HEALING THE WORKPLACE CULTURE

Carolyn Hastie

 

Introduction

I am going to explore the issue of healing the workplace culture from a position which encompasses three major standpoints.

 

The first, is that birth is fundamentally critical to the health and vibrancy of a culture and the way birthing women and babies are treated say everything about a culture. That what happens to mothers and babies during pregnancy and birth profoundly influences their future.

 

The second is that midwifery is a powerful and vital force. It is a sacred contract to share in a transformational process of epic proportions.  Midwives are the guardians of normal birth. Midwives are uniquely situated to ensure a safe and loving space for each new individual to enter this world.

 

The third is that this universe and everything in it is governed by natural law.  Quantum physics, neuropsychoimmunology, perinatal psychology, and the black hole theory have helped us to understand natural law and its effects.  These modalities have shown us how our attitudes, whether conscious or unconscious, creates either a chaos or a cosmos for each one of us.

 

What’s wrong with the workplace culture?

 

Your first question when you heard or saw the title of my paper may be why does it need healing, what’s wrong with it?  You might even feel dismissive, thinking there is nothing wrong with where you work.  Or you may feel tired and disillusioned, thinking you have heard it all before, done everything you can do and things are only getting worse.

 

Whatever your reaction, let’s explore the current situation and think about what is the reality and whether healing is necessary or even desirable.

 

The current situation

Just look around this room and notice the predominant age group. According to studies both in Australia and overseas, the population of midwives is aging. The average age is about 47.  Where are the young ones and why are so many of those people who are beginning midwifery either not finishing or not choosing to stay in the profession when they do complete their studies?  Researchers on both sides of the world (Hadikin & O’Driscoll 2000; Fenn 2000) have found that our midwifery culture is a culture of criticism. It is said that midwives are fearful and afraid to speak up (Robinson 1999; McCall 1996).  According to these researchers, the emotionally and psychologically abusive midwifery culture is causing difficulty with retention and recruitment of new graduates. 

 

Meg Taylor (Taylor 2000) suggests midwifery is dying, caught up in the reality of medical dominance, the apparent heroic excitement of surgery, in line with our society’s “fix it quick” mentality, becoming the norm.  Meg comments that midwifery will become extinct because sitting with a woman is invisible and therefore dispensable. Is the sick culture, the culture of criticism, a symptom of decay?  The violence merely the result of the death throes of a species that is no longer viable?

 

We have many excellent tomes written about dominance and control, fear based iatrogenesis in childbirth (Murphy Lawless 1998;  Roberts, Tracey & Peat 2001), patriarchy and it’s effects on women’s issues (Martin 1987; Waring 1988; Koutroulis 1990; Lather 1995 ), including the profession of midwifery (Kirkham 1996; Hunt & Symonds 1996; Katz Rothman 1991; Davis 1999).  We have endless research and published evidence of the appropriateness and viability of midwifery care for pregnant women.  We have a plethora of evidence that women birth well and feel good about themselves when there is a strong, autonomous midwifery profession (Wagner 1994; Kitzinger 1988; Burch 1994).  And still, intervention rates are rising and primary health care initiatives for maternity care provision are few and far between. Why is that so?

 

We had Vicki Chan present to a Central Coast audience a couple of weeks ago.  Vicki and her presentation “Birth matters” was so well received at a recent childbirth educators conference, Vicki has been invited to speak all around Australia and England. Vicki challenged us to ensure the woman was central to our care;  to ensure that love was the elemental force that permeated our actions and our care.  Vicki highlighted the importance for women to feel safe and supported in their process and for midwives to trust and honour the birthing woman.  Vicki also emphasized the necessity for midwives to have a fundamental trust in and respect of the birthing process.  The audience was made up of people from the community and midwives. The response was mixed.  All the women I spoke to were ecstatic.  They felt powerful, reaffirmed and capable.  The midwives reactions were polarized.  Some felt ‘bashed’ and defeated. Others felt affirmed and inspired.  Some were angry and defensive of the ‘status quo’ saying ‘she should have researched her audience’.    Interesting.

 

Maintaining the Status Quo

 

Psychology (Mook 1987) tells us that we humans have a negative reaction to the unfamiliar.  Because we are creatures of habit and convention, when something violates our perspective of the way things are, which has an inherent assumption that the way things are is the way they ought to be, then we have a disturbing reaction and seek to restore our feelings of comfort.  An example (Mook 1987:478) of such a disturbing reaction was when Igor Stravinski’s ballet The Rite of Spring was first performed in 1913, it caused an outrage. People demanded their money back, complaining “This isn’t music”.  The music flouted so many accepted conventions that the discrepancy was unacceptable.  People no longer riot about Stravinski’s music.  Some like it, some do not.  The music hasn’t changed, but people’s schemata has.  We have heard music like it before and so it becomes incorporated into what we know and no longer causes such a violent reaction.

 

The Four Stages of Learning or Knowing

 

Dubin (1962) has a wonderful model for explaining how we come to know things and how information or knowing, becomes incorporated into who we are.   There are four stages of awareness or knowing in this model. The first is Unconscious incompetence, we don’t know what we don’t know.  The first time we are exposed to something, it generally passes us by, unless, like Stravinski’s music in 1913, it so totally contravenes accepted behaviour it causes outrage.  Marketing experts know this well.  Current marketing research indicates that information has to be presented at least seven times to become accepted as a fact by the subconscious which then of course, leads us to pick the item, often unconsciously, when we are out shopping.  Once we become aware that there is something to know, then we are in the Conscious incompetent stage.   If it is a skill or knowledge we seek to acquire, we recognize how little we know.  This stage is when we know we need to know and we set about learning it – the phase of discovery.  Then we repeat what it is that we are learning, again and again. This is the stage of Conscious Competence - we have to think each step of the way about what we are doing.  It is painstaking and we make mistakes – remember learning to palpate a pregnant woman?  Once the information or skill is integrated and is easily accomplished or remembered, it becomes a habit, an integrated skill and then we are in the stage of Unconscious competence.  This is how we are able to do difficult tasks with ease and do several difficult things at once. For example, palpate a pregnant woman, explain a procedure and hold an interesting conversation, whilst observing a woman’s physical condition and being alert to relationship issues – all without losing track of what is happening. This is the way we move from novice to expert and, because of the way the subconscious works, once an expert, can apprehend situations in a flash - before we engage our conscious minds to ‘think’ about the situation. This is called tacit knowing.

 

The four stage process of learning is constant.  As we learn and assimilate, our conscious mind can move on to new things.  Learning is potentiated by emotion and times of high emotion is when learning is fast and profound.

 

The Power of Emotion

 

Daniel Goleman (1996) adds convincing evidence to the idea that emotion and thoughts intertwine and shape our reactions to everyday life, dictating our perceptions of the world and behaviour. In explaining brain architecture and the roles of emotion and rationality, Daniel explains we are modern day social creatures whose biological templates for emotional life are still grounded in the stone age necessities for fight or flight when faced with perceived danger. According to Daniel, emotion has a central role in what we perceive, experience and do. John Heron (1981) identifies three basic human emotional needs; one, a need to be loved and to love, to give and receive caring; the second, understanding – to understand and be understood and three – choice needs, to be able to take part in the decisions that affect our lives.  According to the perspective taken by Daniel Goleman and John Heron (1990) our power and ability in human affairs is a direct result of our feeling nature. Our deepest feelings, comments Goleman, are meant to guide us in how to live our lives.  John Heron (1990) suggests that it is when our basic emotional needs are not met that we develop dysfunctional patterns of behaviour.

 

The Amazing Brain

Our human brains are fascinating. It has long been suggested that we are 10% conscious and 90% subconscious and that we use only about 3-4% of our brain. According to current psychological thinking (Kirton 2001) it is now believed that we are in fact, only 1% conscious, the subconscious processes making up to 99% of who and what we are.  The role and power of the subconscious is truly astonishing. It is the seat of habit.  It controls our basic survival functions, like breathing, circulation, digestion, reproduction, elimination and it orchestrates our healing and immune systems. It is easy to see why these functions are not under the control of the will, with it’s vagaries and inconsistencies.  It is the storehouse of memory and the wellspring of desire.  It is the fount of creativity and the conduit to the collective unconscious and inspiration. There are trillions of chemical and electrical interactions going on in our bodies at any one time all orchestrated by the enormous intelligence of the subconscious.  A tiny example is that of our process to recognize faces.  According to current knowledge, the part of the brain that codes faces, runs through 3 million faces we have been exposed to with each face we see, seeking familiarity.  Our whole brain works to make the unfamiliar familiar.  There is evidence that there is mind in each cell of our bodies.  Each cell in our body has intelligence and is able to select and utilize substances for its growth and maintenance.

 

The role of the Watchman at the Gate

 

Our brains have a function that screens information coming in and coming up from our subconscious.  Trillions of bits of information are available at every moment. The discriminating function of our brains ensures that what happens is noted and filed in our subconscious and it selects that which we have identified as important to be allowed into our conscious mind.  This filtering system ensures that troublesome hidden aspects of ourselves are kept subconscious.  It also ensures that events, ideas, people and things in the outside world do not gain admittance to our conscious mind if they do not match our particular perspective of reality, or have already been accepted as fact.   An example of this function is when we went to Beirut last year.  We were stunned by the sight of ravaged, bombed buildings everywhere. When we commented to our companion ‘wow, look at all these bombed buildings”, he said “Where?” The buildings and their destruction were part of his knowing and had slipped from his conscious mind and he no longer saw them. We habituate to the familiar and it no longer shocks us.  This is necessary for our conscious mind to move on to new things.

 

Becoming aware

 

Once we know how our brain works, then we can understand how our view of the world may be limited.  Then we can chose to become aware.  Cultivating awareness means becoming an observer of ourselves and our world.  When we become aware of ourselves and observe the inner dialogue, we can readily notice any gap between how we see ourselves and our actions.  Transpersonal psychology teaches us that how we are on the inside dictates how we behave, how we relate to others and how this translates into our experiences in our environment.  Expanding our awareness enables us to cultivate our capacity to observe how we operate in certain circumstances and what sort of situations at home or at work can trigger us into responding or reacting in certain ways. Expanding awareness gives us choice.   We can choose how any situation or experience is going to affect us. 

 

Emotional Competence

 

The ability to chose how any situation is going to effect us and how we are going to respond is what John Heron (1991) describes as ‘emotional competence’.  John Heron contends that there is a lack of training and education in our western culture for effective management of the troublesome and difficult feelings of anger, grief and fear.  Instead, we are taught as children to deny and suppress uncomfortable emotions, causing maladaptive displacement responses and contaminated communication as adults.  The constant cycle of repression and denial throughout childhood and life generally, creates a ‘prison of the mind’ – a system of defensive walls and barriers (Mezner 1985).  Stanislav Grof (1996) a transpersonal psychiatrist, has found through his work, that the origins of personal distress and the disposition to violence and self destructive tendencies are rooted in perinatal dynamics and birth circumstances.  The hypothalamus (part of the watchman at the gate brain function) has been found to be smaller in babies who have been subject to perinatal trauma (Bremner 1999).

 

So what does that mean for midwifery and the workplace culture?

 

John Heron (1990) has a broad integrated model to explain problems associated with unconscious behaviour in therapeutic and interpersonal interactions. John Heron’s model of social relations contends the presence of a vast social pathology in our society.  John says we all have an internalized version of the wounded child.  He argues that coming to personhood, a place of personal autonomy – the full grown exercise of discriminating choice is a hazardous business in western society. John Heron (1990:21) has identified six states of personhood, ranging from those people with little insight and little or no control, whose behaviour is ‘effectively conformist to the culturally proscribed norms’, to the ‘self-transfiguring person’  who ‘freely chooses to unfold the inner spiritual self”.  John Heron (1990:154) describes how unresolved personal distress adversely interferes with professional relationships. Displacement responses such as “projections, distortions and degenerative and perverted interventions” can be mixed up with legitimate interventions and practitioners ‘can’t tell the difference”.  

 

John Heron (1990) argues that the professional role is often used defensively and oppressively, claiming an excessive degree of expertise. Barbara Duden (1993), a German historian would agree. Duden describes how childbearing women have been put under obstetric surveillance, their inner knowing dismissed and denied by health care professionals so women only ‘feel’ pregnant when they can ‘see’ it, the pregnancy’s reality diagnosed and confirmed by experts.  By the use of ultrasounds, measuring tapes and monitors, the experts have symbolically taken the fetus out of the body of woman, constructing the fetus as a ‘life’, separate from that of the mother.  Duden (1993) contends the fetus is now constructed as an endangered species, the woman as an inherently dangerous and faulty ecosystem and the woman has been disabled for natural birth.  The urge for control and the assumption of the role of expert in rendering childbearing women incompetent in modern medical discourse and practice is used to distance the professional from uncomfortable feelings. Joan Rafael-Leff (1991:223) discussing psychological dangers for staff assisting birthing women, highlights the deeply arousing nature of the ‘naked emotionality and urgency’ of birth. Joan Rafael-Leff (1991) claims institutions and practitioners have developed strategies to minimize staff anxieties in maternity care where primitive emotions are invoked for staff.   Strategies used to minimize staff anxieties include task orientation, rather than individualized care, rotation of staff, which stops staff forming attachments with each other, fragmentation of care, thus minimizing contact between midwives and women and promoting ‘professional’ detachment as desirable. Other strategies include the promotion of myths such as all women are similar and can be treated the same, and all health professionals are uniform and interchangeable. The use of technological aids to replace direct contact for example, the application of the fetal monitor to labouring women’s bodies instead of palpation of contractions and auscultating the fetal heart, are used to dissipate subconscious anxiety for the midwives.   Unconscious tactics, such as splitting, projection, denial, blame and avoidance of change, coupled with a system of checks and rechecks, upwards delegation, active discouragement of staff taking any personal initiative and using their own discretion in clinical decision making, have been constructed to redistribute conflict and help individual professionals avoid experiencing anxiety, guilt, doubt and uncertainty (Heron 1981:1990; Raphael-Leff 1991:225-6).  Problems generated by the use of these conscious and unconscious strategies to repress and deny feelings include impersonal and standardized care and the often violent resistance to any attempts to change the status quo. The defense mechanisms of denial and repression alleviate any sense of responsibility and limits effectiveness of care.  Joan Rafael-Leff (1991) cautions that caring, satisfaction and gratitude are lessened where people are treated and behave in depersonalized ways.

 

In the self-aggrandizing search for money, position and power of corporate life in modern institutions and corporations, where market forces are given precendence over human concerns, the human spirit or love “our essential true nature” has been denied and repressed (Marie L. Kerpan 1993:77). Barbara Shipka (1993:91) recognized the similarity in the expressions of feelings of fear, anxiety, a sense of isolation, apathy and despair within refugee camps and modern day organisations. Shipka labels this phenomenon ‘spiritual poverty’.  An example of the effect of spiritual poverty is that described by Jean Robinson (1999:459) when she commented on toxicity in the midwifery workplace environment and claims midwives are too busy ‘watching their backs to concentrate on the job they love’.  Hostility and back biting are rampant in midwifery units, warns Jean Robinson, citing the presence of an ‘organisational emotional virus’ within health care institutions, leaching away morals and ethics, turning ‘enthusiasm into cynicism, compliments into complaints and care into malice’.  Within midwifery culture, group behaviour is restricted by the oppressive norms, values and beliefs that flow into and permeate it from the surrounding hegemonic culture (Clare 1993:Roberts 1994: Heron 1990;Barker 1999).  Group behaviour is further distorted by various anxieties of participants and influences from past and present distress flooding the group dynamic, throwing it into a rigid, defensive form (Barker 1999:153).  Games of one-upmanship and sabotage flourish in these toxic environments, wherein midwives can play the roles of persecutor, rescuer or victim, finding others who subconsciously or intuitively sense others who play complementary roles (Whitehouse 1991:46).

 

Somewhere and somehow, midwifery has been derailed by the mechanistic and reductionist view of human beingness.  We have learned to embrace and value problem based care rather than sitting with women and supporting their inherently normal and transformational process.   We have moved, or allowed ourselves to be moved, from recognizing, honouring and working with the emotional, spiritual and psychological aspects of the childbearing experience – helping women to find their inner wisdom and strength, thus safeguarding the physical expression of the process and ensuring women enter parenthood well equipped and strengthened to ably cope with the demands of parenting.  Instead, we have been seduced into the fear based tactics of imposing physically based interventions onto the primal, beautiful, fluid, holy expression of human reproduction.  We have been tricked, fueled by fear and bound by protocols into being the handmaidens of torture.  We have been trapped and imprisoned by our own adoption of a position of powerlessness and helplessness.

 

As Eleanor Roosevelt said ”Nobody can make you feel inferior without your permission.”

So what do we do?

 

We are the people who can help women birth their babies well and easily. You may think it is a coincidence that you are a midwife.  It is not.  As I mentioned before, we have a sacred contract to ensure our society’s babies are born into a loving environment. We are the people who can ensure a safe and sane society by helping women avoid trauma and drama.  We know from the research that when women’s emotional needs are met, physical problems melt away. The experience of pregnancy, birth and the immediate postnatal period has a deep and profound effect on a person’s psyche (Verny 1981; deMause 1995) and is critical to a person’s worldview, self-perception and experience in and of life.  It forms the basis of the way that character is developed.

 

It is essential that we adopt two strategies immediately.  The first is to truly value and love what we do, whom we do it with and how we do it.  To move into a place of deep respect for ourselves, our colleagues, the women who trust us and midwifery itself.  The second is to become more aware of ourselves, what drives us and how we interact with our environment.

 

Robert Metzner (1985:45) suggests for integration and wholeness to take place, we need to ask ourselves what is it we most want to hide, what thoughts or impulse do we have that we least want someone to know about? Robert Metzner (1985:45) encourages us to face our shadow, to accept the possibility that we might be like whatever it is we don’t like in another.  Robert Metzner (1985:45) acknowledges it takes courage and humility to face our shadow and own our ‘evil’ aspect. John Heron (1989:37) advocates that practitioners must engage in personal growth work or counseling to facilitate healing of unresolved personal distress to avoid the pitfalls inherent in unconsciously driven defensive behaviours.  Heron’s idea of what makes an effective helper is ‘an interaction between inner grace, character and cultural influence’(1990:12).  Helping, says Heron (1990:11) manifests ‘according to the norms, values and belief systems of the prevailing culture’ and when effective is ‘the wise flow of love from person to person’, the combination of ‘concern, empathy, prescience, facilitation and genuineness’ and maintains that helping is the ‘spiritual heritage’ of human beings.  As Kahlil Gibran, the Lebanese poet and artist wrote ‘work is love made visible’ and nowhere is this more obvious than being ‘with woman’.

 

In conclusion

 

To heal the workplace culture we must heal ourselves.  We must have a vision of how we want to be and then do what we need to do to.  Having a clear vision enables us to create the culture we want. We then can manage stress easily (Crews 2001) and move towards what we want with grace and poise.  There are clear pathways to ensure this happens.  I’m going to highlight a few points from my discussion paper on horizontal violence.  The paper is in your conference satchel.  It will give you clear and concise practical strategies to heal both ourselves and our workplaces. 

• Each of us must take responsibility for our experiences and our behaviours. 
• Each of us must decide to be the best person we can be.
•  It is essential that management provide an example by ensuring safe working conditions.  Management must set a good example by valuing midwifery, providing good role models, ensure safe and effective pathways for people to address issues of horizontal violence. 
• In-services must address the issues and create the environment where proper conduct and behaviours can be discussed.  The destructive behaviours that are the result of our hurt childhoods and socialization must not be allowed to manifest nor flourish in the workplace.  
• We must find ways of building bridges with our medical colleagues so that all of us can work together in partnership with women for the best possible experience for them and their babies.

Our future as a safe and sane society depends upon it.

“Open up our hearts to see” (with slides) written and sung by Penny Lang

 

For all of us who’ve lost our vision

Open up our hearts to see

For all of us who’ve lost direction

Open up our hearts to see

For all of us  who numb our feelings

Open up our hearts to see

For all of us who kill the spirit

Open up our hearts to see

For all of us who fear delivery

Open up our hearts to see

For all of us who sell our souls

Open up our hearts to see

For all of us who can’t stand proudly

Open up our hearts to see

For all of us who hate our neighbours

Open up our hearts to see

For all of us who’ve lost our goodness

Open up our hearts to see

For all of us with no compassion

Open up our hearts to see

For all of us who need recovery

Open up our hearts to see

Open up our hearts to see

 

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