Today is International Day of the Midwife and so it felt appropriate to blog about midwives and the incredible work they do!
The word midwife comes from Middle English and directly translates as ‘with (mid) woman (wife)’. It means midwives are there to advocate for women at one of the most remarkable, important and vulnerable moments of their life. Midwives are the guardians of normal physiological pregnancy and birth, and low risk mothers and babies have the best outcomes when they receive midwifery models of care. Here in the UK this means that these mothers can be looked after throughout the continuum of pregnancy, birth and the postnatal period entirely by a midwife and it benefits them more to receive this model of care than input from a obstetrician would.
Giving birth has the power to be a transformative experience for a woman, enhancing her physical and psychological wellbeing, giving her confidence in her capabilities as a mother and thereby giving her baby the very best start in life. Evidence consistently demonstrates that women’s satisfaction with the birth experience is higher in midwifery settings than in obstetric settings. Therefore, with midwives being so well qualified to facilitate and support normal physiological birth, it’s easy to see how fundamental they are to women having positive experiences of childbirth. I could weep with gratitude when I think about what my midwives mean to me. Having had so many women before my own experience of labour insist that they ‘couldn’t have done it without me’, I was always so dismissive of my contribution to their birth. But there ‘on the other side’ in labour with my own baby, I now fully understood what they meant. As someone who was previously so fiercely independent and unable to depend on anyone, to have these two women, so utterly dependable, whom I trusted entirely be there to ensure the wellbeing of my baby and I, and provide unrivalled support when I needed it most, was and is still priceless. I am forever grateful to them, and it serves as a constant reminder of why I’m still a midwife despite all of the challenges that come with it.
In the developing world, midwives are fundamental in the bid to tackle preventable maternal and newborn mortality. Governments that have invested in midwifery models of care have seen significant and sustained reductions in mortality as a direct result of including midwifery in their core healthcare systems. For example, in Cambodia where the Bill and Melinda gates foundation have been running Maternal health programs since 2000, maternal mortality is now a third of what it was in 1990. Research has also indicated that investing in midwifery education and provision of midwifery services could produce a 16 fold return on the investment in terms of lives saved and unnecessary caesareans avoided.
But despite all of this praise to be heaped upon midwives, there is a less well known, much darker side to the job. Midwifery is under siege in the UK for a multitude of reasons. The birth rate has continued to rise steadily throughout the period of government underfunding of an already squeezed maternity service. There is a national shortage of midwives and student midwife training places and staff are leaving the profession in their droves. I can remember the first night shift I worked as a student midwife where I went without a drink, toilet or meal break. I wouldn’t let a dog go for twelve hours without a drink, yet this is what midwives are expected to endure today. Midwifery also has a long standing history of bullying within the profession which a number of campaigns have only been moderately successful thus far in addressing. Any midwife who goes against the cultural norms of maternity services is opening herself up for criticism and yet this is what the evidence tells us is the best for women. We can choose either to adhere to our NMC code and deliver evidence based care to the women we care for, but run the risk of being bullied, criticised and excluded, or we can keep our heads down and deliver institutionalised, out dated, non-evidence based care which makes for an easy work life. No wonder so many are leaving.
So why am I telling you this? I’m telling you this because I think you deserve better. I think you deserve to be cared for during your pregnancy and birth by midwives who work in an environment that cares for them and supports them to deliver safe, effective, evidence based care. If we as mothers and midwives want better maternity care we must continue to lobby the government to keep improvements to maternity care high on the list of priorities. We must ensure they fully implement the findings of the national maternity review, in particular the parts about caring for the midwifery workforce which were notably absent in the NHS long term plan for maternity services earlier this year. And because on this day of the midwife I wanted to share with you not just how incredibly important midwives are, but also how incredibly hard they are working for you, because they too know how much birth matters.