Midwives provide stunning leadership learning. Totally fascinating.

About how they lead when they are “ in the room”. How they use (or choose not to use) their power, listen hard, build trust,  cope with stress.

And about how their voice disappears when they step out of the room and into the wider world. They may well have perfected listening themselves “in the room” but out of it no one listens to them. And yet the voices of many still break through.

Through the @ICM and the glorious ICM team Liselotte Kweekel, Charlotte Renard, Shree Mandke, Molly Karp and Ann Yates, I have met many midwives and interviewed for this podcast Olajumoke Adebayo, Nayiga Harriet, Luseshelo Simwinga, Neha Mankani and Sylvia Hamata. .

I have loved every minute spent on this episode and learnt a huge amount. I think everyone can.

Julia Middleton 0:01

Sylvia 3:17

I think their first patient, I tried to practice what I have learned in the city where I trained, and it was not working. Because firstly, I was not confident in myself. And it's I believe it showed to the woman because then the women also didn't look like she had any confidence in me at all. Because I was frantic, I was up and about, I knew that theory, but the practice was a whole lot different. So I think I would carry my, my textbooks with to the world. And I that's when I really prayed a lot. At that time, I asked the Lord to come in with me as I as I help these women because I didn't really trust in my skills. So I think I just thought must have you know what I'm going to have to trust these women so that they informed me what it is that they are going through, what it is that their body's telling them. And then I will use my knowledge to meet with their information halfway. So I will tell the women let me know what you're going through what your body's telling you now, and from what I've learned, like when there's a contraction when there's whatever I know what to check for, but at least I trusted her to let me know what was happening within her. And it really worked because the women felt in charge of this process. And I also felt good because then now I was able to really tell when something is going wrong but most instances nothing is going wrong and then you just deliver a very healthy baby. And I really learned that when I didn't so much trust the women when I was following what than learned in practice the way you are in charge of these delivery, women are not being really cooperative because I didn't understand what you're trying to do. And I think being in an unfamiliar environment, it made them even more anxious. But when I told them, you know what, we are going to tell you about this baby do let me know what's happening to you now, do let me know how I can help you. They were really, really cooperative. And they believed I was the best midwife ever, but they didn't know that it was difficult, because I was really not confident in my own skills at the time. But it worked out in the best way. So it's when you learn about leadership from those moments that not trust the people, when you are in a position where you are leading a person to achieve a certain goal. Trust them, they know better the process, they know what it is. And I think just be in the position where you use your knowledge and your skills to guide them. And it requires you as a person to be knowledgeable, at least. And that's why I carried my textbooks all the time. If there is something that I think I didn't know that out, run to my textbook at that moment, it was really quite an eye opener as well, how women felt that they met that during this process.

Julia Middleton 6:21

What I learned from leadership, that I find so powerful in that story is that if you trust the women, then the women start to trust you. So in a way, your definition of leadership is sort of let people do it. Let them get on with it. And your job is to provide guidance, but your job is also to accept guidance.

Sylvia 6:50

Yeah, yes. Because you can't guide a person who you are not free already to accept guidance from as well.

Julia Middleton 6:59

So much leadership. And yet when you walk out of that room, your voice isn't heard. It's sort of makes no sense. So we'll come back to what happens outside the room when you are a Silvia says just a midwife. But for the moment let's stay in the room. Nayiga talked to me about the patience you need as a leader in that room and explained the difference between empathy and sympathy, fascinating.

Nayiga 7:34

As leaders, there is no way we can lead without patience, because in many situations, other people looking to us for support, and not all the times we shall have what they need. Many times we shall need to say no. And we mean no. So that we are not pressurised. Pressured by the needs of the people around us, however, we are there to attend to them, you still stand with them with empathy, with compassion, that you care. However, they might not get what they need, at that particular moment. Also results as leaders, we should be results oriented. Many times we wait for a result and they do not come as we expected them to come and we need to be patient. So, as a leader, I need to be patient most of the time, so that I am effective at my work so that I allow the natural processes to take course.

Julia Middleton 8:47

Crucial to this is the difference between empathy and sympathy, is that right?

Nayiga 8:52

Being empathetic, a person, a patient is in need, sometimes urgent or imagines and she thinks she needs something. But according to you, as a midwife, or a health care provider, it is not what she means at that moment. So I have to boldly tell the person that this is not right. And also she may be going through a painful experience and your heart or your mind may be taken up to got down and cry with her and fail to provide the necessary care. So during her painful experience, I stand with her to show her the love and care but I remain strong and standing on the truth. That is being empathetic because when you are sympathetic, you may become so weak to help this mother appropriately,

The skill and the judgement and the sheer leadership skills are sort of overwhelming. And also, I suppose the burden and the risks seem to me to be completely terrifying. So I asked Ola what she does when she has a sense of panic occasionally, which surely even even midwives must feel sometimes.

Ah, okay. I think when first of all, you have to be aware that you panic about things, you need to know what triggers you to stop panicking. And the other thing is, once you know, you're panicking about something immediate, you can make very good decisions at that time, mitigate another colleague to help you and accept that at this point, you're quite useless to the woman, you're panicking and your mind is everywhere. So when I panic about things, ask for help. I just always ask for help. And then I tried to breathe and say, Okay, I'll come down, I excuse myself so that I don't make any mistakes. Cause any mistake you make at that point can really go a long way. So I read and excuse myself, ask for help. And when I feel bad, I come back. I don't have any magic. Just basically, ask for help, ask for help.

You don't hide the fact that you're panicking to the to the woman?

No I mean, we are all human? I mean, is when you're vulnerable, that people are also vulnerable with you, you have to be able to open up to to patients, I find that sometimes when I even have personal problems, and I just bring it out a beat, they go, oh, you know, you could try this, that I'm not even aware of. And then I demo them, I try them. Oh, wow, that works. So you really don't have all the knowledge, even if you're a health professional. And I like to listen to women, a lot of times you don't listen, it's very, it's very tempting to be a health professional, because you have all the knowledge. And you assume things before they happen. You assume things for your patients, you assume things for women, and we forget that everybody's unique with their bodies, with their persons, how they react, everybody has a unique personality. So I like to always listen. And I remember that there are times where listening to the pain points of my patient has actually helped to prevent something disastrous happening. They go oh, because Nayiga, they still use use my surname, so no Adibayo, I'm not comfortable. I'm not comfortable. I'm like what do you mean I'm not comfortable. And then she tells me oh, this is this. And I'm like, Okay, so like, check again, I'm like, Are you sure? I've checked, and I don't think anything, but still you should check, I will check again. And then I go back to check. And then I realised, oh my gosh, okay, we need to do something about it. So listening helps a whole lot. And in doing that, I'm for you to be able to listen, you have to make sure that every assumption, every knowledge you think you have, you need to drop it, you need to remove yourself from that high or soft power that you think, Oh, I have all the knowledge, I'm here to deliver this baby, you need to come down from the high horse and say, Okay, I need to listen. So what's wrong with you? Do you feel comfortable this way? You feel like anything is wrong with you. Okay, if you feel this way, let me know. And because of the real, the real meaning of midwife is to be with a woman, and I think is because it's called midwife, we always forget what we're supposed to do, we are best friends with the woman if you are not best friends with a woman, she will still bet anyways. Because the body is designed to do that. You're just there to ensure that there are no complications. And if you spot any complications, because she's vulnerable and can't do things on our own, you're able to help by making good decisions and take her through and prevent anything. So I try to ensure that every form of power that I think I have, I strip myself of that, and ensure that I'm working with the woman, I'm listening to her, I'm empathetic with her. And you find that women respond to things like this, once they see that you listen to them, they will tell you everything, they don't keep things from you, they tell you everything, they will come up to you. And then they know okay, this person has my interest does that and they begin to trust you that way. Especially when they say something, you listen to them, and then you respond to it. Also, even if you're not able to do something, but you still try to explain to them that okay, I'm not able to do this, but this is what I can do. Is that fine with you? Or what do you think we should women would always respond to?

I think that's the most beautiful answer.

Thank you. Sometimes you don't even need to give a response. Sometimes you just say, I understand. I hear you. I'm very sorry about that. I'm like you're fine. Sometimes we feel we have to always give our opinion about something. Sometimes people don't need your opinion. Just listen. It just needed to listen and you know, sometimes you find that someone says thank you for listening. I just needed that. There are several times. And people just say I, but we think that okay, as health professionals, I just somebody's complaining to us, I just need to give out all the facts and details and everything. But it doesn't really work like that sometimes just just listen and take in all the emotions that's happening that time.

If you've learned the power of listening so strongly, how do you cope when you go outside the bubble of midwifery, and nobody listens?

Okay, so this is very frustrating. I think I've also come to terms with the fact that I listened to people doesn't mean people will listen to me, that's the first thing I did myself had to come to terms with that. Not everybody's listening to you. It's very frustrating for me, if I'm very honest with you.

And so on, it takes us to the second question in this episode, which is devoted to midwives? It's a question that if I mean, if we've learned so much about leadership in the room from Sylvia, from Nayiga, from Ola, now, let's go outside the room, to the outside world, generally, and to the world of health, where every single midwife that I have spoken to tells me they have no voice. So I went back first, Sylvia, described to me what it feels like to have no voice.

It's suffocating. To have no voice, it's very suffocating. Because there's so much that you see so much that needs to be said, and so much that will go on without your voice. And it's it's really suffocating. I think that the best way I could I could describe it. Because really, you want to say something, nobody would listen to you. You see, not always wrong, but you see things that are not right. And you are not in a position to say so. So it's really, really suffocating.

And I suppose you just sort of simply you sort of open your mouth and nothing comes out.

Yes, I mean, imagine being in a position where you're opening your mouth and there isn't anybody to listen to you. What's the point?

Does it almost make you feel that you that you have nothing to say and that maybe you don't have a voice? Because what you have to say as I was saying, does it make you lose your own confidence in yourself?

Oh yes, yes, we will. You start doubting yourself, you start doubting yourself. Maybe the reason why nobody's listening to me is because what I say is doesn't mean anything. Maybe it's really, maybe I'm not smart enough. Maybe I don't listen, good enough. Maybe I'm just not good enough. Maybe I'm wrong. It brings out that you start doubting yourself and you become used, you stay away, you pull back, and you go back into that little corner where you it's safer, if you don't say anything, because you don't want to be criticised, you are scared of what people would say if you speak out. And then you you remain this person who really doubts yourself, and I'm not sure on what to do or what to say. And really wondering if you belong in any case, and that's that's the pathway, you you just become this person, I think the the message that you get is I'm not good enough. I think that's that's in once you get into that moment, you're not good enough, you stay quiet. And when you are quiet, it will only be one day when you realise being quiet or when you just boil and then everything comes out at once. And that's when everybody sees the emotional part of it. Because it's mixed. It doesn't make sense. It's irrational, because it's all about you are trying to bring to the table things that have come out that have been going on for quite some time. And they don't even make sense at that time because they're trying to put everything together. And I think that's where you are viewed as this person who is irrational, emotional and being as I show you, okay, it was at that time of the month. I think that's the most degrading statement ever. Which is used to shut you up in a way and to demean you. Once you are asked, are you sure it's not that moment of the month? And you're like, oh, especially if it's really that powerful, that moment of the month and you start doubting yourself really, but it's not just me because it's that moment of the month, but it's because you have something to say but it's the means or it's downgraded to the emotional part of it. Yeah, it's quite frustrating. And you become a perpetually frustrated person that even when there's something good happening, you're not you might miss it, because you just see everything that is wrong. Every even when there is a little bit of improvement of an area, you just see it as wrong because you are so frustrated. And yeah.

You've been there, haven't you, Sylvia?

I've been in those positions, I left midwifery, practising midwifery because of that. I just thought I was not hurt. And in the instances when I had an audience, it was not an audience that was there to hear me it was an audience that was there to to understand why I'm wrong, basically. So yeah, I've been there. I, I've experienced it. Or sometimes you just start taking action. If nobody wants to listen to you, you start taking action. And then maybe you say, Okay, maybe if I do this, then they're going to hear me just take action and let it, let it be. I think I when we spoke earlier, as I spoke to you about the provision of family planning and immunisation to women and children in the facility or where we're at and the services we have sheduled, for thing, it was Wednesday's of the week, every Wednesday of the week, mornings. Our uptake of those services was very, very poor. Because the region we I was practising in, I think the only mode of employment that was there was a farm working, women were picking grapes. So we're not really having uptake of the services because women would not spend the whole morning at the facility, waiting for family planning and immunisation and lose out on an income. So when one of them came to the hospital with a child that was not well, and I found that the immunizations were not up to date, I started offering immunizations at night, as soon as I have an opportunity. I have contact with a child and I would provide immunisation, and the mothers would also take it for granted. I guess it's like another half of my contraceptives, right. Okay. So that was a challenge when it was found out because I was moving outside the norms of the policy, which services should only be given for that, and understandably, so it was good for planning. But for me, it was not making sense. You have these services for the people. But if people are not making use of it, what's the point? So I think I had to get out, I had to get out for it to be noticed. And it didn't go without a warning. But at least the policy was changed. So you will resort to really unconventional means to get attention. So yeah, it's how we cope when nobody's listening to you.

What triggered you, or what flipped you, what inspired you to suddenly get a voice because listening to you now, there is no doubt you have a voice.

I think it really matters when you have somebody talking to you and telling you, you matter. Your voice deserves to be heard your experiences deserve to be heard, and there's no right or wrong, anything in life, you just share. And yeah, all of a sudden, you're hearing that you are not the only one who has self doubt issues that all the women that you see around you, who are doing great things they do so even when they are scared, they doubt themselves. They ask themselves whether they are good enough and they still have gone on to do great things. So it was a it was good for me to see that what this what I think of myself is normal, I suppose. And don't be scared about whether you are in a team of highly achieved people. They know what they know and you know what you know, don't doubt yourself for anybody.

They know what they know. And you know what you know. Sylvia's words are ringing in my head and ringing I then went on to talk to Lucy Shelo Who has a very has to be honest, very little experience of good leaders, very few good leaders who've ever said to her, how much she matters. Mostly her experience has been of bosses not leaders. Have a listen.

So a boss I think a boss will lead you will will order you around like do this. You have to do this and when you maybe you try to tell them how it's it can be properly done they will crush you. The bosses will feel like they know everything, right they will not do not want anyone to tell them what to do. They'll not want anyone to to provide like the decisions in the matter but then a boss a leader leads the way he does will say let's do this. Let's do this together. Yeah, in when when some when, maybe the subordinate is providing some decision on what they're talking about, they'll try to adapt. They'll not literally abandon the decision. Maybe they'll adapt. Let's do it like this. Yeah. While leading the way and knowing what to do in the process, without ordering the people around.

Have you worked many bosses?

I've worked for bosses and worked for leaders as well.

Tell me what impact the two of them have on you.

So on me personally, I think the bosses, they bring out aggressiveness and defensive from me because as soon as I've known that this one is a boss and not a leader, I will not listen to them. I will not be a good subordinate. But once I've known that I'm working under a leader, I become defenceless, because I know this one knows what she's doing, or he's doing, and I'm glad to work under them. I'm glad to have to follow what they want to. They want to tell me because he does mostly they also try to teach you because you cannot know everything. So they will make you grow in your career. They'll make you grow as a person as well. But a boss, I think the boss will only want you to help them advance their own goals to advance their own careers.

I almost tremble at the thought Lucy Shalo, when she's decided not to be a good subordinate. Not an easy task for a boss to take on. But then I thought I'd ask her about whether there was ever a leader that she'd actually forgiven.

So I was I was on night duty, and we had a client, a woman who was in labour, and so she had, she had foetal distress. Her baby was going into foetal distress. It was at night, so we were supposed to call the theatre team to come operate on the woman but then we did not have a fuel in the car that was at the hospital. So the theatre team did not come up until the woman lost her baby in uterus. So when when the boss came, when we inquired further, they said the boss's car, it was a government car, but then it was in service of the boss. So they said the boss's car had fuel, but then the other cars at the hospital did not have have fewer. So in the morning, I went to the boss and then I confronted him like your car had you. But then we lacked fuel to go collect the theatre team to help this woman up until we lost the baby. So the boss was quick to the leader. Now I will say the leader was quick to say, I'm very sorry that happened to you. And from now onwards, you can use my car for when when you want to improve the client. So that and him a lot of respect from me. I was like a leader who can say sorry for subordinates, I have so much respect for this leader.

So let's move on to Neha. I asked her just how bad does it get? Is it just that younger midwives suffer? Or does Neha suffer as well?

I've been in labour rooms I've been with obstetricians I've been with in rooms in big meetings, and I felt like someone's asked a question, I've known exactly what the answer is. But I couldn't vocalise my answer, because I didn't have the confidence for it. Because I had always felt like, oh, as a midwife. Why would I know the answer to this question? Or why would what I have to say the important and that is a very good example of not having a voice because I literally didn't have one in that that situation. Or if someone if you're sitting with 10 people, and you answer a question, but someone else talks over you, again, you feel like your voice doesn't matter. And that makes you voiceless, essentially.

What's the emotion that sort of stirs up inside you?

I think what I would say is, a lot of times it was frustration. And that frustration in a lot of times would kind of translate to it does translate to anger, I would say in a lot of places, and it does translate to, its anger, it's frustration, it's disappointment.

And when you do have a voice?

When you have a voice, when you feel like you believe in the work that you do, it also kind of starts reflecting in how you work. Like if I have the confidence I know that what I'm thinking is right, I don't second guess my own work. I don't second guess my own beliefs. I don't second guess my own values. It starts reflecting in how I work as well. It changes the quality of my work, it changes the integrity of my work. So I think it's very interesting that way, like how it kind of changes the outputs and what you put into the universe and into the world.

Absolutely. And it's interesting, you change you use the expression when we spoke, fake it till you make it but then you changed it, act it till you make it and tell me your logic.

A lot of people when they're put into new situations in business thing that's happened to me, I think it's happened to a lot of people around us where they put in new situations where they don't actually know how they will navigate, navigate these situations or whether they have in them what it takes. And you know, an example of this is just when the same kind of situation with midwives, where they put in situations where they don't know if they are going to be able to deal with it. And the first few times, you tell people that a lot of times I've seen this happen so much where people, midwives will say, Yeah, I know, I know how to deal with this case, I know how to deal with this situation, I can deal with this emergency, but they probably at that point, are really, really scared. But like the first 10 times that you tell yourself that yes, I can do it, the 11th, you'll actually be able to do it. And that's true of clinical skills. But it's also true of our earlier conversation of finding your voice, that the first you know, I think I know so many people who have impostor syndrome, because the first they are put into situations where they don't actually know the answer that they're saying, or the value that's been assigned to them shouldn't be there. Where, you know, why am I being treated with so much importance? Am I an important person, but then you'll see, you'll hear yourself and you're in that situation, and you hear what you're saying, and you hear how people are responding to you. And you say, okay, maybe I shouldn't have impostor syndrome, maybe I really am who people think I am. So that's part of my you know, fake it till you make it or act it till you make it process that I think about quite often.

And it even happens when you are as successful as you are.

Even now I've had a lot of speaking opportunities over the past few years. But every time I would enter that room, whether it's virtual room or real room, I would think Why would anyone want to hear what I have to say? Except it was exactly like that, like I spoke, after the first few times I realised that maybe my input is important, maybe what I'm saying is irrelevant on some level. And it just kind of comes together in the exact same way that you when you give people opportunities to kind of hear what their own thoughts are, it just changes how they start thinking about themselves.

So to end these discussions with midwives, I went back to Ola, who talks about the need to strip yourself of power when you're in the room, she then qualified that, because as she says, when you go out of the room, you can't afford to strip yourself of power. You might even have to do the opposite. What are the things you're saying is a lot of leadership is about stripping yourself of your own power.

Yes, you have to be very conscious of whatever power you have whatever set in and know how best to use it. When it's a man space, or a masculine space, those type of things won't work, because they don't function with that. You have to hold your power. So you definitely even have to know when you hold your power and use your power, it's a very tricky balance.

Hang on, let me just go back on that what you just said, I think was you shouldn't strip yourself of power if you're in the man space.

Yes, yes. If you're in a man's space, men don't strip themselves of power, let's start with that. They don't function with that. So in a man space if you strip yourself of power, I don't think it will help you. I mean, in our, in our space, our daily space, everyday spaces, I have experienced walking into the masculine space or a space filled women. And as a woman, I don't even feel that powerful and then the little power I have I tried to ensure that I hold on to it so that I don't get intimidated or I don't get thrown to the back. So every male, in a man space or a masculine dominated space, I don't think that the best place to strip yourself of power. Because it's going to you find that you get what I want to use, you get thrown to the back. So you have to be very conscious of that. I would not go down to so much power when I'm having to deal with a woman in labour because that's a very vulnerable space. But a masculine space is not vulnerable, that's nowhere to restrict yourself and be vulnerable. In fact, if you're not careful when you use your vulnerability against you, so they'll say oh, I mean you still get the easy a woman can be properly. o why would I want to strip myself off really to power that I have in a mans space. I don't think I want to do that. So it's a tricky balance. If I'm being honest.

Thank you Silvia. And thank you Harriet and thank you Ola and thank you Lucy Shallo and thank you Neha. I have found this episode utterly transfixing. I tried to make a list and it became quite a long list is the truth of all the things that I it's actually, it's got 15 points. What did I take, leaders have to listen, have to listen actively and ask questions and show people that listening, leaders have to get it really clearly across that we're doing this together? Third, leaders have to trust people, and then they begin to trust you. Fourth, you have to give and accept guidance. It's two way. Five, patience is so crucial, judging the timing of things is so crucial. Six, the difference between empathy and sympathy. Seven, remember to be human, to open up to ask for help. Eight to strip yourself of power to come off your high horse, but only when you can afford to. Nine to get out of the way, as a leader. 10 to speak up and not boil over and anger because you haven't. 11 to tell people that they matter. 12 to remember that you're not the only one with doubts. 13 to say you're sorry. 14 to keep going and know that the 10th time you do it, you'll do it even better. And maybe 15 to give other people opportunities. What a golden list. I'm going to do more with midwives. I'm not I'm not walking away from this, I am fascinated by midwives and their leadership skills. And I'm going to work, I'm determined with the ICM, to reach out to more midwives. If you want to come and join us, let's talk let's talk a lot about leadership. I'm fascinated by it. So today is Wednesday, on Friday. Our next live for the expedition happens at 9 Am UK time on Friday, the 30th of September. I'm afraid most of you in North America, and South America will be fast asleep. I'm sorry, but lots of other people in the world will be awake. So we'll, we'll have some fun. We'll answer each other's questions. We'll talk about the expedition. And we'll talk about other things. And particularly, I'd be with, if you remember all the lives always has another member of the expedition part of them. And this time it's Fatima. So it'll be Fatima and I Fatima is a member of the expedition and I answering all your questions either about the expedition or perhaps about Fatima's passion, which is because she's based in Brussels, how does cities where so many cultures meet together thrive because of them being the centre point of many cultures meeting together. So it'll be fun. Come and join us 9 AM UK time on this Friday that starts in two days time. In the meantime, much love. much love to everybody who is a midwife out there. Please, please, please tell me your stories. I have learned so much from them. Lots of love.

Thank you for listening to the podcast. We would love you to follow the expedition and provide your own stories and perspectives. You can do this by subscribing to this podcast and joining the women emerging group on LinkedIn where you can have your say.