by Marinah Valenzuela Farrell
© 2006 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 80, Winter 2006.]
This is the first of four articles on bullying, a problem that has been identified within the profession of midwifery, as well as in many other areas. The next issue will feature The Bully (identifying the bully).
Tonight she left my house in tears and in a rage of depression. I felt my stomach tighten as I tossed and turned thinking of our conversation.
Was this a pregnant client? No, it was a young midwife who had just started practicing in my area and came to me out of loneliness and desperation to be heard. As I lay in bed considering our conversation I realized, in addition to the internalized abuse and oppression issues, just how intense the problem of bullying is among midwives. So many times I hear it characterized as conflict among "powerful women"—as though we are bullying one another simply because we are so strong. The truth is that our bullying reflects the fact that we are powerless and fearful.
Carolyn Hastie, the author of many excellent pieces on bullying and horizontal violence in the workplace, has written a particularly touching article entitled "Dying for the Cause" (www.acegraphics.com.au/articles/hastie01.html). It begins: "About 5 pm on a Monday evening in June 1995, a twenty-five-year-old midwife, Jodie Wright, ended her life. Jodie gassed herself in her car. Her suicide note clearly stated her disillusionment, her frustration and her profound sense of hopelessness. Her words implicated the way our profession treats women—as midwives and as mothers—as the basis for her decision to end her life.
"Jodie was one of those 'bright young things' that older, cynical midwives knowingly smile at each other about and comment how they were like that once. Enthusiastic, passionate about her work, talented and committed to learning as much as she could about her chosen profession, Jodie was equally committed to improving the situation for the women and babies in her care. Jodie went to every conference and workshop possible within the limitations imposed by shift work and rosters. Those of us who knew Jodie were aware of the difficulties she experienced as she sought to influence practices and improve care for women and their babies in the institution in which she worked. Instead of support, interest and encouragement from the institution and its management, Jodie met hostility, criticism and intimidation. Comments such as 'what would you know, you are only a new graduate, I've been doing it this way for "x" number of years' were common responses to her suggestions and ideas based on her rapidly accruing knowledge. Jodie developed a deep sense of isolation and despair. Gradually her confidence was shattered. Continued criticism and disparagement led her to doubt her value and abilities."
By way of this example Hastie writes about bullying among midwives and notes how many midwives (and other health care workers) leave the profession because of disillusionment with the lack of change in the status quo and because of their inability to bring about true betterment in the care of women and babies. Horizontal violence (hostile and aggressive behavior by individual or group members towards another member or groups of members of the larger group) occurs among health care workers, especially midwives, at an alarming rate. The more research I did into bullying the more I realized that the health care system has done a good job of imposing the status quo on us and we in turn impose the destructive behavior of oppression on one another.
Oppression, as Hastie defines it, is a manifestation of "subtle forms of self hatred such as divisiveness, lack of cohesion, lack of participation in professional groups, back-biting, destructive gossiping, fault-finding and other forms of violence and contradictory behavior…."
Does this sound like your midwifery community? We all need to recognize this behavior if it exists within our profession so that midwifery will continue to survive as a healthy alternative for women as health care providers, as well as for the women we serve and mentor.
What exactly is bullying? Unfortunately, little has been written in the US on the topic of bullying among adults, and not as much is written as should be regarding schoolyard bullying. Thankfully for my children and me, our charter Waldorf School organized lectures on the topic, which gave me an introduction. However, I had never thought that what I was learning about children was essentially the same among adults!
The most devastating realization I came to was that adults who are bullied (or targets, as they are called) can become physically ill, psychologically depressed and permanently debilitated without professional help. We have no problem grasping the seriousness of the situation when a child cannot sleep or is sick because she is tormented on the schoolyard. We must understand, however, that adults may abuse one another in the same way and cause great pain and trauma. This is especially true in a field such as midwifery, where our jobs are already stressful.
Bullying makes people feel scared or unsafe and is used as a means of control. Many different types of bullying behavior exist, from physical abuse to speaking about a person behind her back in a way to discredit or harm her. The Web site www.bullying.org notes that leaving someone out of a peer group is also bullying behavior.
Barbara Coloroso, author of The Bully, the Bullied, and the Bystander, writes, "Bullying is not about anger. It is not a conflict to be resolved. It is about contempt—a powerful feeling of dislike toward someone considered worthless, inferior or undeserving of respect. Contempt allows [bullies to harm others] without feeling empathy, compassion or shame." This sense of contempt frees a bully to feel "[a] sense of entitlement…an intolerance to difference…and a freedom to exclude, bar, isolate, and segregate others."
The Workplace Bullying and Trauma Institute (WBTI) in a detailed survey listed the top reasons people feel bullied. The number one reason was "I remained independent, refused to be controlled or subservient" (70%) and number two was "My competence and reputation were threatening" (67%).
In the midwifery community midwives feel bullied not only among one another, but also in our daily interaction with other health care professionals. Identifying the fact that midwives are an oppressed group with the fears endemic to counterculture groups—such as isolation, ridicule and economic suppression—allows us to develop a language to prevent mimicking the painful behavior of the dominant medical hierarchy.
One element of bullying is that "bystanders," or those not directly involved as a bully or a target, remain silent about the injustice being done by one midwife to another or within a midwifery organization. This is the element of bullying that I find most discouraging and that seems to exist within all levels of obstetric health. By providing words and definitions to understand bullying, perhaps we can begin to apply the proper language at meetings and in discussions as a way to heal our own traumas, support a targeted midwife or even aid midwifery organizations in becoming less fearful or preventing internalization of the oppression that is a daily part of mainstream professional culture. In short, proper language will serve to consciously identify the act of bullying and with this identification of bullying midwives can then, either as individuals or collectively, prevent bullying by adopting personal or organizational ways of coping. Most importantly, we can protect our own health by bringing bullying out of the shadows where it has been a shameful secret of midwives for far too long. Many midwives are leaving the field of midwifery as a result of illness directly brought on by forms of oppression in interactions with other midwives!
In some cases midwives internalize the violence of bullying and often unconsciously pass it on to new generations of students who then go on to operate under the fears of generations of midwives before them. Again, our culture tends to value the aspects of bullying that reward achievement and recognition above all else. Midwives may mistakenly believe that only by excluding those midwives who have "less" of something (credentials, education, licensing, years in service, etc.) can they remain safe practicing in the field. This affects the midwifery community in unhealthy ways that foster hostility when midwives who maintain their identity, speak their truths, or forge new paths challenge existing midwifery practices or bring attention to the profession. Those midwives tend to not last very long in our communities, which is a shame since they may bring the most spirit into midwifery. Instead, they are driven out and the community goes back to living in silent fear and oppression. Students learn that they must conform to this standard and may not learn how to teach without some type of contempt around the whole system of midwifery. This is not a healthy cycle!
The WBTI lists the following emotional and psychological health symptoms that can be a direct result of bullying:
- Poor concentration, forgetfulness
- Loss of sleep, fatigue
- Spontaneous crying, lost sense of humor
- Panic attacks, anxiety
- Clinical depression
- Feelings of insecurity, being out of control
- Nightmares about the bully
- Obsessive thinking about the bully
- Always anticipating the next attack (hyper-vigilance)
- Shattered faith in self-competence, feelings of worthlessness
- Shame, embarrassment and guilt
- Self-destructive habits: Substance abuse, workaholism
- Altered personality, unrecognizable to family and friends
- PDSD/PTSD (Posttraumatic Stress Disorders)
- Suicidal thoughts
- Violence: suicide or violence against others
These symptoms are serious enough that we all need to come together and break this pattern in our dealings with one another. I recognize, as does Hastie in her article on the young midwife Jodie, that rarely does a midwife reach the point where she ends her life. Instead many midwives leave the field early, students give up the path and too many young midwives feel shut out and very lonely in their community.
I believe our profession doesn't have to be this way if we take the initiative to recognize our internalized abuse and not only speak out against it but also decide to stop the cycle.
We need to ask ourselves some of the social justice questions Hastie asks in her article: "What is my vision for midwifery? What is my vision for maternity services? Am I satisfied with the status quo in maternity care in this country? How do I support/encourage/nurture my midwifery colleagues, especially the up-and-coming midwives? Am I part of the solution or am I part of the problem? What is the culture in my organization? Is conflict and change seen as an opportunity or a threat? Are problems and differences of ideology dealt with openly or smoothed over and ignored? Is the emphasis on individual or shared action and responsibility? Do we recognize that change is an ongoing process, that it has circularity and is not an event that just happens?"
If we are able to focus on these questions as they affect our personal visions for midwifery and organizational mission statements we will help to ensure the health of our profession as well as to safeguard our own health. Most midwives come into midwifery out of a desire to serve and promote positive change for women. The field of midwifery is a beautiful profession and I am astonished at how many times I need to remind students and midwives that our profession (not just the births) is truly a beautiful and powerful field of change and peaceful activism. In focusing on our vision of midwifery we can be clear that bullying has nothing beneficial to offer in our challenging and exhilarating field. The desire to effectively address bullying and eliminate it through education, discussion and zero tolerance could truly make us a powerful community in a culture that does what it can to destroy community.
Like Hastie, I will end by citing the steps to professional happiness listed by Ruth Lubric, an inspirational midwife and author. I felt these professional steps were important to add because, as well as being motivational, they directly help to negate some of the damage done by bullying. Lubric's steps can halt oppressive behaviors and help us to heal from the trauma of being bullied while at the same time provide encouragement to those who become targets in this profession because they aspire to leadership and creating positive change.
I also do so in the hope that my sister midwife who left in tears will find a way to heal, and that her disillusionment and the message of Jodie's suicide will open the door to others' pain and give them words with which to heal. I have felt the brunt of bullying as a young midwife in my community, as well as the lingering health effects from such abuse. Yet, never have I met women more amazing and transformative than midwives. Together we can break the cycle of bullying among us and create the community we all dreamed about as we began our journey in birth.
Ruth Lubric's steps for professional happiness:
- begin with the needs of the people you serve
- take care of all the people of the nation [by being socially and environmentally responsible]
- trust your caring instincts
- learn to tolerate uncertainty
- choose your professional colleagues for their caring philosophy
- be aware of the limits of the medical model
- avoid anger (consumes energy)
- avoid bitterness against professional adversaries
- base design for change on the best science possible
- overcome the fear of leadership
Marinah Valenzuela Farrell, LM, CPM, is a midwife with Sage Midwifery in Phoenix, Arizona.
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