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How safe is a tired midwife? Strategies to enhance the provision of effective care in situations of sleep deprivation

Abstract:

Setting the scene: It’s late. Actually, it’s early… whatever the time is, your time with this woman and this birthing has been long. You’re tired, so is she and so are her companions. The steady ebb and flow of this labour is beginning to unravel, your trust in this woman’s process begins to erode, some new decisions are needing to be made. She and the little one, all of you in fact, are wrapped in the protective cocoon of your relationships with one another but as the hours unfold and a crisis develops, how safe are your decisions? This paper will explore some of the tensions which emerge when midwives attempt to strike the balance between maintaining the continuity we promise (and the woman and her family have come to expect) and providing safe care in a situation where we are sleep deprived. There is much research in the field of how sleep loss affects performance in a variety of ways and I will use this research as a basis to describe some strategies for ensuring that we meet our obligations both to the families we care for, and to ourselves as safe and effective practitioners. I will uncover some of the ethical dimensions involved in this subtle interplay between the discourses of continuity and our need to sometimes acknowledge that enough is enough, and I will explore the impact on partnership inherent in this interplay.

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continuity of care, expressive role, instrumental role, midwifery decision making, safe and effective care by tired midwives, sleep deprivation