I met midwife Katherine Hales at an Association of Radical Midwives meeting (she's the national co-ordinator) and I immediately suspected she had a few stories to tell.
We didn't get the chance to discuss anything other than what was on the official agenda that day, but a quick Google let me know I was right. An independent midwife with nearly thirty years' experience, with seven of her own children born over four decades, Katherine has a lot to teach.
Today I'm pleased to hand Midwife Diaries over to her so she can tell us exactly why midwifery regulation in the UK needs improving and how we should go about achieving this.
We'll be going in deep and looking at the history of midwifery here so I've broken Katherine's teaching down into 10 main facts about the state of midwifery today.
Once you've got to grips with how things have changed, I hope you can help us spread the word!
1. Let's Start With The History of Midwifery in the UK...
In 1902 the UK Midwives Act came into being. It was to legislate for the work of midwives, formalising what used to be fairly unregulated lay-midwives, handywomen and nurses, as well as local women involved in the care of the dead and dying.
Some were very skilled and experienced through long practice and others were likely to cause harm. The Midwives Act set out criteria for training and kept a register and set out midwives' rules and standards too.
2. The Beginning of Supervisors of Midwives
The Midwives Act also started the 'Supervisor of Midwife' framework, which was added to the law.
Back then, the work of Supervisors of Midwives, or SOMs, involved inspecting the equipment and premises of community midwives.
The board controlling midwives was at first dominated by the medical profession. This was to protect public safety, but we can't forget that medics would also have wanted to protect their position and income in terms of being called out for complicated births.
Therefore midwives rules and standards have always stressed that while midwives are experts in normal pregnancy, labour and birth, they have a responsibility to call for medical help when complications arise.
3. Midwifery Regulation Was Taken Over By Nurses
Until 1979 we actually had a 'Central Midwives Board' in the UK which was made up of midwives and medical professionals. But this was replaced by the 'UK Central Council of Nursing, Midwifery and Health Visiting' in 1979. At the time, the Association of Radical Midwives and other groups were concerned because this body had a much greater nursing presence - were midwives' voices going to be drowned out?
There was a good midwifery committee as part of the council, but many were worried midwifery input would eventually weaken.
In 1999 things took a turn for the worse when the central council was replaced by the Nursing and Midwifery Council (the NMC we have today) and the midwifery committee became non-statutory. This means the midwifery committee wasn't legally protected anymore, and this was done despite outcry from midwives and others.
4. Supervisors of Midwives Were Threatened
At this point, Supervisors of Midwives were still protected by law.
Supervisors of Midwives were experienced midwives who helped keep midwifery safe, were the 'go-to' people when things became dangerous on shift, contactable 24 hours a day, had power to identify when midwives needed more training or to be taken off the register, and also helped women when they wanted to make choices outside of hospital guidelines.
The concern at this point was that the Nursing and Midwifery Council eventually wanted supervisors to somehow be combined within the nursing model of regualtion. Midwifery started to be more about academic rigour at the expense of clinical experience.
5. Many Midwives Became Concerned About Midwifery's Future
From 1989 - 1999 the Association of Radical Midwives, as well as other important midwifery bodies, campaigned for a new Midwives Act. This failed, in part because the Royal College of Midwives, the midwives' union, withdrew their support for the project.
Many midwives and other informed parties predicted that midwifery would lose control over its education and leadership as the larger nursing group prevailed and as the public increasingly viewed midwifery as a branch of nursing.
6. What's Going On In 2017?
Now we're in 2017 and these prophetic fears have been realised.
Supervisors of Midwives have been taken out of law.
There are complex events that led to this and the role had been used inappropriately in some cases - see more here.
The other issue is that this change was implemented despite midwives overwhelmingly opposing it. Our 'leader' in England is now the Chief Nursing Officer Jane Cummings. Where is midwifery's voice?
7. Midwifery is not well represented at official levels
The Royal College of Midwives have been campaigning and there is now a midwifery panel at the Nursing and Midwifery Council. But a one day a week midwifery advisor (currently Donna Ockden) is not sufficient to regulate midwifery well. Professor Mary Renfrew is a midwife and health researcher who is drawing up new guidelines for the education of midwives.
It's unclear how these professionals were chosen or how much influence they have over midwifery.
8. The Nursing and Midwifery Council Is Being Criticised
The Nursing and Midwifery Council have been called to account this year for a number of ill-advised decisions, especially around stopping independent midwives practising due to insurance questions.
There are also investigations ongoing into the Council in terms of how they handled the investigation of the deaths of Mums and babies, and substandard care, at Morecambe Bay Trust.
The loss of leadership and influence in midwifery is a complicated thing to think through. Joining the dots in terms of it impacts midwives and women on the shop floor is hard to do.
But crucially, Supervisors of Midwives used to be who women went to for support. They could get the advice of an experienced midwife so the safest plan of care possible could be put together. This is no longer possible.
9. The Midwives Rules and Standards which used to be in law have also gone.
The really worrying thing about this is that legally, the description of midwives in terms of antenatal care, postnatal care, emotional support and monitoring in labour, breastfeeding support and so on can be given by non-midwives.
The Better Births 'National Maternity Review' published last year is crying out for midwives supporting women in a one-to-one fashion across pregnancy, birth and the postnatal period.
But it looks like the government have just legislated away from this, as the role of a midwife is no longer protected in law.
10. The Campaign For Better Midwifery Regulation
When I studied to become a midwife I hoped to be able to provide a professional relationship with a woman supporting and empowering her with her family to transform into their new life.
In theory, it's now possible for trusts to employ far fewer midwives. Their role might be to oversee the work of non-registered staff on labour wards, popping into birth rooms as the head crowns to catch babies, as happens in the USA with obstetric care.
Care might become more fragmented and the personal relationship which adds so much in terms of satisfaction and improved outcomes could be lost, as could women’s rights and choices.
Katherine has just given you ten pieces of information about midwifery regulation and why it needs to change.
Can you comment letting us know which of these you weren't aware of? What did you learn?
This will help us spread awareness.
And please share this with anyone else who would find it interesting or needs to know.
Thanks for reading and caring. You rock. Much Love, Ellie x
Please join us and raise awareness of our Campaign for Better Midwifery Regulation! #savethemidwife