British Journal Of Midwifery - Midwifery in Wales

Abstract

As part of our series on the UK and Ireland's midwifery policy, Helen Rogers and Kathleen Jones discuss the strengths and challenges of maternity care in Wales.

The Welsh Health agenda continues to provide challenges to midwives in the country. In 2014, there was a fall in the birth rate of 0.6%: from 33 747 in 2013 to 33 544 (Office for National Statistics (ONS), 2015a). However, although teenage pregnancies have fallen in some parts of Wales to reflect the UK statistics (27.9 per 1000), in some parts of North Wales this figure has risen to 41.2 per 1000 (ONS, 2015b).

The Welsh Government recognise that the high levels of poverty and unemployment contribute to the health and wellbeing of pregnant women and their families. Public health is an important part of the midwives' role and has a high level of commitment from all of our Health Boards. Because of this, Wales introduced a new model of midwifery supervision in August 2014. The model was developed as it was felt that the supervisory function had been weakened and it was necessary to improve supervision of midwifery in Wales. The new model means that:

Appointed supervisors of midwives (SoMs) are on rotation to the Local Supervising Authority for a period of 18 months

There is increased visibility and access to SoMs for midwives

An all-Wales 24-hour on-call for SoMs has been established, which provides advice and guidance

SOMs do not have to juggle their time to do their role effectively

There are more efficient and timely opportunities to undertake investigations in neighbouring Health Boards

There has been the opportunity to enhance the interface between SoMs, quality and safety agendas, and the wider clinical governance strategy

Promotion of supervision through clinics/surgeries for students, midwives and user group forums

Networking on an all-Wales basis has promoted best practice

A robust annual review process, introducing group supervision, action learning and sharing good practice has been established.

This model has been embraced by midwives and there has been very positive feedback.

Revalidation

Jackie Smith, Nursing and Midwifery Council chief executive and registrar, states that ‘Revalidation is an important system of regular checks to make sure that nurses and midwives are up to date and fit to practise throughout their careers.’

Six organisations in the UK were chosen to take part in a pilot project of revalidation. In Wales, Aneurin Bevan University Health Board was chosen. Fifty six midwives took part in the project, which was completed in the spring of this year. Piloting the project was essential as this is the biggest change to registration for midwives and nurses for decades.

Student midwifery societies

Wales has four student midwife societies, one in each of our universities that provide midwifery education. These societies demonstrate the enthusiasm and motivation of midwifery students and, collectively, they have won them many awards. They have organised conferences and events and have shared these with midwives in Wales.

Prudent health care

Many of the challenges in NHS Wales are similar to those in the rest of the UK. Rising costs of health care and increasing demand mean that everyone providing health care must do so in the most cost-effective way possible, but they must also constantly look to improve the quality of that care.

In Wales, we have taken on the principle of prudent health care. The principles of this are that any service or individual providing a service should:

Achieve health and wellbeing with the public, patients and professionals as equal partners through co-production

Care for those with the greatest health need first, making the most effective use of all skills and resources

Do only what is needed, no more, no less, and do no harm

Reduce inappropriate variation using evidence-based principles consistently and transparently.

The challenge for midwives is to see how these principles could apply to maternity care—we have the Birthplace study to help us with this (Birthplace in England Collaborative Group, 2011). We know from the study that the proportions of babies with an adverse outcome were similar in births planned in midwifery units compared to those in obstetric units. The principle of minimum appropriate intervention fits very well with midwife-led units. One of the benefits of midwife-led care is that it can fit the needs of women and avoid wasteful care that may not be in her best interest. The study clarifies which women are suitable and which should not give birth in a midwife-led setting. By using the findings in the study we can see how we can put our maximum resources where there is greatest need.

Midwives have always worked in collaboration with women so the idea of co-production is not new to them. There are, therefore, many opportunities and the evidence to support maternity services applying the principles of prudent healthcare to maternity care.