Guest Blog on Burnout

I had the pleasure of meeting Amity while she was studying for a BSc midwifery degree in London. As a senior midwifery lecturer at the time, I noticed Amity’s passion for midwifery and was sure she would become an excellent midwife. The classification of first-class degree was well deserved. It wasn’t until I read Amity’s book ‘Overdue. Birth, Burnout and a Blueprint for a Better NHS’ (2020) that I was made aware that Amity had endured such profound occupational burnout that she was sadly forced to leave the midwifery profession. The fact that Amity left the NHS after less than three years is a travesty. Ever the quiet warrior though, the depth of Amity’s philosophical values and her inherent strength are combined in the final chapter to offer a practical blueprint for a better and more psychologically safe NHS.

Like many midwives, I entered the profession in mid-life, after having my own children and a starter career. I’d been lucky enough to receive excellent continuity of care in both of my pregnancies, with the midwife I’d seen antenatally in my second pregnancy also attending me at home in labour. Those experiences, particularly my home birth, instilled in me a profound appreciation of my body’s strength and my own capabilities. But it gave me something else too: a newfound appreciation for the role of the midwife. What a privilege it must be, I thought, to facilitate such acts of extraordinary humanity every day, and to witness women discovering their own wild power.

Not long after my youngest child’s birth, I started working as a doula. Supporting women as they became mothers felt like what I was meant to do, and I loved every moment of it. Soon, I had left my journalism and editing jobs behind. When I began my midwifery training three years after that, I was absolutely certain that midwifery was my calling, that it was the next logical step in my career. I poured my all into those three years, working hard on my essays and exam preparation, reading everything I could get my hands on, and going to every conference and networking event I could afford to attend. I lived, slept, ate, and dreamt midwifery, doing everything I possibly could to ensure that by the time I qualified I would be a competent, confident, midwife with a passion for woman-centred care and creating change within the system. Initially, I thought I’d succeeded, and very well at that. But nothing – not my excellent training, not my first-class degree, not my six years of hands-on experience of supporting birthing people – adequately prepared me for what it’s like to be a newly-qualified midwife in a system that is chronically understaffed and under resourced.

I’d always said that when I qualified, I would go straight into independent practice, or at the very least a home birth or community team. That’s where my passion was, after all. I was very good at watchful waiting, at being ‘with woman’, and I knew that these were the environments where I would thrive. I very much wanted to provide the level of continuity and relationship-based care that I’d received myself, because I knew how life-changing it could be. But like every other student who is about to qualify, I was advised by more senior midwives to do my preceptorship first, to ‘hone my skills’ on the wards before I joined midwifery-led, low-risk teams. It has never escaped me, the irony with which we send our most passionate advocates for physiological birth, fresh from an intense training programme that ensures they can facilitate such births, out of the rooms where physiology is unfolding as it should and send them to the highest risk and most medicalised areas instead. Still, I gritted my teeth and did what I was told, working to improve my high-risk skills and gaining plenty of experience in obstetric emergencies.

What I was also collecting along the way, unbeknownst to me, was all the pain that came with that. Day after day, I witnessed trauma in all its forms: physical, emotional, psychological, moral, intergenerational. Feeling helpless to prevent the obstetric violence and systemic racism happening all around me haunted me long after the women had been discharged. I knew that many of them would be going home to try to pick up the pieces of their broken bodies, their broken hearts, their broken trust in themselves, and us. It created fault lines and cracks in my own heart, ones I knew I’d have to fill and harden if I was to carry on.

But I couldn’t do it. I couldn’t harden myself against the women, or against their pain. I’d seen some of my exhausted and battle-worn colleagues do so, and I swore I would never resort to being unkind and impatient, worried more about my PIN and fitting in than with providing respectful, individualised care. So instead, I internalised it, turned it inward, drew it into myself and tried to store it somewhere so deep that it would never see the light of day. Somewhere it could never hurt me, or them. It turned out that wasn’t possible though. Soon, instead of dreaming about the joys of midwifery, it became the stuff of nightmares, extending its dark tentacles into every corner of my mind until there was room for nothing else. Not joy, not confidence, not passion. Just sadness and frustration and anger.

I kept myself running like a machine so that I could continue to go to work, continue to try to do good, but it came at a huge cost to myself. Soon the cogs stopped turning and I began breaking down, piece by piece, because I was not a machine after all. In order to make the journey towards recovery, I knew I had to leave my job as an NHS midwife. After a second period off sick, I handed in my resignation, too unwell to even work my notice period. I’d only been qualified for two-and-a-half years.

It is now more than five years since I left the NHS because of burnout, and it has taken many of those years to fully recover. But my passion for women and for respectful maternity care has never wavered or turned to apathy. It still burns so brightly in me, in the part of me that remains hopeful and optimistic that change can and will happen. My role with White Ribbon Alliance (WRA) UK, as the Training and Resource Lead, has led me back to the work I will never give up on: creating safety in birth in all its forms, not just physical survival. With WRA’s Free From Harm initiative, a highly-acclaimed resource and training course for maternity care professionals on how to recognise and combat obstetric violence, there is a growing movement to address the emotional and psychological damage being done not only to birthing people and their infants, but to maternity staff as well. Harm cannot be eradicated until the system itself is no longer harmful to those who work within it too.

There is talk of the NHS as we know it ending soon, of it falling apart completely. But much like my experience of burnout, the spirit of our universal healthcare system cannot be broken. Is it tired? Yes, undoubtedly. Perhaps also a little jaded, creaking with the unease of sorely neglected joints. But no matter how many politicians and private corporations try to dismantle it, to quash its spirit and crush its dreams, the beating heart of it – its hope and humanity – can never be taken apart and sold off. We will find new ways of working, new ways of accessing care, new ways of helping each other. Even if it means a complete overhaul, a razing to the ground to then rise from the ashes, or a revolution in the streets. Love and compassion will eventually lead us back home to ourselves, as they always do. My belief in that will never burn out.

Amity’s book, Overdue: Birth, burnout, and a blueprint for a better NHS (Pinter & Martin, 2020) is widely available from most online book retailers. More of her writing and activism can be found on her social media channels