Resilience, Wellbeing, Reflection, Human Factors & Leading Care

Resilience, Wellbeing, Reflection, Human Factors & Leading Care

Midwifery is rewarding but emotionally and physically demanding. The Future Midwife standards expect midwives to maintain their personal health and wellbeing (1.26), to take responsibility for continuous self-reflection (1.27), to develop the strength, resourcefulness and flexibility to work in stressful situations (5.13), to recognise vulnerability in themselves and colleagues (5.14), to practise compassionate self-care (5.15), to apply human factors and strength-based approaches (5.4), to lead and manage care safely, including delegation (5.19, 5.20), and to plan their career development (5.18).

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Personal Health and Professional Responsibility

The NMC Code (20.9) requires registrants to maintain the level of health they need to carry out their professional role. This means:

• Recognising when tiredness, illness, stress or personal circumstances could affect safe practice, and seeking help early.
• Taking rest breaks, staying hydrated and eating during long shifts, and planning recovery between night shifts.
• Using occupational health services, employee assistance programmes and local wellbeing support.
• Not working while impaired by alcohol, drugs or medicines that affect judgement.

Health conditions are not in themselves a barrier to practice. The NMC focuses on whether a professional can practise safely, with adjustments if needed.

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Recognising Stress, Burnout and Moral Distress

• Burnout is described by three features: emotional exhaustion, depersonalisation (feeling detached or cynical) and a reduced sense of personal accomplishment.
• Moral distress or moral injury can arise when staff know what good care looks like but cannot provide it, for example because of staffing shortages.
• Second victim experiences follow involvement in an adverse event, with guilt, anxiety, sleep problems and loss of confidence.
• Signs in colleagues include withdrawal, irritability, increased sickness, mistakes, or changes in behaviour. Midwives should approach colleagues with kindness, listen, and encourage them to seek support.

Support after Traumatic Events

• Debriefing: a brief "hot" debrief immediately after an emergency, and a structured "cold" debrief later, help teams process events and learn.
• Peer support schemes such as trauma risk management (TRiM) identify colleagues who may need further help.
• Schwartz Rounds give staff from all disciplines a regular space to talk about the emotional impact of their work.
• Support for staff involved in incidents is part of a just culture, alongside learning through PSIRF.

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Reflection and Restorative Supervision

Reflection turns experience into learning and is required for revalidation (five written reflective accounts and a reflective discussion with another NMC registrant every three years).

Clinical supervision has three functions (Proctor): normative (standards and accountability), formative (learning) and restorative (emotional support). In England, the A-EQUIP model (Advocating for Education and Quality Improvement) provides restorative clinical supervision through Professional Midwifery Advocates (PMAs), who also support personal action for quality improvement and professional development.

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Human Factors and Strength-Based Approaches

Human factors is the science of how people interact with each other, their equipment and their environment. Most errors arise not from careless individuals but from systems that make errors easy. Important human factors include:

• Fatigue, hunger and stress, which reduce attention and decision-making.
• Distractions and interruptions, for example during drug calculations (use of "do not disturb" tabards can help).
• Situational awareness: perceiving what is happening, understanding it and anticipating what will happen next. Loss of situational awareness, such as "fixation error" on one problem, was a recurring theme in maternity investigations.
• Hierarchy and communication: junior staff may not speak up, so teams use structured tools such as SBAR, safety huddles, closed-loop communication and the right to "stop the line".
• Equipment and environment design: similar-looking drug ampoules, confusing infusion pumps and poorly laid-out rooms increase risk.
• Checklists and standardisation: for example, the WHO surgical safety checklist adapted for maternity theatres, and standardised emergency boxes.

Strength-based approaches focus on what goes well as well as what goes wrong. Learning from Excellence schemes allow staff to report good practice, and appreciative approaches build on team strengths. Focusing on strengths improves morale and helps teams understand how safety is created every day.

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Leading and Managing Care: Prioritising and Delegating

Midwives coordinate care for several women and babies and work with maternity support workers, students and other professionals:

• Prioritising: using structured assessment (ABCDE), early warning scores, symptom-based triage (for example, the Birmingham Symptom-specific Obstetric Triage System) and regular safety huddles to identify who needs care first.
• Delegation: under the NMC Code (section 11), registrants are accountable for their decisions to delegate. They must delegate only tasks that are within the other person's scope of competence, make sure the person is adequately supervised and supported, and confirm that the outcome of the delegated task meets the required standard.
• Maternity support workers (MSWs) can undertake tasks such as observations, infant feeding support and postnatal checks within their competence framework, but they cannot replace the midwife's assessment or the midwife's one-to-one care in labour.
• Escalation: when workload exceeds capacity, the midwife informs the coordinator, uses red flag reporting and follows escalation policies.

Positive Leadership and Role Modelling

Leadership is not limited to managers. Every midwife leads by example: treating colleagues with civility, welcoming questions, supporting students, speaking up for women and acknowledging mistakes. Psychological safety, in which people feel safe to speak up without fear of humiliation, is a key feature of high-performing teams.

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Career Development

Newly qualified midwives usually complete a period of preceptorship, guided by the NMC's principles for preceptorship, to consolidate their skills. Career pathways then include:

• Clinical practice: senior and specialist midwife roles, such as safeguarding, bereavement, infant feeding, fetal monitoring, perinatal mental health and diabetes, and consultant midwife posts.
• Management and leadership: matron, head of midwifery and director of midwifery roles.
• Education: practice education, university lecturing and professional development roles.
• Research: research midwife roles and clinical academic careers.
• Policy: national, regional and professional body roles that shape maternity services.

Continuing professional development, reflection and feedback from women and colleagues support progression throughout a midwife's career.