Midwifery from 2017-2020

Adapted from an article originally written for the Student Nursing Times.

July 2020.

This constitutes my last blog for the Student Nursing Times as Midwifery editor, in a few short months I will have finished the programme and my portfolio will be sent to the NMC for consideration on the Register. During the three years that I have been studying for a Midwifery degree, there have been many changes to the landscape of both of birthing in the UK today and also to the profession of working with birthing women. Between 2017 and 2020 the following has happened:

2017       Independent Midwives (IMs) were required to have private indemnity insurance for providing midwifery care, putting many IMs out of practice overnight.

Supervision and regulation of midwives was separated, supervision became employer-led. The requirement for the NMC to have a Midwifery Committee was removed.

Training for Student Midwives would no longer be funded by the NHS.

New indemnity options were made available via the private sector for IMs, increasing the price of employing an IM.

NHS Long Term Plan published, committing to “most women receiving continuity of the person caring for them by March 2021” in line with the aims set out by Better Births (2016).

2018       The OASI Care Bundle was introduced as a pilot research project across 16 units, making ‘hands on’ practice an opt-out rather than an opt-in. Students are trained in this practice.

2019       Closure of Neighbourhood Midwives.

One to One Midwives goes into administration.

New Standards for Education were introduced with an increased focus on the biomedical model and hospital-based clinical skills.

2020       Due to the Covid-19 global pandemic, many homebirth services throughout the UK are withdrawn, birth centres are closed to turn into Covid bays and many women are instructed to birth in hospital.

Maintenance grants are reintroduced for Student Midwives from September 2020, although the cost of training remains ultimately self-funded.

A major indemnity provider for IMs withdraws from the UK market and leaves many IMs with the choice between ceasing to provide midwifery care or increasing their costs.

A Student Midwife successfully campaigned for the NHS to replace the term ‘Mongolian Blue Spot’ with the term ‘Blue Spot’ in an effort to decolonise language within maternity.

The OASI Care Bundle will be rolled out in 20 further units, with a view to establishing ‘hands on’ practice for all UK births.

These changes are not exhaustive and some are very positive! However, even they are set against the backdrop of MBRRACE reports finding that ethnic minority women (still) have significantly higher chances of dying during the perinatal period, the closure of many freestanding midwifery units and the removal of Midwives Rules and Standards. Whilst NHS continuity teams are being set up around the country, care is being centralised and medicalised. Both induction and caesarean rates are increasing, regular ultrasounds for fetal growth monitoring are routine in many pregnancies.

Maternal mortality and morbidity, as well as stillbirth and neonatal death rates are at an all-time low, statistics truly worth celebrating… but is a safely ‘delivered’ baby this all there is to maternity care? Are we losing sight of wellbeing, compassion and love? The private nature of birthing?

As practitioners we need to be asking ourselves, are we seeing the changes we want to see in maternity service provision? Do we feel that birthing women are being given real choice in where they birth and who supports them? Are the initiatives we are putting in place supporting or hindering women’s physiology? Who benefits when midwives are restricted in how and where they can practice? Is a centralised NHS model the only model we can offer women?

There are many reasons to be thankful for a midwifery qualification achieved during 2017-2020, not without mention the huge dedication and perseverance it has taken for the 1709 cohort during the pandemic. My colleagues have proved themselves to be level headed, hard-working and loyal – I have witnessed great personal sacrifices made. But we must not lose sight of the bigger picture: are the changes we have witnessing during our training the changes we want to see made? And if not, what are we going to do about it?