ARM Study Day 2018: Conference Review by Ruth Weston

The 2018 ARM study day in Wigan was described by Dr Lesley Choucri as “Midwifery Nourishment” and I couldn’t agree with her more. This was a wonderful day of learning, sharing and refilling our cups ready to go back to our own regions “Stronger Together”.

“Stronger Together” was one of Kathryn Gutteridge’s themes, which came out of her desire to remind us all that we need to stand together during these challenging times. She pointed out that all midwives are midwives, whether they work for the NHS, private companies or as independent midwives. For the good of the profession – and every midwife – we MUST support each other. There is so much horrific bullying, and areas of practice which are lacking in compassion. Can each person make a change by reflecting on their own practice?

Of course, Better Births was an essential part of the ARM study day, and Claire Mathews , deputy Head of Midwifery for NHS England, outlined its implementation with a focus on Continuity of Carer. Because this was a midwifery audience, Claire focused on the understandable worries that some midwives have of how continuity will work for them, especially as some midwives have experience of continuity services where they were given entirely unreasonable caseloads. With a short-term target of around 20% of women to have continuity, Claire recommended that initially trusts worked on encouraging those midwives who were interested in offering continuity to jump in and have a go, lighting the way for others to follow.

I was particularly struck by Jo Dagustun’s talk on her research into women’s experiences of birth which was an uncomfortable listen for the audience of midwives. Jo explained her PhD research which included women’s experiences of  the maternity system.

The key messages I heard in this excellent, many-layered reflection were:

  • That for women the key antenatal teacher/education was their experience of the maternity system itself.  What women are told in antenatal classes and by professionals about what they can choose, the care they can ask for or receive is over written by actual experience.
  • That women’s experiences of the maternity system, including birth, is of a ‘hostile’ environment; spaces and interactions that do not feel friendly towards the health and wellbeing of mother and baby. Women therefore made decisions on what they saw as the best way of protecting the physical and mental well-being of themselves and their child. Far from this resulting in choices for midwifery led care it often resulted in women choosing a medical birth. It also resulted in women providing partial information or telling professionals what they think is expected rather than the truth.
  • Finally, the women interviewed did not see midwives as a distinct profession with in maternity. Indeed they were not clear what midwives are. Processed through a fragmentary system and seeing multiple professionals, midwives did not stand out. In this context women did not want continuity so much as kindness from the professionals they were with.

This final point provoked a lot of reflection. It is shockingly sad that kindness is not standard in the maternity system. It is also disturbing to realise that midwifery does not stand out to most women in the maternity system. Is this how far the profession has faded? Just another health care professional doing their job? It also has some real consequences for continuity, for instance, who would want continuity from a midwife who did not show kindness?

Finally, Jo, with admirable tact and honesty, presented an example of an interaction between a service user and professionals on social media. What came through to me were professionals who thought they were being kind and helpful but from the service user’s perspective were not. Also, she showed health professionals who wanted the service user to see it from their point of view but did not themselves ‘stand in the shoes of the woman’ – surely a mark of the with-woman profession of midwifery. We need to reflect on how much the maternity system has broken the midwifery tradition of being with-woman and made the midwife a just another health care professional.

In better news, a big shout out needs to happen to Airedale Hospital Trust who have been a shining light on the issue of Independent Midwives and their ability to offer intrapartum care, as Airedale is providing them with indemnity to ensure that they can continue to practice. In return the Trust has these amazing and skilled midwives sharing their experience and knowledge, leading to improved services to women and happier staff. Airedale join several other Trusts across the country who are supporting Independent Midwives in a similar way, as is outlined in the recent IMUK blog.

Aquabirths Hi-Lo Keeling Birth ChairMargaret Jowitt’s Hi-Lo system was on display alongside the Aquabirths stand (see photos to the left for two ways that the Hi-Lo can be used). Also known as the Osborne Kneeling Chair, this wonderful piece of kit is a must for every obstetric room. It is a simple, strong and easily cleaned frame with cushioned supports which women can kneel, lean or sit on. The Hi-Lo is designed to ensure that midwives can easily access women for observations, and the small footprint means that it will fit into most obstetric rooms with ease. A video explaining how the Hi-Lo works is hereSoftbirths Mini birth couch

Aquabirths also had their Softbirths mini birthing couch on display which midwives Deborah Hughes and Deborah Neiger had fun modelling as you can see!  A smaller version of the full birth couch, the mini couch fits into smaller spaces to provide comfort and support to women in different upright birthing positions.

ARM Coordinator, Katherine Hales, rounded off the day with an update on ARM’s campaign for an independent midwifery regulator. The NMC is not fit for purpose as has been discussed on this blog multiple times. ARM now believes that it is essential that midwifery is separated from nursing, and has regulation which focuses on the needs of midwives, which the NMC simply does not do. The focus now is on the midwifery code and midwifery panel being managed by midwives under the umbrella regulation of the Health and Care Professionals Council which oversee many other similar sized groups, such as physiotherapists. This regulator seems to work better to support the professionals it oversees than the NMC does.

All in all, an exceptional day – many thanks to ARM for all their hard work!





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.