The Safeguarding Role of the Midwife

Where is the Supervision?

Virginia Hewitt - Head of Safeguarding Children

ABMU Health Board South Wales UK

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Background

MA in Medical Humanities 2011

Named Midwife for Safeguarding Children

Acknowledged the impact of the midwife’s safeguarding role and a potential lack of support

Identified the subtle nature of the ‘midwife – woman’ relationship and how this may conflict with protecting the newborn

Set out to evaluate whether statutory supervision supports the midwife’s role in safeguarding children

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Methodology

Literature Search using humanistic principles

The role of the midwife was explored using literary and historical references

The midwife’s safeguarding role includes ethical and legal dilemmas such as the removal of the baby at birth

Aspects of safeguarding supervision were considered as well as statutory supervision of midwives

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What is a Midwife?

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‘As Old As the Hills!’

An ancient profession

- Anthropological evidence

- Ancient Greece

- Biblical references

Originally female – myd wyf – with woman

Other terms – priestesses, wise women, gamps, witches, god-sips, hags

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The Professional Midwife

End of C19 – need for social reform, improve health of poor

Medicalisation of birth

Sairy Gamp image ‘dirty drink-sodden

old hag without skill or conscience’

(Leap and Hunter 2003)

Midwives became professionalised in 1902

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Early Safeguarding Role

Biblical reference - Protecting Hebrew baby boys from death

Babies baptised during or straight after birth to prevent being ‘firebrands of hell’ (Thomas 1971)

Testifying in court with regards to infanticide

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Midwife’s Safeguarding Role Today

Often first professional to work with potential new parents so need to recognise early signs of neglect and abuse

Public health role - smoking/domestic abuse/substance use/mental health – impact on unborn & baby

Teenage Pregnancy

The younger they are the more vulnerable they are

Midwives have a responsibility up until 28 days after birth

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Unique role of the midwife

Cares for mother and baby together not as two separate entities

Works in partnership with women (International Confederation of Midwives 2005)

Professional Accountability to keep mother and baby together

Supports mother re choices - refuses antenatal care, birth at home, free birth, lotus birth

‘Balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or

refuse treatment’ (NMC 2015)

Caring for the woman when the baby dies – stillbirth/miscarriage BUT also when baby is removed from mother due to child protection concerns

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Conflict in Responsibilities

A legal requirement to ‘safeguard and promote the welfare of children’ (Children Act 2004)

Responsibility to report issues that could affect unborn and/or baby

Unborn has no legal rights – Birth Plans to remove

Removal at birth is unlawful unless instructed by court of law

The safeguarding role of the midwife is not widely recognised

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Comments

‘ I have felt a great responsibility re child protection, but at the same time feeling quite inadequate to meet that responsibility.’

‘ The amount of time we spend ensuring that we fulfil our duty to these women AND their babies not to mention their often abusive partners by far outweighs the actual time spent with the woman.’

(Midwives on RCM Forum 2010)

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The origins of Midwifery Supervision

Following professionalisation of midwives in 1902 – Inspectors of Midwives were introduced

Punitive Role

‘Usually ‘respectable’ women such as clergymen’s daughters’ - some suggest ‘patronising and judgemental’ (Heagerty 2006)

1937 – renamed supervisors – more supportive and to have ‘sympathy and tact’ (Rutherford 2009)

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Supervision of Midwifery Today

To protect the public from malpractice

Statutory Requirement – Midwives’ Rules

Not clinical supervision

Some supportive elements mainly practice related

Safeguarding Children issues not acknowledged in midwifery supervision training material

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Two Hats

Managed or Supported?

‘To root out bad practice is very different from the support skills needed to foster the confidence in the face of uncertainty’

(Kirkham 1996)

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Safeguarding Supervision

Focus on practitioner

Developed from models of clinical supervision

Restorative – listening, challenging, supportive

Allows practitioner to identify & clarify situations which

have legal, professional and ethical components

Managerial aspect to reduce risk

Recommended as essential protective factor in child protection work (Laming 2003, 2009)

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Findings

Professionals working within the safeguarding children arena find the work emotionally demanding

Midwifery work - high emotional content

The safeguarding role of the midwife is not always acknowledged in comparison for example to the health visitor

An assumption that supervision of midwifery provides appropriate support

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Recent Changes

Serious failings - Maternity Unit Morecambe Bay

Ombudsman – Review of Midwifery Regulation 2013

‘ Midwifery supervision and regulation should be separate as it led to a conflict of interest between midwives and supervisors’

Kings Fund Review of Midwifery Regulation 2014

‘The additional layer of regulation...for midwives and the extended role for the NMC over statutory supervision should end’

Morecambe Bay Report 2015 ‘Urgent response to King’s Fund findings with effective reform’

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Recommendations

Royal College of Midwives are determined to retain the supportive aspect of supervision and the responsibility of the future of midwifery supervision now sits with the chief nursing officers

Ideal opportunity to explore the safeguarding role of the midwife

Further research to understand some of the dilemmas midwives face within this important role

Devise a model of supervision that will empower and support the midwife

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Conclusion

It has been argued that the relationship between mother and baby is the most powerful relationship human beings experience (Taylor 1996)

Midwives sometimes become part of a process that breaks that bond.

This can cause emotional distress for a midwife whose prime focus is the mother

Good safeguarding supervision is needed to support the midwife and to ensure the safety of the baby.

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Thank You

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