For many years I worked in HR; head of services, people manager, organisational design and development, employee relations…my point is – I’ve seen the worst of the worst when it comes to behaviours and systemic issues within organisations.
And for years maternity reports and investigations have warned of toxic cultures in midwifery units. Staff describe tribalism, being bullied and harassed, fear of speaking out, fear of being pushed out and a disturbing lack of kindness and compassion.
However. Just like with bad care this isn’t (usually) because midwives get up in the morning, clap their hands together and declare ‘rightio, today I’m going to be a massive cnut’. It’s a systemic issue caused by the system. Take dogs, autocratic dictators and playground bullies as examples and you’ll see there’s normally a deeper reason for bad behaviours.
Management – and for the purposes of this I mean the levels of structure that are in any way above the shop floor tier and again, systems not individuals – are in many ways the centre of toxic cultures. Partly because it’s in their gift to be change makers, and partly because they contribute to the systemic issues. Let’s look deeper…
Hierarchical Structures: When managers progress up the chain they do it by not being different to the organisational norm. The NHS hates tall poppies. That means copying behaviours that exist in order to have a face that fits and therefore progress. They promise as they rise that they’ll make change from the inside – but they’ve been replicating the poor behaviours for so long they become normalised and forever replicated by the new generation of management. This institutional socialisation is a real issue in places with very steep hierarchies – like healthcare.
Ladder Lifting: When real authority is scarce, people protect their hard-won power. They gatekeep opportunities, maintain strict power hierarchies and discourage challenge and collaboration. My guy, if there’s not enough pie for everyone we make more pie! Hoarding pie only leads to rotten pie.
Role Transition Without Skill Transition: Usually people progress through the ranks because they’re clinically good (or, at least, they can BS people into believing they are). But managerial roles are completely different with different skill sets required, and often management training isn’t adequate if it exists at all. If you’re inherently good at communication, conflict resolution, systems thinking and emotionally intelligent you may be a great manager! If you’re not you learn from the people around you..and if they’re not good…? If collaborative and compassionate leadership doesn’t exist then it needs to be taught into existence.
Crashing Out: If you’re working in an under resourced, under funded, over stretched unit being piled on by government targets, investigations, media and gobby birthworkers like me you’re going to be under intense pressure. Control and rigidity can feel like the only safe tools available even if they negatively impact wellbeing. And to be clear – they do.
Collective Trauma: We all know about intergenerational trauma now yeah? Well the same thing happens in organisations, except for the DNA exchanges. If stuff isn’t processed and dealt with the harm perpetuated. THIS IS WHY MIDWIFERY SUPERVISION IS SO IMPORTANT AND NEEDS TO BE BROUGHT BACK.
Misogyny : Professions dominated by women are undervalued and marginalised within the organisations they sit within. This additional tension and source of stress combines with and exacerbates everything else we’ve looked at. And let’s be real: women who’ve internalised the patriarchy can be as misogynistic as anyone else which you’ll have seen any time you’ve seen a midwifery colleague refer to the team as being catty, bitches, gossipy etc.
Yes there are bad managers and toxic cultures within midwifery. But this is less to do with individuals and far more to do with systemic issues within the organisational structure itself. Without structural investment in management training, reflective practice and a commitment to collaborative shared power the cycle will continue.
Why does all this matter? Because it all suppresses psychological safety, and evidence shows that in teams with high psychological safety there’s better performance and fewer adverse outcomes. That means it’s better for staff, birthing people and babies if we got this under control.
