Direct-entry midwifery

FROM: Stephanie Stevens, midwife/health visitor

SUBJECT: Direct-entry midwifery
EMAIL: stephanie.stevens@ntlworld.com


Dear editor
I have read with great interest the comments made by Jayne Elstone (Midwives December/January 2010) and Caroline Gillet (Midwives April/May 2010). I qualified as a direct-entry midwife. I then trained as a health visitor, one of the first direct-entry midwives to do this. However, shortly before qualifying, it appears that the NMC had made an error in telling me (and many others) that once we had qualified we could let our midwifery registration lapse and be purely registered as health visitors. The NMC has now set up a list of competencies that we use as a health visitor, in order to maintain our midwifery registration. They have also written, assuring me that I do not need to work as a midwife or maintain a contract as a midwife, in order to maintain my registration. Both myself and my supervisor of midwives feel very uncomfortable about this, as these competencies are very vague and certainly not sufficient to practise safely as a midwife. I am therefore extremely confused as to why there appears to be one set of rules for those in my situation, and another for nurses such as Jayne and Caroline. In reply to Jayne's comment about direct entry being the future of midwifery, I have to disagree. It may be the future of midwifery, but not having a nursing background has probably meant the end of my career. I am not happy about having to sign an intention-to-practise form, when I do not intend to practise nor feel at the standard required, but if this form is not signed by us both, I can't remain a health visitor, despite loving the job. I feel it is high time this issue is addressed properly, not only to support a fair career structure, but most importantly, to protect the public.
 
NMC response:
As you know, the NMC is the regulatory body for two professions, midwifery and nursing. The legal position required by the Nursing and Midwifery Order 2001 is that for anyone to be registered with the NMC, one or both of these registrations must be gained and maintained. The implications of this for anyone who has the additional specialist level qualification in community public health nursing is that they must maintain their initial registration as a midwife or nurse, hence a previous decision on this matter had to be revised. 

This decision was communicated in two ways. All specialist community public health nurses (SCPHNs) who had not maintained their initial registration as either a midwife or nurse (or both) received an individual letter informing them that the previous decision regarding not maintaining their initial registration was erroneous and had to be changed. We also included details of what was required in order to maintain their registration as an SCPHN.

Those SCPHNs who had maintained their original registration as a midwife or nurse received information through the NMC News and were contacted at the time of their renewal of registration.

We also communicated with the local supervising authorities about what was required of midwives who work as SCPHNs. This has been reinforced by advice on our website to assist supervisors of midwives at the annual supervisory review to have appropriate and meaningful discussions with midwives in a similar situation to Stephanie.

Midwifery and nursing are two separate professions leading to two different parts of the register with different training requirements, competencies and spheres of practice. It is therefore appropriate that in order to maintain registration, different areas of practice must be demonstrated, according to the post-education registration and practice (PREP) requirements.

It is disappointing to hear that this midwife feels they are being disadvantaged, because they have a midwifery background rather than a nursing one, and we would advise in such situations to discuss this with their union representative as this is an employment issue, which I'm afraid is outside of the NMC’s remit. It is certainly not our intention as a regulator to disadvantage direct-entry midwives working as health visitors, which is why we published the SCPHN competencies for midwifery PREP. This document provides examples of SCPHN practice, which may be used for midwifery PREP practice purposes, in order to maintain midwifery registration.