Chapter 2 The emotional context of midwifery
In this chapter the emotional context of midwifery work is explored. Pregnancy and childbirth are emotional experiences for the woman and her family. Midwives need to work in an emotionally aware and sensitive way, in order to ensure that these feelings are acknowledged and responded to. To do this effectively, midwives also need to be aware of their own feelings. Much of midwifery work is emotionally demanding. Midwives need to understand why this is so, and find ways to manage feelings that are effective and sustainable. How midwives ‘feel’ about their work and the women they care for is important. It has significant implications for communication and interpersonal relationships with both clients and colleagues. It also has much wider implications for the quality of maternity services in general.
By its very nature, midwifery work involves a range of emotions. Midwifery is rarely dull. Even when it entails what may appear to be routine and mundane activities, these are often far from ordinary experiences for those on the receiving end of maternity care. While it is easy to see why birth is a highly charged emotional event; it may be less obvious to appreciate why an antenatal booking or postnatal visit can generate emotions. But women tell us that this can be so (Edwards 2000, Redshaw et al 2007, Wilkins 2000). There is clear evidence from research studies that women do not always receive the emotional support from midwives that they would wish (Beech & Phipps 2004, Berg et al 1996, Redshaw et al 2007).
It may also be less easy to understand how maternity care may be an emotional experience for those providing care – but we also know from research evidence that midwives have just this experience (Begley 2003, Deery 2005, Hunter 2004a, 2005, 2006, Kirkham 1999). In the words of a first year midwifery student:
Over the past 25 years there has been growing interest in how emotions affect the work that we do (Fineman 2000). This interest was stimulated by an American study undertaken by Arlie Russell Hochschild in 1983, which drew attention to the importance of emotion in the workplace, and to the work that needs be done when managing emotions. Hochschild’s study of American flight attendants identified that a significant aspect of their work was to create a safe and secure environment for passengers, and that in order to do so, they needed to manage the emotions of their customers and themselves.
Hochschild defined emotional labour as: ‘The induction or suppression of feeling in order to sustain an outward appearance that produces in others a sense of being cared for in a convivial, safe place’ (Hochschild 1983, p 7). In other words, it is the work that is undertaken to manage feelings so that they are appropriate for a particular situation (Hochschild 1983). This is done in accordance with ‘feeling rules’, social norms regarding which emotions it is considered appropriate to feel and to display. (For example, Hunter and Deery (2005) note how midwives describe suppressing their feelings in order to maintain a reassuring atmosphere for women and their partners.)
Hochschild used the term ‘emotional labour’ to mean management of emotion within the public domain, as part of the employment contract between employer and employee; ‘emotion work’ referred to management of emotion in the private domain, i.e. the home. Hochschild’s research focused particularly on commercial organizations, where workers are required to provide a veneer of hospitality in order to present a corporate image, with the ultimate aim of profit making (e.g. the ‘switch on smile’ of the flight attendants or the superficial enjoinders to ‘have a nice day’ from shop assistants). This requires the use of ‘acting’ techniques, which Hochschild (1983) argues may estrange workers from what they are really feeling. My research study (Hunter 2004a) suggests that the emotion management of midwives is different to this. Midwives were more able to exercise autonomy in how they controlled emotions, and emotion management was driven by a desire to ‘make a difference’ based on ideals of caring and service, that Bolton (2005, p 93) describes as ‘philanthropic emotion management’. Thus I will use the term ‘emotion work’ in this chapter.
Although the emotional aspect of work appears to be as demanding as physical labour, it is often unrecognized, under-reported and under-valued (Hochschild 1983, James 1992). It is particularly common in public service work, and is often part of the ‘invisible’ work undertaken by women. The idea of emotion work is particularly relevant to healthcare, and there has been growing interest in this issue over the past 15 years (e.g. Bolton 2000, James 1992, Smith 1992). Smith (1992) investigated how student nurses learnt to ‘do’ emotion work. She observed that they gained emotion management skills ‘on the job’, using senior nurses as role models. Their emotional responses changed during their education. By the time they reached their final year, most had learnt self-protective coping strategies to manage feelings of distress and grief. These strategies included distancing themselves from patients and using a task-orientated approach to care. There is also evidence that midwives may use similar strategies (Hunt and Symonds 1995, Hunter 2004a).
What is it about maternity care that generates emotion work for midwives? On the surface, it could be presumed that midwifery is the ‘happy side’ of healthcare, and that only positive emotions will usually be felt. While it is often the case that the childbirth experience is a source of joy for all involved, sadly this is not always so.
Research studies suggest that there are various sources of emotion work in midwifery. These can be grouped into three key themes, which are discussed in turn:
It is important to note that these themes are often interlinked. For example, the organization of maternity care impacts on both midwife–woman relationships and on collegial relationships.
The nature of pregnancy and childbirth means that midwives work with women and their families during some of the most emotionally charged times of human life. The excited anticipation that generally surrounds the announcement of a pregnancy and the birth of a baby may be tempered with anxieties about changes in role identity, altered sexual relationships and fears about pain and altered body image (Raphael Leff 2005). Thus it is important to remember that even the most delighted of new mothers may experience a wide range of feelings about their experiences.
We must also remember that pregnancy and birth are not always joyful experiences: for example, midwives work with women who have unplanned or unwanted pregnancies, who are in unhappy or abusive relationships, and where fetal abnormalities or antenatal problems are detected. In these cases, midwives need to support women and their partners with great sensitivity and emotional awareness. This requires excellent interpersonal skills, particularly the ability to listen. It is easy in such distressing situations to try to help by giving advice and adopting a problem-solving approach. However, the evidence suggests that this is often inappropriate, and that what is much more beneficial is a non-judgemental listening ear (Clement 1995).
Childbirth itself is a time of heightened emotion, and brings with it exposure to pain, bodily fluids and issues of sexuality, all of which may prove challenging to the woman, her partner and also to those caring for her. Attending a woman in childbirth is highly intimate work, and the feelings that this engenders may come as a surprise to new students. For example, undertaking vaginal examinations is an intimate activity, and needs to be acknowledged as such (Bergstrom et al 1992, Stewart 2005). In the past, the emotional aspects of these issues have tended to be ignored within the education of midwives.
Relationships between midwives and women may vary considerably in their quality, level of intimacy and sense of personal connection. Some relationships may be intense and short-lived (e.g. when a midwife and woman meet on the labour ward or birth centre for the first time); intense and long-lived (e.g. when a midwife provides continuity of carer throughout pregnancy, birth and the postnatal period). They may also be relatively superficial, whether the contact is short-lived or longer standing. There is evidence that a key issue in midwife–woman relationships is the level of ‘reciprocity’ that is experienced (Fleming 1998, Hunter 2006). Reciprocity is defined as ‘exchanging things with others for mutual benefit’ (Oxford Dictionary 2003). When relationships are experienced as ‘reciprocal’ or ‘balanced’, the midwife and woman are in a harmonious situation. Both are able to give to the other and to receive what is given (e.g. the midwife can give support and advice, and the woman is happy to accept this, and in return affirm the value of the midwife’s care).
In contrast, relationships may become unbalanced, and in these situations emotion work is needed by the midwife. For example, a woman may be hostile to the midwife’s advice, or alternatively, she may expect more in terms of personal friendship than the midwife feels it is appropriate or feasible to offer. Some midwives working in continuity of care schemes have expressed concerns about ‘getting the balance right’ in their relationships with women, so that they can offer authentic support without overstepping personal boundaries and becoming burnt out (Hunter 2006, Stevens & McCourt 2002a,b).
Establishing and maintaining reciprocal relationships can prove challenging at times. The concept of being a ‘professional friend’ (Fraser 1999, Pairman 2000, Walsh 1999) can be helpful in these situations, as it describes a model of midwife–woman relationships which is not only warm and supportive, but also sustainable for all concerned. It is also important that midwives pay careful attention to the power dynamics of their relationships with women. Both Leap (2000) and Cronk (2000) provide insights into these dynamics, noting the potential that exists for midwives to assume power over women. In different ways, they suggest practical solutions to help re-balance such relationships.
Relationships between midwives and their colleagues, both within midwifery and with other health and social care professionals, are also key sources of emotion work. Much of the existing evidence pertains to relationships between midwifery colleagues. These relationships may be positive or negative experiences.
Positive collegial relationships provide both practical and emotional support (Sandall 1997). Walsh (2007) provides an excellent example of these in his ethnography of a free standing birth centre. He observed a strong ‘communitarian ideal’ (Walsh 2007, p 77), whereby midwives provided each other with mutual support built on trust, compassion and solidarity. He attributes this to the birth centre model, with its emphasis on relationships, facilitation and cooperation.
Sadly, however, such experiences are not always universal. There is also evidence that intimidation and bullying exists within contemporary UK midwifery (Hadikin & O’Driscoll 2000, Hunter 2005, Kirkham 1999, Leap 1997). The concept of ‘horizontal violence’ (Leap 1997) is often used to explain this problem. Kirkham (1999) explains how groups who have been oppressed internalize the values of powerful groups, thereby rejecting their own values. As a result, criticism is directed within the group (hence the term ‘horizontal violence’), particularly towards those who are considered to have different views from the norm. This type of workplace conflict inevitably affects the emotional well-being of the midwifery workforce (Hunter 2005).
The way in which maternity care is organized may also be a source of emotion work for midwives. The fragmented, task orientated nature of much hospital-based maternity care creates emotionally difficult situations for midwives (Ball et al 2002, Deery 2005, Dykes 2005, Hunter 2004a, 2005, Kirkham 1999), as it reduces opportunities for establishing meaningful relationships with clients and colleagues, and for doing ‘real midwifery’. The study by Ball et al (2002) identified frustration with the organization of maternity care as one of the key reasons why midwives leave the profession. A study by Lavender and Chapple (2004) explored the views of midwives working in different settings. They found that all participants shared a common model of ideal practice, which included autonomy, equity of care for women and job satisfaction. However, midwives varied in how successful they were in achieving this. Advantageous factors were thought to be strong midwifery leadership and a workplace culture that promoted normality. Free-standing birth centres were usually described as being more satisfying and supportive environments, which facilitated the establishing of rewarding relationships with women and their families. Conversely, consultant-led units were often experienced negatively; this was partly the result of a dominant medicalized model of childbirth, a task-orientated approach to care and a culture of ‘lots of criticism and no praise’ (Lavender and Chapple 2004, p 9).
In general, it would appear that midwives working in community-based practice or in birth centre settings are more emotionally satisfied with their work (Hunter 2004a, Sandall 1997, Walsh 2007). Although there is the potential for continuity of care schemes to increase emotion work as a result of altered boundaries in the midwife–woman relationship, there is also evidence to suggest that when these schemes are organized and managed effectively, they provide emotional rewards for both midwives and clients.
A key reason underpinning these differing emotion work experiences appears to be the co-existence of conflicting models of midwifery practice (Hunter 2004a). Although midwifery as a profession has a strong commitment to providing woman-centred care, this is frequently not achievable in practice, particularly within large institutions. An approach to care which focuses on the needs of individual women may be at odds with an approach which is driven by institutional demands to provide efficient and equitable care to large numbers of women and babies 24 hrs a day, 7 days a week. When midwives are able to work in a ‘with woman’ way, there is congruence between ideals and reality, and work is experienced as being emotionally rewarding. When it is impossible for midwives to work in this way, as is often the case, midwives experience a sense of disharmony. This may lead to anger, distress and frustration, all of which require emotion work (Hunter 2004a).
So how do midwives learn to manage emotions, and what are the ‘feeling rules’ within midwifery regarding appropriate emotional display? In my own research study (Hunter 2004a, Hunter and Deery 2005), I found that midwives described two different approaches to emotion management: ‘affective neutrality’ and ‘affective awareness’. These different approaches were often in conflict and presented mixed messages to student midwives.
Affective neutrality could also be described as ‘professional detachment’. From this perspective, emotion must be suppressed in order to get the work done efficiently. By minimizing the emotional content of work, its emotional ‘messiness’ is reduced and work becomes an emotion-free zone. This approach fits well within a culture that values efficiency, hierarchical relationships, standardization of care and completion of tasks. Personal emotions are managed by the individual, in order to hide them as much as possible from clients and colleagues. Coping strategies, such as distancing, ‘toughening up’ and impression management are used in order to present an appropriate ‘professional performance’, i.e. a professional who is neutral and objective. When dealing with clients, there is avoidance of discussing emotional issues and a focus on practical tasks. This is clearly not in the best interests of women.
Although this may appear to be an outdated approach to dealing with emotion in contemporary maternity care, there is ample evidence that this approach continues, particularly within hospital settings. This can be problematic for midwives who wish to work in more emotionally aware ways, and can detract from the quality of care. An example from my research is the experience of a student midwife who, early on in her clinical experience, had cared for a woman whose baby was stillborn (Hunter and Deery 2005). The student was very upset by the experience, and described how she had been shocked and in tears. However, there was no opportunity for her to discuss her feelings with her colleagues; in fact, any possibility of this was effectively squashed by the decision of the senior midwives to send her home early. The impression she received was that personal emotions should be suppressed at all costs and that she should not seek emotional support from her colleagues. This was very different from the approach that she had been encouraged to adopt by her lecturers, and she felt confused and frustrated. Similar experiences have been described by Irish student midwives. Begley (2003, p 25) found that ‘student midwives suffered strong feelings of distress when caring for women encountering perinatal loss’, and that they lacked support in both clinical and educational areas. An accumulation of unsupportive situations such as this may ultimately result in midwives deciding to leave the profession (Ball et al 2002).
In contrast, ‘affective awareness’ fits well with a ‘new midwifery’ approach to practice (Page & McCandlish 2006). In this approach, referred to by Copp as ‘the professional with a heart’ (Copp 1998, p 304), it is considered important to be aware of feelings and express them when possible. This may be in relation to women’s emotional experiences, or when dealing with personal emotions. Sharing feelings enables them to be explored and named. It also provides opportunities for developing supportive and nurturing relationships between midwives and women, and between midwives and colleagues. For example, a student midwife in my study described how her mentor encouraged her to talk through her feelings after she had cared for a woman during an obstetric emergency (Hunter & Deery 2005). The student considered that sharing her feelings acted as a ‘release valve’, which helped her to come to terms with her experience and feel that she was not alone in her reactions.
Affective awareness fits within a wider contemporary Western culture which emphasizes the benefits of the ‘talking cure’, that is the therapeutic value of talking things through (e.g. via counselling or psychotherapy). However, it is important that midwives recognize the limits of their own expertise, so they do not find themselves out of their depth. Working in partnership with women, particularly in continuity of care schemes, means that midwives are more likely to develop close connections with women and their families. If emotionally difficult events occur, midwives ‘feel’ more. This was a frequent experience of community-based midwives in my own study (Hunter 2006). We need to be alert to this, so that we do not become so overwhelmed by our clients’ experiences that we lose our own personal boundaries. We will be of little effective support to women and colleagues if this happens. It is important to know our limits and make use of agencies who can offer skilled support as appropriate (e.g. Relate, SANDS, MIND. See list of useful addresses below).
It is also important not to be overly critical of midwives who adopt an ‘affectively neutral’ approach, but to try to understand why this may be occurring. In my research study, most participants did not consider this to be the best way of dealing with emotion, believing that ‘affective awareness’ was the ideal way to practice. But when they felt ‘stressed out’, they described ‘retreating’ emotionally and ‘putting on an act’ to get through the day (Hunter & Deery 2005). Stress may be the result of unsustainable workloads, staff shortages, conflicts with colleagues or difficulties in personal lives. In order to understand emotion work in midwifery, we need to be aware of the broader social and political context in which maternity care is provided. Understanding emotion work requires us to think carefully, not just about individual midwives, but also about the complexities of the maternity services. In order to move away from a blame culture in midwifery, we need to work at developing empathy, in order to better understand each others’ behaviour.
It is also important to ensure cultural sensitivity in relation to emotion. The ways that emotions are displayed, and the types of emotion that are considered appropriate for display will vary from culture to culture, as well as within cultures (Fineman 2003). Midwives need to develop skills in reading the emotional language of a situation and avoid ethnocentricity.
It is possible to develop emotional skills in the same way as it is possible to develop any skills. In other words, we can develop our ‘emotional awareness’ (Hunter 2004b) or ‘emotional intelligence’ (Goleman 2005). Goleman (2005) claims that emotionally intelligent people: know their emotions, manage their emotions, motivate themselves, recognize the emotions of others and handle relationships effectively. He suggests ways that emotional intelligence can be developed, so that an individual can have a high ‘EQ’ (emotional intelligence quotient) in the way that they may have a high IQ (intelligence quotient).
The idea of emotional intelligence has caught the public imagination, although some would argue that Goleman’s ideas are rather simplistic and lack a substantive research base (e.g. Fineman 2003, p 52). Instead, Fineman (2003, p 54) prefers the notion of ‘emotional sensitivity’, which he claims can be developed through ‘processes of feminisation, emotionally responsive leadership styles, valuing intuition, and tolerance for a wide range of emotional expression and candour’. Whatever the preferred terminology, it would seem that these ideas have particular relevance to midwifery, given the emotionally demanding nature of this work. Midwives need to develop emotional awareness so that they know what it is they are feeling, why they are feeling it, and how others may be feeling. They also need to develop a language to articulate these feelings, in a manner that is authentic.
So how can midwives develop their emotional awareness? There are a number of options that may be helpful. Attendance on counselling courses and assertiveness courses can help to develop insights into personal feelings, which by extension provide insights into the possible feelings of others. Supervision may also provide opportunities for exploration of the emotions of both self and others, with the aim of recognizing and responding appropriately to these.
It is particularly important that emotional issues are given careful and sensitive attention during pre-registration education. This could take the form of role-play, or by making use of participative theatre. Drama workshops have been used effectively with student midwives (Baker 2000) to explore various aspects of their clinical experience, including a range of emotional issues, in a safe and supportive environment. One advantage of such an approach is that participants realize that they are not alone in their experiences. With a skilled workshop facilitator, difficult situations can be considered in a broader context, so that they are understood as shared rather than personal problems. These methods could also be beneficial for qualified midwives, especially clinical mentors, as part of in-service training.
Emotional issues also need attention within clinical practice, if they are not to be seen as something that is explored only ‘in the classroom’. As we have seen, there may be ‘mixed messages’ about what emotions should be felt and displayed. These mixed messages are not helpful in creating an emotionally attuned environment. Supervision of midwives could have a role to play here. It has the potential to provide a supportive environment for understanding emotion, particularly if a ‘clinical supervision’ approach is taken. This is a method of peer support and review aimed at creating a safe and non-judgemental space in which the emotional support needs of midwives can be considered (Deery 2005, Kirkham & Stapleton 2000). The importance of ‘caring for the carers’ is crucial, but often underestimated.
Finally, as Fineman (2003) recommends, those in leadership positions within midwifery need to set the scene by adopting leadership styles which are emotionally responsive. In this way, a ripple effect through the whole workforce could be created.
Midwives need to develop skills in emotion work in order to manage sensitively and effectively the feelings of women, families, colleagues and also to manage their own personal feelings. Providing a supportive, non-judgemental space for midwives to explore and better understand the emotional demands of work is essential. Understanding emotions helps us to develop empathy, crucial for interpersonal relationships with colleagues and clients. There is much about midwifery practice that is emotionally demanding, so it is imperative that midwives become skilled emotion workers, and that this is valued as much as technical skills. By developing these skills, midwives have the potential to enhance the emotional well-being of the women they care for, and also the emotional well-being of themselves and their colleagues. As a result, the quality of maternity care will also be enhanced.
Baker K. Acting the part: Using drama to empower student midwives. Practising Midwife. 2000;3(1):20-21.
Ball L, Curtis P, Kirkham M. Why do midwives leave? Women’s Informed Childbearing and Health Research Group, University of Sheffield, 2002.
Beech BL, Phipps B. Normal birth: women’s stories. In: Downe S, editor. Normal childbirth: evidence and debate. Edinburgh: Churchill Livingstone; 2004:59-70.
Begley C. ‘I cried…I had to…’: Student midwives’ experiences of stillbirth, miscarriage and neonatal death. Evidence Based Midwifery. 2003;1(1):20-26.
Berg M, Lundgren I, Hermansson E, et al. Women’s experience of the encounter with the midwife during childbirth. Midwifery. 1996;12:11-15.
Bergstrom L, Roberts J, Skillman L, et al. ‘You’ll feel me touching you sweetie’: Vaginal examinations during the second stage of labour. Birth. 1992;1:10-25.
Bolton SC. Who cares? Offering emotion work as a ‘gift’ in the nursing labour process. Journal of Advanced Nursing. 2000;32(3):580-586.
Bolton SC. Emotion management in the workplace. Basingstoke: Palgrave Macmillan, 2005.
Clement C. Listening visits in pregnancy: a strategy for preventing postnatal depression? Midwifery. 1995;11(2):75-80.
Copp M. When emotion work is doomed to fail: Ideological and structural constraints of emotion management. Symbolic Interaction. 1998;21(3):299-328.
Cronk M. The midwife: A professional servant? In: Kirkham M, editor. The midwife–mother relationship. Basingstoke: Macmillan; 2000:19-27.
Deery R. An action research study exploring midwives’ support needs and the effect of group clinical supervision. Midwifery. 2005;21:161-176.
Dykes F. A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England. Midwifery. 2005;21(3):241-252.
Edwards N. Women planning homebirths: Their own views on their relationships with midwives. In: Kirkham M, editor. The midwife–mother relationship. Basingstoke: Macmillan; 2000:55-84.
Fineman S, editor. Emotion in organizations, 2nd edn., London: SAGE, 2000.
Fineman S. Understanding emotion at work. London: SAGE, 2003.
Fleming V. Women and midwives in partnership: a problematic relationship? Journal of Advanced Nursing. 1998;27:8-14.
Fraser D. Women’s perceptions of midwifery care: a longitudinal study to inform curriculum development. Birth. 1999;26:99-107.
Goleman D. Emotional intelligence. London: Bantam Books, 2005.
Hadikin R, O’Driscoll M. The bullying culture: cause, effect, harm reduction. Oxford: Books for Midwives Press, 2000.
Hochschild AR. The managed heart. Commercialization of human feeling. Berkeley: University of California Press, 1983.
Hunt S, Symonds A. The social meaning of midwifery. Basingstoke: Macmillan, 1995.
Hunter B. Conflicting ideologies as a source of emotion work in midwifery. Midwifery. 2004;20:261-272.
Hunter B. The importance of emotional intelligence in midwifery. Editorial. British Journal of Midwifery. 2004;12(10):1-2.
Hunter B. Emotion work and boundary maintenance in hospital-based midwifery. Midwifery. 2005;21:253-266.
Hunter B. The importance of reciprocity in relationships between community-based midwives and mothers. Midwifery. 2006;22(4):308-322.
Hunter B, Deery R. Building our knowledge about emotion work in midwifery: combining and comparing findings from two different research studies. Evidence Based Midwifery. 2005;3(1):10-15.
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Kirkham M. The culture of midwifery in the National Health Service in England. Journal of Advanced Nursing. 1999;30(3):732-739.
Kirkham M, Stapleton H. Midwives’ support needs as childbirth changes. Journal of Advanced Nursing. 2000;32(2):465-472.
Lavender T, Chapple J. An exploration of midwives’ views of the current system of maternity care in England. Midwifery. 2004;20:324-334.
Leap N. Making sense of ‘horizontal violence’ in midwifery. British Journal of Midwifery. 1997;5:689.
Leap N. The less we do, the more we give. In: Kirkham M, editor. The midwife–mother relationship. Basingstoke: Macmillan; 2000:1-17.
Page LA, McCandlish R, editors. The new midwifery. Science and sensitivity in practice, 2nd edn., Edinburgh: Churchill Livingstone, 2006.
Pairman S. Women-centred midwifery: partnerships or professional friendships? In: Kirkham, editor. The midwife–mother relationship. Basingstoke: Macmillan; 2000:207-225.
Raphael Leff J. Psychological processes of childbearing. London: Centre for Psychoanalytic Studies, 2005.
Redshaw M, Rowe R, Hockley C, et al. Recorded delivery: a national survey of women’s experience of maternity care. Oxford: National Perinatal Epidemiology Unit (NPEU), 2007.
Sandall J. Midwives’ burnout and continuity of care. British Journal of Midwifery. 1997;5(2):106-111.
Smith P. The emotional labour of nursing. Basingstoke: Macmillan, 1992.
Stevens T, McCourt C. One-to-one midwifery practice part 2: the transition period. British Journal of Midwifery. 2002;10(1):45-50.
Stevens T, McCourt C. One-to-one midwifery practice part 3: Meaning for midwives. British Journal of Midwifery. 2002;10(2):111-115.
Stewart M. ‘I’m just going to wash you down’: sanitizing the vaginal examination. Journal of Advanced Nursing. 2005;51(6):587-594.
Walsh D. An ethnographic study of women’s experience of partnership caseload midwifery practice: the professional as friend. Midwifery. 1999;15:165-176.
Walsh D. Improving maternity services. Small is beautiful – lessons from a birth centre. Oxford: Radcliffe Publishing, 2007.
Wilkins R. Poor relations: the paucity of the professional paradigm. In: Kirkham M, editor. The midwife–mother relationship. Basingstoke: Macmillan; 2000:28-54.
Dryden W, Constantinou D. Assertiveness step by step. London: Sheldon Press, 2004.
This short book is written by well respected authors in the field. It offers practical, evidence-based advice on developing assertiveness and emotional awareness
Fineman S. Understanding emotion at work. London: SAGE, 2003.
A lively and readable book that provides additional insights into how emotions impact upon the workplace. Considers issues such as leadership and change, bullying and sexual harassment. Although the book is aimed at those studying the sociology or psychology of work and organizations, there is much here of interest and relevance to midwives
Goleman D. Emotional intelligence. London: Bantam Books, 2005.
The key text explaining the concept of emotional intelligence. A popular and easy to read book
Heron J. Helping the client: a creative practical guide, 6th edn. London: SAGE, 2001.
A classic text used in many disciplines. Describes six forms of ‘helping behaviour’ which can be adopted by any practitioner who works in face to face situations with clients. Heron’s six stage model is often used as a model for clinical supervision of nurses and midwives
Hunter B, Deery R, editors. Emotions in Midwifery and Reproduction. Basingstoke: Palgrave Macmillan, 2009.
This new edited book brings together the work of leading international researchers. The book explores the significance of emotions to the day-to-day work of midwives
Kirkham M, editor. The midwife–mother relationship. Basingstoke: Macmillan, 2000.
This very useful edited book provides many insights into the emotional aspects of maternity care, from the perspectives of both women and midwives
Relate (relationship counselling) Relate (relationship counselling) Tel: 01788 573 241 www.relate.org.uk
MIND (mental health charity) MIND (mental health charity) 15–19 Broadway, London E15 4BQ Tel: 020 8519 2122 www.contact@mind.org.uk
SANDS (stillbirth and neonatal death charity) 28 Portland Place, London W1B 1LY Tel: 020 7436 5881 (helpline); 020 7436 7940 (head office) www.uk-sands.org