midwifery
midwifery
Exploring horizontal violence
Carolyn Hastie
alking down the corridor at work on Thursday, 20th
of July 1995, I was told by one of the midwives that
Jodie Wright’s mother had called and wanted to speak with
me. She had left her number for me to ring her back. As I
walked to the phone, wondering what Jodie’s mother
wanted, I thought fondly of Jodie and the workshop we had
both attended a couple of months earlier. The two-day
workshop on parenting education had been great fun, 15 of
us from different units had attended. Over the two days, we
had all discussed our ideas and passion for midwifery.
We talked for hours about women-centered care, the joys
and difficulties of midwifery, the dynamics of the health
system and our feelings about all aspects of our work. We
discussed our dreams and our frustrations with our work.
W
Jodie was very memorable. She was a young, enthusiastic,
new graduate midwife. We discovered during our
conversations that Jodie read everything she could get her
hands on. In her first year of midwifery practice, Jodie had
already attended several midwifery-oriented workshops
and seminars; she was very open and shared her ideas and
experiences with us. She voiced many of the concerns and
feelings of disappointment with the system and the attitudes
of senior midwives at her workplace that I had heard from
other students and new graduate midwives throughout my
midwifery career. I remembered thinking how passionate
and caring she was, and I had instantly recognised how her
experiences reflected the degree of threat her enthusiasm
and joy for midwifery and women-centered care
would generate in the established midwifery culture.
It’s interesting how thoughts can travel at lightning speed.
In the few minutes I took to reach the phone and ring
Jodie’s mother, I had revisited our workshop and run
through the conversations we’d had. I was aware of my
feelings of distress that often arise for me when I consider
or am confronted with the brutality that often exists towards
each other in my beloved profession.
Jodie’s mother’s voice was halting. She told me that on
Monday evening Jodie had killed herself. At about 5pm she
had put a hose from the exhaust pipe in through the window
into the interior of her car, shut the door and turned on the
engine. As Jodie sat in the car dying, she wrote her
suicide note.
midwifery
“In corporations, fear, anxiety, a sense of isolation, apathy and despair are the results of spiritual poverty, and their
effects on us are similar to the disease, starvation and death in refugee camps.” Barbara Shipka (1993:14)
“…I don’t want to do this anymore. I’m sick of trying and
getting thwarted. I’m almost too scared to try harder or try
something else just in case I will feel the same. I love my
work, unfortunately some of the senior people there don’t
seem quite as enthused. I don’t feel trustworthy or equal to
them even though I would not want to be like them. They sit
on their bums! I love working with women and baby’s (sic).
They are all individuals…”
Her parents wanted to talk.
Jodie’s mother told me Jodie always shared whatever was
happening with her. Of late, she had been talking about her
frustrations and difficulties at work. Following the
workshop, she had talked enthusiastically of her
discussions with me. I was in charge of a maternity unit at
that time. She had told her parents that the sort of changes
she wanted to see were possible because I was
implementing them where I was working. In the midst of
their distress, they were trying to understand what would
have caused their daughter to end her life. They wanted to
know what would lead Jodie to mention the senior
midwives in her suicide letter. I don’t remember much of
that initial conversation.
I agreed to meet with them. I went to Jodie’s parents’ place
the next weekend. They lived about one hour from me and
several hours away from where Jodie had been living and
working. I remember the awkwardness of that initial
meeting. I remember the sadness, the emotional pain and
the courage of her family as they struggled to understand
the midwifery culture and come to terms with their
daughter’s act. I remember the anger, the feelings of deep
distress and the sense of futility I felt as I watched them
going down every possible avenue seeking understanding,
clarity and change within that particular institution. Jodie’s
parents sought to highlight the problems within the health
care system for new graduates generally. They spoke with
Jodie’s midwife colleagues, visited the hospital, the health
department, spoke with the state’s premier, the state’s
nurses registering authority, the papers, local government
members and a national magazine seeking answers and to
expose a problem they came to recognise as endemic in
our culture.
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Exploring horizontal violence
Hostility, innuendoes, false accusations, minimising and
subterfuge were behaviours displayed by official people
during the search for meaning and understanding by Jodie’s
parents. I was told by various contacts within the health
service hierarchy that it was said by officialdom that I was
‘using those poor grieving people for her (my) own
political agenda’. This was an obvious tactic to play down
the issues, as I had been asked by the parents to help them.
In one instance, Jodie’s parents asked me to accompany
them to a meeting with the local member, the Chief
Executive Officer of the hospital and the social worker of
the hospital where Jodie had been working. Once at the
meeting site, the parents were invited in and then were
refused permission for me to accompany them into the
meeting. They told me after the meeting that they felt
intimidated and patronised. They felt that their concerns
had been trivialised, and they were told that things would
seem bad because they were ‘grieving parents’. They were
also told that Jodie’s general mental health was the
problem, the officials commenting about Jodie’s early
teenage issues with bulimia. Distancing, projection and
counter transference of issues were psychological ploys
used by officialdom when discrediting the possibility of an
unhealthy or toxic work environment being a factor in
Jodie’s suicide.
The coal miners used to take a canary down into the mines
to detect when the mine air was unable to sustain life. The
canary was carried in their cages down low on the ground
level. When the canary stopped singing (Barrentine
1993:9), the miners knew that the canary had died because
the air at the floor level was toxic. Miners knew the toxicity
would rise and kill them all if they stayed. They had to get
out of the mine. Jodie’s suicide reminded me of the story of
the miners’ canary. Her desperate act and her suicide note
were signs of toxicity in her place of work. Towards the end
of her parents’ search, they discovered the hospital had been
the subject of a Health Department review in the previous
September, because ‘the existing organization structure for
(the hospital) has had an unsuccessful history to date’…
‘nursing services’ ‘…despite the introduction of the Nurses
Career Structure…the personal growth and professional
development of nursing staff has been stifled’. The report
went on to say: ‘nurses at (hospital) have repeatedly
identified to the Director of Nursing, their concerns about
the need for leadership and direction, the rigid
management style, need for a more participative
management style, lack of autonomy over their work area
and poor communication, yet all these concerns still exist
today. This has contributed to the extremely low morale
amongst nurses, high level of absenteeism approximately
4.4% and turnover rate (39%).’ (Reference unpublished)
The findings of the review had not been released and were
not available to the staff. No action on the 56
recommendations of the review had been undertaken when
Jodie committed suicide. The report was not mentioned at
any time during Jodie’s parents’ discussions with any
official. When news of the report and its findings reached
the parents, no official wished to discuss it. Jodie’s parents
rightly questioned whether their daughter would have died
if action had been taken earlier.
Toxicity in the nursing and midwifery culture has been
termed horizontal violence (Duffy 1995, Roberts 1983).
Current literature includes it in the more general term of
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MIDIRS Midwifery Digest 16:1 2006
workplace bullying. I undertook a pilot study in 2000,
exploring the issues of horizontal violence with new
graduate midwives. During the interviews and my reading,
I became aware of deeper and broader dimensions to the
experiences new graduates were having. It became
apparent that there were personal and system issues that
impacted on experience for new midwives and led to them
embracing or abandoning midwifery as a career. I was
intrigued to find extraordinary courage, resilience, insight
and yet, often hopelessness, a sense of isolation and despair
among many new graduates.
It is with this rich background of human tragedy, courage
and passion for change that I am compelled to explore these
issues more deeply through an ongoing research process.
It is vitally important to find solutions to negative
workplace issues and to assist maternity care systems to
provide emotionally and spiritually healthy supportive
environments for new graduates.
The following is a distillation from transcripts of seven
interviews, two focus group discussions and one-on-one
discussions with new graduate midwives. The comments
document a deepening and expanding understanding of
horizontal violence and its impact on individuals.
Every respondent indicated that horizontal violence (HV)
or workplace bullying (WB) involved senior midwives
interacting negatively with junior members of staff. As one
respondent replied, ‘the attitude and treatment from other
workmates, like other certified midwives that you’re
working with… negative behaviour… the way that people
speak to you… like downgrading or in a negative tone…
they look down on you… it’s just overall treatment’.
Another respondent saw HV and WB as a way for senior
midwives to emotionally and psychologically ‘assert their
authority over you’. One saw HV and WB as sabotage of
learning opportunities, thus reinforcing a medical model
and another said it was a ‘a way of releasing their
frustrations… they build up their frustrations and then
release it as anger on their fellow workmates that are on the
same level or considered lower’. Two respondents said that
it was senior midwives ‘making life difficult for you’
because ‘they know they have it over you’.
Analysis of the interviews indicated that horizontal
violence involved ‘verbal criticism from the peer group’
plus ‘negative’ non-verbal behaviour. For two respondents,
the tone of voice used was very significant in the way
people were, in one respondent’s words, ‘talking down to
somebody’. The other said ‘tone and the way they word
things’ was a problem. It could be, she continued, ‘like just
brushing you off… or being very aggressive and invading
your space… when they talk to you… just sort of stand
over you’. One respondent related how ‘one midwife…
would not even talk to you when you came on if you were
allocated to work with them. They’d just walk off and you
just basically had to follow and they were very snappy in
their tone like “you should know this” and “why don’t you
know that?”…not very supportive’.
Non-verbal behaviour is seen by six of the respondents as a
source of very powerful ‘put down’ messages. Respondents
talked about ‘blank’ or ‘disinterested looks’ or ‘lack of
looking’ at the junior staff member when that junior staff
member was attempting to talk with the senior midwife.
Mention was made of the ‘non eye contact … plenty of that
Exploring horizontal violence
Respondents indicated that they felt vulnerable concerning
clinical decision-making when women were in labour and
cited experiences of having their management of various
clinical situations attacked, or had observed it happening to
someone else. As one respondent related, her feelings and
experience of being attacked: ‘…really freaked me out, but
those sort of situations where people attacking
management were quite common I found… junior staff
being attacked really for management decisions and not
being supported. Even when the outcomes are fine and it’s
just a different way of reaching the same goal’.
Feeling left out, not included and not accepted was
mentioned as an issue experienced by four of the
respondents. In response to the question ‘when this
happened to you, how did you feel?’, one respondent said
‘…not part of the place… you feel really isolated and
useless’. Another respondent said that horizontal violence
was ‘all about exclusion’. This midwife had observed that:
‘say it’s time for morning tea, getting everybody who’s on
shift to come into the tearoom but somehow forgetting to get
the person who they’re bullying. Or making attempts to
make sure everybody else is able to come to tea but maybe
only just mentioning it in passing “Oh we’re going to tea
now” and then when they arrive, packing up and saying
“Well we’ve had our morning tea, you just take your time”.
Leaving them there on their own’.
According to three of the respondents, horizontal violence
is so subtle it’s difficult to identify for the person
experiencing it. One respondent gave an example of what
she had observed, ‘people leaving the (tea) room when they
come in or sitting in a particular way… facing away’,
positions or actions that exclude the person being
victimised. Horizontal violence was also experienced as
something that happened behind people’s backs by four of
the respondents. For example, ‘talking about what they do
to other workers in a negative way but not actually directly
taking up the issue with the person that they’ve got a
problem with. So I’ve found that it’s generally subtle ways,
very subtle ways that are hard to pinpoint, that are difficult
for the person who’s receiving the violence to actually label
because it’s like filling up a bathtub with drops of water’.
The metaphor of a bath filling up with water to represent
horizontal violence illustrates the subtlety of the
experience. Observing it happening to someone else
prompted one respondent to say ‘I think that I can’t stand
it, but I’m also aware of the pecking order in the culture and
as a sort of new member or less experienced member, I
don’t feel like I’ve got a power base to challenge it a lot of
the time… and so I’m in a bind then, I feel caught between
wanting to speak out against it but also wanting to protect
my position as well. So I think it sort of self perpetuates and
I think the nature of the violence is often so subtle that even
as somebody witnessing it, you’re just sort of seeing
glimmers of things and as with the person who’s
experiencing the violence, there’s not a lot to pinpoint’.
The subtle nature of horizontal violence led to a situation
where, as three of the respondents explained, they
questioned whether it was ‘just me’. As one respondent
put it ‘you just feel as if… I don’t know… I think it’s
just me, but I feel as if they’re watching you… criticising in
their minds’.
midwifery
happens’; and ‘facing away’ by four of the respondents as
significant factors in leading to feelings of worthlessness in
new graduate midwives. One said she experienced senior
midwives ‘ignoring you, (they) just pretend that you don’t
even exist when you walk up and say hello’. Three
respondents mentioned how senior midwives would walk
away as they were talking to them, for example, one
respondent said ‘I’ve had people literally turn their gaze
away and walk away from me’. Another commented ‘their
non verbal stuff is pretty big… really disapproving, like
crossing arms, just the really impassive sort of expression
on the face… really, really judgemental pose… the “I can
hardly be bothered listening to you look”… they just don’t
act like you’re worth the attention’. What signified as
verbal ‘put downs’ was expressed by one respondent as
‘They might correct something that somebody does in front
of the client or another worker. So they’ll be quite overt
about saying “Oh, actually we don’t do it like that here” or
“I better check that”. You know, maybe observations or that
your choice of managing a particular situation, the choice
of drugs that you might give somebody if you were
choosing analgesia’.
‘Being watched’ excessively was mentioned by three of the
respondents as a form of horizontal violence, because as
one respondent put it ‘they used to always come and ask me
what I was doing or what was happening in my room. But
it was on a really regular basis and it was like, I thought
initially, what have I done? Or is she trying to get me? Is
she trying to catch me out on something?’. Another
respondent related a situation where a junior midwife, who
‘had stories circulating about her practice being
substandard’ was subjected to a ‘sort of over vigilance of
her practice. So the more they watched her, I guess the more
they were able to find fault with what was going on with her
practice… so I think that over vigilance was part of the
horizontal violence because I know from my experience
that I seem to fit in ok and I don’t feel like there was
anybody closely supervising me. And there was a lot of my
practice that I think probably would’ve been found faulty if
people had actually been watching me. Whereas with this
other woman, she was being watched constantly’.
Another respondent commented that when someone is
mentioned as a ‘problem’, that ‘person becomes someone
who is watched by a lot of people’.
The tearoom is a place of high visibility and was mentioned
by three of the respondents as a site where horizontal
violence is experienced or observed. A comment from one
respondent is representative: ‘you hear things in the
tearoom, you know, so and so did this and this, you know,
the gist of what they’ve done… just what they’ve done or
haven’t done… mainly judgemental… lots of bitching…
and you feel for that person’.
Every interview respondent mentioned that horizontal
violence acted to make them ‘fit in’ and was fiercest with
people who were perceived as different and therefore a
threat. One respondent spoke about a male midwife who
was ‘under ten times as much scrutiny as everybody else
and instead of encouraging it and opening up the
profession and to grow and see what perspective he can
bring into it, they’re punishing him because he’s a male’.
One respondent related a story concerning someone who
‘came from a background that no one really appreciated
and she was heckled that much and given little support…
that she actually quit’. Two respondents said they
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Exploring horizontal violence
‘toed the line’, one saying she couldn’t afford to get in the
‘black book’. One respondent, who had been a nurse
specialist before doing midwifery said ‘regardless of what
you’ve done and your past experience, it has absolutely no
relevance to becoming a midwife whatsoever. It helps you
to do little things, but people who work in speciality areas
I believe are threatened by other people’. This respondent
said she was ‘a bit frail after the course’ she had been
‘watched and attacked a bit’ and still felt ‘delicate’ in her
role as a new graduate midwife.
Another respondent explained the way she adapted to the
midwifery environment. ‘And it’s almost sometimes that
they’re looking for conflict. Like in the last week because
I’ve been nearly full-time, I could have had about five
different (fights)… and sometimes I think it’s up to us too to
realise not to get on the defensive because you realise that
you are a new grad and you’re in a different perception.
You’re in a different environment and your perception of it
has to be non-defensive. So you have to be not ready to
defend your actions. But sometimes it’s really, really hard
when they find little things to pick on’.
Another respondent related how ‘…they don’t trust you.
Even if they’ve worked with you and know what you’re
capable of and what your limitations are, they still make it
very hard and you don’t feel like that you’ve got the support
and the same amount of respect that they have. That’s
probably the big thing for horizontal violence I think. As a
new midwife, is like that you’ve got to start off at this
bottom rung and crawl your way up to the top and be made
to suffer every step of the way because that’s the way the
people before you have had to do it’.
The same respondent said that horizontal violence
reinforced a medical model by sabotaging opportunities for
mentoring or facilitating learning: ‘they’ll take away the
confidence basically of the person that’s trying to learn and
keep putting it back into their restraints of working in the
hospital’. Another said ‘you learn by doing it wrongly and
getting told after…’.
Self-criticism was common following incidents of
horizontal violence. For example, for one respondent,
feeling victimised and unsupported, said ‘I did exactly what
they did to me, I did to myself. I turned on myself and was
really hard on myself and chewed myself out about it for
days and days and days. Instead of putting it into the
perspective I should’ve put it into like it’s hard to do that…
into something I could learn from and say maybe I was
treated this way because of such and such and such. Instead
of doing that and getting on with everyday stuff. Like every
day at work it would be in the back of my mind and I’d be
actually making other stupid mistakes because I was so
preoccupied with this one thing. Instead of being able to put
it to the side, learn from it and move on you’re just
continually been drawn back into it and it stops you from
progressing into the next level and learning more I think.
Things like just really thinking about how incapable I was.
About thinking, oh well, it must be all my fault, that there is
some defect in my personality. Just had really, really bad
thoughts like emotionally about myself. Just any time I
made a little mistake with something else it didn’t matter if
it was even in any other area of my life, it was still, oh my
God, that’s just another thing that I’m bad at. Like it’s
amazing how even though it’s a work thing, it flows over
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MIDIRS Midwifery Digest 16:1 2006
into everything else if you’re not getting that support
professionally. Like it does impact on other areas of your
life which is not good. Mainly just bad thoughts about my
abilities and my coping mechanisms and that led to me
thinking I’m not cut out to do this. Do I want to do this?
Because I know, I mean you’ve had heaps of thank you
cards, heaps of things like that, like good, positive
reinforcements. Suddenly none of that mattered. Like all the
good stuff that I had achieved just didn’t matter…
I basically got to the point where it had made me physically
sick because I had worried about it so much that I just had
to put in my own head — right, enough is enough.’
Insecurity caused by a lack of midwifery experience
stopped three midwives from addressing an experience of
horizontal violence, as evidenced by one of the
respondent’s remarks.
‘I think I really should’ve, even at the desk, tried to defend
my position. But I don’t feel qualified enough to do it. I feel
like I’m still learning and I know that there are several ways
of looking after somebody and because I’m learning I don’t
believe that I would automatically always choose the right
way to do it. So that’s my fear, not fear but I guess insecurity
that I don’t feel secure enough with my practice to always
stand up for myself. But I guess in that situation I know that
there was nothing I did wrong and I should have stood up
for myself and I wish that I had but also don’t think it would
have achieved much even if I had. I guess what I would
want would be for (senior midwife) or whoever to
acknowledge that I wasn’t doing something unsafe or I
wasn’t doing something unreasonable and that they
shouldn’t be yelling at me in front of other people. But I
don’t think that they would do that. I’ve had conversations
with people, a whole group of them went down to a
conference and listened to a talk on horizontal violence and
we were chatting about it on night duty and I was saying
yeah, it’s pretty rife here and they said “Do you think?”
Like total denial about….’
None of the respondents were satisfied with their reactions
to the experiences of horizontal violence, but their
responses to the question ‘Would you do anything
differently now?’ indicated that for three respondents, there
was a lack of confidence to do anything different. One
respondent said ‘Not yet. Because I just still feel like I don’t
know enough’. For the other four, things had shifted
because as one respondent said ‘I have a hell of a lot more
confidence in my abilities now. I let them speak down to me
and push me down into that little hole, whatever you want
to call it. But I would stand my ground a lot more now
because I’ve learnt heaps in the last twelve months. I know
that I’m still only on the beginning of the continuum sort of
thing but I’m at a point now where I’m a year older and life
experience wise I’m more confident in myself anyway.
But I wouldn’t let them push it all on me and I would stand
my ground’.
Each respondent was asked ‘In what ways do you think
your experiences have affected the way you work?’
The responses were varied.
For one, ‘It’s turned me off delivery suite and that’s where
I wanted to be but I know that at this stage of the game I
don’t feel secure enough in my practice and I just don’t feel
strong enough as a person to cope with it.’
Exploring horizontal violence
For another, however, ‘I’m a lot more decisive now. I don’t
um and arh and that’s a bit sad in some ways because I
used to be able to like to discuss things with people and I
used to do that as a student and that was acceptable and as
a new grad that was acceptable with the right people. But
now I don’t show them my hesitation because if they see any
hesitation they play on it. Not everybody just a few. So I’m
a bit more careful about when I work with people. If I’m not
sure of something, instead of asking, I’ll go and look it up
or I’ll go round to (another part of the unit) and I know
someone there will discuss it with me without putting me
down… I keep to myself a bit more… I tend to be a lot more
perceptive of the students. I observe how they are and make
sure they’re okay because I know how bad I felt and
particularly when I came back (as a new graduate).’
For one respondent, ‘I try and not to let it affect the way I
deal with women because I think at the end of the day that’s
what we’re there for and the women that we’re dealing
with, pregnant women and women who are giving birth are
expecting us to do what is best for them. So I try not to let
the influence of other people affect me. But there are
occasions where you acquiesce to a more powerful member
of staff so that you do kind of fit in with them and just flow,
not causing ripples. Perhaps maybe working with
somebody who has specific ideas about how to manage
pain in labour or how to manage a woman’s progress in
labour and… so you’re often consulting with them about
what’s happening in the room that you’re working in. And
as a junior midwife I like to refer to the senior midwife I’m
working with and if it’s their suggestion to get the doctor to
augment the labour or it’s preferable to give narcotic
analgesia or to organise an epidural even though my
personal philosophy might not be to do that. I may take
their advice partly because I have to rely on the fact that
they’re more experienced than me and also that it will make
for a more harmonious workday. But a lot of the time I’m
not influenced heavily by that.’
The respondents identified a set of characteristics that were
more common for midwives who used tactics associated
with horizontal violence. For one respondent ‘they tell the
people that they’re looking after what’s happening. They
make their decisions about their management… if you had
an argument with them, they’d eat you up… I just don’t
think that you cross them really’.
Another respondent described her way of managing her
emotions: ‘One of things that I really think which I don’t
know whether this is true or just the way I try to make
myself feel better, is I box them all and think okay you’re
obstetric nurses and you’re scared of what you’re doing so
therefore they’ve got to control the woman labouring,
they’ve got to control the delivery, they’ve got to control the
staff that are working around them. That kind of thing. And
I don’t know whether that’s true or that’s just my coping
mechanism to box them like that but they do tend to be the
delivery suite midwives. People who are CNS (Clinical
Nurse Specialist) status or have a bit of responsibility I
suppose so I guess that’s why they want to control it
because they want to get off at the end of the shift and know
that everything was okay. And most of them are not
One person was particularly clear regarding her
observations of the mindset of these midwives.
‘ …they still are the ones jumping up and down saying “We
want to be autonomous within our own rights, we’re
midwives not nurses. But yet they’re the ones who cling to
the whole structure of the medical model. And it’s just like
as soon as anything unfamiliar or challenging or
threatening comes upon them, they’ll stick back to the
policies and procedures of the obstetric mould. Like I know
they’re within those confines because they’re in the hospital
but it’s like none of them … would stand up and challenge
it and say “Well just because it’s the way it is, does that
mean it’s the right sort of thing?” It’s just the way it’s done
so it’s the way it’s done. They use (policies and procedures)
to boost themselves up and say this makes me a better
practitioner because I do it this way. Instead of saying I’m
a better practitioner because I question everything I do.
There are huge comparisons drawn continually between
those of us who have trained in the uni system and those
who were trained in the hospital system. Not everybody by
any means, but a minority who have trained in the hospital
system who are very suspicious and very anti-uni. But I can
honestly say that we might have had the disadvantage of
not having the practical experience but I think the fact that
I think a lot more constructively and I pull a lot more things
to pieces and don’t just accept things because I’ve been to
uni. I don’t always do it at work but I always think it. Like
it’s always going through my mind. It’s just because of the
level that I might actually be on at work that you can’t
actually do anything about it. That instead of just accepting
things like that labour needs augmenting because the
Resident says it does because they say “This is the way we
do it at xxx Hospital”. They can give women more
information about what alternatives they’ve got and say
“You have the choice of this, this, this and this”. Instead of
saying this is their choice because this is what they do at
xxx Hospital.
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Another ‘learnt something about communication in that
situation… it’s made me a lot more conscious of it’.
university trained which I don’t know how that would
influence… but they tend to be ‘old school’ nurses.’
I don’t really think they do that (inform women) to a great
degree. I’ve seen that happen and those who are core staff
there who have been there for a long time and have the
confidence to speak to doctors and stand their mind, it’s
like they’re teaching the Residents and stuff who are coming
through, yes, it’s alright to have the attitude and to try and
always be the one step above the women. And say, they’re
like rehashing that this is what you do because you’re a
doctor. This is what you tell them… so the doctors are
thinking that it’s alright to keep that going. Because they’d
see their top dogs acting like that. They’re just mirroring
their behaviour I guess… it’s a whole mindset sort
of things.
They’re the first people to knock. They’re the first people to
deny, like if a situation arises they’re the first ones to cover
their own backs and to deny any sort of involvement.
They’ll push it off onto someone else. If they’re challenged
by anything they’ll hide behind whatever they can… they
won’t take it upon themselves to think. They just take it as a
criticism. If it’s challenging it’s having a go at them
personally. They don’t have the ability to step sideways and
look at things. Maybe they see things two dimensionally I
guess is what I mean. There’s not the ability to step to the
MIDIRS Midwifery Digest 16:1 2006
29
Exploring horizontal violence
side and look at things from the other alternative. I find that
they’re often just really rigid personality wise… they like
the safety net of the hospital system and they like knowing
their space and their role and they like everybody else to
know what their role and everything is… and they reinforce
that just by the negative behaviours… but I guess they must
have a lack of confidence in themselves to think like that
anyway, if they can’t handle being challenged… that’s one
huge thing that I think I’ve taken in over the last twelve
months is that it’s not necessarily my problem… they are
just really resistant to change… but I think that goes more
with the taking everything personal because change is a
bad thing. Like it threatens them and their place in the
whole big wide world. I guess so that yeah, just really
resistive to any change. I mean you’ve got to have bad
changes to get positive changes because you’ve got
to learn.’
not be scared to fail at something… to be better at
something else… to make positive changes for everybody I
think is probably the biggest thing.’
The following is a representative set of answers from one
respondent regarding the characteristics of those midwives
who were helpful and supportive in the clinical setting.
It is important for each of us to reflect on our practice and
behaviour and ask ourselves ‘am I open and easy to talk to?
Do I admit I can make mistakes? Do people live in fear of
me or am I someone people can feel comfortable to be
themselves with? Am I aware of my own behaviour? Am I
open to receiving feedback? Am I part of the problem or
part of the solution?’.
‘…extremely open, really easy to talk to. No matter how
busy they are, if they don’t have time then… they’ll let you
know that you’re still important and that they’ll make time
later to go over things. So you don’t feel like you’re a hassle
or a burden to them… that they actually want to help you
learn something. If something happens it’s like “ yes it’s
happened, lets deal with it, lets move on”. It’s not the end
of the world. They’re there as more than just professionals.
They’re there as someone to talk to if you need that. If you
need that sort of way of letting go. They’re not afraid to be
themselves. They don’t put their mask on when they come to
work. They admit that they can make mistakes and be
human and that makes them a lot more likeable and good
to work with. And just gets the whole idea of team work
together. Things work a lot more cohesively I think if you
can get that sort of rapport with your workmates rather
then living in fear of them. Probably just the way that they’ll
open themselves up and just not be resistant to change and
30
MIDIRS Midwifery Digest 16:1 2006
Another respondent said the midwives she gets her support
from ‘are the ones who just sit back and let the woman do
it all! …they are just there and basically, always say “I’m
here to help you, you tell me what you want” and they’re
the people that I’ve learnt off’.
While I would love to be able to say that things have
changed since I did these interviews in 2000–2002, I have
found that this is not the situation. These comments, from
the letters, emails, phone calls and face-to-face
conversations I have had over the last five years with
student and new graduate midwives from all over Australia
are still relevant and are representative of the current
climate within midwifery.
References
Barrentine P ed (1993). When the canary stops singing: women’s perspectives on
transforming business. San Francisco: Berrett-Koehler Publishers.
Duffy E (1995). Horizontal violence: a conundrum for nursing. Collegian, Journal of
the Royal College of Nursing Australia 2(2):5-17.
Shipka B (1993). Corporate poverty: lessons from refugee camps. In: Barrentine P ed.
When the canary stops singing: women’s perspectives on transforming business. San
Francisco: Berrett-Koehler Publishers.
Roberts SJ (1983). Oppressed group behaviour. Implications for nursing. Advances in
Nursing Science 5(4):21-30.
Hastie C. MIDIRS Midwifery Digest, vol 16, no 1, March 2006, pp 25-30.
Original article written by Carolyn Hastie, Midwifery Manager,
Belmont Birthing Service, Australia. © MIDIRS 2006.