FEATURE
DR ALEX BARTLE MB, BS, FRNZCGP, DIP OBST, MM (SLEEP MEDICINE)
SHUT-EYE AND GETTING OFF THE LOOP: IMPROVING SLEEP QUALITY FOR MIDWIVES At one time or another, midwives are bound to have experienced trouble sleeping, whether as an isolated event, or a more pathological pattern. The intensity of midwifery, combined with unrelenting shift or on-call work can lead to sleep disturbances and/or cyclic thought patterns whereby midwives replay events from their day, questioning their decisions and/or worrying something has been missed. Dr Alex Bartle, Director of Sleep Well Clinic, generously shares his insights into the world of sleep for midwives and offers practical tips for those instances when the land of nod remains elusive. Being a midwife is one of the most rewarding professions, but with it comes responsibility and stress. The ability to be able to switch off after a birth or shift, whether it has been straightforward or complicated, is not always possible, with one potential consequence being difficulty sleeping. Sleep is one of the essential pillars of health and is such an active process that denying sleep will negatively impact on all aspects of our physical, cognitive and emotional health. Whether on shifts or on call, nighttime work is inevitable for midwives. In the literature, the definition of shift work varies, but is generally considered to be working any hours after 7pm and before 6am, not just overnight. Up to 20% of the adult workforce can therefore be considered shift workers. For LMC midwives, being on call for extended periods of time means night work is less predictable - in timing, frequency and duration. Consequently, managing workload is vital, although not always possible.
26 | AOTEAROA NEW ZEALAND MIDWIFE
Approximately 20% of those working shift work will suffer from ‘shift work sleep disorder’ implying that they struggle with changes to their circadian rhythm. Therefore, there will be some who struggle with this unnatural sleep/wake cycle. Working as an employed midwife, shift work is often more structured, when compared to the unpredictable nature of working as an LMC midwife, although a number of core midwives also have on-call responsibilities to staff maternity facilities if required. Shift work schedules can vary widely depending on potential workload, but generally a rotating shift work pattern is the least helpful for sleep, and indeed for family and social life. Short periods of night work can be tolerated more easily than working five to seven consecutive nights, and eight to ten hours are preferred to 12-hour shifts in a profession that requires periods of intense concentration. LMC midwives may be on call 24 hours a day, for lengthy periods of
time, depending on how they have set up their practice arrangements. Most people will need seven to eight hours sleep per night, which can be achieved in one, two and occasionally three episodes. However, consistently less than six hours sleep will undoubtedly impact on cognitive function including concentration, memory, mental agility, motivation and mood - all vitally important when involved in a potentially life-challenging activity. We have all suffered nights of little or no sleep, either with work or with young families, and cope well as long as we are eventually able to return to adequate sleep. The key is to ensure that you are well rested when needed for work, or an important personal situation or event. There is now irrefutable evidence that sleep is vital to functioning at our best. How then to cope with this challenge to sleep? There are a number of strategies that can be used to ensure healthy sleep for night workers. Maintaining wakefulness at
