Sign up for the Self-Care Trailblazer Group email list and receive our updates and newsletters!
By Angelique Mugirente, Program Officer, Jhpiego, Nanuka Thapa, Senior Program Officer, Jhpiego, Vusi Ndaba, Project Officer, Jhpiego, Yvonne Delphine Nsaba-Uwera, University of Rwanda School of Nursing and Midwife.
In collaboration with the Self-Care Trailblazer Group and Jhpiego, we hosted a workshop earlier this summer at the International Confederation of Midwives’ Triennial Virtual Congress on the role of self-care in taking care of ourselves and our patients.
Self-care often has many different meanings to different people. When we talk about self-care, we are using the World Health Organization’s definition as “the ability for individuals, families, and communities to promote, maintain health, prevent disease, and cope with illness with or without the support of a healthcare provider.” Each one of us has seen the power of self-care in our own lives and in our midwifery practice.
Unfortunately, self-care can often be misunderstood. Many people believe that midwives and other health professionals are opposed to self-care. But we know that isn’t true. Self-care is an essential part of everyone’s life, especially health workers. We know that self-care benefits our patients and ourselves. But it is not surprising that there are myths and misconceptions about self-care because it’s often not discussed. That’s why we want to dispel common myths and share why self-care is important to us as health professionals and to our patients.
A care mindset is what led us into our profession. It’s not uncommon to put our own physical and mental health on the backburner, so we can care for our patients. In a survey conducted among midwives in Rwanda, more than half of the respondents reported that self-care is for their patients.
We’ve heard midwives say, “I should be able to cope” or “I don’t have time for self-care. I need to do other things first.” But this mindset can come at a cost. A recent systematic review of burnout among healthcare providers in Sub-Saharan Africa found high rates of burnout among midwives along with emotional exhaustion and other physical issues. As health workers, we must walk the talk. We need to prioritize our physical and mental health and practice self-care – just as we promote it for our patients. Self-care should be integrated with occupational health and safety in the workplace. Employee wellness programs can also be streamlined to address the self-care gaps by healthcare providers.
Many people believe that prioritizing your own health is a selfish act. This belief is all too common amongst some health professionals. We’re trained to put others’ needs before our own. As midwives we are always short of time and think we don’t have time for self-care. In the survey of Rwandan midwives, 79 percent of the midwives responded that they do not have time to take care of themselves. In a Rwandan midwife’s typical week, the time allocated to self-care is almost nonexistent, not only for the practice itself but also for discussion and advancement of self-care amongst the team. So many of us have thought, “What will others think about us if we’re practicing self-care when we have patients who are in pain?”
But the truth is nobody will benefit if we as midwives ignore our own physical and mental health. Even short breaks to make sure we’re attending to our own physical health needs can have a tremendous impact. We will not be able to take care of our patients if we’re in poor physical health or emotionally exhausted. It is important to remember that our need for self-care doesn’t go away the busier we get. By taking care of ourselves, we are making sure we can continue to take care of others. Self-care is not a selfish act!
We have heard providers’ concerns over policies and programming that promote self-care – worrying that it can be unsafe or diminish their role in patient care. The reality is only a small percentage of the care patients receive is from health professionals. The majority of healthcare people use throughout their lifetime is outside of the health system. Self-care is an essential part of all aspects of our work as midwives. Self-care approaches are used in family planning to prevent unintended pregnancies and provide infertility services. Self-care helps eliminates unsafe abortions and is used to prevent sexually transmitted infections and improve antenatal, delivery, postpartum and newborn care. As midwives, we are trained to partner with our patients to ensure that they know about and are able to access evidence-based self-care such as self-injectable contraception or digital health apps. This helps them have ownership of their health, improving health outcomes. At the same time, it also helps us focus our time and attention on our patients with the highest needs.
Similar to the concern that self-care diminishes the role of the provider, there is also a prevailing myth that self-care is a substitute for the formal health system. Too many people believe that self-care is an ‘either or’ proposition where people either have access to the full services of a health system or they will have to practice self-care on their own. Self-care is not a work-around to the health system. The strongest health systems around the world recognize that self-care is an essential part of the health system. Those health systems support providers in partnering with their patients. These providers work to ensure that individuals have the knowledge, tools, and resources to promote and maintain physical and mental health, prevent illness, and continue to care for themselves after they have left the clinic to exert more control over their health.
The term self-care is often used in popular culture to mean de-stressing and finding a way to relax after a hard day. But for something to be self-care, it has to have a positive impact on one’s health. For example, studies have found that there is a high percentage of cigarette smoking among healthcare workers in some countries. In some countries, there’s even a higher rate of smoking amongst health workers than the general population. Healthcare workers who smoke often report it is to relieve stress or feel less anxious. Other people will spend time trying to destress or find temporary relief in the short-term by using harmful or destructive behaviors. But gaining short-term relief at the expense of our long-term health isn’t self-care. Instead there are healthier behaviors that people can adopt to help cope with stress such as yoga, meditation, or physical exercise.
Self-care has received attention over the last 18 months because of the COVID-19 pandemic. We’ve all been practicing self-care by washing our hands, checking symptoms to make sure we don’t have COVID-19, or using digital platforms to avoid going to a clinic for care. The pandemic has demonstrated that our patients can practice self-care safely in the privacy of their homes by using evidence-based tools and approaches. This has reduced the risk of exposure and allowed us to focus our time and attention on the most critical tasks. But, self-care isn’t only important during a pandemic and not only for vulnerable patients – it is for everyone at all times. Self-care has existed for millenia and it will continue to exist long after the pandemic has ended. What the pandemic has done is create a critical opportunity to chart a new frontier in healthcare where we can take what we’ve learned about the benefits of self-care and strengthen the policy and regulatory environment for self-care interventions.
Many people hear the term self-care and they think it’s free and just a cost-cutting measure for the health system. While some interventions, such as performing a breast self-exam, are free, that’s not universally true for all self-care measures. There are often associated costs with self-care approaches whether it’s a woman using a self-sampling for human papilloma virus (HPV) kit in the privacy of her home or midwives providing health education sessions to their patients about antenatal care. The products, tools, and providers’ time does come with a cost and it’s important that those costs are not shifted to our patients and that healthcare providers’ time goes uncompensated for supporting self-care. Self-care can be a cost-effective method for health systems, but we must recognize that these approaches still have costs and should be included in health budgets.
These myths about self-care are untrue. What is true is that midwives and other healthcare providers are key partners in promoting effective self-care, equipping people to follow best medical practices, and driving awareness of how patients can safely contribute to their own health. As healthcare providers, we should practice self-care in our own lives and champion it with our families, patients, peers, communities, and in our professional networks. We can advocate within our country’s health systems to include self-care in policies and midwifery curriculum. Our professional associations should provide training to members about self-care practices so that members can support their patients and themselves through self-care approaches. We can also join in the self-care movement that is working to educate people about the benefits 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.