Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour (Royal College of Obstetricians and Gynaecologists et al, 2007) recommended the recruitment of at least one consultant midwife per 900 births in order to provide adequate clinical leadership. However, despite this recommendation, in many individual organisations the numbers of consultant midwives remain small.
The role of consultant midwife was first introduced in the UK in 2000 (Byrom et al, 2009) with post-holders attaining key senior positions within maternity services to provide professional leadership and a senior level of clinical midwifery expertise (Coster et al, 2006). A key element of the role is education, training and development (Department of Health, 1999). Historically, the main focus of the consultant midwife tended to be either normality or public health, but more recently other areas of expertise have begun to emerge, for example, high-risk care. The role is diverse and highly collaborative, with consultant midwives linking with multidisciplinary colleagues in their own Trusts and externally with peers across the UK.
Redfern et al (2003: 154) have suggested that while consultant midwives are practice-based advanced practitioners, they should have a key role in creating and maintaining ‘partnerships between the NHS and local universities… to enhance education and research functions’.
The journey to becoming a consultant midwife: Carolyn's story
I qualified as a midwife in 1989, having previously worked as a nurse in women's health. I have had clinical experience in all areas of maternity services since qualification, in a variety of clinical, educational and managerial roles. My particular areas of interest include normal birth, vaginal birth after previous caesarean section, complex birth planning, and anxieties and fears about childbirth. I have been a consultant midwife for 3½ years and, while I enjoy all aspects of the role, the clinically focused and educational activities are my real passions.
Why teach?
I have always enjoyed working with students, from being a clinically-based mentor to being employed within a local higher education institution for 5 years in a clinical-focused role as the link between the education and placement providers. I have always valued personal learning and enjoy seeing and supporting others to learn and develop. Educationally, I have Master's level qualifications in clinical leadership, education and research, which have been fundamental in developing my role as a consultant midwife. Additionally, my personal learning and clinical experiences have enabled me to link theory to the practice setting in facilitating teaching sessions for both student midwives and qualified staff.
The sessions
My input into the pre-registration midwifery education programme focuses on leadership in midwifery, collaborative working or areas of clinical expertise or interest; for example, normality or vaginal birth after previous caesarean section. I enjoy exploring topics where I have expertise and sharing my experiences with the student midwives across the 3 years of the pre-registration midwifery programme. Leadership and management topics feature in the teaching that I undertake with third-year students. These sessions are designed to be interactive as well as informative, because hearing the students' views, experiences and reflections encourages me to reflect on my practice and, in so doing, further develop my own learning. There is also involvement in teaching sessions that focus on areas that I have an interest in developing (but in which I would not profess to be an expert); for example, I have a forthcoming session on obesity.
I believe it is important for expert clinicians to be involved in pre-registration education in the classroom setting. Otherwise, if student midwives' expectations of clinical practice are developed solely through theoretical understanding, they may be at odds with the realities of practice. By discussing real-life cases in the safe environment of the classroom, students can link theory to practice, thereby enhancing their problem-solving and decision-making skills in preparation for clinical placements (Burns and Paterson, 2005). The exploration of the realities of practice in the classroom challenges students' preconceptions and encourages them to undertake further self-directed learning to ensure they provide evidence-based care in the workplace.
The consultant midwife role represents a clinical career pathway offering advancement in a varied but clinically focused role, rather than one which focuses on a management or educational career. In my experience, the students view this positively and are keen to know more about the road to becoming a consultant midwife, in addition to the individual aspects of the role.
Student evaluation
Feedback from students indicates that they value the input of expert clinicians into pre-registration midwifery education. It appears that the opportunity to link theory and practice in a safe environment supports and enhances meaningful learning. While educational activities are a key component of the role of the consultant midwife, the opportunity for students to draw on the expertise and knowledge of a senior clinician through discussion acts as a catalyst for further exploration, learning and reflection. I also engage in joint teaching with academics, which I feel further enhances the links between education and placement providers; a collaborative approach the students appear to have enjoyed.
‘The opportunity to link theory and practice in a safe environment supports and enhances meaningful learning’
Conclusion
The consultant midwife holds a prestigious position within maternity services, with the four fundamental features of the role being (Department of Health, 1999: 6):
This challenging and multifaceted role provides individuals with the opportunity to link theory to practice by working across education and clinical placement providers.
In addition to giving students the benefit of being taught by an expert clinician, it is also hoped that inviting senior clinical colleagues like Carolyn into the classroom will enable student midwives to feel more confident in interacting with senior midwives in the clinical area, thereby encouraging an openly supportive, non-hierarchical working environment.