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More midwives are needed at a senior level, say midwifery leaders

A director of midwifery should be introduced at every hospital trust and health board across the UK to help ensure safe maternity care, says the Royal College of Midwives (RCM).

In its latest leadership manifesto published today, the RCM said that the voices of maternity services struggle to reach the highest levels of management within trusts, heath boards and the wider health service.

The report, entitled ‘Strengthening midwifery leadership: a manifesto for better maternity care’, outlined seven steps to ‘strengthen leadership’ for those in the profession.

It warned of the ‘severe’ cost of getting maternity services wrong including financial loss through clinical negligence claims, damage done to lives and even the loss of life.

‘Increasingly outdated’

Alongside a director of midwifery at every board and trust, the manifesto recommended a head of midwifery is introduced at every maternity unit in an organisation.  

Currently, heads of midwifery - which are distinct from directors of midwifery in that they often report to the director of nursing and do not take strategic decisions - are routinely the most senior practising midwife in an organisation.

But the report stressed that 'the current norm of having a director of nursing responsible for midwifery at board level is increasingly outdated' as not only is midwifery a ‘distinct’ profession from nursing but undergoing a ‘fundamental shift’ away from big hospitals and towards the community. 

In addition, the RCM called for specialist midwives - such as those who cover mental health, bereavement, diabetes, infant feeding and safeguarding - to be introduced at every trust and health board. 

RCM chief executive Gill Walton highlighted that midwives are increasingly seeing women with complex healthcare needs and who choose to have children later in life, and so there is a greater need for specialists.

Ms Walton continued: 'In far too many parts of the country these specialist midwife posts do not exist, meaning women are going without this specialist care they need and midwives are not able to access knowledge and expertise that would improve the quality of care they are able to deliver.'

The seven steps to strengthen midwifery leadership outlined in the report are: 

  • A director of midwifery in every trust and health board and more heads of midwifery across the service
  • A lead midwife at a senior level in all parts of the NHS, both nationally and regionally
  • More consultant midwives
  • Specialist midwives in every trust and health board
  • Strengthening and supporting sustainable midwifery leadership in education and research
  • A commitment to fund ongoing midwifery leadership development
  • Professional input into the appointment of midwife leaders

‘Uphill battle' 

Ms Walton said that without senior management and clinical leadership advocating for maternity care and services at board level, midwives are facing an ‘uphill battle’. 

She continued: ‘We simply cannot expect midwives across the UK to continue to deliver high quality maternity care against a backdrop of underfunding, staffing shortages and a lack of investment in maternity leaders.

‘What we need to see is an investment in strong high quality leadership in the right places in our maternity services and the RCM’s manifesto sets out the steps we believe need to be taken to make a positive difference to the current situation.’

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