I met a group of student midwives a few days ago. New to midwifery, they were keen and bright-eyed, eager to learn and be part of the midwifery family.
Midwives magazine: November 2004
I was privileged to sit in on their education programme their questions were intelligent and thoughtful, and their teacher answered them in such a way as to expand their thinking about midwifery knowledge, at the same time as raising further questions for them to reflect on.We all agreed that this is an exciting time to be in midwifery.
Later in the week, a midwife came to see me to talk about something that was worrying her. Then, as always happens with midwives, we drifted into `talking midwifery', sharing experiences and ideas around practice. Perhaps because I am aware of the development of the RCM Virtual Institute for normal birth, I noticed that when she talked about the care of the women during pregnancy and childbirth, her words were intense and joyous, her face radiant with a love for what she does, and what we all, as midwives, live and work with every day.
Sometimes I think that in the hustle and bustle of the busy delivery suite or antenatal clinic, it is too easy to forget this intensity, excitement and joy gained through the thoughtful care that we give.We have all experienced the emotional intensity of caring for a woman and her partner dealing with the loss of their baby. Supporting them through this can be exhausting, at the same time as being incredibly rewarding.
Perhaps the most draining elements are apathy, constant change that feels like change for change's sake, yet another newspaper article criticising NHS staff and services, Trusts wanting to save even more money by freezing vacancies. The end result is that you feel as though there is too much to be done by too few people, and that you will face criticism despite doing the very best you can.
Midwives have always been at the forefront of change ± making services better for women and their babies. Even before the 1902 Midwives Act, there were midwives ± like Jane Sharp - working with and for women. It was those formidable women who fought for and achieved the Midwives Act, but midwives today are also strong people who need to garner collective strength from each other in moving practice forward and in changing ways of working.
In the early 1990s, all four UK countries introduced national policies impacting on midwifery practice (Welsh Office, 1991; Department of Health, 1992; Department of Health, 1993; Scottish Office, 1993; Northern Ireland Maternity Unit Study Group, 1994). These inspired many midwives to think about how best to provide care for women and babies in the contemporary UK and, although many of the schemes started at that time are no longer in place, this is not a failure for midwives. Rather it reflects a reluctance at senior management level to invest philosophically and financially to support the different schemes and models.
The new maternity module of the National Service Framework for children, young people and maternity services needs to be seen as the next step towards providing a truly women-centred and baby-focused service, built on a strong and enduring partnership model. The policy documents mentioned provided the foundation for these very practical standards. Some of them may not look new, but they are measurable and will be measured. Midwives can and must take these standards, translate them into service, and see them as practical tools.
But midwives and managers must also think about protecting, nurturing and securing the future of the profession. By this, I do not just refer to student midwives. Who is teaching the student midwives of today? Are there enough teachers of midwifery for today and tomorrow? Are they included or excluded from their clinical roots? The RCM midwifery education strategy highlighted the problem of midwife educationalists being distanced from practice. It is crucial at this time that educationalists are involved and included as part of the wide midwifery family.When I came into education,midwifery teachers were an integral part of the service, attending meetings and forums, organising `teach-ins', assessing students and working as midwives. The move into higher education led to geographical and sometimes deeper separation.We cannot go back and nor should we however, nor should the baby go out with the bath-water! Like all midwives, midwifery educationalists lecturers and teachers need to be nurtured, supported and involved. On their own midwives can achieve a lot together the whole midwifery family, in partnership with women, can move mountains.
Sue Macdonald is the RCM education and research manager
Department for Education and Skills. (2004) Maternity module for the National Services Framework for children young people and maternity services. Department of Health: London.
Department of Health. (1993) Changing childbirth: report of the expert maternity group (Cumberlege Report). HMSO: London.
House of Commons Health Committee. (1992) Second report on the maternity services (Winterton report). HMSO: London.
Northern Ireland Maternity Unit Study Group. (1994) Delivering choice: midwife and general practitioner led maternity units. Northern Ireland Maternity Unit Study Group: Belfast.
RCM. (2004) Virtual Institute for normal birth. See: www.rcm.org.uk/data/info_centre/data/virtual_institute.htm
RCM. (2003) Valuing practice: a springboard for midwifery education. RCM: London.
Scottish Office. (1993) Provision of maternity services: a policy review. The Stationery Office: Edinburgh.
Welsh Office. (1991) Protocol for health gain: maternal and early child health. The Stationary Office: Cardiff.