Sister Julienne struggles to take care of Eva, a pregnant woman clearly being abused by her husband, in this week’s Call the Midwife episode. Eva initially refuses to engage with Sister Julienne or to accept the care she offers. Eva seems simultaneously wary of angering her husband and resigned to continued abuse. You can feel Sister Julienne’s frustration at Eva’s rebuffs, but Sister Julienne is also a bit lost herself; she is fatigued, sad, and disconnected from her calling.
“I have known so many Eva Baldwins, have helped so many Eva Baldwins. And yet, still, the Eva Baldwins keep on coming,” she laments to Sister Veronica. She is also concerned about the changes in health care as community home birth is rapidly being eclipsed by efforts to move birth work to hospitals – she is still bitter about attempts to separate the nuns of Nonnatus from their calling to deliver health care to the inhabitants of Poplar. She feels powerless and exhausted by the seemingly continuous onslaught of poverty and its sequelae.
This type of exhaustion has its own term: compassion fatigue. Professions particularly vulnerable to compassion fatigue include social work, health care work and, more generally, “helping” professions. One concern with compassion fatigue is that it is harmful both to the provider and the patient. Providers struggle with reduced empathy and poor coping methods, and in turn, patients are more at risk to experience and receive substandard care.
Sister Julienne spends this episode navigating compassion fatigue and burnout, a familiar threat to many nurse-midwives, including myself. In one recent study surveying burnout in the nurse-midwifery profession in the United States, 40.6% of respondents met burnout criteria. This is alarming not only for individual nurse-midwives, but also for the women and families in their care. Factors contributing to burnout are complicated and include unsupportive practice environments, poor pay, high patient volume/overwork, and compassion fatigue.
Given that nurse-midwifery care has been shown to decrease preterm birth, neonatal death and cesareans; and to lower health care costs while increasing patient satisfaction, it is in everyone’s best interest that burnout in the nurse-midwifery profession be noted and addressed.
For Sister Julienne, a tricky surprise twin birth managed entirely between herself and Eva provided a strong reminder of the power of her skills and helped re-energize her. It also gave Eva the confidence to demand a better life for herself and her daughters. While I would agree that systemic changes are needed to support the longevity of the nurse-midwifery workforce, on a personal level, every birth I attend is a jolt of infectious joy and fills me with a wave of gratitude to be witness and aid in such an intimate and profound moment. That feeling never gets old!.
Una Sammon, CNM, has been a practicing certified nurse-midwife since 2019. She attends births at Vanderbilt University Medical Center.
