Guest post: “It will be a unique opportunity to shape the future of midwifery”

[MumsnetGuestPosts]

More than 2000 women become pregnant every day. They will be cared for throughout their childbearing journey by the more than 40,000 midwives working in the UK. Midwives will be there for each woman, and her baby and her family, from pregnancy through birth and beyond, whatever her circumstances.

Many developments are affecting women, babies, families, and the health service. New evidence is informing the delivery of care, the health needs of the population are changing, and recent policy developments are setting new directions of travel for maternity care in all four UK countries.

We need to make sure that the education of student midwives keeps pace with these changes, so that all midwives have the skills and knowledge they need when they join the profession.
The Nursing and Midwifery Council (NMC) has now launched its future midwife consultation on the draft new standards that the next generation of midwives will need to meet when they qualify.

These standards, when finalised, will replace the current set that were introduced in 2009. They will raise the bar in terms of what the midwives of the future need to know at the point of registration, enabling them to provide the best and safest care.

We’ve worked in partnership with midwives, mothers, families, educators, other healthcare professionals, representative organisations, advocacy groups and many others in drafting the new standards. In all, we have worked directly with over 600 people so far.

The draft standards are based on the best current evidence, so all the latest developments are all included.

They have a core focus on the needs of women and babies and on the views and preferences of women and families, recognising the key role of the midwife in meeting those needs and in advocating for women.

Some topics have a greater priority than in the past. For example, public health and health promotion is included in more detail. There is a greater focus on mental health – the first time that this crucial area for women, newborn infants, partners, and families has been prioritised in this way.

The draft standards emphasise the need for women to receive continuity of care, so that whenever possible, the same midwife will provide care throughout pregnancy, birth, and after birth.

They also focus on the key role that midwives play as members of a multidisciplinary team of professionals, so women, babies, and families will receive the right care at the right time from the right people, whatever their circumstances. This will include working with social care as well as other health care professionals.

We want the new standards to help promote trust, confidence and professionalism in midwifery for the next generation. Today’s student midwives are the future scholars and leaders of the profession, and key advocates for women and babies.

But our draft standards are not the finished article. That’s why we want to hear from everyone who cares about great midwifery care. We’ll be holding a programme of events across the UK as well as webinars and Twitter chats so everyone will have the chance to get involved and have their say.

And remember, anyone can take part. You can respond as an organisation or in an individual capacity – or both.

After the public consultation, we’ll consider all the responses and comments and refine the standards further, before the final version goes to the NMC’s Council for approval.

The final standards will then be published in January 2020, with the first student midwives studying programmes governed by them in September 2020.

Our consultation will be a unique opportunity to shape the future of midwifery, and we hope that as many people and organisations as possible will take part – so please sign up to a consultation event, a webinar or a Twitter chat and get involved.

Professor Mary Renfrew will be returning to this guest post at 2pm on 18/02/2019 to answer any questions you may have.

[spinabifidamom]

Will there be any surveys to fill out or not? Can I read the proposed standards? Where will the events be held?

Are they free or not?

[TableforJane]

Will the proposed changes affect the recently approved Midwifery Apprenticeship standard?

[birdonawire1]

Will the views of parents whose child has been damaged by poor midwifery care be taken into account? Non recognition of potentially dangerous symptoms and appalling mistakes reading CTGs are far too common.

Midwives appear to have an attitude of complacency which leaves women open to mistakes of omission. Surely they should be trained to rule out 'worst case scenario' before assuming a mundane cause for symptoms?

Perhaps talking to mothers of damaged or stillborn babies should be a part of the training?

[HoustonBess]

I don't see how any improvement is possible when midwives are so overworked, underpaid and stressed. I'm sure most of them would like to do their jobs better but working conditions make it impossible. Will another document help?

[SeaWitchly]

Agree with Houston. Perhaps concentrate on improving working conditions and supporting best practice rather than producing more useless documentation which overworked midwives are required to read

[northernlites]

I agree with@HoustonBess too
This overhaul is asking them to basically do more which is great if you have the resources....there are not enough resources.
Continuity of carer for example is a high staff:patient ratio model and the midwives life and work revolves around the woman,
I feel this is skewed in a world where we should be trying to get employees work life balance right especially in a caring profession where midwives and nurses are often working beyond hours without breaks due to shortages, a burnt out staff cannot give more
I appreciate it maybe what some women want but let's think about the women providing it too

[LucheroTena]

The problem with these sort of standards revisions is they become a stick to beat people with. Invariably there will be no additional funding or staffing to implement any of it. So the demoralised and overworked workforce will be expected to just get on and do it. Because, you know, some people wasted a lot of time and money on the exercise. And then even more experienced staff get fed up and leave the NHS for easier and better paid jobs. In future years I anticipate a very junior nursing and midwifery workforce propped up with unregistered staff. But it’ll be cheap.

One thing I’d like to question is how a single midwife can care for a woman through pregnancy, birth and aftercare. Are they expected to be on call all the time, not go on holiday or have rest days? I’d prefer my midwife to be well rested and on top form thanks. In the middle of birth I couldn’t have cared less who was there other than that they needed to be highly competent/expert, caring and not too exhausted to think straight.

[vivariumvivariumsvivaria]

Can you teach your midwifery students how to do a 12 hour shift juggling six birthing mums or a postnatal ward with 23 mums and their babies with no time for a pee or a drink of water?

You don't have a training problem. You have a resource and respect problem.

[PhoenixBuchanan]

As a midwife I agree with the above comments and will be responding to the consultation as such. I now work in Canada as a caseloading midwife (on call, providing antenatal, birth and postnatal care in a continuity model) since that is the only model of practice here. SO many of us here want out of this way of working and to have different opportunities that don't require us to give over our entire lives to this job, often to the detriment of our families and our health.

I had rose tinted spectacles once and thought continuity was the gold standard of care. And it is, for women. But it is so, so hard on midwives and burnout rates are sky high. There needs to be a balance.

[Treacletoots]

Actually my experience of being on a labour ward for 7 days was very eye opening. The midwives who were the best, kind and non judgemental were the ones not trained in the UK. The UK seems to create midwives who treat their patient like an idiot, who has no say of what happens to their baby or their own bodies. I had an elective c section due to complications but when I tried to discuss the matter when issues started occurring my midwife refused to discuss it and spoke to me in a very condescending manner.

Midwives need to take their own personal oponions out of the care for their patients and do what's best for their patient. How many times have we heard of midwives doing what they wanted despite repeated requests from the woman?

[northernlites]

Absolutely agree with @PhoenixBuchanan
The new models proposed to deliver the Better Births targets involve caseloading to achieve what is necessary and whilst this ticks the boxes and does definitely provide excellent care for women, it comes at a cost as it requires uires higher staffing ratios
That cost is on an underfunded NHS.
That cost is a midwifery staff already largely working above and beyond and are tired.
It's difficult to achieve with a polarised workforce where one end is at retirement and the other are young having families and can't meet the on call commitments.
That cost is also asking the midwife to give up her quality of life, sometimes at the expense of her own family, in exchange for the care she gives and therefore is not healthy for the workforce...it can't be sustained for long periods.

I also think that this new ethos is the desire of only a certain demographic of women. I think the consultation events for Better Births only attracted such women and because of this is a polarised view. Not all women want the same midwife all the way through. Some women prefer the convenience of appts wherever whenever, no matter who is delivering the care. Some women also really don't mind who is with them at birth.
I do agree though that continuity does improve birth outcomes but this can be achieved with teams... it just need the proper investment

[PanamaPattie]

Midwives will be there for each woman, and her baby and her family, from pregnancy through birth and beyond, whatever her circumstances.

This statement is not accurate.

Midwifery in its current state is not working. The service needs to be scrapped and started fresh. There is no point in trying to paper over the cracks. Not enough trees.

[ProfMaryRenfrew]

Hello everyone

I’m really looking forward to this session today – we’ll be discussing the new draft education standards for midwives, produced by the Nursing and Midwifery Council, which is the regulator for midwives.

These draft standards aim to identify the knowledge and skills that all new midwives need to have when they quality. So we’re not thinking about what experienced midwives can do – we’re focussing on newly qualified midwives

We are hoping to have a lot of input from people – women, families, midwives, advocacy groups, educators, and colleagues from other disciplines – to help us make these new standards as good as they can be.

There’s a survey that’s open to everyone to respond – you can read the draft and respond to the survey at this link - nmc.org.uk/future-midwife

Thank you!

[ProfMaryRenfrew]

Thanks for all the comments so far about this work - really helpful.

I can see that some of you are concerned about the pressures that midwives are under in the workplace. We do know about that and have thought about it a lot – we talked with hundreds of people when we were drafting these standards and they talked with us a lot about this. We have factored that into the draft.

We hope that these new standards will help, by giving new midwives the knowledge and skills that they need – not only to care for individual women, babies, and families, but also to work in an organisation, to ask for help when they need it, and to respond appropriately when they see something going wrong.

[chickhonhoneybabe]

As part of the new standards I feel that not only should students be appraised by their placement mentor, the placement mentor should also be apraised by the student and this should form part of the midwives annual review and CPD requirements as part of maintaining their registration. This hopefully will help reduce bias which the mentor sign off currently has.

[ProfMaryRenfrew]

@spinabifidamom

Will there be any surveys to fill out or not? Can I read the proposed standards? Where will the events be held?

Are they free or not?

Thanks for this question spinabifidamom - there is a survey to complete. There are different versions for midwives, for other professionals, for members of the public, and there is an easy read version too.

Here's the link to the surveys and to the draft standards -nmc.org.uk/future-midwife

Please do respond, and encourage others too - we really do want to hear from as many people as possible, with many different perspectives and experiences

[ProfMaryRenfrew]

@ProfMaryRenfrew

[quote spinabifidamom]
Will there be any surveys to fill out or not? Can I read the proposed standards? Where will the events be held?

Are they free or not?

Thanks for this question spinabifidamom - there is a survey to complete. There are different versions for midwives, for other professionals, for members of the public, and there is an easy read version too.

Here's the link to the surveys and to the draft standards -nmc.org.uk/future-midwife

Please do respond, and encourage others too - we really do want to hear from as many people as possible, with many different perspectives and experiences[/quote]

There are events planned that anyone can attend, and they are free to attend. At the moment they are planned in London, Newcastle, Nottingham, Leeds, Belfast, Cardiff, and Edinburgh. Information here - //www.nmc.org.uk/news/events/upcoming-events

There will be webinars and Twitter chats as well - please look out for news of these

[ProfMaryRenfrew]

@HoustonBess

I don't see how any improvement is possible when midwives are so overworked, underpaid and stressed. I'm sure most of them would like to do their jobs better but working conditions make it impossible. Will another document help?

Thanks HoustonBess - yes, as you'll see from my previous answer, this is a concern for all of us. These new draft standards are particularly about education for student midwives - hopefully helping to prepare them as well as we possibly can

[ProfMaryRenfrew]

@chickhonhoneybabe

As part of the new standards I feel that not only should students be appraised by their placement mentor, the placement mentor should also be apraised by the student and this should form part of the midwives annual review and CPD requirements as part of maintaining their registration. This hopefully will help reduce bias which the mentor sign off currently has.

Thank you for this interesting suggestion, chickhonhoneybabe - yes, assessment and mentorship are really important for all students. I will pass it on to my colleagues to discuss

[chickhonhoneybabe]

Thank you 😊

[ProfMaryRenfrew]

@IheartNiles

The problem with these sort of standards revisions is they become a stick to beat people with. Invariably there will be no additional funding or staffing to implement any of it. So the demoralised and overworked workforce will be expected to just get on and do it. Because, you know, some people wasted a lot of time and money on the exercise. And then even more experienced staff get fed up and leave the NHS for easier and better paid jobs. In future years I anticipate a very junior nursing and midwifery workforce propped up with unregistered staff. But it’ll be cheap.

One thing I’d like to question is how a single midwife can care for a woman through pregnancy, birth and aftercare. Are they expected to be on call all the time, not go on holiday or have rest days? I’d prefer my midwife to be well rested and on top form thanks. In the middle of birth I couldn’t have cared less who was there other than that they needed to be highly competent/expert, caring and not too exhausted to think straight.

Thanks for this, IheartNiles - some very important points here, thank you for telling us about your experiences. Several others have also raised concerns about continuity of care. We talked a lot about that with many people when drafting these standards. The evidence is clear that it is better for women and babies to have continuity throughout pregnancy, birth, and after birth, and there are ways of organising rotas and partnering with other midwives so they are not on duty all the time.
People have told us that it's important that new students understand this from the start. They are likely then to have a greater understanding of the importance of this when they qualify - hopefully it will then be easier for them to practice in this way.

[ProfMaryRenfrew]

@Treacletoots

Actually my experience of being on a labour ward for 7 days was very eye opening. The midwives who were the best, kind and non judgemental were the ones not trained in the UK. The UK seems to create midwives who treat their patient like an idiot, who has no say of what happens to their baby or their own bodies. I had an elective c section due to complications but when I tried to discuss the matter when issues started occurring my midwife refused to discuss it and spoke to me in a very condescending manner.

Midwives need to take their own personal oponions out of the care for their patients and do what's best for their patient. How many times have we heard of midwives doing what they wanted despite repeated requests from the woman?

Thank you for telling us about your experiences, Treacletoots. It's helpful for us to hear about this. Communication skills are a key priority in the new draft standards - students will have to learn to communicate with respect and kindness, listening to women and advocating for women, babies and families. I hope this will help to prevent the kind of experience you have described. Please do respond to our consultation, because it is really important that your views are heard - nmc.org.uk/future-midwife

[ProfMaryRenfrew]

@birdonawire1

Will the views of parents whose child has been damaged by poor midwifery care be taken into account? Non recognition of potentially dangerous symptoms and appalling mistakes reading CTGs are far too common.

Midwives appear to have an attitude of complacency which leaves women open to mistakes of omission. Surely they should be trained to rule out 'worst case scenario' before assuming a mundane cause for symptoms?

Perhaps talking to mothers of damaged or stillborn babies should be a part of the training?

Thank you for raising such an important topic, birdonawire1. We have talked with many parents, midwives, and advocacy groups about lessons to be learnt from examples of poor midwifery care. They have talked with us about students learning about loss and bereavement too. We have also learned a lot from examples of good midwifery care, best practice, and the best current evidence.

The care of women, partners and families who have experienced loss is certainly included in the new draft standards. Please do have a look and response to the survey if you have time, to see if there are ways in which this draft could be improved - nmc.org.uk/future-midwife

[ProfMaryRenfrew]

Thank you to everyone for your interest and support with this work. Your experiences are so helpful in helping to shape the new standards and telling us what is most important. I will make sure that my colleagues working on the project all see your comments.

The education of student midwives is really, really important, as they are the midwives of the future. We really do want the new standards to be as good as they can possibly be, so please do tell us what you think and make suggestions, and encourage others to take part - we want everyone who cares about midwifery and its future to have a say.

You can email us directly at [email protected]
You can complete the survey at this link - nmc.org.uk/future-midwife
You can register for events at this link - www.nmc.org.uk/news/events/upcoming-events/)

Thank you!

[vivariumvivariumsvivaria]

thanks for doing this.

I wish midwives had fewer complaints and more recognition.

I had two difficult births and one decidedly ropey one. And two good midwives and one who was clearly a bit worn out.

Very grateful for them all. Wish they had time to pee and reflect on the difficulties of the job as a team.