‘A square peg in a round hole’: Navigating maternity as an autistic student midwife and beyond

Students and midwives alike come from a variety of backgrounds and experiences. In this article Holly Conley-Reid, a newly qualified midwife, shares her personal experience of having autism as a student and provides advice for educators and midwives.

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‘A square peg in a round hole’:

Navigating maternity as an autistic student midwife and beyond

I was diagnosed with high-functioning autism when I was 30 years old and halfway through my third and final year of my midwifery degree. It didn’t come as a surprise to me, or to those closest to me. Since a very young age, it was something that had been suspected, but never actioned. After toiling through school, my first university degree, several jobs and starting from scratch in my late twenties to pursue a lifelong career in midwifery, I finally decided to ask my GP for a referral to adult autism diagnostic services. The catalyst for this decision was my first year of the degree, as I was really struggling with aspects such as groupwork, presentations, making friends, and sitting shoulder to shoulder in a lecture theatre with around 60 others all talking at the same time, to name a few. However, it would be a further two years before I received the actual diagnosis, by which point my degree was almost complete, and as a result I felt that I was unable and unentitled to ask for help up until that point.

My main autistic features are that I occasionally have difficulty expressing myself or verbalising how I am feeling and what I want to say, or I start tripping over my words when I am speaking. Sometimes I struggle to speak ad lib (which was why I preferred to be able to have a comprehensive script of sorts for presentations in university) and can appear to have a delayed reaction if I am asked a question, as it can take a little longer for my brain to process what I have just been asked. I get very anxious about social situations, find it hard to make friends and most of the time I prefer to do things on my own. I need routine and organisation, and I suffer if this changes or I cannot control it. If I get overwhelmed or overstimulated, I tend to ‘shut down’ and ‘go inside of myself’; this could be caused by multiple factors, such as stress and workload, loud noise, or a lot of different noises happening all at the same time. I also use ‘stimming’, which is an attempt to reduce sensory input and a coping mechanism to deal with stress or anxiety and block out uncertainty, usually in the form of rubbing or scratching my skin or fiddling with my fingernails. In our female society, and certainly in midwifery, we are expected to be social; I struggle to initiate or maintain casual ‘chit chat’ and often feel that I cannot join in with conversations that are going on around me. I am happy to join in conversations in smaller groups, especially when I feel comfortable with the people involved, but not as much in big groups; I worry that if I do join in then people will think that I’ve said something ‘weird’ or make fun of me behind my back, but if I say nothing then I worry that people will think that I am boring. I never use my autism as an excuse not to do things, but I finally feel comfortable enough to tell people if I think that it might affect a task or activity that I’m going to do or might be asked to do, just to give my peers some awareness that, if I get a bit overwhelmed or have a meltdown, this is why, and please let me do what I need to do to get through it.

I am sure that there will be readers who, at this point, are thinking ‘So how on earth can Holly be a midwife?’, given that I have said I struggle with some core aspects of the role! The answer is masking. Masking is not ‘pretending’ or ‘being false’. It is the suppression of autistic or neurodivergent traits in order to pass within society and is regarded as a complex survival strategy. This makes daily life exhausting for those who are neurodivergent and, particularly at the end of a thirteen hour shift of masking, my battery is well and truly empty. I was told throughout my degree that, for example, my communication skills with women and their families are excellent; I can do it because it is part of my job role and because society has required me to mask most days for the last 31 years, so it has become second nature.

Post-diagnosis, the university staff, in particular my personal tutor, were excellent. However, unfortunately, the same could not be said for a small number of midwives that I worked with during placements and, if I felt uncomfortable with the person I was working with because of this, it seemed to make my autistic traits even worse. During my third year, I was told by one midwife that I was too quiet and needed to integrate with other members of the community team more, otherwise I would not be seen as a ‘team player’. The same midwife told me “I think you’ll struggle when you’re qualified. I think you’ll really struggle”, in regard to social aspects of my autism, which is not what any student wants to hear, but particularly a student who is painfully aware of her neurodivergence. When I told my practice supervisor about my diagnosis, I was told “Well, everyone is on the spectrum really”, however this is not strictly true and felt like downplaying. The same practice supervisor told me “You’re going to have to come up with coping mechanisms”, which was frustrating to hear as I felt that I was already doing that and can only do it to a certain extent; this is how my brain is wired and it has been with me since birth. Telling someone with autism that they’re ‘just going to have to try and cope better’ is akin to telling someone with depression to ‘just snap out of it’; it’s easier said than done. I once made the mistake of disclosing just a small fraction of my obsessive compulsive disorder in regard to germs (people with autism frequently have associated issues such as obsessive compulsive disorder, eating disorders, and anxiety/depression, all of which have affected me) to a midwife, who promptly scoffed “You’re in the wrong profession then”. I was told during a community placement that my postnatal check was ‘too structured’ and not casual enough, like I was doing it step by step going down a list, which felt like a criticism; I have made progress with this, but my way of thinking is structured and logical and I would rather stick to the ‘script’ in my head in order to ensure that I ask all of the correct questions and obtain the information that is the most vital.

These are just a handful of comments that I experienced, and they caused a lot of upset. What kept me going were the positive comments from women and their families that I had cared for; glowing service user testimonials, thank you cards and other tokens of appreciation which reassured me that I was doing something right. As long as I’m doing my job safely and effectively, what does it matter if I’m a bit quiet while I’m in the community office or sat in the break room at the hospital? I will always be respectful and polite to my colleagues and peers and help them whenever they need it, whether they’re overloaded with tasks or if they simply need a shoulder to cry on, which is really important in a work culture that’s frequently regarded as being toxic. Autism can be very difficult for people who are neurotypical to understand and, from experience, it tends to be those with big, bubbly, loud personalities who struggle to understand and accept it the most. It takes all sorts of personalities to run a maternity unit; if everyone was massively extroverted, it wouldn’t work. I know when to raise my voice, I know when to speak up, but otherwise I’m simply there to do my job well, keep my head down, be on good terms with everyone, and go home.

I hope that, by writing this article, educators and midwives may feel an increased sense of awareness and may feel an interest in self-education, in case they happen to work with anyone or care for anyone who has suspected or diagnosed autism. My experiences of being a student midwife with autism have definitely influenced how I will act as a practice supervisor or practice assessor when I have my own student midwives to take under my wing. Think about what kind of situations an autistic student midwife might struggle with and what can be done to help make things a little easier for them; having flexibility when it comes to groupwork in university, not putting that person on the spot where possible, providing the option of a safe and quiet space, writing down instructions step by step rather than firing them off, and creating little guides and ‘cheat sheets’ to refer to could all be beneficial. It is also important to not paint everyone with autistic spectrum disorder with the same brush, as it is a wide spectrum; for example, just because one person with autism may struggle with eye contact, does not necessarily mean that another individual will. I have, on more than one occasion, overheard a midwife leaving a woman’s room and making a remark along the lines of: “Her partner in that room is a right weirdo, I reckon he’s definitely on the spectrum”. Flippant comments like this are unsuitable and far too common these days. Just because someone is a bit different, does not necessarily mean that they have autistic spectrum disorder. Furthermore, such remarks could be hurtful to those around you who may truly be on the spectrum, much less disrespectful to the woman and her partner.

If there are any student midwives reading this who suspect that they might have autism, I would encourage them to do their research, to seek a diagnosis and to not be afraid of asking their educators and peers for help. Having autism is nothing to be ashamed of and being a student midwife is difficult enough as it is without feeling like you are ‘a square peg trying to fit in a round hole’. I would also advise to not be afraid to mention it when it comes to starting a new placement or starting a new job. I ignored advice not to mention my autism at my job interview, and instead chose to link it to good qualities, such as noticing small details, being thorough, preferring to enforce organisation and genuineness; all of which are important and beneficial in midwifery. The condition also potentially has benefits in regard to the possibility of encountering women and their family members who may have autism too and having a better understanding of how to provide them with effective and compassionate care, as well as being able to respectfully advise and educate peers and colleagues on this. It is also worth remembering that, if an organisation chooses not to employ you because of your autism alone or because they feel you may not be good at the job because of it, that is discrimination, and it is not acceptable.

The way I like to describe my autism is that I see and experience the world in a slightly different way to others, and that sometimes this can be beautiful, but other times it can make everyday life extremely difficult. At the time of writing, I have been a newly qualified, practicing midwife for one month. I will have my beautiful moments during my midwifery career, and I will have my moments that are extremely difficult. I may be autistic, but I am also resilient and passionate about what I do. Having autism does not mean that you cannot be a midwife, and it certainly does not stop you from being a brilliant one.

Holly Conley-Reid

Enquiries: [email protected]

November 2022