Words matter and so does evidence based thoughtful care

By Cathy Warwick, CEO on 15 August 2017 RCM CEO

As I come closer to my final day as CEO of the Royal College of Midwives I find myself as busy as ever. Why? Surely August is a quiet month? Well some may think so!

After a busy few days responding to media interest on closures of maternity units, last Thursday the RCM answered an email query: ‘could we update on the status of the RCM’s Normal Birth Campaign?’ Of course we could: three years ago this campaign was replaced by our Better Births Initiative, a broader based piece of work but still encompassing educational elements of our normal birth campaign. A simple question: a simple answer. However this ‘old’ news got into the media and what a stramash ensued. An intense debate ensued in mainstream and social media around the world about normal birth with an incredible range of views strongly and passionately expressed reflecting, I suspect, the importance of and meaning given to the everyday yet critical process of giving birth.

The RCM’s primary purpose is and remains to support midwives to provide the highest quality maternity services to women and babies.

What the RCM does not support is normal birth being promoted beyond the point of safety or women being made to feel failures if they do not have a ‘normal’ birth. We will do everything we can to ensure neither of these is the case including examining the language we use carefully. It is really important that we reflect on the impact of the language we use – we know what it means, but for many it has a judgmental quality that we absolutely do not intend.

In terms of what we do support: the RCM absolutely believes that our overarching aim and that of maternity services is to ensure that women and babies have a safe birth. The concept of safety encompasses both physical and mental dimensions. If women and babies are to be kept safe it is important that their birth, whether straightforward or complex, is kept as normal - or physiological or straightforward or optimal - as possible. Doing ‘too much too early’ can cause just as much harm as doing ‘too little too late’. The provision of high quality maternity care necessitates careful balancing of these two opposing elements.

Normal birth is currently an internationally recognised term. It is also recognised internationally that the specific expertise and responsibility of the midwife is to promote normal birth whilst ensuring early detection of deviations from normal and timely referral. It therefore follows that if governments are to ensure the safest care of women and their babies a critical underpinning element of this is to promote midwifery and midwifery led care within an overarching climate which ensures a positive multidisciplinary culture and ease of transfer between all providers along the pathway of care.

The RCM also continues to support midwives to achieve the highest standards in their role. The midwife is recognised worldwide as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period; to conduct births on the midwife’s own responsibility; and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

So I hope that answers many of the questions the RCM has received in recent days. I hope too that RCM members will trust that the RCM continues to argue these points whenever there is any opportunity.

My tenure at the RCM is of course nearly over but I do hope that all of our members will support the RCM’s new CEO, Gill Walton, as she continues to influence. In future when any questions are raised about the RCM’s stance I hope everyone feels able to counter immediately any suggestion that the RCM has abandoned our fundamental purpose. We have not. We remain as absolutely committed as we always have to ensuring that all women have a safe and satisfying maternity experience.