NMC: Not for Midwives, Not for the Public – Not Fit for Purpose!

By Ruth Weston

It is the fifth of May, we are having a protest outside the Nursing and Midwifery Council (NMC) headquarters, and 5 of us get to meet the NMC’s CEO inside (although we did not know until the day that this would happen).

Their response to the outrage pouring out from midwives and mothers regarding the banning of IMUK midwives is revealing, as is their response to the many midwives countrywide upset at the loss of independent supervision, the midwifery code and the attendance of family and friends ban.

The NMC’s clear message was – “We are not here for midwives, it is not about what you want.  Our role is to protect the public.”  And this was the attitude to all of the Midwives’ complaints made during the meeting.

However, when I asked what their public engagement programme was and how people got involved, and how and where the public could hold the NMC account, they were equally clear that they had no programme and no mechanisms for doing so.  They are, they say, just building them now!  So – they ignore Midwives because they say they are not there for midwives’ benefit, but they do not listen to or engage with the public who the NMC say they speak for and protect!

There are two pieces of twisted logic entwined in the NMC’s aims and focus:

On the NMC’s website, under the “about us” section, they say, (link)

“We regulate nurses and midwives in England, Wales, Scotland and Northern Ireland. We exist to protect the public”.  Later in the page, “We are not responsible for representing or campaigning on behalf of nurses and midwives”

The NMC want everyone to know, including midwives, that they do not represent midwives. They are extraordinarily clear about this on their public statements, and they also repeatedly remind midwives of this in communications where midwives are asking for support and guidance.

So here we have what I would term a false dichotomy pitting the safety of the public against the welfare of midwifery as if they are in competition.  Those of us who use the midwifery service (the public which the NMC claim to be protecting) know that our safety and autonomy as women and birthing mothers depends a great deal on the wellbeing and good practice of the midwifery profession and the midwives within it.  They are not competing priorities.  They are the same thing, our interests are entwined: the NMC cannot support safety in maternity without supporting midwives.

But here we have the organisation that midwives are obliged by law to be registered with stating that it ‘is not there for the midwives’.  To make it explicit: the organisation set up to regulate midwifery, set up to ensure good safe midwifery practice, to ensure midwives are good midwives  is clearly  and publically stating that ‘it is not there for midwives’ . How can a profession’s regulatory body NOT be interested in the health and well being of the profession it is regulating and the individuals it regulates?  Surely the point of safety and protection of the public is ensuring that the people you are regulating are fully supported and in the best position to practice in the best interests of the public, the state of midwifery is very much the NMC’s concern because it impacts on their stated public protection obligation.  Only when it comes to the rare conviction of malpractice in midwifery is it a penalising body and by this time harm has possibly already been done to the public. Surely, most of the public protection work is working out what safety means for the public and working with midwives to ensure the profession is in best fit to deliver that safe practice.  It beggars belief that a regulatory body full of highly qualified professionals that are not midwives have not worked this out for themselves – or checked best practice with other regulators.

The second part of their faulty logic and policy is their understanding of what it means to be an organisation that protects the public.  If you make strong statements that you are not there for midwifery, but instead to protect the public, then you would assume that the NMC is an organisation with a strong public engagement ethos or else how can they speak for the public or know what and how the public are protected.  No way!  The NMC is there to protect the public but is only now beginning to set up an engagement programme. At the meeting they admitted to only one consultation meeting with one user organisation – NCT.  No attempt has been made to engage with the wide range of service user organisations in maternity to find out what is important to them in terms of public protection.

To make it explicit, the regulatory organisation which says it is there for the public – does not actually engage with that public, consult and listen to them, nor does it enable us to hold them to account for their decisions.

As one insider said to us of the NMC terms ‘it is dog’s breakfast’.  And this is why the IMUK decision came about as it did and is causing such a problem to the NMC. The NMC did not talk to the women who use the service about what was important to them, they did not listen to the public and consumer organisations, and they did not do an impact assessment on the safety of withdrawing a service at short notice over the Christmas holidays.

And that is why I say #nmcnotfitforpurpose  – because it says it is not there for the midwives but for the public – but it is not even there for the public.  It has set up a false dichotomy between midwives and mothers showing how little it understands the evidence of its own appointee Mary Renfrew in the Lancet Series on Midwifery (link)  Women need a strong, autonomous midwifery profession as this protects women and their babies.  Until the NMC ‘gets’ that it is not fit for purpose as it is, the midwifery profession is not safe. #savethemidwfe

The NMC has its back against the wall –  Now nurses are also angry at the behaviour of NMC – the same grumbles.  And without the support of the public it will have lost all credence.  Time to act! Stay in touch with the campaigns:

  1. Save Independent Midwifery Facebook Group – ask to join – a good place for all kinds of information, and ideas for action and planning to do more
  2. Association of Radical Midwives (ARM) are leading the charge in setting up a new regulator – join this wonderful organisation whether you are a midwife or not and watch out for campaign meetings on this issue
  3. Join AIMS, helping to support their work in ensuring that women have a strong and united voice with the NMC.

March on the NMC: What Bornstroppy said

The NMC is not fit for purpose when it does not understand the profession it is regulating and does not work with the people it is supposed to be protecting.

This was the message Ruth gave at the demonstration outside the NMC headquarters on the 5th May 2017.  Led by Caroline Flint on International Day of the Midwife, mothers and midwves partners and children from all over the country came to protest at the actions and attitude of the NMC. A small delgation of mothers and midwves also met with NMC’s CEO, Jackie Smith and two members of her team.

It  was Ruth’s, first open air speech with a megaphone so here is what she would have said if she had not been up a ladder shouting over the traffic!

Her speech was captured on video here.

Our vision is for families in Britain to be happy, healthy, strong and stable.  We need a midwifery profession to be there to nurture, enable and empower mothers and their families to be just that.

In the words of Margaret Jowitt former editor of Midwifery Matters :

“Women need a strong midwifery profession with autonomous midwives backed up by a governance system NOT paid for, or supplied by, the Trust for which they work. Midwives keep birth safe. Midwives treat women as individuals. Midwives respect women’s right to choose.”

And so we want a regulator that understands this.  We want a regulator who nurtures, empowers and supports midwives so they can nurture, empower and support mothers.

Midwives keep birth safe and a midwifery regulator is there to keep midwives safe and midwives respected.

We therefore need a midwifery regulator that has an open and transparent culture, which is accountable both to the mothers and their families it serves and also the midwifery profession it regulates .  Do we have this? NO! Do we want it? YES!

We need a regulator that is supportive rather than punitive, a regulator that does not run on fear but on mutual professional respect, a regulator who midwives can ring up for advice and guidance without fear of retribution.   Do we have this? NO! Do we want it? YES!

We want a regulator that rather than increasing litigation by its activity reduces it!  And we don’t want a regulator who just bans attendance at the births of family and friends to try and get itself out of a tight spot. We want a regulator that acts reflectively and with sensitivity for best practice and compassion.  Do we have this? NO!  Do we want it? YES!

And we want a regulator that knows what a midwife is for goodness’ sake!  We want a regulator that knows the difference between employment and self employment in the profession! That understands and discourses with midwives from all branches of the profession – Do we have this ?NO!  Do we want it? YES!

I am a mother.  A mother of five children, and where I had good quality continuity of carer I remember the names of my midwives – they are etched on my heart.  Thank you Ann Devanney, Thank you Madge Boyle.  Thank you Michelle Irving.  Independent Midwife Michelle Irving was my midwife for Child number 5 because the NHS care I was being offered was no longer safe and my complaint had been ignored and refuted.  Independent Midwifery was a choice for safety and it cost 20% of our income and it took 2 years to pay it off – but we decided that a good, safe birth is priceless.

The NMC knows the cost of everything but the value of nothing. It speaks the language of legal regulation and public protection but does not speak to or listen to the mothers who know the real cost of their policies and the real value of a safe and compassionate midwife!

The NMC is not fit for purpose when it does not understand the profession it is regulating and does not work with the people it is supposed to be protecting.

NMC reform yourself, or we, the mothers and grandmothers of this nation, will TAKE YOU DOWN!

And we WILL take you down, Jackie Smith, if you do not start talking with us and listening to us. Julia Cumberlege talked to parents all over the country as part of her Maternity Review – the NMC should be doing this as part of their engagement and accountability programme.  It is courtesy to the public you say you protect.

So my call to you here today as mothers and midwives of this generation is to set about making the regulator we need and deserve for the benefit of the midwives and mothers to come.  It will take work and cunning and more work and political wheeling and dealing and a hell of a lot of campaigning but it can be done and we can do it.  That all mothers are supported through the maternal pathway is our vision, that the centre of our practice is nurture and good evidence is a value, but  OUR BIG HAIRY AUDACIOUS GOAL is to have a fit for purpose regulatory body for midwives.  And if you won’t do it, NMC, we shall do it ourselves.  Because we, the public, want to be protected and to be protected we need a strong, autonomous, respected midwifery profession.

Follow me – Bornstroppy – on my blog.  Join the #savethemidwife campaign on FB.  Write to your MP AGAIN!  And tell your family, friends and neighbours, your sisters, cousins, children, tell your colleagues at work, the people in the supermarket queue, the people you meet on the train tonight.  This is about our babies, our bodies, our births!  It is about our profession, our good practice, our future autonomy. We do not ask for it because it is a nice thing – we demand it because it is our human right to be respected and nurtured to birth safely how we choose.  And a strong respected well supported compassionate midwifery profession is required to deliver this.