P SYCHOLOGY FOR M IDWIVES Self-Care for Becoming a Helper: Triggers, Burnout, Boundaries and Coping

U NDERSTANDING S TRESS What is Stress ? – The response of the body to any demand made on it; – the arousal, both physical and mental, to situations or events that we perceive as threatening or challenging.

U NDERSTANDING S TRESS : S OURCES OF S TRESS

U NDERSTANDING S TRESS : E FFECTS OF S TRESS HPA Axis Sympathetic Nervous System

S TRESS & P ERFORMANCE

U NDERSTANDING S TRESS : E FFECTS OF S TRESS Stress and the HPA Axis: Stress and the HPA Axis: Prolonged elevation of cortisol is related to: increased depression, memory problems, etc. impairment of the immune system, which leaves the body vulnerable to disease.

U NDERSTANDING S TRESS : E FFECTS OF S TRESS Selye’s General Adaptation Syndrome

S TRESS AND I LLNESS Cancer: Cancer: related to genetic predisposition and environmental factors Cardiovascular Disorders: Cardiovascular Disorders: related to stress hormones, certain personality types, and certain behaviors Gastric Ulcers: Gastric Ulcers: caused by bacteria or stress? Or both? Posttraumatic Stress Disorder (PTSD): Posttraumatic Stress Disorder (PTSD): anxiety disorder following extraordinary stress

W HAT IS S ELF -C ARE ? Self care is personal (psychological, physical, emotional) health maintenance. It is any activity with the intention of improving or restoring health, or treating or preventing disease.

T RIGGERS Topics, situations, individuals/types of individuals that elicit certain emotional reactions from you like anger, fear, pain, and disgust

B URNOUT Occupation Burnout: state of psychological and physical exhaustion resulting from chronic exposure to high levels of stress and little personal control More likely in midwives with the following characteristics: young, have children, relatively newly employed in large services serving a high proportion of welfare clients, and often lacking physician, nurse, and consumer support (Cole Beaver, Sharp, & Cotsonis, 1982)

B OUNDARIES Set them early, in the first meeting or during the informed consent meeting: Rules: When is it okay to call you at home? How do you interact if you run into your client out in public? Roles: What is your responsibility? What do you expect of the client, her partner (if applicable)? Why are boundaries so important? First and foremost, they recognize the inherent power inequity of the relationship and set limits for the midwife's expression of power. Second, they set a structure for the relationship, providing a consistent, reliable, predictable, knowable frame of reference.

S OME M IDWIFE R ESPONSIBILITIES : (a) Prepare a written plan of action with the family to ensure continuity of medical care throughout labor and delivery and to provide for immediate medical care if an emergency arises. The family should have specific plans for medical care throughout the prenatal, intrapartal, and postpartal periods. (b) Instruct the patient and family regarding the preparation of the environment and ensure availability of equipment and supplies needed for delivery and infant care, if a home birth is planned. (c) Instruct the patient in the hygiene of pregnancy and nutrition as it relates to prenatal care. (d) Maintain equipment and supplies in conformity with the rules adopted pursuant to this chapter. (6) The midwife shall determine the progress of labor and, when birth is imminent, shall be immediately available until delivery is accomplished. During labor and delivery, the midwife shall comply with rules adopted by the department pursuant to this chapter, which shall include rules that govern: (a) Maintaining a safe and hygienic environment; (b) Monitoring the progress of labor and the status of the fetus; (c) Recognizing early signs of distress or complications; and (d) Enacting the written emergency plan when indicated. (7)(a) The midwife shall remain with the postpartal mother until the conditions of the mother and the neonate are stabilized. (b) The midwife shall instill into each eye of the newborn infant a prophylactic in accordance with s

C OPING : Two major approaches: 1. Emotion-focused (changing one's perception of stressful situations) 2. Problem-focused (using problem-solving strategies to decrease or eliminate the source of stress) attempt to manage stress in some effective way

C OPING R ESOURCES 1. Health and Exercise 2. Control (Internal vs. External) 3. Positive Beliefs 4. Social Skills 5. Social Support 6. Material Resources 7. Relaxation 8. Sense of Humor

Sociocultural Messages about Motherhood and Fatherhood

The Social Constructionist Approach All knowledge is historically and culturally specific Use of language to construct our worlds Language is constructed into a series of discourses  Set of meanings, metaphors, representations, images, stories or statements that in some produce a particular version of events

The Social Constructionist Approach and Feminist Psychology The bulk of knowledge is constructed, accepted, and perpetuated by those in power  (here: men, whites, upper-class, educated, Christian) We as a society have constructed ‘motherhood’ as essential and vital component to femininity  Particularly the martyr version of motherhood Many of (both men and women) accept and internalize the messages about motherhood (more broadly: gender, race, sexual orientation, social class)