A Celebration of Midwifery- past, present and future Caroline Diamond Head of Midwifery and Gynaecology NHSCT
A Social History of Childbirth – An understanding of this is key as it has shaped the service we currently provide and includes; • The regulation and training of midwives and doctors • Efforts to tackle maternal deaths • The move of birth from home to hospital • Medical dominance and patriarchy • The rise of consumer groups. We are now at a time when the midwifery profession, and the wider structure of maternity care, is a matter for popular and political debate
A Brief history of time • 1902 - saw the introduction of the Midwives Act, fully enacted 1905 – The decline of the unregulated, untrained handy woman – Little difference to care experienced by mothers • 1930s - High rate of maternal deaths – Salaried midwives, hospital services • 1936 - Midwives Act – Community midwives, AN and PN care • 1946 - Creation of the NHS – Free access to healthcare and increased standards of living – Women began to expect more from their experience of pregnancy and birth
A Brief history of time • 1960s - emergence of ‘science’ in childbirth – Discovery of the fetus – Technology in childbirth • USS • Epidural • CTG monitoring – Hospital birth became the desired norm – 1967-Peel Report , recommended 100 per cent hospital deliveries with medical and midwifery care • 1990s- Changing Childbirth – Widely perceived at the time as being of seminal importance – The Three Cs- Choice, continuity of care and carer
Today’s practice driven by Strategy
The maternity Strategy acknowledged that the context in which midwives work is complex. Our lifestyle is creating an epidemic of obesity, diabetes and heart disease. Many women also now start their families later in life. This means some women need more specialised care. On the other hand, we also know that in certain instances we are using too many complex interventions.
The Global Perspective On the continuum of maternal health care globally, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). • TLTL is care without adequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is associated with high maternal mortality and morbidity and ascribed to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. • TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. TMTS can cause harm and increases health costs, and often concentrates disrespect and abuse. TMTS is typically ascribed to high-income countries
Midwives save Lives on a global scale “when midwives are educated to international standards, and midwifery includes the provision of family planning, it could avert more than 80% of all maternal deaths, stillbirths and neonatal deaths.” WHO “Midwifery care improves over 50 other health-related outcomes, including sexual and reproductive health, immunisation, breastfeeding, malaria, TB, HIV and obesity in pregnancy, early childhood development and postpartum depression” Experts have calculated that scaling up the skilled midwifery workforce would prevent close to two thirds of all maternal and newborn deaths, saving millions of lives every year. Midwives are, by far, the best value option for delivering high-quality maternal and newborn care, offering a 16- fold return on investment. The state of the World’s Midwifery 2014
The aim of implementation of the strategy was better maternity care for all women • Better informed – a true partnership • More choice in place of birth- Home, AMU, FMU • Midwife as 1 st contact and Lead professional for women at low risk of complications, providing continuity of care • Consultation obstetrician as Lead for women with complex pregnancy • Promoting the physiological process of birth and reducing variation in interventions and practice • Early public health and pre-conceptual messages
Maternity Handheld Record (MHHR) The purpose of the regional MHHR is to serve as a central repository for planning the delivery of care; and documenting communication with and interactions between members of the multi-disciplinary health care team, between the health care team and the woman to provide safe, person-centred care. Objectives; - to facilitate co-ordination of care and continuity of care - to improve maternal, fetal and neonatal surveillance - to promote safe, effective, and evidence based maternity care - to provide appropriate and adequate information for informed choice - to avoid duplication of information - to empower women to be partners in their care - to promote a culture of excellence in record keeping
Getting Ready for Baby GRfB ANTENATAL CORE 6 GROUP SESSIONS CARE PATHWAY S O L I H U L L
Getting Ready for Baby (GRfB)- Antenatal Parenting Programme Highlight the importance Group based of infant programme mental health Opportunities Provide social Solihull for midwives opportunities Antenatal and others to for expecting Parenting work together parents Group Combine healthcare Better engage assessment fathers and parent education
Today’s practice driven by safety and learning
Maternity Safety Collaborative
Safety is the focus, but…is it really driven by the people we claim to care for?
The new narrative in childbirth- A grass roots movement • Use of language eg. ‘Failed induction, failure to progress’ ‘delivering a baby’ • Women are not vessels, they do not deliver anything • Women ‘birth’ their babies, midwives support them to do this • Rite of passage and a Human right • Real empowerment for women during childbirth- not to be endured
The Future of Midwifery… Future Midwife- key themes • Enabling and advocating for human rights of women and newborn infants • Developing, finding, critiquing, using best evidence • Taking personal responsibility for ongoing learning and development • Enabling and advocating for needs, views, preferences, decisions
Future Midwife- key themes • Understanding local context, connecting with local communities • Working across the whole continuum of care • Providing continuity of care and carer- the evidence is compelling
The evidence for CoC • 16% less likely to lose their baby • 19% less likely to lose their baby before 24 weeks • 24% less likely to experience pre-term birth • 15% less likely to have regional analgesia • 10% less likely to have instrumental birth • 16% less likely to have an episiotomy • 5% more likely to have a spontaneous vaginal birth • No difference in caesarean births • No identified adverse outcomes
Future Midwife- key themes • Coordinating care - interdisciplinary and multiagency • Optimising normal processes • Anticipating, preventing, responding to complications • Working to mitigate health and social inequalities • Physical, psychological, social, cultural, spiritual factors • Public health, health promotion and protection
Standards of proficiency for midwives Six inter-related domains
So...an exciting future for midwifery • Year of the Midwife and Nurse, global leadership programme and nightengales • New maternity strategy awaited • Transformative change, new models of maternity care, GRfB, CoC • Working in partnership with women and families • Strong midwifery leadership
THANKYOU FOR LISTENING
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