 Wait a second, I'm going to introduce you Felicity and then unmute you. All right, so I'd like to have the pleasure of introducing Felicity Finn. She says that midwives are amazing at empowering women. And she's going to talk to us about that over the next half an hour or so. She has worked with women and children since 1995 and raised three children of her own to nearly adulthood. Felicity loves working in women-centered care and has completed her master's of midwifery since 2016. She has a very special interest in self-care for midwives and also in the promotion of well-being for women in general. Felicity plans to undertake future research in these areas as a PhD later in the future. Okay, so now we are going to find you. I did it already, Catherine, sorry. Oh, you did? Yeah, she's good. Okay, great. So take it away, Felicity. Okay, thank you very much for that, Catherine. I'm really honoured to be presenting here today with midwives primarily from all around the world. I'm absolutely rapt to see some students here. I work a lot with students in my role in continuity of care and I think they are absolutely the living, breathing future of our profession. And I'm really, really, really glad to have some of them here. Midwifery is such a popular and loved and respected profession. Anytime you go to a social occasion and you tell someone that you're a midwife, you always get, oh, isn't that lovely? What a wonderful job. You always get really beautiful comments made. Okay, so it really is important that we're able to value ourselves enough as midwives to understand how important self-care is for us and for the longevity of our careers. When I did my midwifery and that was around about 12 years ago, I did a grad dip after being a nurse for several years, as was the way back then. We had an amazing education on woman-centred care. Amazing, but in self-care it was pretty much non-existent. The main textbook that we used had about two pages in it, literally two pages around self-care and 900 pages about looking after women. So that shows you just how much of a blind spot it's been for us as a profession. It's really important that we understand this because we are charged with the responsibility of nurturing the women that are going to be nurturers of our next generation. And it's really important that we understand that that's got to come from the foundation of our own self-nurturing, of our own self-care. It's really important we can't give what we don't have, essentially. Why is this relevant? It could not possibly be more relevant. When I was preparing the background research for this presentation, it was noted the World Health Organization are predicting a 15% increase in non-communicable illness and disease. This is worldwide by 2025. That's what their prediction is. So there's going to be a huge demand on health services and that's going to impact on nurses and midwives enormously. And we work in essentially very similar environments. However, there are a lot of alarm bells being rung about the status of our own health, the status of our own well-being. You know, because we are overrepresented in stats, we definitely don't want to be represented. We have three-fifths of us in Australian research being found to have one or more chronic health condition, but yet we have a climbing retirement age. So the questions being asked, how are we going to take care of ourselves and our communities into the future? Because the strategies that are currently being used are not necessarily helping us. We have at the moment something known as a mental health day. This has actually been studied. They actually did research on this and found that in a study of over 5,000 Australian nurses and midwives, over half of us were averaging about two mental health six days a year, which is where, you know, the costs blow out. That costs $97 million and that's just in our country alone and that's just the ones that were reported. Now, this is a really interesting stat because often when people get to the point where they're taking a mental health day, which can be very valid, some workplaces you do need a break from, it's underlying the fact that behind all that, they've been working in a culture that's very destructive and non-supportive and they're not coping with what's going on at work. They're not coping with the behaviour they're seeing around them. They're not coping with the demands that are being made on them. But unfortunately, this just adds to the burdens and the problems because we have other staff turning up for work and the shift is less well staffed because of this thing. And also, it doesn't actually address the issues. It doesn't actually solve any problems, unfortunately. It tends to be a little bit of respite, but it's not getting to the key issues and it's not building true resilience. So it doesn't help us. Also, the interesting thing is that in 2017, there was a study done that found that health professionals, this includes doctors as well as nurses and midwives, reported greater sleeping problems and suffering more depression and burnout than when compared to the general population. And that's quite a concerning stat because we know that if we're not sleeping well, we're also, it tends to have knock-on effects in so many areas of our life. We tend to be more irritable. We make more mistakes. We tend to eat poorly. I could go on and on. But you get the idea. It's not just due to our shift work, but that doesn't help us. It's more due to the fact that we are carrying work home too much with us and living in this tension day in, day out. And that is not supporting us in our longevity in the profession. Our burnout rate in Australia from 2017 is estimated to be around about 15% a year. That means 15% of us are leaving the profession every single year. And those, those, those stuff have to be replaced. We also have an underlying problem of presenteeism, which is really interesting phenomenon. But it's very, very hard to measure. But it's basically people coming to work sick or they're coming to work well below capacity or they're coming to work and they're disengaged. They've given up. They don't care as much, all that sort of stuff. This is all playing out in our workplaces every day. Another strategy that, that isn't helping and it's, it's basically just a stopgap measure is the phenomenon of excess drinking. When they did research in 2018, Australian research from the University of Technology in Sydney, they found that nurses and midwives are overrepresented in terms of our drinking rates are much higher than the general population. And I've heard it countless times. I'm sure there's many others, others of us on this, on this call that can say, they've heard the expression, after a busy stressful shift, go home and have a few wines. Totally understand why that gets said and why it happens. But does it actually deal with workplace stress in a way that solves it, in a way that allows us to move on? It seems to be that it doesn't. It's ineffective with dealing with stresses and it just basically takes the edge of life that doesn't deal with that underlying unresolvedness that we, you know, that happens when we take on too much of what we're working in. And this is tragically playing out in terms of the stats. We are an increased risk of suicide just by our occupation alone. And the most recent stat I've got on that is 300 deaths in seven years in the UK, nurses and midwives due to, due to the job, basically what's happening to us, happening to us in the job. If you want to look at what our bodies are taking on, it's not a healthy stat either. We have about 60% of us current nurses and midwives in Australia are in the unhealthy weight range and half of that 60% are actually in the obese range. We have 10%, as I've just mentioned, having risky levels of alcohol use daily and 10% that smoke, 31% of us sleep poorly, 50% of us have musculoskeletal pain, 10% have serious mental health issues and nearly a quarter of us are planning to leave in six to 12 months. Yet we say that we self-care, so what's going on? Okay, when I did a Masters in Canberra in 2015, I conducted a literature review on self-care for nurses and midwives and I found a really interesting fact and that is that self-care is actually very broadly defined. So for some people, that may be, okay, I'm going to go out and have a few drinks. For some people, it may be, right, I'm going to go out for pizza. For some people, it might be a yoga retreat. For some people, it might be going for a job. It's different things to different people and although it's very valid that we most definitely have to approach self-care in our own way, it's really important to ask the question, what self-care actually supports us? What self-care is going to reduce the tension that we feel? What self-care is actually going to make a difference to us? And I remembered back to when I did my nursing undergraduate degree and where there was a nursing theorist, I'm sure some of you will have had to have written essays on way, way, way back and her name was Dorothy Aram. She was an American and she made a lot of observations about self-care but what she said was that self-neglect is actually the lack of self-care and if you stop and think about what that means, that's really, really profound because it basically says everything we do has an impact. Nothing is neutral. Every behaviour, every action, every choice either creates or detracts from self-care. Nothing is in fact neutral. And the way to know what is actually impacting us for the good or for the bad, so to speak, is how does our body feel? Okay, I might go out and have a few drinks because I've had a really crap week and that's just how I'm going to deal with it, but how's our body feeling at the end of that? Or I might go out and I might actually do some meditation. I might do some deep breathing. I might be extra careful with what I eat. I might be extra careful with what I drink. I might make sure I get some early nights. Do you know what I mean? Where's our body at as the end result of what we consider our self-care or our response to workplace stress? Those choices to be. Another interesting thing I found when I was researching as well was to look at a lot of information about mindfulness in the literature and one thing I found is that when people were becoming very aware of their body, they actually naturally incorporated mindfulness, like the mind comes with you essentially. I'll explain that a bit more down the track, but you don't need to do mindfulness if you're already aware of your body, basically. It encompasses it. And the other thing that emerged from the literature was that self-care does not have to be something that is added on, tacked on to the end of a day, to the end of a busy shift, as yet another thing nurses and midwives are expected to do. There are ways of incorporating self-care based on the body into every aspect of our shifts. Every single thing we do can be self-care because when I looked at the studies from around the world, from the UK, from America, from Australia, students, midwives, academics, no matter who was being researched in relation to stressors in midwifery, the same things kept on coming up. There's a lot of underlying exhaustion. There's a lot of difficulties with colleagues. That's in every institution that I could find. There's a lot of issues where we feel like we're selling our soul. And I remember for me, that was very much around working in a busy ward where I had so much paperwork to do, I actually didn't have time to look after the women in the way that I wanted to. I was far more forced into the paperwork. And that was really hard. You don't want to resent women buzzing because, oh, my God, you know, they're going to need me and I don't have time. We entered this profession because we love and care for women. That's the basic reading. You ask any student about why they want to do midwifery. That is the sort of thing they will tell you. So not being able to complete our job in a way that gives us satisfaction. It is soul-destroying. And as a result, some feel they want to leave midwifery. We sometimes see care that is not okay, that we're not happy with, where we think that woman really did not have informed consent. That woman was not given respect. That woman was, you know, there are countless examples of that. There's also the work-life balance. I found this particularly interesting in working in a continuity model to work and to understand, you know, where you have to draw the line and where you have to say, no, I can't come in for that woman on my days off. Even if we, you know, we've already had the last four babies together. My own family needs me. Or whatever the issue is. Or no, I know they're short-staffed in birth suite, but I actually need to not go in for an extra shift because my family need me. But often there's a conflict for midwives. We're not happy about trying to juggle that. And also in midwifery, I don't know what it's like in the rest of the world. But in Australia, women have, there's a 20-year time in which women can actually take legal action over what they feel is a poor outcome from a birth where they feel they've suffered as a result. So you have that going, you know, you have that running with you at all times. You had, you know, concerns about that. You know, is that going to be me? Will this come back at me in 20 years from now? There's enormous pressures on us. And it should come as no surprise that we are also very well represented, sadly, in the Post Traumatic Stress Disorder numbers. There was Australian research done in 2017, which showed one in five midwives actually have a form of Post Traumatic Stress Disorder. And the interesting thing about this is that they've also found it essentially gets into our bodies. It actually gets down into our DNA. And that is really interesting because that then affects how our bodies work. Essentially, we embody experiences that have happened to us unless we really are skilled at not doing that, okay? So it's really important because we can see that the walking wounded can be found everywhere. I know, and I'm sure there's many of us on this call that will know the same thing. I know midwives who will never again care for twins or who will never again do a water birth, you know? And they pass it exactly, Sarah, I agree. They then pass this trauma on to the next generation. It propagates itself. There are some people that are absolutely terrified of working in birth sweat. And there's reasons for that. We all have areas that we are more suited to and that's perfectly acceptable. But often there's a background of trauma that is living with us that we have not been able to deal with. So that's why it's really, really important that we actually, as professionals, develop the ability to not take things on. It's really important, especially to observe and absorb what is going on, to actually observe and not absorb what is going on around us because this world that we're in is not perfect. It doesn't matter how many CTGs we put on women, how many doctors visits, how many skilled practitioners, we are always going to have adverse outcomes. We live in an imperfect world. The human body is not perfect. And as much as we care, no matter how much we read, we're always going to have adverse outcomes. We cannot ever escape that. So it's really important that we have a caring attitude towards ourselves. But in the event of an adverse outcome, that becomes even more important. But if we haven't got a foundation of this, how on earth do we bring it out of the box, so to speak, in the event of an adverse outcome? Which, like I shared in the previous slide, is creating a lot of the post-traumatic stress disorder that we see amongst our staff. How do we actually draw on this well of self-care and self-compassion if we aren't actually building it daily in everything we do? It's really, really hard. And as the Australian College of Nursing did a special journal in winter last year about self-care. And one of the points they made is learning from mistakes doesn't require yourself, doesn't require you to beat yourself up. But I've seen this, I've borne witness to this time and time again that that's exactly what happens. People do beat themselves up. If something goes wrong or if they think that a woman had an adverse outcome and you were involved in that care, there's an enormous amount of blaming. Exactly, Celine, I completely agree. But there's self-blame. So there's either scapegoating or we're being blamed externally. And that is the reality of an environment that we work in where we're surrounded by people that technically and culturally do not understand the self-compassion and so they're not likely to pass that on to other people. It's very, very sad. But it's important that we know that our self-worth is non-negotiable and it needs to come from knowing firstly who you are, rather than being linked just as wholly and solely what you do. And it's important that we realise that we're going to develop that from deep self-care. So in order to actually observe and not absorb, we've got to be able to maintain perspective. We're not what we do no matter how much we want to give to the profession, how much you want to give to the women. It's really important to know that not absorbing what is going on around us is absolutely crucial. And the beautiful thing about it is that when you do it, you're still providing just as much care and sensitivity and support for the woman in that room who needs you. You're not neglecting her, you're not being cold, you're not being, you know, impervious, but you are definitely not taking it on into your body, basically. You're not absorbing the whole emotion of what's going on. And we know it makes sense to us because when we're with women in labour and they're losing it and we know that they need our help and we know we've got to bring them back. We've got to help them get through this next point. One of the things that one of our main go-tos is we will actually focus them back on their breath. We will actually talk to them about how are you breathing. Come back to your nose breathing. I always say to women, just breathe in very, very gently because it's very, very calming and it gives them something very concrete to focus on. I've found 99% of the time that takes an enormous amount of the anxiety, stress and tension away and it makes an enormous difference, okay? And, you know, just to be aware of, like, how is my body feeling? You know, notice the next time you go into a room where something's tragic happened, what happens to your body? What's going on? What are you taking on? Because us taking an on isn't going to help. Us being sensitive and responsive and understanding and supportive will help, however. And we can do that much better if we're not overwhelmed by it ourselves. One thing I really love about a couple of the comments that I've seen is that it would have been really amazing, Karen's saying, to have been taught to observe and not absorb skills early in my career. And I completely agree. I'm lucky enough to be able to go to universities and I do pass this on to students whenever I can. And one thing that I am also passing on very much is the idea that students bring an enormous amount with them right from their very first day as student midwives. They may look at me with a look of shocked surprise when I say that because they think, well, I don't know anything. I'm only a first year. It's not about that. A midwifery skills and knowledge and how to express yourself as a midwife, that will all develop. But that underlying ability to care about someone else, the willingness to listen, the willingness to understand what's going on. This is something that usually I'm finding all students have and they have it in abundance, the willingness to make it about the woman, the being free of workplace politics. This is all absolutely beautiful. This is what students bring with them. And I often will make a point of bringing that to their attention and saying, do you know you are streets ahead because you have none of these things impacting on you and you are here for the pure essence of what our job is actually about. And it's about caring for women. I know myself. I got very disillusioned years ago when I entered nursing because I felt like my days were all about surviving workplace politics rather than actually being there to care for the women. And I want to make it very clear to midwifery students, they don't have to be part of the stats that have been found in the UK where half are already headed for burnout. That is not absolutely inevitable. It's really important if they learn how to love themselves, how to develop self-compassion, how to develop self-care. They don't have to end up in the stats that they see around them. They don't have to end up bitter and twisted like some of the people they've seen in the workplace. Unfortunately, we all know they exist. They can still maintain their love and care for midwifery endlessly if they're able to develop their own self-care and their own perspective on what's going on and what they actually bring to the workplace. Another thing I find is that students often have a lot of trouble appreciating themselves and I just think they already have so much their offering. They already bring a lot and their willingness to work cohesively with the staff member that they're allocated with. That in itself is absolutely brilliant and needs to be encouraged and valued. And yes, I agree, Carrie-Ann. I totally understand the very resilient students are the ones that are at the moment surviving some pretty terrible behaviours but I wonder how we got that bad and how we got that damaged and so I'd say that those damaged midwives have never been taught or shown or inspired around the concept of self-care and I think it's about time that changed and I think this has been a huge passion for me. I've never ever given up. I've never ever let it go and I keep persevering. I've worked in many different workplaces. They've all got their issues. It doesn't matter to me what's going on around me so much as I know that it's important to keep going and to keep holding on to what you really believe in. Whether that's around birth choices women having a v-back, breastfeeding issues. It doesn't matter what it's about but it's important to really hold onto things that you know can make a difference. It's really important that we truly empower ourselves as midwives to say this stops with me, this toxic workplace culture stops with me. I'm not going to propagate it, I'm not going to enjoy it. I'm going to keep going. I know that a lot of students are excellent at sourcing mentors and I've made it a point that hey, I've got 12 years experience I'm still going to get mentors. I'm still going to talk to people about what's going on for me. I'm still going to ask a second opinion. I'm still going to put my head together with other midwives and share what I know. I'm still going to be a part of professional associations because the worst thing that can happen is when we disengage because then we really, we let go of so much and we're not there in the same way it would be not only for our women but for our profession and where this profession goes is up to every single one of us and every single choice we make. And another thing that gets, that comes up very, very strongly in the literature is very much around shift work. You know, people say that shift work takes the toll on the body. Absolutely, it's not ideal to be up through the night. We know that but hey, since the start of time babies have arrived all around the clock and the same in nursing, healthcare is needed in all different times of the day. So we're always going to have to work shift in nursing and midwifery. What I found really interesting though was that when you actually look at lifestyle choices within midwifery i.e. high sugar intake that sort of stuff you will actually find that you can't just blame it all on night shift because it makes a huge difference the choices you make within night shift. It really does and if we develop a ritual that actually brings us back to our body going back to body awareness regularly throughout the shift that can make a huge difference as well. It's really important not to overdo the sugar or caffeine because they can make us really, really racy but to actually make sure we're well hydrated. Prepare nourishing food that supports your work. Soups are excellent on night shift because they don't have to... they're easier for the body to digest and also make sure you're not eating really, really heavy meals if you're doing night shift and make sure you get some daylight sunshine or go out for a walk, do the two together. It's really important and it will make a difference to how your body handles night shift. In the UK they had a wonderful initiative I'm not exactly sure if it's still going but it's called caring for you and there are initiatives all around the country at all different hospitals and workplace environments all healthcare related for healthcare professionals and one of the things that came out of that is there was a study done in a large tertiary hospital in the UK it's unpublished so I can only say this is preliminary findings but basically they looked at self-care and they looked at implementing a program and this was voluntary the midwives involved they developed the questions they developed the way the research was to be conducted and it was for 12 weeks and for six weeks for six different themes in two week blocks so what they found with that is that food, hydration and basically taking a moment to actually just detach, reconnect see how your body is feeling these were all really simple really, really easy initiatives that could be done that could be integrated into the workplace really simply and it should come as no surprise that all the respondents in this confirmed the link between self-care and the quality of care provided and one thing that was really crucial and I think is the key to effective self-care is they actually the respondents found that they developed more self-awareness throughout the program so they're able to see gosh I am actually really tired I've never really noticed it before I usually just reach for a coffee at this point or oh no I can see that that's now my fourth chocolate biscuit for the day maybe I don't need that much sugar maybe I could make a healthier choice but the awareness that they got was absolutely critical to how they then felt about self-care because the more self-aware they became the more willing and interested they were to take self-care on and it was also really important that they noticed the impact of different foods and so when you're looking at taking a moment that's as simple as it sounds it really is it's just regular stop points through the day the most important thing is that you're actually getting a sense of how your body's feeling and it's done with no judgement you're not saying oh my god I'm tired again what's wrong with me you're actually saying okay I feel tired what could that be about is it because I had a late night is it because there's too much going on whatever the reason is and make adjustments as needed assess what our body needs eat, hydrate and stretch and actually have a rest it will be one of these things that you need to do and it's really important that we actually take the time to go this is going to support me in the workplace when it comes to food as Tammy has noted and I agree with you completely Tammy I notice a difference too if I eat not healthy foods I know I feel the difference straight away or if I eat really heavy foods I notice the difference straight away if I take the effort and the time to notice what I'm eating makes a difference it's everything it makes a difference between how I feel in my shift and what I'm able to bring to the women it makes an enormous difference and even in terms of how we are when we're eating do we make the time to actually sit down or do we think it's okay to try and stuff down a muesli bar while we're running off to some other place in the hospital like it's really important that we're actually looking at the quality of how we do it are we actually really honouring ourselves we're just giving our bodies a little bit of a break I know we work in busy workplace environments but wherever we can be far more aware of how we're doing all of this and also if you know you've got say a week of night shift coming up for example prepare work in advance that's actually going to support us and work out for yourself and for your own body what is going to support what is going to make that difference because it's no good someone else saying oh you should eat this this and this it's much more powerful if it comes from your experience of my god I had that week where I mainly ate soup for dinner and I found I slept so much better or I found I didn't get as tired when I was on night shift or whatever the awareness is that you come to be your own experiment on this and hydration isn't this a really simple but often a neglected thing how often that we are telling women you know you need to hydrate you know we always tell our pregnant women and our laboring women how important hydration is and of course our breastfeeding women as well but how often are we doing that and we haven't had a drink for hours and hours and hours and another thing is even if we are drinking well how often are we you know indulging that full bladder and just letting it sit there and not actually emptying our bladder when we really should be there's actually been a huge research paper done in Australia again 2019 it's only just been published but it's all about the phenomenon known as a nurses bladder where we hold on to a bladder much much longer than we should and how that affects us how we've got you know stressing continents amongst our nurses and midwives how we've got UTIs how we've got you know who knows what the impact is of ignoring the bladder sensation long term you know day after day year after year and not actually emptying it in a timely manner I know that sometimes you know in the middle of a cardiac arrest you can't go running off to the toilet of course you can't but we you know when we can please make the effort please acknowledge that okay I'm going to theatre with a woman I'm going to be there for a couple of hours I'm going to empty my bladder beforehand you know or you know you're going into the second stage for someone have a drink of water empty a bladder and then you know you're going to be in a much better place to look after her in second stage okay and also notice the colour of our urine that'll tell us I mean we know when a woman hands us a urine sample and we see the colour of it we know straight away it gives us a great picture of what's going on notice that within ourselves are we dehydrated are we are we needing to drink more are we well hydrated and you know really you know do something about it if you are dehydrated it's really easy to use bottled water you can just take that I don't think I've ever seen a laboring woman object to us bringing in our own bottled water to sip on when we're looking after her so it's easy to achieve I've even gone off to theatres with a bottle of water just tucked in the bottom of the the cop there somewhere there's a way you can do it you've got to make sure that you prioritise it because it does matter it really does matter in terms of sleep there's lots of research on what we're not doing around it but if I could make it really really simple and I know a lot of us work shift so it's really really important it's when we're not on shift you know let's just leave the iPhones and the computers and everything away from us for at least 30 minutes before sleep research recommends longer than that it's whatever you can do that works for you and in terms of sleep it's really important that we're winding down that we're actually not essentially going 100k's an hour and then stopping at a stop sign by slamming on the brakes your body actually would much rather be be winding down in order to actually go into a sleep much more naturally and to get more value out of our sleep before midnight are known to count enormously in terms of actually replenishing and refreshing the body so really important whatever we can get in terms of hours before midnight I mean I work on calls sometimes I'm calling at 10 at night there's nothing you can do but when you can do it please make it a priority to support yourself and on night shift if your workplace allows you know please do get a short nap is found to be very supportive if you can do it we don't all have that but if you can please utilize it and also exercise and stretching is really really important I know myself if I'm with a woman in second stage obviously we're facilitating the birth in whatever position works for that woman but sometimes let's face that we can end up in positions where we're really contorted and twisted ourselves okay so make sure that you're actually consciously doing some shoulder roles you know consciously actually acknowledging where there's tension in the body and actually letting it go and you know if we're one of those rare people that in nursing and midwifery that do a do an office job where we sit at a desk then get up and move around if you've been sitting still for a long period of time because you really really need it okay and body awareness which is what I was mentioning earlier is actually really important this is really valuable because it connects the body with the mind in really really simple ways again this can be integrated this is something that we can just do as part of any task we're performing we can feel our feet while we're walking along the corridors we can feel our fingers typing on the keyboard we can feel our hands opening the doors it's amazing just don't take my word for it just experiment and see for yourself how do you feel at the end of the shift if you've actually bought focus to that do you feel calmer do you feel more in control do you feel more centered then you'll have your answer if this works or not if it's worth persevering with or not I can definitely say the research supports it and it's naturally very calming because we are actually checking in with the body and valuing what it's saying and also at the same time taking stock of our breathing pattern it's really really important okay so I'd like to I'd like to hear from people on the webinar about how they think self-care can be supported in their workplace I've got a few mentions there up on the slide but I'd love to hear from you what you think will help you support self-care in the workplace for yourself or for your colleagues if anyone's got any comments to make I'd love to hear them I love the pajama idea in the chat box that's brilliant that's a good one I'll integrate that one myself yeah if anyone feels to share anything Lorraine they may have their microphones blocked by the look of things if they're wanting to share I'd love to hear from anyone okay I think some of the this is Catherine again I think some of the previous comments about a supportive environment all together in the workplace is really like Celine's comment earlier about tension between self-care for midwives and fragmented care is very key yeah because unless we support each other we're not going to we're going to be feeling if you do self-care but nobody else in the practice supports it or does it for themselves there's going to be conflict so a supportive environment all around and I don't know regular staff meetings, retreats that's kind of thing where the whole practice is involved yeah, yeah it's important to understand that we can do self-care in a way that other people might not even notice you're doing it you know what I mean it doesn't have to cause conflict but it can be like I was saying before about the body awareness or about making sure you're hydrated all that sort of stuff that should be taking place no matter what sort of environment you work in sometimes there can be I know having worked in continuity there can be a lot of pressure to do excessive hours it definitely happens and it's not necessarily supportive for self-care absolutely but what I want midwives in today to come away with is the understanding of their own empowerment around self-care in terms of you can do a lot of this regardless of what that workplace environment culture dictates so it's really really really important and supportive is that it's mentioned and it's raised and it's discussed I've seen self-care become much more awareness around it in lots of hospitals in Australia and particularly in my workplace but also I'm working with people that I'm reminding them about self-care constantly bringing it to their awareness saying look you've worked way too many hours do you need a drink do you need a break do you need someone to take over whatever it is constantly reminding other people people usually don't mind if you're self-caring on their behalf I found and it can be one of those things where we have to be really good at saying no we actually have to say look I can't take on that extra woman or I can't take on that extra shift or I can't cover that weekend for you because you know my needs are actually really important and I have to prioritize them and that's really really important that we make a commitment to self-care and like Deb's saying in the chat box the more that you self-care the more other people tend to consider it I've found that absolutely true I found that really really important and I think once midwives make the connection that the way we look after ourselves directly impacts how we look after the women I think that the tendency to embrace self-care will be pretty much guaranteed we're being asked to have management policies and initiatives and things like that to support self-care and absolutely we can do that we can get managers on board fantastic but when it comes down to the day to day living of self-care for ourselves we can only do that for ourselves we can never make self-care compulsory we can never make it something that people are in trouble for not doing it is actually listed in our Code of Conduct around looking after our health and well-being but I think it would only be an issue for the board if it was people who were in serious neglect of their health and well-being i.e. drug and alcohol abuse that sort of thing but having said that it is there in our Code of Conduct so technically we do have a commitment to self-care as a profession but I'd like to see this lived more I'd like to see this embodied more on awards I'd like to see more midwives understanding this and I'd like to see students supported to engage in self-care as well I'd like to see self-care being really deeply understood and yeah Felicity that is very inspiring I hate to cut you off we have to leave the room to get so that the next presenter can get ready but we really we really do appreciate all your thoughts and experience on this obviously very very important topic for us as individuals and as a as a profession yes absolutely it is an absolute pleasure to share with you all today and thank you very much for attending the webinar okay I am going to um what am I going to do I have to get my slides back Lorraine I gave them to you all you got to do is click okay Felicity's got some great great resources here too as well for you if you want to follow up on some of the studies that she mentioned