Who wants to be a consultant midwife?
By Sally Price on 04 June 2008 Midwives Magazine
When the post of consultant midwife was introduced, Sally Price certainly felt it was one for her. She explains how she feels well-placed to fulfill the key requirements of the role and improve joint agency-working.
Midwives magazine: January 2006
At first I was delighted to have the opportunity to write about my role as a consultant midwife and readily agreed. However, now the time to actually write has come, I feel rather daunted.What can I possibly say that my consultant colleagues have not said before, and far more eloquently than I ever could? So, I have decided to write from the heart – to tell you not only what my role involves, but also how I feel about it and how I got here. I hope this will inspire you to consider whether the role of the consultant midwife might be a career opportunity that is right for you.
I know that I am fortunate to have such a dynamic and challenging role within midwifery. Perhaps it is because the organisations I work for recognise the value of such roles, or perhaps it is the fact that I have a job within midwifery that allows me to practise in a way that suits my philosophy of care, or maybe it is because I work with deeply committed professional women and men who are passionate about midwifery. Five years after being appointed, the one thing I remain certain of is that it is a tremendous privilege to be a consultant midwife.
I suppose I entered the role of consultant midwife via a non-traditional route. I registered as a midwife in 1993, after a three-year diploma programme. Prior to this, I had worked for 14 years in education and social services as a nursery nurse. Many of my skills and experiences were transferable, but nothing could have prepared me for the reality of working as a rotational midwife in a busy consultant unit. I did this for almost two years and was then appointed as a traditional community midwife in an area with a high home birth rate (13%). I was very fortunate to work with a midwife who had over 30 years’ experience and was on a mission to teach me everything she knew before she retired. After three years in this role I worked as practice development midwife while the post-holder was on maternity leave, and then returned to my community post.
I first became aware of the concept of consultant midwives following the publication of Making a difference (Department of Health, 1999). I think I was highly motivated by my peers and managers at that time to make sure that my professional portfolio of skills and experience reflected the requirements of the role (although I have heard it suggested that I was a woman possessed!). This meant that when the post was advertised I was in a strong position to apply, and I was appointed in November 2000.
In common with many of my peers, my role is focused on public health. This can be challenging, not least because anything and everything to do with midwifery practice seems to fit under the public health agenda. One of the skills I have had to develop over the years is to be very clear about what is and is not within my remit, and I tend to take the view that if something has an impact on vulnerable women or populations that are at risk, then I do have a role. The temptation is to become involved with all things midwifery-orientated, but this would mean I am less effective and unable to do anything really well. I am delighted that the National Service Framework for children, young people and maternity services (Department of Health, 2004) is inclusive of vulnerable populations. This means I am able to prioritise the strategic work for public health developments within the service and share my agenda with the wider maternity and health community.
My post as a consultant midwife is different to many of my peers, in that I have a joint appointment between North Bristol NHS Trust and the University of the West of England (UWE). This means I am well-placed to fulfil the four key functions of the role – clinical practice, consultancy and leadership, education and practice development and research and service development. I am also able to integrate these functions across both organisations, something that is of great benefit to both them and me, and of course ultimately to the midwives and women with whom I work. An example of this is the Bristol Pregnancy and Domestic Violence Programme (Salmon et al, 2003). Along with my colleagues at UWE, in particular Kathleen Baird, and with the support of Trust managers we have been able to create, implement and evaluate a programme of education and support thatenables midwives and others to effectively inquire about domestic violence in pregnancy, and to support women who disclose their experience. Having worked within both organisations I am sure this type of joint working would have been possible without my role. However, I am also sure that my dual appointment has enhanced the process, and made the collaboration far easier than it might have otherwise been.
A key aspect of my role as consultant midwife is supporting midwives to practise effectively and provide high-quality care for women and their families. In many ways I think this is the most important thing I can do. The concept of consultant practitioners was intended to ensure that experienced midwives remained in clinical practice, therefore ensuring that clients had the direct benefit of their skills and expertise. I think this is rather presumptuous since I know that while I am a competent midwife and provide excellent hands-on care, so do many of my colleagues. If the quality of care is to be improved and maintained for all women, then each and every midwife must be highly skilled, competent and confident. However, this on its own is not enough. Midwives must be empowered to practise to the fullest extent of their ability and supported in their professional development to enhance the quality of care they provide.
A significant part of my role is to facilitate educational opportunities, such as in-house training for midwives and healthcare workers around topics such as mental health or domestic violence. I also contribute to pre- and post-registration courses at UWE and have recently worked with colleagues there to develop a continuing professional development module ‘Promoting normality in midwifery’. In the clinical setting, my educational role is less structured, and is more focused around service developments. What often happens in clinical practice is that midwives will identify a gap in provision or have an idea of how to enhance care, and I work with them to make it happen. The most recent development of this type at North Bristol NHS Trust is the ‘Come and meet everyone’ (CAMEO) group for women who use our maternity drugs liaison clinic. The women who use this clinic were not attending mainstream antenatal classes or postnatal support groups. The lead midwife Vicky Blunsden identified the requirement for a specific group to meet these women’s needs. She and I devised a work plan to make her vision a reality. This involved consulting service-users, developing a business plan, enlisting the support of the maternity managers and the multi-agency team, finding premises and funding and devising methods for evaluation. The group began in September in a local children’s centre and is run by a midwife, health visitor and exservice- user. The service-users are attending regularly and I am looking forward to the first evaluation.
I suppose that if I had to define my role in one or two words it would best be summed up as ‘professional leadership’. However, leadership is one of those strange terms that is used all the time – we all think we know what it means, yet the interpretation probably differs from individual to individual and over time. Maybe someone should undertake a concept analysis of leadership in midwifery – now there is an idea for a research degree. My own stance echoes the theories of transformational leadership, with an emphasis on transparency, accessibility, approachability, shared vision and supporting a development culture (Alimo-Metcalfe, 2000). I use this perspective in an attempt to empower others and further the profession and individuals within it. Another way is through supervision, and I believe being a supervisor of midwives enhances my role. Participating in the on-call rota also means that I maintain my skills of acute care and crisis management and stay grounded in the reality of midwifery practice. Just like my colleagues, I then face the challenges of managing my own workload in combination with managing the demands of the service, including supporting my midwifery colleagues.
Being a consultant midwife can be quite an isolated role and I am lucky to work within organisations and with people who are very supportive. However, I am the only consultant in post in the south-west region and have to draw on the support of my peers from the Midlands and north of England, as well as London. Although this is a disadvantage, the uniqueness of the role within my area does add strength to the post, allowing me to be creative in problem-solving and developing the role. However, there is definitely scope to increase the number of consultant posts in the south-west and I would welcome closer peer support. This leads me to think about succession planning.
So, are you a future consultant midwife? Before you dismiss the idea out of hand, consider the skills and experience you already have, and think about what you would need to develop to fulfil the role. For some this will not be too much of a leap and I would urge you to think carefully and plan your career to meet the criteria required. The four primary functions of the role are expertise in clinical practice, consultancy and leadership, education and practice development and research and service development. You may already be highly skilled in two or three of these areas and could seek opportunities to develop the remaining aspects. If you would like to find out more about the role, my consultant colleagues and I would be happy to provide shadowing opportunities or informal discussions. Being a consultant midwife is a fabulous role and gives a high degree of autonomy and job satisfaction. The role really can make a difference to women and their families and, perhaps most importantly for me, to the profession as a whole. If I can do it, so can you.
Alimo-Metcalfe B. (2000) Heaven can wait… leadership in the NHS. Health Services Journal 110(5726): 26-9.
Department for Education and Skills, Department of Health. (2004) National Service Framework for children, young people and maternity services. Department of Health: London.
Department of Health. (1999) Making a difference. Strengthening the nursing and midwifery contribution to health and health care. Department of Health: London.
Salmon D, Baird K, Price S, Murphy S. (2003) An evaluation of the Bristol Pregnancy and Domestic Violence Programme. See: www.nbt.nhs.uk/ midwives/domesticviolence/index.html (accessed December 2005).