Mamas – are you being heard? Midwives, students, health practitioners – are you hearing your patients, or are you just listening? These two terms may seem to mean exactly the same thing, but in health care, recognising the difference between the two – and practicing it – is an essential skill for a great clinician.

I’m sure we’ve all had experiences at a café, supermarket, retail store where something you’ve said has not produced the desired response from the employee. And this can be insanely irritating when it happens!

Well, it can be the same in health care. Listening means being aware of, and paying attention to, sound. Hearing can mean both the process of perceiving sound, and also the opportunity to be heard and understand. We spend our days (and nights, if you’re a student or midwife!) immersed in conversation and words. But are you actually hearing the true meaning behind the words? Health professionals are taught crucial communication skills during their studies at university – namely the art and practice of verbal and non-verbal communication. This is aimed at developing our abilities to read situations (such as gauge someone’s level of comfort) and respond sensitively (verbally and non-verbally communicating empathy, comfort, medical care).

However, listening versus hearing is not something I’ve seen considered as part of this. Hearing means you are paying attention to the specific words being used, as well as the non-verbal cues accompanying the words. This skill can take a little to fully comprehend and practice, but it will make the world of difference to our patients if you can nail it. It might also mean you are the one who can figure out what’s going on in a complex case.

You could be forgiven for getting to this point and thinking “I don’t get it – of course I’m empathetic, and listen, and respond accordingly. I did that subject in first year of uni, anyway!”. Well, consider my example below:

 

A few weeks after I had Emilia and had brought her home, I had to take her to the GP for a referral for a hip ultrasound. On the outside, I probably looked like I had my shit together. Internally, I was a mess of crippling anxiety relating to having a tiny, premature baby completely dependent on me, coupled with the unresolved trauma of my experiences in pregnancy. I was terribly unwell, and I was struggling. And, probably subconsciously, this appointment was a point of contact to the medical community, and even though the appointment was for Emilia, each clinician has a duty of care to ensure that baby's wellbeing, which includes the health of the baby's carers. I mean, potentially she was at risk - if my anxiety had worsened to the point where I neglected myself or was not coping.

Anyway, the GP started with a few questions about her history. He asked me how my pregnancy was. “Horrendous!” I shouted, way too emotionally, then cut myself off from saying more. First red flag. GP then asked about the pregnancy complications and management, which I rattled off the seemingly unlimited list of things that went wrong. Again he didn’t twig – of course, he was doing a job, but there was certainly no sign of the active listening skill here. Finally, he examined her, which required her to be clothes and nappy off – and I practically begged him to find a set of scales and weigh her too if we were getting her clothes off. See, I had this huge fixation on her weight gain (being tiny and premature), but this was completely unnecessary as she’d been weighed a week earlier and was gaining well. However, he indulged me, and then sent us on our way, referral in hand, but he'd unwittingly started a new battle in my head of "has she put on enough weight?" instead of taking the chance to reassure me. I look back now, many of those mental battles resolved and with the ability to think rationally back, and I think “what an absolutely terrible missed opportunity”. I also think - "how many other parents have had similar experiences?". How many times is someone experiencing some inner turmoil that manifests in covert symptoms that aren't picked up, or are dismissed as personality traits or difficult behaviour?

How many of our mums-to-be or new mums must be struggling with their worries about their baby, with a level of shock, trauma, and unresolved distress at some particular part of their pregnancy or birth journey? Coupled with the common stresses that accompany this time - sleep deprivation, relationship adjustments, and financial challenges – it is no wonder that postnatal mood disorders are at an all-time high. And we, as practitioners, are often task-focussed (often a side effect of a busy, overburdened health care system), just trying to get the job done. But in doing so, we miss actually hearing what our mamas are telling us. And the clue might just be in one word ("horrendous!") or subtle body language.

From a legal perspective – it’s important to consider the potential ramifications of missing something. In my case, eventually I recovered and so you could say there was a good outcome. However, had my emotional state continued to decline, I would have become seriously mentally unwell, and this would have threatened the health of myself and Emilia. Who knows what might have happened. And I can’t help but think of some of the terrible news stories that happen sporadically about parents who hurt themselves and/or their children. How many warning signs were not observed? How is it possible that such emotional distress in one person is not detected?

From a mental health and wellbeing perspective, it upsets me to think that our mamas are living in such hidden, emotional turmoil. For some, they are well aware of their feelings, but hide out of shame, or fear, or for other reasons. For others, they might have absolutely no insight at all, and this is not helped by people who foster this myth that just because you have been pregnant, given birth, have a baby, are sleep deprived and so on, that it is normal to feel this way. Sure, it might be expected to feel like that after the experience, but this does not mean we have to accept these feelings and push through.

Here’s another example of listening, but not hearing.

I rang the breastfeeding hotline when Emilia was about 8 weeks old (but 3 weeks corrected age based on her due date). It was the evening, and she’d been really unsettled, on and off the breast, and I was questioning my milk supply (the ol' number one suspect, but much maligned and usually innocent!). The woman I spoke to asked about our feeding practices, which at this stage we were giving Emilia two bottles a day of expressed breast milk, to give her medication (as directed by paediatricians). This woman did not hear that information. She heard ‘bottle feeding’ and immediately went on a bit of a lecture about how bottle feeding was dropping my supply and causing the baby’s behavioural changes, and I needed to stop this immediately or I’d lose my supply. Definitely NOT the greatest advice for a vulnerable new mum. Luckily, I still had the brainpower to know it was NOT my supply (I had just expressed 80ml in 3 minutes!). It turned out to be the beginning of colic, and I was just unfamiliar with the behaviour pattern which emerges around that time and will resolve on its own. I’m just glad I ignored the fear of low supply, which is what pushes some new mums to abandon ship so early on (often when it’s just a perceived lack of supply, rather than a real one).

But you can see again from this example how easy it is to get your clinical practice wrong if you are listening but not hearing.

Mamas, what are your thoughts on this post? Are you being heard? Does this prompt you to speak a little louder if you are not being heard?
Student midwives and midwives – next time you are working with a new mum, or mum-to-be, focus on whether the words are matching her presentation as well, as this will give you even more of a hint as to what might be going on for her. Having had these personal insights as a mum, now as a midwife I can recognise these behaviours in many of my patients. And I can say, I reckon with any patient that you might be struggling with, that you can’t quite engage with, who has difficult behaviours or seems odd  - it’s probably anxiety (and another suspect that flies under the radar still is family violence). So then you need to dig a little into the history and see what might be in there that would prompt some distress. This can be something very low-key for us health professionals (like induction of labour), but overwhelming for our mamas (because of the intervention, because it took forever, because it was so quick, because of the pain…and so on). I have even seen a mama traumatised after what seemed to be a beautiful water birth, just because it was not how she’d somehow developed a notion that waterbirth = painfree, glamourous and easy (when it is anything but!). Hopefully this post has helped any health professionals reflect on your own skills of hearing what a mum is saying, and you mamas might feel more in tune with why some interactions with your midwives and doctors leave you feeling like they are not quite getting you!