Where do we find the midwifery profession in the 21st century? To some extent, the romanticised view of the profession remains, as portrayed in programmes such as Call the Midwife. But what is the reality?
Midwifery has come a long way from women routinely giving birth
at home, having one-to-one care and the local GP visiting if there was a problem. Indeed, since the continued medicalisation of childbirth we are constantly bombarded with the ever increasing numbers of assisted or operative births. Therefore, birth within a consultant led maternity unit is now the norm. There is little doubt that the challenges faced daily by those at the coalface are also increasing, and there are women with medical, physical and social conditions who require highly complex care that is now provided in maternity units. We need modern midwives to respond to this demand, and so far they do. It could be argued that we have lost sight of the basic skills midwives relied upon in the past.1 However, these skills have been replaced with an enormous range of new and equally important ones that suit childbirth in the 21st Century.
Despite several significant government reports, beginning with Changing Childbirth in 1993,2 looking at normalising birth and another led by Dame Cumberledge on the way, it may still feel there is little choice in the location women give birth in or progress in normalising birth. Until recently, birth centres were unheard of in many areas and few women were cared for by a midwife at home. But today, despite the majority of births occurring within a maternity unit, women have greater choice than ever before. Fortunately the evidence is also now beginning to finally stand behind a return to more traditional midwifery with support for low risk births back in the home,3 which is great news for midwives.
There can be little doubt that the skills required to be a midwife have had to evolve and change, which is reflected in the training student midwives receive. The older generations of midwives didn’t have much equipment to use to glean information, managing with a single text book, a doll and pelvis. Today we have a plethora of life-like models and fancy equipment to support our learning and practice. Learning is done in a safe environment in university before being practised on real women. The basic midwifery skills of palpation and vaginal examination are still taught, but many additional roles have become routine practice for the modern midwife. To cannulate or examine the hips of a newborn would have fallen under the remit of a GP or doctor, now these skills can be found in a midwives toolkit at the point of qualification.
Sadly, a legacy of the constant pressure is evident. The stress staff are under on a daily basis – not just from the complexity of care they are asked to manage, but also the constant changes and demands can devastate moral. However, I would like to end with a positive. Always remember it isn’t actually midwifery that’s the issue. No matter what generation you come from and whatever skills you have at your disposal, you are working in one of the most admired professions in the world. No matter how much politics or bureaucracy is out there, being part of helping families through childbirth is a unique and privileged place to be. Modern midwives have the skills and the evidence to reshape childbirth for future generations.
1. Department of Health. Midwifery 2020 Delivering Expectations. DH London; 2010.
2. Department of Health. Changing childbirth: Report of the Expert Maternity Group. HMSO London; 1993.
3. National Perinatal Epidemiology Unit (NPEU). The Birthplace cohort study. University of Oxford; 2014
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