During the pandemic, midwives faced what researchers call a “pragmatic paradox^[1]” – a situation where contradictory demands are imposed on individuals who can neither refuse nor fulfil the demands.

Midwives needed to care for women and babies despite the risk of infecting them with the virus. Their experiences shed important light on how we can think about no-win situations in the workplace.

In our recently published research^[2], we surveyed 215 New Zealand midwives about their experiences of working through COVID lockdowns and how they coped with what felt at times like a no-win situation.

The absurdity of contradictory demands

Pragmatic paradoxes place workers in absurd, no-win situations. They can occur simply because of leadership issues or glitches in management bureaucracies. They can also happen during unique crises – such as the pandemic.

But many workers are so used to feeling powerless that they may not recognise – much less question – the absurdity of contradictory demands.

This is especially true in situations where workers lack opportunities to discuss or challenge the directives^[3] they receive from above.

When the pandemic struck, midwives’ professional roles suddenly entailed an inherent contradiction they had no opportunity to question.

They were contractually obligated to protect societal wellbeing by providing ongoing maternity services. Yet due to the fast evolving situation and initial shortages of safety equipment, providing those services entailed risking public wellbeing by exposing themselves and their clients to the virus.

As one of our research participants explained:

I felt that I was in a very difficult situation. I was connecting with multiple “bubbles” on a daily basis. I was scared that I could be in a position to pass COVID on to vulnerable people.

As expected, most midwives in our study felt disempowered by the tensions of this situation:

I felt extremely vulnerable. As a lead maternity carer midwife, considered an essential service, I had no control over whether I could just not work.

But surprisingly, a small number of midwives were seemingly motivated by it. As one explained,

[My family] thought I was “brave” and “courageous” to keep working – but this was simply my job! I felt like I had a duty to pregnant women to front up and continue as per normal.

During the pandemic, midwives faced a pragmatic paradox – they were expected to enter multiple people’s homes while also preventing the spread of COVID-19. metamorworks/Shutterstock^[4]

Recognised and supported?

Why would some midwives feel motivated by their contractual obligations to fulfil contradictory demands?

The crux, we found, was not whether they were aware of the contradiction inherent in their situation, but whether that awareness was accompanied by a sense of professional recognition and support.

If midwives felt like they were recognised and supported in their ongoing efforts – like valuable members in the “team of five million” – they framed and accepted their contradictory situation as part of a societal duty.

Midwives placed particular importance on recognition and support from the government and the public. As one explained,

I felt the love. Heading out on the motorway I would see the sign thanking essential workers. And the government was always mentioning us and thanking us.

In contrast, if they felt like health system leaders and the public were oblivious to their situation, they interpreted contradictory work demands as stressful and disempowering.

Another midwife said,

I became very angry and felt midwives were like lambs to the slaughter – we had no PPE, we were being told to carry on working, in the media we were invisible. Our professional body seemed to put the women we cared for ahead of our wellbeing.

Managing pragmatic paradoxes

There are two ways to look at the implications of our findings. One is to suggest pragmatic paradoxes are not as bad as they initially seem.

Contradictions abound in contemporary society, so it may be inevitable people face conflicting yet unrefusable demands in their jobs. But if leaders and managers can motivate workers to embrace those demands – or at least recognise the difficulty of the tasks – the outcome can be positive.

An alternative reading is workers who feel motivated by pragmatic paradoxes are casualties of something akin to gaslighting^[5]. According to this logic, contradictory demands are imposed by those at the top of their respective organisations and societies, so that’s where the demands ought to be dealt with.

For example, the government could have minimised the risks midwives faced during the pandemic by better access to protective equipment^[6], thereby resolving their contradictory situation. Suggesting contradictory demands should be passed down to lower-level workers is therefore equivalent to accepting a certain level of oppression.

Whichever interpretation resonates more, our research underscores the importance of communication^[7] as a means of ensuring workers are not disempowered by pragmatic paradoxes.

Over the course of the pandemic, healthcare workers worldwide eventually improved their contradictory situation by posting on social media and talking to the press. Political leaders and health management recognised the workforce needed greater support to navigate the contradictory demands of risking wellbeing to protect wellbeing.

The broader lesson is when people face contradictory directives, they should be able to discuss and challenge them.

Research^[8] suggests that in interpersonal situations, humour may be an effective means of doing so without directly threatening the power or competence of those in charge.

Of course, this brings us to one final paradox: that encouraging humour and employee voice requires fostering the type of environment where pragmatic paradoxes are unlikely to thrive in the first place.

References

1. ^{^} pragmatic paradox (journals.aom.org)
2. ^{^} our recently published research (journals.sagepub.com)
3. ^{^} lack opportunities to discuss or challenge the directives (www.sciencedirect.com)
4. ^{^} metamorworks/Shutterstock (www.shutterstock.com)
5. ^{^} gaslighting (www.psychologytoday.com)
6. ^{^} better access to protective equipment (www.nzdoctor.co.nz)
7. ^{^} the importance of communication (journals.aom.org)
8. ^{^} Research (journals.sagepub.com)