7 minute read
BURNOUT AND BACK
BURN OUT AND BACK
From earthquakes to Covid-19, how much can we take when working under so much pressure?
after the earthquakes
It is 10 years this month since Christchurch experienced the first of several devastating earthquakes. The second major quake took the lives of 185 people, laid waste to the city and turned lives upside down. Here, Elizabeth Winterbee describes how the trauma affected her, exacerbating pressures she was already feeling in an increasingly demanding role as a community midwife.
Now living in Nelson and working as a core midwife she explains how she changed her life and recovered to find new meaning in her work. Many midwives have experienced stress in recent years as the maternity service has come under pressure and this year the pandemic response added extra demands. On pages 23-25 we look at ways to minimise the risk sleepless nights of course, as violent aftershocks continued of burnout and strategies for safeguarding your own health and well being. to hit the region. But there was I was a Lead Maternity Carer (LMC) purchased midwifery gear and undertaking large concert held in Hagley midwife in Christchurch from 2007 through my first bookings. I took great pride in Park saw over 100,000 Cantabrians came to 2016. After nine years as an on-call carrying a pager for something as sacred and together to celebrate their resilience and midwife with my own caseload, I was special as being a midwife. I told anyone and strength. exhausted. I no longer enjoyed my job; I had lost my passion for midwifery. I knew my work as an LMC had left me feeling incredibly burnt out, but I had stopped short of a deeper reflection as to why. everyone who asked (or not) that I was a midwife. My first birth as an LMC was a transfer from primary unit that resulted in a caesarean section for obstructed labour. The next few Tuesday 22 February 2011, 12:51 pm however, marked darkly the start of a ”new normal”. Buildings fell, trapping and killing almost 185 people, some of whom survived the initial quake only to succumb to their
When I enrolled in a postgraduate paper births included a shoulder dystocia so severe injuries in the coming hours as they lay that required me to reflect on normal birth the obstetrician broke the baby’s clavicle, trapped beneath the rubble, waiting for and my role as a midwife, it became clear. and a post-partum haemorrhage requiring rescue that never came. The next few days This writing is what resulted - a before, during manual removal of the placenta in theatre. were like living in a slow-motion horror and after of what accelerated my professional Yet my passion for midwifery did not falter, movie. The relentless, severe aftershocks, lack burnout – the Canterbury earthquakes. and nor did I allow these experiences to deter me from encouraging women to birth also a degree of celebration. A BEFORE at home or in a primary unit. I loved being It wasn’t until my late teens that I first learnt a midwife. I loved midwifery. I was sure Professionally, the most what a midwife was. Immediately, an nothing would or could ever change that. daunting aspect of being a innate passion for midwifery emerged, but it took over a decade of very hard work for me DURING midwife at the time was to realise my dream of becoming one. Twelve years and much hard work later, I graduated and became a registered midwife. The joy In the dark early hours of 4 September, 2010, the first Big One arrived with what sounded like a freight train about to crash into the being responsible for the wellbeing of others – mums, and sense of accomplishment I felt for house, followed by such violent shaking the babies, families - when achieving my goal was beyond description. I moved from my home city to Christchurch, walls of my bedroom seemingly moved a metre in every direction. Across the region, I was just as afraid and and eagerly began my life as a Lead buildings were destroyed, but there was no stressed as they were. Maternity Carer. I can still vividly recall loss of life, and only minor injuries. There the excitement of carrying my bag of newly was anxiety, high levels of stress and many
of power and running water, reduced fuel supplies, empty supermarket shelves and the presence of New Zealand Defence Forces – army tanks carrying armed soldiers patrolled the inner-city streets enforcing a city-wide curfew. Piercingly loud alarms and sirens all over the region were triggered with every major aftershock. The brightly coloured, falsely cheerful spray painted graffiti that covered the city for months afterwards - left behind by the dozens of international rescue teams who came to help – marked where lives were lost, and the total count of bodies recovered from each pile of rubble.
In Canterbury we adapted, with contingency plans for where and how to contact loved ones in case of another big earthquake. The powerlessness of not being
able to reach loved ones (due to widespread telecommunication failures) in the hours following the fatal quake, was something no one wanted to experience again. The “new normal” meant never leaving home without your cell phone fully charged. It meant never having less than half a tank of petrol in the tank. Always having thick soled shoes right by the bed so that if you needed to flee for safety in the dark, your feet would be somewhat protected against broken glass, fractured furniture, strewn belongings. It meant continually assessing your surroundings for the fastest escape routes and / or where to hide for cover when the next big one hit and incessantly scanning buildings and overhead structures looking for cracks and more subtle signs of damage. Never parking in carpark buildings, garages, or near overhanging objects; making the wrong decision was potentially a life or death one. Three weeks after the February earthquake I drove past a wrecked car in Riccarton covered with that sickeningly bright spray-paint indicating loss of life. The car had been crushed to knee height.
Thousands of aftershocks continued to hit the city in the coming months, with more than fifty of these of a size magnitude 5.0 or more. After the two major quakes, there were over 200 aftershocks in just the first 24 hours, the ground never still for more than a few minutes at a time. For two years, it was the norm to feel the ground move most days, and much longer before seismic activity was felt only on a weekly basis. With the larger aftershocks, the inside of houses became scenes from Poltergeist – drawers abruptly flung open spewing out groceries, cutlery and plates; walls and cabinets flinging their contents and smashing onto the still moving ground. None of these sounds could be heard above the sound of the earthquakes themselves, however. Like many others, I resorted to sleeping under my kitchen table in a sleeping bag, purposefully positioned under a doorway, surrounded by the essentials (torches, radio, and stored water) and my beloved dog, who was petrified and barked and trembled with every shake.
Professionally, the most daunting aspect of being a midwife at the time was being responsible for the wellbeing of others – mums, babies, families - when I was just as afraid and stressed as they were. One of my big fears at the time (other than being crushed or trapped in a crumbling building) was being with a woman in labour during another February-like earthquake. I would not be able to simply pack up and go home. I would need to stay, regardless of what was happening outside in the real world. Any concerns I might have about family and loved ones would have to be ignored for however long it took for the baby to be born and for both to be safe and well. This was a different form of feeling trapped, I suppose, but one with the same sense of powerlessness.
Yet my work as a midwife provided me with a feeling of purpose, and a degree of control. I might be powerless over Mother Nature, but with midwifery, I knew what to do. I knew how to prepare mothers for birth, help them through the highs and lows of labour, assist with breastfeeding, and how to manage the “big stuff” - shoulder dystocia, postpartum haemorrhages. I threw myself into my work, giving it my all. Keeping busy provided a much-needed distraction as the city around us continued to crumble, metaphorically and otherwise.
What I wasn’t prepared for though, was the trauma and sense of powerlessness experienced by other people. Following every significant aftershock, I would be inundated with calls from anxious women reporting reduced foetal movements, abdominal pain, or who were worried they were in premature labour. Mothers with new babies had other fears - formula fed babies had no access to clean water, and power cuts meant no way to sterilise or heat bottles. Breastfeeding mums worried about their milk supply running out,
