Marking a time of international recognition and appreciation of midwives, NHS England’s chief midwifery officer (CMidO) Kate Brintworth sits down with Madeleine Anderson to discuss the unique role and impact of those working in community settings.
In an interview with Nursing in Practice ahead of International Day of the Midwife held earlier this week on 5 May, Ms Brintworth said being a community midwife was about creating accessibility, tackling inequalities and ‘going into other people’s world’ to provide personalised care.
Ms Brintworth has been CMidO since 2023, having previously served as regional chief midwife for London. She maintains her clinical practice and works as a community midwife one day a month.
She explained how community midwives work with patient’s as they transition into having a new family, supporting parents through antenatal and postnatal clinics in the community and offering advice to keep both babies and families healthy during and after pregnancy.
While recognising that a ‘typical community midwife’ does not exist and that the role is varied, it was her view that many people have a narrow understanding of midwifery which overlooks the range of skills that midwives have, as well as the diversity of settings they can work within.
Where do community midwives work?
Community midwives work in various settings, including GP practices, child health clinics, and increasingly in pop-up sites on local highstreets and in shopping centres.
‘They’re everywhere. But the point is that they are where women are – so bringing care to them rather than women having to come to hospital,’ Ms Brintworth told Nursing in Practice.
She added that growing numbers of mothers are going through pregnancy with multiple long-term health conditions, but she explained that all parents deserve the choice to access midwifery care in the setting they are most happy with.
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What is the approach of community midwives?
Ms Brintworth said a holistic approach was ‘absolutely baked in’ to all community midwifery, with community midwives appreciating the central role that factors like housing, income and personal relationships can play in shaping mothers’ health.
‘[When community midwives] visit women in those circumstances, [it’s about] making sure that they had everything they needed, and sometimes really advocating for those women who can feel intensely vulnerable and part of the midwives’ role there is to advocate for them to be in suitable accommodation,’ she explained.
‘They provide care across a range of environments, accessing patients in asylum hotels, hostels, and in other forms of insecure housing,’ she added.
For parents living in rural areas especially, Ms Brintworth said health systems risk setting parents up ‘to almost fail’ by putting barriers up to care access, especially when hospitals and other healthcare settings are a long distance away.
‘By providing care in the community you’re creating accessibility, and accessibility means you are tackling inequalities. It’s also about understanding where people are coming from,’ she said.
‘If you see people in a hospital setting, it’s about you bringing them into your world. This is about doing it the other way around, going into other people’s world, and then you can make the care more bespoke and personalised to what they need, and recognise the issues that they’re facing.’
Supporting parents in the community environment helps build up trust and more relaxed relationships between clinicians and patients, she added.
Previously, Ms Brintworth was based in a GP surgery where she worked closely with health visitors and the practice team.
‘So, at the point of the woman being discharged from our care, we were able to have those conversations to make sure there was a smooth transition. And that’s so, so important,’ she explained.
But she noted that it was becoming ‘more unusual’ to have community midwives based in GP practices, with teams being increasingly moved to children’s centres or other community hubs.
Ms Brintworth was clear that the use of estates was constantly evolving, especially with a rise in digital healthcare, and cautioned against seeing this transition as a purely negative move.
‘I think we always have to be careful about not assuming the process makes good quality care [because of] the venue,’ she said.
She added: ‘So, I think the important principle is that we hang on to good communication, make sure we’ve built relationships with our colleagues, so that it feels seamless for those we’re caring for. I don’t think we should get so hung up on the estates.’
Enhanced continuity of care
Recently, NHS England has been focusing on enhanced continuity of care in community midwifery, examining how best to support vulnerable parents around wider determinants of health including food and digital poverty.
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‘It’s really important for the midwives and maternity support workers, because the enhanced continuity of care model has put in those maternity support workers to help the midwives wrap the care around the women around those important areas,’ Ms Brintworth explained.
Under Ms Brintworth’s leadership, NHS England has increased its focus on the digital role of community midwives. Since she joined her post, 113 women have been given sim cards and 34 have been given mobile phones to date.
This has enabled mothers who otherwise would not have had access to a mobile phone to be able to contact their midwife when they are worried about their baby, or to contact solicitors or support workers once they have gone into labour or need other additional support.
Ms Brintworth described how community midwives are also especially skilled at understanding the local profiles of their patients and appreciating the specific approach to care that different populations will need.
‘Being able to understand your community, and therefore where and how you can seek help for those that you’re looking after is a really important skill,’ she added.
Nursing associates in midwifery settings
Last month, NHS England and bodies including the Royal College of Nursing and Nursing and Midwifery Council, concluded that nursing associates should not work in maternity settings, as part of a new position statement.
Ms Brintworth said that nursing associates are ‘a really important part of the healthcare team’, but she stood by the decision against them working in midwifery settings.
‘I think we reached this conclusion because we were very aware of how they are trained, the opportunities that are afforded to them around how they’re trained, and the role of how their regulation works as it works for all of us,’ she explained.
She added that nursing associates were ‘being asked to do things they hadn’t been prepared for’, which was ‘unfair’.
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‘So, this has felt like a supportive approach to make sure that we’ve got the right staff in the right place with the right skills,’ she added.
International Day of the Midwife
To mark the International Day of the Midwife on May 5, Ms Brintworth shared her thanks to all midwives working across the UK.
‘Every time I go and visit the service, I’m so struck by the passion and commitment of midwives to look after people. They want to look after the women and families who come to their services,’ she said.
‘They are constantly striving to improve the care they give, [and] their attention to detail about sometimes what can seem like the very smallest thing is just phenomenal.’
