What you can do to save midwifery as an independent profession in the UK.

By Ruth Weston and Emma Ashworth

Independent Midwives are in the NMC firing line, and most of the campaigning that you might see is about this. However, the NMC (Nursing and Midwifery Council), which made this decision, did so without a practicing midwife on the board, and the ramifications of the decision affects every midwife in the UK.

For instance, the NMC have stated, “A registered midwife can only attend a woman during a birth if she has appropriate indemnity cover. The midwife cannot avoid this legal requirement by attending the birth in a ‘non-midwife’ capacity… The only exception to this is when a midwife attends a birth in a personal capacity to support a family member or close friend for whom they have not previously provided midwifery services”. “Services” includes emotional and physical support, meaning that midwives are being banned from attending the births of their grandchildren, or their own babies in the case of male or lesbian midwives if they’ve so much as listened in, or supported their partner through morning sickness.

The NMC is removing the midwifery committee, which advises the NMC on midwifery matters. Its replacement will have no budget and delegatory powers and it is unclear who will be on it and what its role will be within the NMC. As the NMC – the NURSING and Midwifery Council – has overwhelming numbers of nurses compared to midwives, and the way it is now being set up means midwives will be regulated by a completely different professional – one geared to nursing sick people rather than caring for healthy women -without their own voice being heard at all.

There is a huge risk that this will toll the death knell to midwifery as an independent and autonomous profession. becoming subsumed into the nursing profession as another branch of nursing.  This is certainly the way the NMC and the Government legislation is treating midwifery at present and would mean Midwives would lose the status of being THE professional experts in the normal maternal pathway and key care provider. This is not inevitable but as a profession and as parents we must rise up and clearly and strongly oppose  the removal of the midwifery code, the midwifery committee and lack of representation for mothers and midwives at the NMC. The profession has never been in more jeopardy, and never has the care of women and their babies been so much at risk since the formation of the profession of midwifery.  It falls to us to do something about it..

What can I do?
1) There have been several petitions. The writer of this one admits that if it had been less rushed it would be better worded, however, if we want Parliament to take note of the voices of women, midwives and their families then this is a good petition to start the ball rolling, so please do support it. https://petition.parliament.uk/petitions/178561

2) Share your story of how midwives have helped and supported you. What impact will the lack of access to IMs have on you?  Share on:

Facebook, Save Independent Midwifery page: https://www.facebook.com/groups/443681876022589/

Send to Birthplace Matters who is preparing stories and letters to the NMC through  birthplacematters at yahoo.co.uk

Send them to the saveourmidwvies.co.uk website.

Don’t forget to include permission to share.

3) Tweet!  Use the #savethemidwife hashtag with your messages about how this affects you. You can  tag Jackie Smith of the NMC using @JackieSmith_nmc, and BBC Watchdog (@BBCWatchdog)

4) Write to your MP. The website saveourmidwives.co.uk has important template letters which answer the cut-and-paste responses that most MPs are sending. Find your MP here: http://www.parliament.uk/mps-lords-and-offices/mps/

5) Join IMUK, the Independent Midwives’ professional body, as a supporting member. It only costs £20: http://www.imuk.org.uk/professionals/join-imuk/

6) Make a complaint to the NMC. E-mail complaints@nmc-uk.org. They have less than 20 working days to respond. It is important to mention that it’s a formal complaint to ensure that you go straight to Stage 2 of their complaints process. If you don’t like the reply, simply respond back, say you’re not satisfied, why, and then appeal the complaint response, escalating to Stage 3.

7) Many women and Midwives across the UK are using their passion, creativity and skills to support independent midwives and to challenge midwifery regulation to do its work better.  Do what you can with the people you can, and watch this space as more developments are in the pipeline.  Thank you!

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This is NOT “Public Protection”

The Nursing and Midwifery Council (NMC’s) decision to stop Independent Midwives (IMs) from practicing is, in their words, for public protection.

IMUK have clearly stated that they feel that their indemnity policy is sufficient. The NMC have stated that they believe it’s not. They also say that they not in a position to state what would be enough. This in no way supports IMUK and in turn this does not support the public who want or need the services of an IM. This is not “public protection”.

But does medical liability insurance protect the public in any way, even if it is “sufficient”, as IMUK believe?

The definition of malpractice, or medial liability insurance (MLI) is a policy which, “protects health care providers against patients who sue them under the claim that they were harmed by the physician’s negligent or intentionally harmful treatment decisions.” (reference: http://www.investopedia.com/terms/m/malpractice-insurance.asp)

There is nothing in that definition which is protecting the public. MLI protects the practitioner. This is not “public protection”.

So, what does MLI actually offer? In the case of IMs, in the unlikely situation that an IM makes an error which causes harm to a mother or baby, the indemnity means that if the parents decide to sue the midwife, the midwife will be able to call upon her policy to pay damages to the parents (after a significant amount of legal wrangling which may take years, and in the meantime the mother or child will receive nothing other than the regular state provided care).

If the injury was not caused by an error by the midwife (or the baby is born with a condition which is unrelated to birth, including some cases of cerebral palsy), the parents will have no recourse from the IM’s indemnity policy and will need to rely on the state provision.

If the state provision is not sufficient for the baby or mother who is damaged by an error, it is not sufficient for those for whom there is no one to “blame”. This is not “public protection”.

In addition to this, there is no evidence at all that MLI changes practice. MLI does not mean that practitioners try harder to not make mistakes, nor that they make fewer mistakes. In other words, the same number of mistakes happen whether or not the practitioner holds insurance. This is not “public protection”.

MLI does not protect the public, so let’s stop pretending that that is what this is about.

Of Priests, Bishops and Midwives

Today I am returned from the service of celebration of the 20th Anniversary of women being ordained at St Asaph Cathedral, Wales. To remind us that we are still radical we had a small picket of people calling upon us to adhere to the scriptures ‘that women should keep silence in churches’. We were there because we had been there 20 years ago when our good friend Kath Southerton was ordained as one of the first women priests in Wales. We took our 2 year old daughter who is photographed in the arms of the presiding Bishop Alwyn.

It is significant for me that we were there 20 years ago and it is significant that I was there today, because this is part of the struggle we face as women to be treated as of equal value with in the world including within our faiths. And misogyny and discrimination remain and most particularly in the two areas of my life I am most passionate about: the maternity system which deals exlusively with women birthing and in the Church whose starting point is God’s love for all regardless of gender and creed and status in life.

Bishop Rachel, first woman Bishop in England gave the sermon. She took as her readings the story of Ruth(!) and the resurrection story of Mary Magdalene in the garden. These were both women, she said, whose context was shaped by the decisions of others.

In the story of Ruth we have a woman whose context is shaped by the decisions beyond her control. A Family of two parents and their sons migrate for work to a neighbouring country. The sons grow up and marry two local girls. This is in a culture where marriages are financial and social contracts where women are commodity as much as people. Tragedy strikes and the Father and sons die leaving the women without the protection of a legally recognised (male) head of household and means of living. Naomi, the mother in law decides to return to her own people where she maybe able to afford some living and protection amongst family and tribes people. Her daughters she releases to return to their families where they would be married off (perhaps as second hand) to another man/family. Ruth looks at the choices she has – shaped by her context and the decisions of others. None of the choices are easy but she chooses to take the risk of going with Naomi, setting aside her own culture and nationality to, in effect, become a daughter of Naomi – her people, her God – taking the risks of an all female household. All ends well for Ruth as with some more courage (and the cunning and audacity of the two women) she marries a wealth relative of Naomi – Boaz – becoming one of the very few women to be named as an ancestor of Jesus in Matthews Gospel. Rachel said that this was a woman taking life changing chances in a context limited by the decisions of others – this is the context of all – men women and children – but very much so for children and women.

Bishop Rachel is the first woman Bishop, but over the last 20-25 years since women were ordained priests in the British Anglican Church there have been many women as clever, as wise as suited to the role of Bishop who have not been ordained due to the ongoing discrimination of the Anglican Church. This will continue to be the case for many years until Women Bishops are the norm. The context of women priests is framed by the decisions of others’, individual women priests face this truth as they follow the path of their vocation.

And so I want to say to my daughters and to my female friends out there. We operate in a context framed by the decisions of others. This can empower us (such as anti discrimination legislation, some maternity laws and the mentoring of women ahead of us) but the decisions can also be limiting – many women I know, myself included have injured ourselves against the glass ceiling – and historically this has often been the case. Our efforts are in the context of a millennia of patriarchy – if we think our steps forward are very small we have to set them in this context – the story of Ruth set in the second millennium BC reminds us of this.

And sisters and daughters, if you have worked hard, you are talented and qualified but you don’t achieve what you should, do not blame yourself (as we so often do!), look at the context shaped as it is by the decisions of others. If you seek to bring about change to benefit women – and I think here of the midwives, birth workers, maternity activists and mothers themselves and you fail ( as I have) or your victories are not great and soon eroded, or you burnout ( as I have), then do not blame yourselves, remind yourself that you have been taking life enhancing action, taking life changing risks in a context that is shaped by the decisions of others.

Today we celebrated 20 years for the women who made it to ordination in the Welsh Anglican Church, whilst remembering the many more who worked, campaigned who suffered much and received little in the years before and since. Today we celebrated with the first woman Anglican Bishop of England celebrating in a few days the consecration of the first woman bishop in Wales, commemorating 20 more years of missed opportunities for the gifts and talents of women in Wales.

Today I also remember the many women priests of birth, the midwives and the doulas, who have empowered and enabled women to make their own healthy choices for birth. I celebrate we who have campaigned so women can choose a birth at home, in water, in a midwifery led unit, with a midwife she knows and trusts, to have impartial information and support whatever her decision. Our successes and failure speak of courageous selfless women taking life changing risks in a context shaped by the decision of others. Sisters we do what we can, we do not blame ourselves for what we can’t and we call on our daughters to stand on our shoulders to take the work forward. Amen

Save the NHS – Waterbirth!

“A woman in birth is at once her most powerful, and her most vulnerable.” Marcie Macari

There are some areas of maternity care which are so valuable, so game changing, that it is remarkable that they are not the default offering for women in labour.  At our most vulnerable time we can be supported to be our most powerful.  Labour and birth in water can transform childbirth, and at the same time it fulfils a vital requirement of our health service: to save money.

Jeremy Hunt continues to force the NHS to make “efficiency” savings, and the NHS has an obligation to provide the best care that it can. Given that waterbirth firmly ticks both of these boxes, it is essential that all trusts ensure that they are providing a sufficient number of birthing pools to be able to offer them to all women who wish to use water.

Tell me more about these cost savings

In summary, water labour and birth compared to land labour and birth reduces the number of interventions or complications that women experience. Some interventions and complications cost the NHS money immediately (such as caesareans, forceps, transfer to the hospital from an out of hospital birth, chemical pain relief) and some also create costs on an ongoing basis due to follow up care (eg caesareans, perineal damage, birth trauma).

Let’s back that up with some research.  Looking at caesarean sections, an Italian study in 2014 found that the women in their study who birthed in water had a 94-99% spontaneous vaginal birth rate, in a country where the caesarean birth rate is 38%! A follow on evaluation of Birthplace 2011 showed a reduction in risk of caesarean birth by 20% for first time mothers. The same review also showed that the number of women who were transferred to hospital having planned an out of hospital birth was also significantly reduced for women who laboured in water.

A 2004 observational study over a 9 year period found that waterbirths reduced the risks of perineal tearing, episiotomies and reduces the mother’s blood loss. This leads to NHS cost reductions in follow up care for tears or cuts, and for treatment for anaemia – and leads to a reduction in women coping with new parenthood without being able to sit comfortably (something that we all need to do a lot of as we feed our newborns), and reduces the number of women coping with pathological exhaustion on top of normal postnatal tiredness.

This is just a very small summary of the evidence that is available, because there are hundreds of studies which show the benefits of waterbirth to women, and to the NHS, which we will continue to blog about over the coming months.

Let’s put this into practice!

Aquabirths came about because of my passion for supporting women in birth, and because to be able to ensure that women have access to a pool if she chooses to birth in a hospital or midwife led unit, trusts need to be able to afford the capital cost of installing them. The original investment will be repaid by saving just a couple of women from an unwanted caesarean, and the human cost of an unwanted caesarean is priceless. Aquabirths fitted pools are available from £2900 including plumbing components, and are discounted even further when 2 or more are ordered. They’re manufactured in one piece to make fitting as easy as possible, and Aquabirths will do the installation if required.  The pools are easy to repair in the very unlikely situation that they’re damaged, due to their fibreglass construction rather than plastic, and they also come with an industry-best 10 year warranty.

Ongoing care is made easy and cheap by the fact that the baths are manufactured in one piece, making cleaning and hygiene control quick and effective. All plumbing components are standard parts, so they’re easy to replace if required, although this is very rarely needed, just like it’s almost never the case that you need to replace plumbing in your own home.

In a follow up post I’m going to talk some more about access to birth pools. At the moment, many trusts have a policy which means that many women are not eligible to use them unless they’re classed as “low risk” (a term which I should also cover at some point!). I’ll just leave this post with one final thought. “High risk” women are often denied access to a pool, but told to take a bath, and the same women are denied access to a pool, but instead offered heroin (diamorphine) in labour without being told what they’re being given. It’s time to take another look at labour and birth in water and the benefits of it to women, babies,

…and trust finances.

Aquabirths are running a special offer of a free birth couch (currently £795, normal price £950) with every Canberra, Venus or Heart-shaped Birthing Pool. Use code SB161102  when ordering the Pool.

 

“In case you sue us”. A discussion on consent.

Guest blog by Emma Ashworth

I had a mole removed yesterday.  Just a simple procedure, done in the GP clinic on a smooth running, efficient weekly service.

Before the doctor went anywhere near me with a scalpel, I was asked to sign a consent form because, of course, even when I ask someone to cut a piece off me, we all need to be very clear about what exactly I have requested, and what they have agreed to do.  I’m quite fussy about consent forms.  I like to know what I’m signing.  I like to read all of the details and to ensure that I clearly understand what is being offered and what the potential risks may be.

Consent forms can often be long and complicated.  This one wasn’t – it was a small piece of text on an A5 sheet of paper and the consent wording was along the lines of, “I agree that I have been fully informed of all of the risks, which may include bleeding, pain and scaring”.  It reminded me of a self-discharge form that I was asked to sign in hospital once.  It stated that, “I have been made fully aware of all of the risks of self-discharging”.  However, the reason that I was self-discharging was that I had been in the hospital for two days without seeing a doctor once, my symptoms had gone and I was clearly low priority, as otherwise I would have already have had a discussion with the doctor, which would have meant that I was, in fact, fully aware of any risks of leaving.  I hadn’t, so I wasn’t.  I declined to sign that form and left anyway.

In AD 579, Emperor Justin II was in need of emergency surgery.  No surgeon would even attempt the procedure because they were too worried about being blamed for it if it went wrong.  Emperor Justin handed the surgeons the scalpel himself to clearly show his request for the surgery, and promised that there would be no retributions if they failed.  In fact, he died, so it’s a good job that they did!  This very early example of consent being gained for the surgeons’ protection rather than the patient’s, is now being repeated time after time in our hospitals and clinics.  The time pressures on clinicians is such that it is extraordinarily difficult for them to walk us through the pros and cons of different options, and so often reduced to the effects of the paternalism endemic throughout history, where the likes of Henri de Mondeville in the late 13th Century stated, “patients […] should obey their surgeons implicitly in everything appertaining to their cure”, and even the Hippocratic texts which recommend, “concealing most things from the patient, while you are attending to him.”

While the lack of information sharing nowadays is almost always for entirely different reasons (a lack of time, not desire for control), we do see responses from medical staff when we ask for more information which perhaps many might get huge value from reflecting on. In my experience, impatience is the usual reaction, which again is likely to be because of time constraints, but sometimes there is perhaps a paternalistic throw back. For instance, I was once in a meeting with a consultant who was in discussions with a doula client.  She had plenty to ask after much preparation between us.  After she had gone through a number of her questions, the doctor asked in rather frustrated tones, “You seem to know an awful lot about this. Who have you been talking to?”

My client responded, “Well, my doula”

To which the doctor snapped back, “No, I meant which professionals?”.

So, to go back to my own minor surgery yesterday. I read the consent form and I pointed out that to sign to say that I was fully informed of the potential risks, without them all being laid out, was not full consent. The doctor replied that there was a list, look, right there, and anyway it’s just, he said, so that you won’t sue if there’s any issues.  I explained that I meant that the wording itself implied that there were other risks that weren’t listed – I couldn’t blanket consent to say that I know everything – and, importantly from his perspective, he was unlikely to be protected if, say, he hit a tendon and caused me to lose function in my hand.

The next day I happened to be in the same GP surgery again for a physio appointment. Because my wound had bled quite badly, I asked the receptionist if she would be able to get me a replacement dressing from the nurse.  “Oh no”, she replied, “you’ll have to have an appointment for that”.

“Why?” I asked. “It’s basically like changing a plaster, I can just do it myself”.

“Well,” she responded, “you might sue us if it’s been bleeding so I need to make sure that the nurse sees you to protect ourselves.”

Is this really where we have gone with obtaining consent? I cannot change my own simple dressing because I might sue for some minor bleeding that I’d already signed to say that I understood might happen?.  On the one hand, are health professionals trying to desperately cover themselves with extensive notes, and consent forms which may or may not be adequate, and on the other hand completely unable to give people in their care the time to actually talk things through properly? What does obtaining consent mean? When women in the throes of labour are bullied in caesareans with long speeches about the dangers of continuing with their vaginal birth, and then they are given complex consent forms with risks such as “death” as they’re being wheeled towards the theatre, can we really say that they’re consenting?  And in the end, who, if anyone, is being protected here?

Consent is not as simple as signing a consent form. Food for thought for both health carers and the people in their care.

 

 

NMC Consultation – Respond before 17th June and here’s some help with doing it.

Guest Blog by Rachel Gardner of Forging Families

Dear Friends,

This is the most important thing I have ever written, and I implore you to read it and act upon it by answering these two questions in this government questionnaire.

This is not about labour or conservatives, this is about midwives and women and birth and about saving women’s choice in birth and about saving the midwives who support these changes.

Please get involved and get others involved. The deadline is 17th June. ACT NOW.

THE MOST IMPORTANT QUESTIONNAIRE YOU COULD EVER COMPLETE.

This questionnaire is here:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

It is for professionals and the public but is worded in such a way that most members of the public would not fully understand what is being asked.

There are two questions that you MUST answer. The rest of the questions you can skip but the first two please respond too, and then submit your questionnaire to the government.

Question 1 is:

Do you agree that this additional tier of regulation for midwives should be removed?

This question is referring to the role of Supervisor of Midwives. Supervisor of midwives role is to protect women’s choice, and women’s choice regarding their birth is one the most important things in maternity. Supervisors of Midwives support women choosing birth outside of ‘policy’ or outside of specific guidelines.
Without the role of Supervisor of Midwives the potential is for Trusts to refuse to care for women choosing care outside box guidelines and there will be no protection or support for midwives providing care in these instances.

This would be a catastrophe for maternity care and for women and for choice in birth.

Midwifery supervision brings challenge to Trusts when advocating for the safety of women. This is a healthy level of challenge ensuring Trusts management maintain women’s safety as the focus of their care, enabling women’s choices to be listened to and respected. SoMs also work collaboratively across trusts sharing best practice, completing external investigations and providing “fresh eyes” on midwifery practice. All this has the potential to be lost with the removal of the regulatory function of Supervisors of Midwives.

Do we agree with this happening? No, no no!

Question 2 is:

Do you agree that the current requirement in the NMC’s legislation for a statutory Midwifery Committee should be removed?

Considering the NMC stands for Nursing and Midwifery Council there is poor representation by midwives in the council. If the midwifery Committee is to be removed from the NMC the voice of midwives will become weaker than ever. Someone has to protect the function and role of a midwife or it will be lost forever. Allied health professionals are not just nurses in the same way as midwives are not just nurses. This is like physiotherapists being regulated by radiographers. It just doesn’t make sense. The professions although within health are completely different.

Should we remove midwives from the Nursing and MIDWIFERY Council? No, no, no!

NMC Consultation: Midwifery Committee Concerns

Guest Blog By Beverley Lawrence Beech and Emma Ashworth of AIMS

Last week I wrote about the proposed changes to the NMC that the DoH is currently consulting on.  While they work on removing Supervision, they are trying to slip in the removal of the midwifery committee at the same time.

This is how the NMC describes the Midwifery Committee:

The Midwifery Committee advises the Council on:

· any matter affecting midwifery, such as policy issues affecting midwifery practice, education and statutory supervision of midwives,

· responding to policy trends,

· research, and

· ethical issues affecting all registrants.

The Midwifery Committee’s recommendations and subsequent Council decisions influence midwifery development in the UK, which affects the lives of individual women and their families under the care of UK midwives.

(for full text, click here)

The consultation states, “Although the NMC regulates two professions, nurses and midwives, the NMC is only required by its legislation to have a statutory midwifery committee to advise the NMC Council on matters relating to midwifery. It has no similar requirement to have a statutory nursing committee and none of the other healthcare professional regulators have a comparable statutory committee. The government has a policy objective to streamline and rationalise regulatory legislation.

However, let’s look at how the NMC is made up.  For every 1 midwife there are more than 12 nurses.  The other healthcare professional regulators do not need to have their own representatives because they are their own representatives, not lost in the noise of another profession. Of course it did not have a requirement to have a statutory nursing committee, the government was forced into legislating for a statutory midwifery committee as a result of the protests from midwives and lay groups who felt that without a statutory requirement midwives would just be absorbed into the nursing profession.

Let’s look at some more history.  When in 1983 the government proposed a single ‘nursing’ professional council, despite opposition from midwives, AIMS and other groups, they amalgamated the Central Midwives Board into the UK Central Council for Nursing, Midwifery and Health Visiting which, in 2002 became the Nursing and Midwifery Council.  The midwives fought for a separate Midwifery Council but lost, although as a sop to their concerns, a review in five years was promised.  It never happened.

Since 2002 the Midwifery Committee has been gradually reduced so that there are now only seven members, of which only two are practicing midwives, and in recent years  its support staff have been withdrawn, the dedicated office closed down,  and there is now only one midwife on the main Nursing and Midwifery Council.

A few years ago the NMC was awarded a £20m government grant for the NMC to address ‘the problems it faces in terms of administration and management’.  But this is but one of the problems.  As far as midwives and users of the service are concerned there is a far greater problem -the dichotomy between nursing and midwifery practice.

Over recent years, too many excellent practising midwives (most of them independent midwives) have been reported to the NMC, and some have been struck off.  Unfortunately, midwives are no longer judged by their peers.  AIMS members have observed hearings where, for example, a community midwife was judged by a labour ward manager who, clearly, was not up to date with the research and, from his questions, had no concept of the principles of informed consent.

Take the case of Beatrice Carla for instance.  AIMS members observing the case soon realised that this case was not only about Ms Carla’s individual practice, but encapsulated the struggle between midwifery evidence, knowledge and skills, and accepted medical evidence, protocols and policies. This struggle was very apparent among the panel members. Perhaps the most worrying aspect of this case was that while the Chair of the panel, Professor Paul Lewis, who was an exemplary Chair, showing fairness, care, courtesy and regard towards all concerned, he had repeatedly to draw the attention of the other panel members to the research evidence on maternity/midwifery care.  It is a serious issue that the NMC has failed, and is continuing to fail, to address.

Until midwives have their own Midwifery Council and allegations of failure in practise are judged by expert midwives these injustices will continue and women will be deprived of skilled midwives who really understand the meaning of normal, undisturbed, physiological birth, informed consent and women-centred care.  The removal of the midwifery council from the NMC leaves midwifery practice being judged by those who are in an entirely different role.  Would doctors accept their cases being considered by nurses?

The real fear is that the changes will lead to midwives being forced to become obstetric nurses, losing the autonomy that has been fought so hard for, for so many years.

There is a General Medical Council and a General Dental Council, so why is it not possible to have a General Midwifery Council?

Please, respond to the consultation and raise these concerns.  Your response is desperately needed.

Consultation link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

Proposed NMC Midwifery Changes: Modernisation or Mutilation?

Guest blog by Emma Ashworth

The Department of Health has released its consultation document on proposed amendments to the NMC and ALL midwives should read it, understand it and comment on it.  This consultation has put together a number of different proposals, each of them hugely important in and of themselves, and each which need to be addressed and considered separately.

I have long been irritated by the fact that when consultations are drafted, their wording is directive, designed to influence the outcome to that which the Consulter wants.  This NMC consultation is no different.  The title, “…amendments to modernise midwifery regulation and improve the effectiveness and efficiency of fitness to practise processes” states that this is what the amendments will achieve.  Who doesn’t want modernisation? Who would disagree with improving effectiveness and efficiency? Who wouldn’t want fitness to practice processes improved?  And yet… let’s look at those words.  “Modernise”.  Not changes, but modernisation.  Removing Statutory Supervision is not an alternative way of supporting midwifery practice, but a “modernisation”.  As is pointed out to Arthur Dent, “there’s no point lying down in the path of progress!” but when there’s a large yellow digger coming to knock down your ability to support women to access services outside of guidelines then shouldn’t we all be lying down in the mud?  (Note: if you don’t know why people are lying down, or why diggers, once you’ve read and commenting on the DoH’s proposal, go get a pint of beer, a towel, and read “The Hitchhiker’s Guide to the Galaxy”)

Statutory Supervision was torn apart following the Morecombe Bay enquiry, where it was decided that there was a problem with the combined role of the Supervisor to both support midwives in their caseloads and at the same time be responsible for investigating complaints against them.  This has been a concern of a number of people before the enquiry, but a solution that did not remove both functions was not investigated by either the DoH or the NMC.  A “modernised” Supervision role should surely create a way that both roles could be fulfilled without any conflict of interest.  For example, two different roles might be created with different people in the Trust holding them, or the investigation of complaints might be moved to the LSA, and the supportive role of the Supervisor be kept within the midwives as is the current position.  There may be a number of ways that this could happen which would not remove the vital role of supporting midwives to support women, and it is this role which is being removed from being statutory.  This is the absolute crux of the issue.  If something is not statutory Trusts will not do it.

The devastating, NHS destroying Health and Social Care Act meant that the CCGs have absolute power to decide on care services, with nothing other than emergency care being mandatory.  We have all seen the catastrophic slashing of services across all areas, not just maternity. We can’t even invest to save, for instance by creating a continuity of carer service which we know would drastically improve outcomes and save vast amounts of cash, even if it takes work and a small investment to set up.  There is a cost to supporting Supervision. How likely is it that it will continue when it is not a requirement?  What will midwives do, then, when they are trapped between women’s needs and wishes, and “guidelines”?  What will you do?

Have your say and respond to the consultation here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

Read more: https://www.rcm.org.uk/news-views-and-analysis/views/department-of-health-releases-consultation-on-nmc

Next: Abolishing the statutory Midwifery Committee

 

 

The Story of Miss Margaret the Granny Midwife

Fifteen year old Tilly Weston has done a work expereince placement with Aquabirths this week.  As part of here work she was asked to choose a DVD watch it and write a review.  Here it is:

Miss Margaret is an inspirational film that is well written following the story of a legendary Granny Midwife from Eutaw, Alabama.

Margaret Charles Smith was born in 1906 and died in 2004 at the age of 98. Margaret was brought up in Alabama by a slave woman; she was the last of 10. She grew up working in the cotton fields until she decided she wasn’t going back to the fields again and she was going to get a different job! She started as a laundry woman, and then continued to do a midwifery course after showing natural skills delivering her husband’s cousin’s wife’s babies.

She became a highly regarded midwife and delivering 3,500 babies at home (in a county population of just 10 000). She never lost a mother and never drove a car – despite travelling all over Alabama and sometimes further. There were times she delivered 4 babies a night, but she said she never gave up on a mother: using prayer and motherwit as her main tools, and patience and kind words as her main techniques.

In her words “They’ll know what they’ve got to do, if you know how to talk to them. Give ‘em love and kind words. That beats it all.”

Then she was pushed into retirement as a law was passed that midwives, like her, were no longer allowed be midwives. So Margaret Smith wrote a book named ‘Listen to me Good’. This along with her phenomenal life story inspired the next generation midwives.

I think this film was beautifully made, inspiring the watcher and emphasing the utter ‘amazingness’ of this woman’s extraordinary life despite the troubles she had being a black woman in America. It also made me think how tough things would have been for women then, how things have improved, and how things should continue to improve for women all over the world to have a comfortable birthing experience. It makes me think what an important vocation midwifery is.

The DVD is called ‘Miss Margaret’ produced by Sage Femme.

You can buy this DVD (and others) at: www.sagefemme.com

You can buy the book ‘Listern to me Good’ by Margaret Smith at http://www.amazon.com/LISTEN-TO-ME-GOOD-PERSPECTIVE/dp/0814207014

And many other online and off line book stores.

Why we couldn’t wait for Kate – the induction and the Duchess

Our blog this month would not be complete without some discussion surrounding the birth of the Royal baby.  Welcome to the world, baby Charlotte.

Much speculation surrounded Kate during the final moments of her pregnancy regarding her due dates and possible induction. My hope is that she banished the entire furore from her home and read not a single article published by the mainstream media.

The Telegraph wins the unofficial Born Stroppy award for Worst Media Outlet after browbeating us with stunningly misinformed headlines like “Kate Middleton, Duchess of Cambridge overdue with second child”, and this very disturbing leader

“The Duchess is thought to be a week overdue, suggesting the latest she would be allowed to wait by her doctors would be next Thursday, the day of the General Election. Some reports have claimed her due date was April 25, which would mean the Duchess may not be induced until a week on Saturday, as doctors treat two weeks after the due date as the cut-off point for allowing labour to come on naturally.”

Yes, you read it right. The Duchess (and her baby) would not be allowed to wait beyond election day.  No pressure, then?

to induce or not to induceLet’s get this straight.  This is the Duchess of Cambridge.  Revered, powerful, selected as one of the most influential people in the world by Time magazine, being told vicariously through institutions such as the BBC and the Mail when she’s no longer allowed to be pregnant.  It seems laughable in that context, but it’s not. It’s not laughable because she is now the latest poster girl for all that is wrong with our views on pregnancy and birth and women’s rights to make informed choices for themselves and their babies.  We wouldn’t let someone tell us how much milk to pour into our coffee, and yet when it comes to the matter of birth we are expected to blindly follow a set of arbitrary rules imposed by people we don’t know, for purposes we don’t understand.

So, in repost to the Telegraph and all the other ill informed journo’s, here is my jargon busting selection of facts and evidence based articles on the final weeks of pregnancy.

Myth 1: If your pregnancy lasts over 40 weeks, you are ‘overdue’.
The truth: 80% of labours begin between 38 and 42 weeks. It is quite normal for a woman to gestate up to and even beyond 42 weeks, particularly in a first pregnancy, whose average duration is 41 weeks. Due dates are estimates. No more, no less.

A study by the US National Institute of Environmental Health found that the length of pregnancy can vary naturally by as much as five weeks, with only 4% of babies born on their 40 week ‘due date’.

Myth 2:  If I allow my pregnancy to continue beyond 42 weeks my placenta will stop working and my baby will die.
The truth: Placental function in an otherwise healthy woman does not simply cease.

Nature is far cleverer than that. It is true that placental function decreases at the end of pregnancy, when the placenta has more or less fulfilled its purpose.  This is a normal feature of a healthy pregnancy, but is used by some as a means of frightening women into accepting intervention that may not be necessary.

A fascinating Cochrane review of 22 studies including over 9,900 women found that if we induced every woman’s labour at 41 weeks, the risk of a baby dying is 0.03% (or three in 10,000). If every woman gave birth at over 42 weeks the risk would gradually increase over time in a reasonably linear fashion to just 0.3% (or 30 in 10,000).  So a doctor or midwife may tell you “you are 10 times more likely to lose your baby” if you go over 42 weeks, but they should also be pointing out that this 10 times risk is actually 10 times a value of 0.03, which is minute.  Putting it another way, 410 women would have to undergo induction (with all its risks and pitfalls) in order to save the life of one infant.  A baby is more likely to die from a cord prolapse (cord prolapse affects approximately 60 in in 10,000) but we don’t evacuate babies before they are ready for that.

To make matters more confusing, some of the data collected doesn’t rule out confounding variables, such as the lifestyle choices of the women in the study.  Some of those women will have had other risk factors, such as smoking (which damages the placenta) or previous known/unknown health conditions.

And there’s more! The researchers at Cochrane state that many of the studies they reviewed were quite old and some of the evidence was not of the best quality, and many of the trials were also considered at moderate risk of bias.

So you see, this is the vital perspective we are missing out on because many healthcare providers don’t have the time or inclination to inform us.  Why? I will let you gather your own conclusions, but I feel it is strongly to do with the culture of fear and forced compliance that surrounds the medical model of birth of which we are so fond in the UK.

If all women considering induction were party to this information, how many women would opt out of routine induction?

Myth 3:  Induction is risk-free.
The truth:  Whilst induction is not nearly as risky for women and babies as it once was, women who have inductions for post-dates (over 42 weeks) pregnancies are not exempt from injury, and there can also be implications for the unborn child, usually resulting from over-stimulation of the uterine muscle causing foetal distress.

This well researched article outlines the risks associated with induction in more depth, the main risks being as follows:

– Induction is slightly more likely to result in a Caesarean section, particularly in first births.
– Inducing labour too early can result in premature birth, which can cause issues such as breathing difficulties in the baby       (and for an individual it is impossible to tell when ‘too early’ really is).
– There may be reduced oxygen supply to the baby during labour, which can affect the baby’s heart rate.
– Increased risk of infection for both mother and baby.
– Increased risk of cord prolapse, a rare obstetric emergency which occurs when the cord slips into the vagina ahead of the   baby.
– Increased risk of uterine rupture, another rare but serious consequence of artificially stimulating the uterus (more common   in women who have 2 or more c-sections)
– Slight increase in risk of forceps or ventouse birth (often due to foetal distress caused by the hormones in the induction       preparation)
– Post-partum haemorrhage (bleeding after the birth), again caused by the over-stimulation of the uterus which can prevent   it from fully contracting after the birth.
– Prolonged stay in hospital (the pessary used to soften the cervix can take up to 24 hours or more to take effect, and can     sometimes be completely ineffective if the cervix is not ready to let the baby out.)

Myth 4: I’m not allowed to go beyond 42 weeks.
The truth: The simple answer to this is that you are allowed to do whatever you like.  Nobody can compel you to make a decision that isn’t right for you.  The role of a Midwife or an Obstetrician is primarily to inform you, and secondarily to advise you. What you choose to do with the information they impart is down to you.

If you find yourself being coerced or bullied by a healthcare professional into any situation you do not feel comfortable with, it is useful to ask them the following questions, based on a system known as the BRAIN acronym:

Benefits – what are the benefits of this procedure?  How will this help me and my baby?  Evidence?
Risks – What are the risks associated with this line of action?
Alternatives – What are my other options? Are there alternatives to this procedure?
Intuition – What is my gut feeling about this?  What is my instinct telling me?
Nothing – What is likely to happen if we do nothing?

Now, if you ask a healthcare professional, “what is likely to happen if we do nothing?” and they reply with something emotive like “your baby will probably die”, you know instantly that you are dealing with someone who is either very misinformed or is stretching the truth beyond its limits.  If you go through the BRAIN questions and get well informed answers with some concrete evidence to back those answers up, you are dealing with someone who is honest and at least reasonably objective.  I know who I’d rather put my trust in.

This helpful blog on informed consent by anthrodoula goes into more detail about how to implement the BRAIN acronym in a real life scenario.

Myth 5:  I cannot have a natural/normal/home/water/intervention free birth if my pregnancy lasts more than 42 weeks.
The Truth:
Yes, you can.  As a Doula I have supported many women in their 43rd week of pregnancy and all of these women have made a fully informed choice to refuse induction, for various reasons.  I highly recommend reading this article from the Homebirth UK website on ‘overdue’ babies, which is excellent reading whether or not you are planning a home birth.  In it, the author discusses the alternatives to induction and clearly demystifies the statistics and the guidelines used by the NHS. You will also find some empowering stories of babies born beyond their due dates.

A final note on the Duchess of Cambridge. Some of you may have noticed that she did not reveal her ‘due date’ to the press or public.  Any mention of dates in the papers was purely speculation.  And Kate is bucking a trend.  Many women are now choosing not to reveal their dates, instead favouring the option of a birth month. I believe this will work its way further into the public consciousness over time, as more women take back control of their choices, their bodies and their births.  Reader, I hope you are one of them.

This month’s guest blog has been written by Caroline Ward, Doula and birth rights campaigner.

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