Neil Stewart, Editorial Director, Maternity and Midwifery forum, reflects on current circumstances and suggests a solution.
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As the International Confederation of Midwives (ICM) meet in Bali to review the world of midwifery there is fantastic progress to report after the WHO Year of the Midwife.
Midwifery and maternity services in the UK, however, are under severe scrutiny and, in many ways, going in the opposite direction from the WHO vision that puts women’s needs first.
A narrative in the UK press has grown up not just about staff shortages but that the way services are delivered is unsafe in many maternity units. Indeed, the Care Quality Commission (CQC) has indicated that 48% of maternity units are less than excellent. But what does that mean? Are they failing in some things or are they failing in everything? A classic example of how to spook pregnant women about their local services.
One of the worst episodes has been revealed by the inquiry into the East Kent hospitals that have the focus not just of a bad report but of a criminal prosecution which resulted in a fine of £730,000.
Not money that went to the families affected but a punishment to the trust management and perhaps an example to others. And further prosecutions have followed.
In all of this midwifery, since the Morecambe Bay report, followed by East Kent, Shrewsbury and Telford and now Nottingham, has been getting a fairly bad press. Toxic cultures, blame games, poor professional practice, guidelines ignored, women’s voices ignored, racial disparity in treatment, and not just baby and maternal deaths (which had been recorded) but a long tail of birth traumas among mothers that had been ignored, disrespected, gone unheard.
Where was the midwifery leadership in all this? Who was in charge? Not, apparently, the midwives. Or not with the power to stop failing services or demand change.
Consider the reports that came out last week about East Kent. There, new documents revealed, the head of midwifery, 9 years ago, had said the services should be closed and yet was over ridden.
Katherine Gutteridge in an article in this newsletter tells the story of her standing for and demanding the equipment needed, on threat that the unit would close. She got it.
This contrast is a constant refrain from midwives and midwifery leaders. How can midwifery have the power to deliver the best service it can for women and babies?
Women giving birth are not ill with a cancer, or degenerative or chronic diseases, but they are at risk. Happily, the majority go through birth with minimal intervention, and it is easy to see how this could be seen to be less dramatic or less urgent than the demands of other high-profile services like cancer.
Yet facilities, equipment and staffing are a constant struggle against fast evolving opportunities in other disciplines.
Kathryne Gutteridge relates the words of a medical colleague which she felt had the hard ring of truth when she mentioned a shortage of equipment and the midwives working through and around the shortage.
‘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’.
What lens do senior NHS management see midwifery through? Too often not the voice of a midwife.
Fran McConville, midwifery advisor to the WHO set out in a presentation last year why in the WHO recommendations she puts as a first priority, to strengthen leadership and policy. A voice at the top table.
Every country affiliated to the WHO has a GCNMO, a government Chief Nursing and Midwifery Office. But in many countries, this is often not even a nurse but a government minister. There are still states in the US where a midwife cannot practice independently. In the NHS, in England, we have had a Chief Midwifery Officer for several years and the 7 regions have CMO, but how it works down below in the complex structure of hospitals and trust and now the new Integrated Care Boards and Integrated Care Services. is less clear.
Who is in charge of midwifery? Is it a midwife? What power do they have in setting budgets and resources and most of all do they have the power to “pull the plug”, close the service if it is not staffed or fully equipped as Kathryn Gutteridge threatened to close the unit. As the new Integrated Care Boards come into being let’s ensure that they have clear midwifery leadership, at the top table, able to call out services that are understaffed or underequipped.
So, with that in mind the Maternity and Midwifery Forum are launching a campaign to have a chief midwife at the top management table at every level in the NHS and to support the development globally, in line with the WHO vision for the best way to improve the safety and birth experience of women and babies.
Donate here to support our campaign work. HERE
Neil Stewart
Editorial Director
Maternity and Midwifery Forum
June 2023