How Does One Midwife Communicate Effectively

I have always been interested how different individuals communicate to be more effective in their career. I moved from NYC to New Zealand in July 2015 and one of the big difference I noticed here from the United States is that midwives deliver babies instead of doctors.

I interviewed Jo Toma, midwife and Lead Maternity Carer (LMC) practicing in two towns, Taupo and Turangi, located in the central North Island of New Zealand. Ms. Toma has been practicing midwifery since 2006 and in November 2015 delivered her 500^th child in the world and she always says to expecting mothers when they are about to deliver, “Are you ready to meet your baby?”

On April 24, 2016, Toma was featured on a Māori community affairs television show, The Hui, on Channel 3 in New Zealand, for her caring work with pregnant Māori women and their families. Māori are indigenous Polynesian people of New Zealand and make up roughly 15% of the nation’s 4.5 million population.

I believe Toma is an outstanding communicator in her practice with clients, medical professional colleagues, social workers, court and law enforcement officials, and governmental agencies because she listens respectfully, respect views other than her own, and is very clear, unambiguous and straight forward in her professional communications. But she also has the ability to look for common ground that can be built upon. I would say she utilizes a communications style that anticipates and prevents problems by clarifying situations to the benefit of all individuals involved in her profession.

Midwifery in New Zealand regained its status as an autonomous profession in 1990. The Nurses Amendment Act of that year restored the professional and legal separation of midwifery from nursing, and established midwifery, and nursing in New Zealand as separate and distinct professions. Midwives work in many ways to provide maternity services to women and their whanau (a Māori word for family).

I interviewed Toma and asked her a few questions about her professional communication style, her communications with clients, and communications with professional colleagues.

Below are some of the questions asked, and summaries of her responses.

Q: Have you taken any communications courses. If yes, how have you applied what you have learned to assist you in communicating more effectively.

Jo: I have taken a 1-day course which is called, SBARR. SBARR is an acronym for Situation (What is happening?), Background (What is the relevant clinical history?), Assessment (What do I think the problem is?), Recommendation (What would I do to correct the problem?), and Response (Is the response appropriate? What will I do?). This communications tool is designed to give all medical information concisely and quickly. So we use it in acute situations to quickly communicate critical care information. It has improved my communications when you need a formal way of communicating with medical staff.

Q: How do you like to be communicated with professionally?

Jo: Clear and concise for all communications, written and verbal. No waffling or going over and over points again and again. I want clear and concise information, quickly with minimum chatter in a business/clinical sense. I hate waffling.

Q: How has your communications style change (if it has) over your career?

Jo: Absolutely! More concise now. I gave the facts that are needed as opposed to my opinion. I cut out the waffle because I know how I appreciate clear and concise communications.

Aaron: What happens if the communications are not direct, what do you do?

Jo: I redirect. I stop them and ask questions. What’s the situation, what’s the background, what’s the assessment, what’s the response, and so give it to me in that format. All professional staff talk in the SBARR format. That’s the gold standard in communicating in medicine.

Q: What was the best advice you received about communicating with others in a business environment?

Jo: Communicating your business and clinical duties is not a friendly chat. It’s getting information across and receiving information. It’s different that chatting with your friends. One line that I draw is about transferring of information. I want it really clear and really concise. I want one word answers/two word answers. Yes, no, I did it here.

Aaron: Are there times when you need to be social or just warm-up to a professional colleague you just met?

Jo: The first time we spend together, lots of background information on both of us, lots of sharing of stories. We talk about that in our medical environment – ‘the sharing of stories’ versus ‘the gathering of information’. We share stories for the human to human friendly side then we go into the business side - concise communications.

Q: Do you use humor as a communications strategy?

Jo: With my clients, absolutely – with my colleagues never.

Aaron: Why with your clients?

Jo: Because I work with a lot of teenage girls who are lower socioeconomic status and I don’t want to not have the barrier of being professional with these women. Working with clients is about working with them on a personal level. You are still trying to gain information but they often don’t have very effective communications skills and so you are trying to tease it out in a caring or humorous way or a motherly role for some of the young girls. Trying to get the pertinent points out of their story. I always, always paraphrase the girls because I need to know that I’ve understood exactly what they have said. I paraphrase with humor or empathy to make sure that I have understood and to make the women feel comfortable. You have to work with what every communication style they are using...a lot of what you learn about a woman having a baby in nonverbal. How she is sitting, her eye contact, all of the other styles of communicating that you pick up.

Q: What are the most difficult conversations you have in your job?

Jo: One is where we have to give the woman bad news about her unborn baby and counsel her on what her options are. I try to keep it very, very clinical but it’s always emotional. You cannot be but emotional but giving clear, concise direct information is important.

Aaron: How do you show empathy in those situations?

Jo: More non-verbal, body language and silence. Just giving them time to digest the information. Silence in those instances are a big communicator.

Q: Who do you admire as an effective business communicator and why?

Jo: Richard Branson because his whole style of management is about empowering people rather than disempowering. He has a great management style for his employees. He has an open-door policy. He is open to all parts of his employees’ life because he understands that their family life does impact on their ability to perform on their job. He has an open style of communications with his staff which I think is great.

Aaron: What does empowering employees mean to you?

Jo: I think the powerful quote Branson says as a CEO is, “It’s not my job to look after the clients, my job is to look after the staff to enable them to look after the client.” So he knows that top level of management should not be concerned with customer service. They should be concerned with employee relations because if you have happy staff, you will have happy customers. It shows that the staff is respected and they are valued members of his team and everybody likes to know that they are contributing. It’s a basic human need to feel valued – that your contribution to this planet is important and he communicates that to his staff really well. His staff turnover rates are low; employee feedback is positive. Most people have a wish for working at Virgin.

Q: What effective communication strategies have you used in working with Māori individuals?

Jo: Using native language when you are able to. Even if it’s not fluent and you are interspersing some Māori words it’s important because it gives cultural identity to your communications. The feedback from clients is that they really appreciate it because you made an effort to acknowledge who they are.

Interviewing Ms. Toma reminded me each profession communicates differently depending on the situation. But there are common communications skills that transverse across occupations like active listening, respect, non-verbal cues, telling stories to connect with others, and confirming that the person you are speaking with understands you and you understanding them.

All the best with your communications.