Tomorrow (17th June) this unassuming consultation on amendments to modernise midwifery regulation comes to an end:
Remarkably the key role that Supervisors of Midwives play in advocating for women doesn’t even get a mention in the consultation document. As an organisation we refer women to SoMs on a daily basis – they are crucial defenders of women’s human rights. Today we need to defend these defenders. That is why we have today submitted the response below to 3 key questions in the consultation. If you haven’t already – please join us in submitting a response…
Q1. Do you agree that this additional tier of regulation for midwives should be removed?
No. At Birthrights, we believe that safe maternity care is contingent on respectful care and that a human rights-based approach offers the best means of improving maternity services in the UK.
In the current regulatory system in the UK, Supervisors of Midwives (known as SoMs) play a dual role: they are responsible for making sure that midwives under their charge abide by professional standards and they are responsible for supporting and facilitating women’s decisions about their pregnancy and birth. SoMs provide a critical protection for women’s rights in maternity care. They enable women who may have been refused access to specific services to obtain the care they want and need; they negotiate with obstetricians and other members of the maternity team to support women’s choices; they are at the heart of planning safe and respectful care for more complex births. Birthrights calls on the help of SoMs for the women we advise on a daily basis. Remarkably, this aspect of SoM’s role does not appear in the consultation document. Birthrights is deeply concerned about the consequences of removing the role of SoMs without giving any proper thought to how to maintain this critical function.
We recognise that improvements must be made to the current regulatory system. Morecambe Bay showed what can happen if the statutory supervision system is not well understood, supported and implemented. A weak supervisory system can be subverted to protect midwives rather than to advocate for women. However, we believe that the response to the tragic failures at Morecambe Bay and elsewhere must put respect for women at its heart. Safety can only be achieved by full recognition of women’s right to dignity and respect in maternity care. This entails much more than compliance with protocols or improved documentation; it means genuinely personalised care given by staff who listen to women and respect their individual needs. This requires ongoing access for women to an “expert” who understands the care setting and can help women to navigate it. The role of SoM, protected by statute, provides a healthy level of challenge to Trusts to ensure they remain focused on women’s needs, and fulfil their obligations under the NMC Code and human rights law.
With the RCM, and others, we are concerned that putting supervision on a non-statutory basis will leave supervision at the mercy of employers to fund and implement. These changes move supervision from a must have to a nice to have. In the current financial climate of the NHS, that does not bode well. Indeed it could create many of the problems with supervision that were reported in Morecambe Bay where supervision was not prioritised, and where SoMs put their loyalty to their employer, and colleagues, above their loyalty to the Local Supervising Authority. Supervisors may be forced to tow the line of their employer or leave themselves exposed for standing up for women. Regulatory systems that fail to protect women also fail to protect midwives: Birthrights is aware of cases in other countries where midwives have faced criminal prosecution because they have supported women’s decisions to give birth in ways that are not supported by mainstream health providers. There is a real risk that eroding the distinctive system of regulation for midwives will leave women and midwives in a highly vulnerable position.
The proposal in the consultation document that supervision continues merely “as a vehicle for professional support and development” entirely fails to appreciate the distinctive role of SoMs in the provision of safe and respectful care for women. In their focus on the regulatory intricacies of supervision, the Department of Health and the NMC have overlooked this crucial aspect of safe care. They do so at the risk of endangering women and babies and degrading the quality of maternity services.
Birthrights calls for guaranteed access for women to SoMs who are explicitly charged with promoting respectful care and upholding the NMC Code.
Q2.Do you agree that the current requirement in the NMC’s legislation for a statutory Midwifery Committee should be removed?
Birthrights does not agree that the statutory Midwifery Committee should be removed.
Midwifery is a distinct profession from nursing. It is not based on a curative model of care, but on a social model, which has significant implications for the way it is both practised and regulated. Midwifery puts the needs of women and their families at its heart; its does not treat a specific complaint but supports a woman in her transition to motherhood. The NMC must ensure that the unique characteristics of midwifery are respected and protected and maintaining the Midwifery Committee is the means of achieving this.
Furthermore, modern regulation should understand and meet the needs of the community that it regulates. It is contrary to best regulatory practice to create super-regulators that are distant from the professionals they serve. The abolition of the midwifery committee will lead to the loss of midwifery standards and ethics in regulation; and the assumption of nursing standards will be detrimental to the distinctive practice of midwifery.
Q13:Do you think that any of the proposals would help achieve any of the following aims:
- eliminating discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010?
- advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it?
- fostering good relations between persons who share a relevant protected characteristic and persons who do not share it?
No. Birthrights is concerned that the elimination of statutory protection for the role of Supervisor of Midwives will have a detrimental impact on pregnant women. Currently, pregnant women have access to a SoM who supports and facilitates their healthcare decisions. This role reflects the unique position of pregnant women in healthcare services; for the majority, they are not receiving treatment for a condition, but seeking support for a normal life process which requires support and respect for their decisions. If pregnant women are no longer able to access SoMs, they will undoubtedly receive less support, the quality of their care will diminish and their safety will be compromised.
These proposals should be changed so that the role SoMs play in supporting women is given proper recognition. This may be by maintaining statutory supervision or by placing an enforceable obligation on Trusts to ensure that women are given guaranteed access for women to SoMs who are explicitly charged with promoting respectful care and upholding the NMC Code.