Life 'on-call' - making it work.

Recently, this question was posted on the IMUK Facebook page:

"I am really interested in the work/ life balance for family and relationships when on call all the time. How does it work?"

A really good question, and perhaps a concern that prevents people from working as an IM (insurance issues aside).  So this blog is for all you midwives, student midwives and aspiring midwives about the reality of life on-call and how midwives (IMs, NHS case-loading midwives, commissioned groups of midwives) find it not only workable, but balanced, rewarding, and fulfilling.

I have worked on call since October 2007; I have taken periods off, I've had periods where I have been on my knees, I have missed some family birthdays, I have even missed a family break.  There have been times I have totally resented it (and even tried to side-step for a bit), however the freedom to manage my working life, the autonomy I have as a midwife, the joy of seeing a family grow as you support the mother and empower her, outweighs the days when being 'on-call' can feel too much.

Working Hours
Developing my own self-imposed 'working times' was one of the first things I had to learn: initially I didn't do this as I was just so excited to provide the care I was offering.  What I quickly learnt was that not having my own 'boundaries' made me tired and resentful.  So now, I never work Sundays unless I am at a birth or it is early postnatal days; Sundays is family day, TV day, reading day; I won't answer texts (unless urgent) or check facebook / emails or make routine appointments.  I stipulate this to clients at booking and I have found that most women fully respect this.  My working 'hours' are 8am - 8pm, and only women in labour or urgent issues get my attention.  I home educate so most of my appointments are late in the afternoon so I can be there for my family.

Switching-Off
This is a real skill that takes time to develop; early in my IM career if a woman was 'imminent', getting to sleep was a problem.  What I have learnt in my time on-call is interesting; if I have not been called by 10pm, then I am very unlikely to be called out in the middle of the night.  I may get an early morning call, or a late evening call, but, in almost 6 years and caring for over 50 women, I have only been called out in the middle of the night a few times.  So if I go to bed without a call, I feel quite confident that I will get a full-nights sleep.

I have also learnt to tell women the days that are really inconvenient to me.... always spoken light-heartedly and with a smile, but since doing this women seem less likely to birth on those days.  I put it down the Oxytocin Factor - if they are worried about me not being there they release adrenaline and don't labour!  I only do this for really important things, like family birthdays and so forth - and of course I will be there if the baby decides otherwise anyway!

Having a Social Life
This was something else I struggled with; frightened to make commitments in case I got 'the call'.  Now, I just live life 'as usual'; I tend to drive myself places so I have the car if needed, women are asked to let me know if they think things are 'happening' so I can get home / sort my family/ make a decision about whether to go or not.  Generally, I will stay close-ish to home.  My family are really supportive and don't tend to mind too much if I can't make something; they do of-course have times when they feel the pressure of my work, but because there is so much time when I am available, around and participating, they get over it quickly.

Friends also know that sometimes I will cancel things last minute - but I guess knowing their friend is attending a birth must seem quite cool.  They certainly like to hear the birth story later!

Drinking is of course a bit of a no-no; turning up pissed to a birth might not be the safest way of practising.  I do have the occasional small glass of wine, and I like to make up for it when I am 'off-call'; personally I think my liver enjoys the time off.  And it saves me money.

The 'best-bits'
Supporting women and knowing what is important to them; not having to 'quickly' read notes and get to know the woman and her 'preferences'; practising 'hands-off' autonomous midwifery; managing my workload (choosing my hours outside of births); drinking tea and laughing with clients; continuity of care; taking my children to meet the new baby; wearing my own clothes (silly, but I hate tunics - so 'official'); being my own boss; lie-ins - no early shifts for me!; feeling proud of what I do; meeting fellow IM's and sharing stories and skills; meeting students - and learning from them as they do from me; having time with my family when I choose to; not waiting for the 'off-duty' to come out; catching babies with inquisitive assistants.......

The list is end-less.  Working this way is not always perfect, and there may be times in my life when working within the NHS will be the right thing at that time and having 'set' hours will be what I need.  Until that time, I will choose to work in this way - and fight to work in this way.

So I hope this answers the question for you - about what it's really like..... and maybe it might help you answer this question on survey monkey:

Would you work as a self-employed midwife?


angela xx