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Change within midwifery

17 June, 2008

Change within midwifery

It was the Victorian statesman Benjamin Disraeli who first commented, ‘Change is inevitable in a progressive country. Change is constant’. That was more than 130 years ago and I often wonder what he would make of the rapid pace of change that is the norm in the UK today.

It was the Victorian statesman Benjamin Disraeli who first commented, ‘Change is inevitable in a progressive country. Change is constant’. That was more than 130 years ago and I often wonder what he would make of the rapid pace of change that is the norm in the UK today. 


Midwives magazine: May 2003


Indeed, as I travel around the country and meet many of you, I am often told about the impact that change is having on your day-to-day lives. So I question Disraeli’s perspective and wonder if instead of progress, we are dealing with change gone mad or change for change sake.


Because, as we all know, some change can be destructive. For example, as Mavis Kirkham wrote, changes in staffing levels can impact on midwife workload, morale and the quality of care provided to women and their families.


That is why, over the past few months, the RCM has been working harder and faster than ever to exert influence at a national level to effect changes that are beneficial to our members and which directly impact on women and families.


The virtual institute and professional development forums


To ensure positive change in the professional arena the learning, research and practice development department at the RCM is providing UK-wide support on a number of fronts.


We hope that the development of our virtual institute for normal birth will soon help midwives to improve their skills and work towards normalising the birthing experience for women. And already, as an outcome of our recent branch review, professional development forums are being piloted in Northern Ireland to help put positive profession-enhancing change into practice.


Agenda for Change


Agenda for Change has, of course, been at the top of our change schedule. It is our belief – as your Council made clear – that this national NHS pay and conditions package offers midwives the best available deal.


Many of you will have attended nationwide workplace meetings, read articles in this journal or even logged-on to our website to get the information you needed to help you make up your own minds. Now, as I write this piece, we have just discovered the outcome of the members’ ballot to see where we go next. The vote was an overwhelming approval of the proposals.


Yet, whatever the outcome, we midwives will continue to provide flexible, woman-centred care that is the envy of the NHS. Indeed, if truth be told, I believe that midwives have often led the way for others because we are a driven breed who focus on very distinct goals.


Reflections on midwifery and the global picture


On a personal level if I think back, more than 30 years, to why I became a midwife the reason was very simple – I wanted to make a difference to women, babies and families. And I am glad to say that I have not been disappointed in this ambition. Attending a woman throughout her pregnancy and being there as she gives birth is probably the greatest privilege that a health professional can enjoy.


However not all women are as lucky as those in the UK. We all know – particularly in these trying war-torn times – the difference that a lack of skilled midwifery attendant during pregnancy and birth can make.


It is a sobering thought that every minute of every day a woman somewhere in the world dies because she is pregnant or in labour – a fact that adds up to a shocking 500 000 deaths per year. And yet, without the efforts of midwives over the years, UK mothers might also be facing a similarly tragic situation.


As you know last year saw the centenary of midwifery legislation in England and Wales. Back in 1902 many women in this country faced a picture as bleak as women elsewhere face today. Few had access to trained attendants at childbirth and maternal mortality stood at 500 per 100 000 births compared with less than 12 per 100 000 today.


The founders of the RCM aimed to improve this situation by raising the effectiveness and improving the status of midwives. In doing so these formidable women set midwives down the path of professional development toward the highly skilled role they enjoy today.


Mothers and babies now benefit from midwives trained and experienced in delivering truly holistic care – attending to each woman’s social, emotional and psychological needs, as well as her physiological state.


Change around the UK


As a member of the NHS Modernisation Board, I regularly see new developments in England. But my role as general secretary gives me an even broader picture. Reviewing recent progress across the UK, I am pleased to see that midwife-led care is at the forefront.


In Scotland an Expert Group on Acute Maternity Services (EGAMS) has been established, while a care pathway for normal midwifery is being piloted in Wales. Yet again we see consultation in Northern Ireland on midwife-led units, while in England a leadership competence model for midwives has been developed.


In short, there are plenty of opportunities for midwives to develop and enhance their practice and improve their ability to provide a flexible response to the needs of women and their families.


As the NHS changes, so midwives are shifting their efforts in the direction of midwifery-led care that enhances women’s experience of childbirth and is also cost-effective.


Midwives have always risen to the challenge of change – and I say to you all, when it comes to change find opportunities, use them and make a difference. 



Dame Karlene Davis

is the RCM general secretary




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