This week global midwives meet for the International Confederation of midwives conference in Bali. Dr Kathryn Gutteridge, independent midwifery consultant, raises concerns about the struggles in England and asks for support.

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‘Because You Care’: midwives call for help

Many years ago, I had just set up my first midwifery led alongside unit and of course there were challenges that faced us.  I was in my first Consultant Midwife post and I was to develop and support normal midwifery in a large maternity unit that delivered more than 10,000 births per annum.  You can imagine my anxiety as a previous community midwife wanting to succeed and make a success of this new venture.

There was a lot that I learnt in this experience and one of the most important was from a colleague (now friend) that I was initially wary of.  One particular day I watched the midwives in the midwifery unit that was full, (5 rooms), passing the Sonicaid from room to room as they needed to perform auscultation.  I went into the kitchen to make coffee and I met the obstetrician who was with his colleague.  ‘What is the state of play in the MU?’ he said and I replied, ‘it is busy and we are doing well thank you’.  However, I went on to tell him about only having one Sonicaid between 5 rooms.  He smiled and said, ‘Why are you still open then if you don’t have enough equipment?’  I was somewhat shocked at his question and said, ‘what would happen to the women?’  He said: ‘you midwives will put up with all sorts of rubbish because you care too much about the women, when you should care about yourselves and your working environment’.  It felt like a light had gone on and I walked away with my coffee and made a phone call to the Head of Midwifery.  I informed her that once these women had birthed, we would close the midwifery unit based upon the lack of vital equipment.  Needless to say, we had the correct number of Sonicaids by the end of the shift.

I never forgot that lesson; he didn’t mean we shouldn’t care about women, but unless we are sufficiently looked after then we will suffer and ultimately fail.  I never compromised again in my endeavours to ensure we had the right equipment and environments.  Hence, the success of Serenity Birth Centre; there was nothing that I compromised over and such was the success that many other midwifery units copied our template.

This last week I received a copy of ‘Closure’ by Becky Reed and Nadine Edwards.  They tell the story of the Albany Midwifery Practice and their success in a challenging demographic in London.  These midwives had a contract with King’s Maternity and were supported by a named obstetrician for referral and opinion.  These midwives worked in the community and had a system of continuity of care for all women in their caseload.  Needless to say, the outcomes were superb and their practice exemplary in both clinical and women’s experiences.  Fast forward 10 years, the midwives were called in to an urgent meeting, the nature of which was unclear.  In a nutshell the midwives were told that their outcomes for term admissions to NICU were concerning and a very questionable audit was the basis for this.  It soon transpired that the midwives were to have their contract revoked and the Albany Practice would soon be no more.  A travesty that has only now been told from the midwives’ perspective, I would urge you all to read this story and reflect.

Why am I telling you all of this?  This week the great and the good in the midwifery world gather in Bali for the International Confederation of Midwives triennial conference.  Midwives from across the globe will join together to share stories and their best work for others to learn and practice.  This meeting of midwives should also reflect upon what is happening to our profession particularly in the UK.  We have been in the enviable position of being the gold standard for midwifery education, regulation and practice, however that may be changing.  I have heard the stories of midwives in the UK, how they feel unappreciated, too few in number and working without their own basic needs being met.

Whilst there are still many student midwives who cannot wait to join our profession they are frightened and worried about their future.  I think we are in a situation never before seen.  The reputation of midwives was always one of respect and love by the communities we serve; look at Call the Midwife for an example.  The goodwill we have extended has been exploited by the policy makers and maternity providers.

I have seen midwifery and midwives targeted over the last 30 years; I have experienced this both just after qualification but also throughout my career.  Marginalisation and side-lining are themes we have witnessed in midwifery. I heard people who do not value midwifery say; who do they think they are, who monitors their practice, who governs them?  The way the media report midwifery is subject to whatever reports occupy the front page.  We never see misreporting corrected by those who have written said reports, so the midwife and midwifery become the whipping boy.  I say that the writer of any maternity report has a duty of care not only to the parents and families but they have a duty of care to the midwives involved in the account.

So as the great and good of global midwifery gather, I would ask them to consider these thoughts.  Midwives are working harder than ever with fewer of us worldwide, and all of this with a more complex demographic.  Why is it acceptable to ignore the evidence around continuity of care and stop or pause implementation of this in England?  How is it acceptable to close or to temporarily shut a midwifery unit or birth centre and yet the admission of women for induction of labour is rising for spurious reasons?  Why is it ok to close a midwifery practice, such as the Albany, when the outcomes were enviable across maternity?  Well, the words of my friend come back to me again, ‘because we care’ we will follow the women that need us to care for them.

I ask those midwifery leaders throughout the world to show leadership and loyalty to midwifery and support us when we need it, as we do now.

Dr Kathryn Gutteridge

Independent Consultant midwife

June 2023