Or at least part of the answer. This blog begins my exploration.

As a Professional Coach I predominately coach midwives. I was a midwife. I understand the demands made on midwives. And it upsets me that these demands are increasing.

A huge benefit of coaching is how its impact can cascade well beyond the person being coached.  The understanding, empathy and encouragement to think and act courageously that the individual experiences seeps into their relationships with their colleagues, friends and family. Over the course of their sessions, they develop a coaching mindset which changes how they show up for others and the conversations they have.  As John Whitmore states ‘Coaching is not merely a technique to be wheeled out and rigidly applied in certain circumstances. It is a way of managing, a way of treating people, a way of thinking, a way of being’. 

I’ve been witness to these changing relationships and the improved working environment that can develop but I’ve not given much thought to whether these newly gained coaching skills were being used when caring for women.

But I started to consider this issue when watching an interview on breakfast television with two bereaved women whose babies had died through proven neglect.  

They were supporting the call for a public inquiry into failings at maternity units in England. My first thought: here we go again. It saddens me that despite a number of enquiries and recommendations very little seems to change.

Listening to those two women the same issues arose:

• I was left on my own.
• I wasn’t listened to.
• They didn’t seem to care.

I fear that any new enquiry will further weaken midwifery even though many midwives are working in toxic conditions, often overworked and undermined. Something different must be considered. We can’t have more of the same.

With my coaching hat on I started to think about whether having a culture which has coaching as it foundation coaching culture in the maternity could improve not just the experience of midwives and other members of the workforce but the women they care for.

As a starting point I considered the most fundamental basis of a relationship: trust. That seamlessly took me to the work of Carl Rogers, one of the most influential writers in the theory of developing a relationship of trust. Back in 1957 he identified six conditions that ‘are both necessary and sufficient’.  His work primarily focuses on therapy and counselling, coaching being a relatively new profession, but they are just as applicable.

The language is a little dated but remain as relevant as they did when they were first written.

So how could these conditions apply to the midwife/woman relationship:

1. Two persons are in psychological contact.

In coaching what constitutes ‘psychological contact’ has changed over time. Even before the pandemic the move to meet virtually had become more commonplace. And with a good internet connection the evidence suggests that there is no detriment to a coaching relationship if a virtual space is used. But, of course, in labour the midwife and the woman need to have physical contact. ‘I was left on my own’ would, however, suggest that this first condition is not always met. But it underpins the following five. 

• The client, is in a state on incongruence, being vulnerable or anxious. 

Most clients come to coaching as they recognise that something needs to change. I would not describe many  of my clients  as ‘vulnerable or anxious’ but are in need of support and challenge to move forwards. But a woman in labour can be described as ‘vulnerable or anxious’ to a lesser or greater degree. She looks to the midwife to reassure and empower her.

•  The second person, whom we shall term the therapist, is congruent or integrated in the relationship.

In the coaching context ‘congruent’ means authentic. Coaches come to the coaching relationship as themselves, they don’t put on a façade. This sounds easy but how many of us say ‘we’re fine’ when we’re not.  

Before a coaching session I spend a few minutes making sure that mentally and physically I’m ready to give my full attention to the client. But how many midwives can claim the same attention to themselves? Can a midwife be ‘congruent’ if she is worried that she may not get the support she needs during the shift or that she may not get a break or have time to go to the loo. Is she required to put on a façade?

• The therapist experiences unconditional positive regard for the client.

Carl Rogers expected the therapist to experience ‘a warm acceptance of the client’s experience’ with neither approval nor disapproval. This feels spot on. No judgement, just warm acceptance.

• The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client.

This is where the magic of coaching comes into its own. To have an ‘empathetic understanding’ you must first listen. As a coach developing the skill of listening is fundamental. We listen to understand not to respond. And we listen with all our senses. We don’t just hear the words, we hear the emotion behind them, we see the body language. From our understanding we may ask questions, we may feedback what we have heard, we use our own body language. The client is in no doubt that they have been listened to. Listening and caring become intertwined.

Reflecting on my own experience as a midwife I fear that I may not have been a great listener. How often did I ask questions whilst fiddling with the CTG? Did I listen to respond rather than to understand? Did I see myself as ‘the expert’ as opposed to a partner in the relationship. I don’t know.

In this condition there is a requirement to be empathetic, not          compassionate.

If we accept the differences between empathy and compassion, it is easy to see why. Empathy is our feeling of awareness toward other people’s emotions and an attempt to understand how they feel whereas compassion is an emotional response to empathy and creates a desire to help.

As an inexperienced coach I often wanted to ‘help’ my client by giving them the answers. I wanted to rescue them. Even now I have to hold myself back as an experienced trade union official from advising them on a work situation. This isn’t the role of a coach. The role of a coach is to support, encourage and challenge the client to find their own solutions. 

Not so for the midwife. She is required by the NMC code to be compassionate. But compassion fatigue is real. 

There is a view that compassion is the answer the failings of maternity services, but  compassion is finite. I know that as a coach I would not be serving my clients well if I spent hours coaching. The amount of attention that my clients are entitled to is tiring. I need to recharge myself between clients. But midwives are expected to care for a woman, possibly more than one, for hours without the opportunity to recharge.

• The communication to the client of the therapist’s empathetic understanding and unconditional positive regard is to a minimal degree achieved.

If all the preceding conditions are fulfilled the woman is unlikely to claim that she was left alone, not listened to, not cared for.

So, what do you think? I’m mindful that I’ve said a lot whilst at the same time only skimmed the issue. There is so much more to say. But this is my first step into considering how a coaching culture could improve the maternity experience for midwives (plus MSWs, doctors, managers etc.) and women. It may also be the  starting point for my dissertation.