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Midwives Support Self-Care

Devoted to partnering with women—to being “with women,” which is the very meaning of midwife—midwives are keen to showcase the ways in which their role upholds and promotes self-care.

The connection between health care providers, such as midwives, and self-care may not be immediately apparent if one sees self-care as separate or in opposition to health care services. But this is just one of many misconceptions about self-care that exist: that midwives and other health care providers are opposed to individuals, families and communities preventing disease and coping with illness with or without their support. Not true. And neither are a whole host of common misconceptions, such as:

Self-care is just for patients.

The facts: More than half of midwives surveyed in Rwanda reported that self-care is for patients—and not for them. The mindset that says, “I should be able to cope. . . I don’t have time for self-care. . . I need to do other things first” comes at a cost. A review of care providers in sub-Saharan Africa reveals midwives experience high rates of burnout, along with emotional exhaustion and other physical issues.

Health care providers need to take their own health off the backburner and walk the talk by practicing self-care in addition to promoting it to patients. Self-care should be integrated with occupational health and safety in workplaces. Employee wellness programs can also address self-care by health care providers.

Taking care of ourselves is selfish and takes too much time.

The facts: The survey of Rwandan midwives reveals that 79% of respondents don’t have time to take care of themselves. In a typical week, self-care is almost nonexistent, not just the practice of it, but even discussions about it among providers who worry, “What will others think about us if we’re practicing self-care when we have patients who are in pain?”

A midwife’s busy schedule does not negate the need for self-care. Even short breaks can help prevent poor health and exhaustion—ultimately resulting in better patient care.

Self-care diminishes the provider’s role.

The facts: The majority of health care happens outside of the health system. In fact, helping patients to learn and practice self-care is an essential part of midwifery practice. Self-care approaches in family planning help prevent unintended pregnancies, unsafe abortions and sexually transmitted infections. Self-care improves the quality of antenatal, delivery, postpartum and newborn care.

Midwives partner with patients to ensure that they know about and have access to evidence-based self-care strategies such as self-injectable contraception or digital health apps. As patients take ownership of their health, midwives can better focus time and attention on patients’ greatest needs.

The World Health Organization defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” According to this definition, self-care includes “health promotion; disease preventions and control; self medication; providing care to dependent persons; seeking hospital/specialist care if necessary; and rehabilitation including palliative care.”

Self-care is a substitute for the health system.

The facts: Self-care is not an “either or” proposition, and not a default mode, where patients either have access to the full services of a health system or have to practice self-care. Self-care is not a work-around.

Strong health systems recognize that self-care is an essential part of the system. Strong health systems support providers to ensure that their patients have the knowledge, tools and resources to promote and maintain their physical and mental health, prevent illness and continue to care for themselves before and after they’ve left the facility.

Self-care is whatever makes you feel better.

The facts: Not all ways of relaxing qualify as self-care, which, by definition, has to have a positive impact on one’s health. For example, studies reveal that some countries have a high percentage of cigarette smoking among health care workers, even higher than the general population. Smoking or drinking to relieve stress or to feel less anxious may bring short-term relief but aren’t self-care.

Unwinding with healthy behaviors, such as yoga and physical exercise, is self-care and has been shown to prevent emotional exhaustion and depersonalization, two chief components of burnout.

Self-care is free.

The facts: While some interventions, such as performing a breast self-exam, are free, or help to cut health care costs, that’s not true for all self-care measures. Approaches such as self-sampling for the human papillomavirus that causes cervical cancer have costs associated with the sampling kit and the time it takes midwives to instruct patients about its proper use.

It’s important that the costs of self-care are not shifted to patients and that health care providers’ time is compensated. Self-care can help health systems to save money, but the approaches DO have costs that need to be included in health budgets.

Self-care is important, but only during the pandemic.

The facts: Thanks to COVID-19, there’s a big buzz about self-care, as in hand washing, monitoring symptoms and using digital platforms during lockdowns to minimize the need to visit facilities. The pandemic has demonstrated that patients can safely practice self-care in the privacy of their homes by using evidence-based tools and approaches, thus reducing their risk of infection.

Self-care, which has existed for millennia and will continue to exist after the pandemic ends, is for everyone at all times. COVID-19 has created a critical opportunity to chart a new frontier in health care. Midwives can take what we’ve learned about the benefits of self-care and strengthen the policy and regulatory environment for self-care interventions.

Now that you know the facts, midwives invite you to join them in a global self-care movement that aims to educate people about the benefits of self-care, bridge the gap between the knowledge and practice of self-care, champion government policies that integrate self-care approaches into health programming and call for increased funding from governments and donors for self-care interventions.

Excerpted and adapted from an article originally written for the Self-Care Trailblazer Group by Angelique Mugirente, Program Officer, Jhpiego; Nanuka Thapa, Senior Program Officer, Jhpiego; Vusi Ndaba, Project Officer, Jhpiego; and Yvonne Delphine Nsaba-Uwera, University of Rwanda School of Nursing and Midwife.

Jhpiego believes that when women are healthy, families and communities are strong. We won’t rest until all women and their families—no matter where they live—can access the health care they need to pursue happy and productive lives.

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