When I was asked to write this column I immediately agreed without giving a thought to what I would write about that would interest you the readers. And then three things happened that made me think about being a midwife and how things have changed: A charity night with friends and colleagues from the unit where I worked as a staff midwife followed by the new series of ‘Call the Midwife’ and then an invitation to a reunion of staff from the unit where I trained firstly as a nurse and then as a midwife.
Similar to the now familiar 6 Cs, which were formally launched by the chief nurse following the Francis Report (2013), I have decided to look at my 5 Rs.
Reflection
All of the three events gave me time to reflect. What a joy it was to be in the company of my fellow colleagues and peers, to remember both my training days and my first experience of life as a midwife in an inner city hospital.
We reflected on the all the experiences we had—both good and bad; highs and lows. As student midwives we had the option of living in the ‘nurses’ home within the beautiful green hospital grounds. We were therefore easily accessible during our community placement to care for any woman on our caseload. It provided us with the opportunity to follow up care in the community. Maybe case loading is not such a new idea? Living in the ‘nurses’ home gave us a unique opportunity similar to that portrayed in Call the Midwife, to discuss the women we were caring for and learn from each other's experiences usually while waiting our turn to use the cooker or the bath. Community midwives were known and had a base in their area so women and their families could contact a midwife during the day. This followed on from the age old tradition of the midwife living in a health authority owned house within the community where she was accessible day and night. While we did not have the bikes or the flowing capes we were never seen without our hats! Home birth rates were high in the 60s and 70s and midwives were the first port of call with GP backup if required. One of the midwives recalled a woman who had 22 children all born at home in the late 40s, 50s and early 60s all of whom survived. We shared stories of the past with one thing in common—mothers and babies.
Reform
Why do all politicians think that when they are in government they have to reform the NHS? For those of us who have worked in the NHS for nearly 40 years we are all reformed out! It is constantly causing fear and anxiety for all staff. The NHS has become a political football with politicians meddling in the infrastructure without understanding the ramifications for staff and public alike. We are forever being told that NHS funding is ‘ring fenced’. I am yet to be convinced that this is the case. Rising costs of medication and treatments are taking its toll but also the enforced cost improvement programme (CIP) is proving hard to meet for the 4th year running. But what are the real effects on mothers and babies?
Results
We all want to see women, babies, and families getting good quality care by confident competent staff but it seems at the moment that all care is focused on results. Payment by results and the maternity tariff is an industry in itself trying to understand codes, pricing, and cross charging. While the bulk of this work is undertaken by finance and business intelligence units, it is imperative that clinical staff are involved in order to decipher the clinical interventions.
It is widely acknowledged that we have an aging population with people living longer and putting strain on resources. This could be attributed to good care, increased public health awareness, improved clinical procedures, and education by NHS staff. Does this mean that the NHS is responsible for the financial chaos? Just a thought!
Respect
Rarely a week goes by without some negative media attention focused on NHS workers. Information about pensions and pay, sometimes wholly inaccurate, is often fed to the public while there is a distinct lack of good news stories to ensure balance. This leads to misunderstanding by the general public about the work of professionals across the health economy giving rise to a lack of respect and sometimes little understanding of roles and responsibilities. As professionals we have a duty to respect our clients but I feel we also have a duty to find a way to increase their understanding of our role and maintain the respect and support of mothers and their families.
Remember
We should look back with pride at how much the midwives' role has evolved and how midwives with women have set the agenda for the evolution of holistic care. Long gone are the days of shave, enema, prophylactic episiotomy for primagravidas, no eating or mobilising in labour. In the month of the International Day of the Midwife, lets us celebrate with our mothers and babies across our nation. The pregnancy, birth, and postnatal pathways are evidence of the role and impact of midwifery care. Changes come and go but the midwife is always there doing what she/he does best—caring for mothers and babies.