian possibility of ceaseless convergence and divergence. It is to find oneself in Kairos time when fixed notions of the “final answers, solutions and conclusions” find no resting place. There never seems a ‘right’ time to stop for the day – nor is there a moment when interpretation is complete! I find it liberating and freeing not to have it wrapped up and formulaic. To be released from the need to have the final word on any phenomenon is absurd yet funded research demands the ‘output’.

apollo

Apollo directs into reason, systems and defined predictable processes

The often spoken secret between us Hermeneutic phenomenologists is knowing there never will be one definitive conclusion; there will always be ‘on-the-way’ findings ‘that satisfies’ the funding agency and those that accept your work for publication. I say secret because however many times I say that this type of ontological work bellies any finality I’m repeatedly asked “so what was your final conclusion?” – I smile, “There simply is no ending to the process of life”.

Maternity care provision in the remote regions of New Zealand is a tale of paradoxical tensions. This tension is between the need to let go into the uncharted yet inspiring territory of what may lay beyond the imagination of our own experiences while taking heed to the Apollonian structured world of the modern maternity systems when ‘things’ are made controllable, timed, charted, documented, where protocols and guidelines dominate and attempt to construct and hold that world together. There is the nearness of being home and feeling safe and fear when one is far from the highly structured world of medical help when needed.

Rural living tells a story of being on the edge and outside of that controlled environment of the 21st century maternity hospital. I see and ‘feel’ hard working down-to-earth pioneer types living frontier lives in these remote regions. People dealing with the challenges of isolation and close community; of scenic places that are often holiday destinations for many of us yet are the homes and birth places of many.

I will not speak in this blog entry further on the findings for that will come later, I promise! For now I am intrigued about the paradox as stated above.

dionysusDionysus eats the intoxicating fruits

This research, like maternity care in rural areas and birth itself requires an openness, receptivity and trust. These unfolding emergent processes epitomize the Dionysian approach. As researcher and midwife I find myself being reminded on this journey that responding to what emerges is about attuning with wonder to what surfaces in a kind of creative evolutionary flow. To be immersed in research that seeks to reveal meaning is to drink of the intoxicating Dionysian wine that releases me to go beyond constraints; it can make me dizzy! In my research on Joy at Birth I wrote:
The birth experience uncovers a drawing near of divinity that puts us face to face with Otto’s holy-other as Dionysus the ecstatic liberator from worldly concerns “… something that captivates and transports … with a strange ravishment, rising often enough to the pitch of dizzy intoxication…” (Otto, 1917/1923, p. 31). I am reminded of the lovely madness just after many births when everyone is intoxicated, fascinated and enchanted. Something enchanting is experienced that can be a moment of transformation; a moment in which we find ourselves able to go forward into new understandings.

I then wrote in my field notes at the time:

As soon as baby came the father held his son up to the night sky offering an Islamic prayer, all the hairs on the back of my neck stood up. This was a holy moment, I continued to attend to the mother yet there was such a presence that touched and thrilled me to tears. [Field notes 2011].

The mood of the Apollonian thinking that comprises systems, measures and to do lists would appear at odds with this intoxicating freedom. Yet that is not what I argue. Both the Apollonian and Dionysian ways of attuning speak to us as humans. Actions in the remote regions to secure safety and positive outcomes require planned actions, sharpened clinical decision making and critical thinking.

A recent heated discussion on social media concerning midwives and promotion of normal birth provoked condemnation from some quarters. Again the splitting of ways in the normal vs abnormal debate bears no useful long term fruit. What is important is acknowledging and appreciating that we are always somehow in the dance of the Dionysian and Apollonian paradox. Statistics at times can be used as weapons to prove “being right” and held up to be the sole voice of reason. Conversely an emotional charged flow of words can imply “rightness” – yet this ‘feeling’ contribution to the debate can be accused of being chaotic, unreasoned and therefore less valued. Both however can come at us like arrows of righteousness and strike us wherever we are situated.
As Rumi, a sufi mystic poet said in the 13th Century:

“Out beyond ideas of wrongdoing and rightdoing, there is a field. I’ll meet you there”

To dichotomise appears to be the domain of inflexible thinking that seeks rightness and disregard of the other. Likewise I am finding once again that the research project (whatever it may be) requires a Dionysian openness and flexibility. At the same time I need to pay attention to the more Apollonian disciplined processes such as the ethics procedures, funding applications, attention to literature (yes -quantitative and qualitative) and the academic restraint on styles of writing. It is in a sense a dance in Rumi’s field. It is neither this nor that, not a wrong way or a right way it is always dialectic, constantly both, one within the other…that is the tension.

Lynn had planned on a facility birth yet had her baby at home by the warmth of her own fire after a cup of tea with her husband and the local rural midwives. The snow storm and the worrisome distance from hospitals and secondary services lie beyond this tender scene. The story reveals qualities of relationships, trust, surrender and feeling safe. Life is always far more than we can predict and order.
For me it is about letting go of being right OR wrong and enjoying the fun of being finite in a universe of infinite possibilities that confound us! Befriend your Dionysian and Apollonian qualities.

Mood at Birth and Christmas past and present

As Christmas arrives, a time of reflection for many on a holy birth, I ponder the way we as society attune at birth today. All human experiences are culturally and historically determined, including birth. Birth as with all other human experience and understanding is contextual. As Gadamer contends we are viewing and knowing the world from an inescapable effective historical consciousness. We are in a way continually walking into our past. I argue like others that birth is not purely physiological but enmeshed in its own unique context. Therefore to explore any phenomenon at birth is at once to address all of birth, past and present which at the same time is connected to future possibilities. There are constant hints from history that gesture towards birth as significant fusing with contemporary horizons of understanding and possible futures. That is to say that how we tune into, tune in or attune at birth reveals how birth is understood.

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