title: 'Midwives Overboard!' Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.
abstract: OBJECTIVE
  Midwifery practice is emotional and, at times, traumatic work. Cumulative exposure to this, in an unsupportive environment can result in the development of psychological and behavioural symptoms of distress.
  
  
  BACKGROUND
  As there is a clear link between the wellbeing of staff and the quality of patient care, the issue of midwife wellbeing is gathering significant attention. Despite this, it can be rare to find a midwife who will publically admit to how much they are struggling. They soldier on, often in silence.
  
  
  OBJECTIVE
  This paper aims to present a narrative review of the literature in relation to work-related psychological distress in midwifery populations. Opportunities for change are presented with the intention of generating further conversations within the academic and healthcare communities.
  
  
  METHODS
  A narrative literature review was conducted.
  
  
  RESULTS
  Internationally, midwives experience various types of work-related psychological distress. These include both organisational and occupational sources of stress.
  
  
  CONCLUSIONS
  Dysfunctional working cultures and inadequate support are not conducive to safe patient care or the sustained progressive development of the midwifery profession. New research, revised international strategies and new evidence based interventions of support are required to support midwives in psychological distress. This will in turn maximise patient, public and staff safety.
  
  
  CONCLUSIONS
  Ethically, midwives are entitled to a psychologically safe professional journey. This paper offers the principal conclusion that when maternity services invest in the mental health and wellbeing of midwives, they may reap the rewards of improved patient care, improved staff experience and safer maternity services.
authors.affiliation: Faculty of Health & Life Sciences, Coventry University, United Kingdom. Electronic address: sally@pezaro.co.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Pezaro
authors.affiliation: Research Development Lead in Health, Faculty of Health & Life Sciences, Coventry University, United Kingdom.
authors.forename: Wendy
authors.initials: W
authors.lastname: Clyne
authors.affiliation: Centre for Technology Enabled Health Research, Children and Families Research, Faculty of Health & Life Sciences, Coventry University, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Turner
authors.affiliation: Centre for Technology Enabled Health Research, Faculty of Health & Life Sciences, Coventry University, United Kingdom.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Fulton
authors.affiliation: The Hurley Group, London, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Gerada
mesh_terms: D005260:Female; D006801:Humans; D008880:Midwifery / Q000458:organization & administration*; D011247:Pregnancy
keywords: Health services; Mental health; Midwifery; Midwives; Psychological distress