Denise and her blog
What Is Happening In Midwifery?
Midwifery appears to be at a crossroads, both in the UK and elsewhere. Practice and education are both under attack, largely from paternalistic factions wanting to control childbirth and the profession of midwifery. Childbirth has become the pariah of healthcare, causing immense stress for expectant and birthing parents, leading midwives to leave the NHS and even the profession, and the government to have knee-jerk reactions in terms of national reviews and even the suggestion of a minister for maternity care.
As a midwife of almost 50 years, I have seen maternity care and midwifery practice change from something akin to the “Call the Midwife” era (I started in the mid-1970s), to the deplorable state we find ourselves in today. We have had numerous reviews over those years, from the 1970 Peel Report advocating hospital birth, to the three Maternity Care in Action reports in the 80s, Changing Childbirth in the 90s, to a string or reports, investigations and attempts to improve maternity care in the 2000s. But what ARE the current problems and how can some of the issues be resolved – or, indeed, can they?
First, in my opinion, is a catastrophic and almost total loss of any understanding – amongst midwives, obstetricians and the public - that pregnancy and birth are physiological life events that simply require careful observation and, in a few cases, when progress deviates from the anticipated norm, medical support. There is also a significant lack of understanding by the government, NHS, obstetricians and even some midwives, of the wide role of the midwife, as defined by the World Health Organisation, which focuses on working with women from the preconception period, through pregnancy, birth and the postnatal period up to one year following birth of the baby.
The denial of “normality” has led to increased medicalisation of birth with premature and unwarranted “cascades of intervention” and excessively high induction (up to 60% in at least one unit known to me) and Caesarean rates that have overtaken spontaneous vaginal births. This is coupled with a deplorably coercive and paternalistic approach to maternity care “options” for expectant and birthing parents, largely driven by a fear of litigation if no action is taken, and the obstetric culture of wanting to “do something”, with controlled management, as in other medical specialties. Expectant parents are “advised” that intervention is necessary to protect them and their babies, with insufficient information given to aid them in making informed decisions about their births. Some parents are so anxious about their maternity experiences at the hands of the NHS, that they choose home birth, independent midwives or even unassisted birth.
Added to the internal issues around medicalisation are the demands from the anti-natural childbirth lobby, which have arisen from various investigations into baby loss. It is, of course, very sad when any baby, or mother, dies in childbirth, but we should be careful to put this in perspective. Whilst perinatal loss and maternal mortality statistics could be a great deal better, the majority of women have – or at least could have, if left to physiology – a perfectly normal pregnancy and a spontaneous vaginal birth. It is often the intervention that adds to the “abnormality” which then leads to further medicalisation. Any national review is only likely to add to the intervention in a “just in case” approach.
On the other hand, we now have many more women with increasingly complex pathological, psychological and social needs, who require obstetric and often general medical treatment, leading to increased staffing requirements, clinical costs and bed occupancy. Whilst the birth rate has fallen slightly, there are additional demands on the maternity services, with medical advances enabling women who would otherwise not have been able to conceive and reproduce, as well as people newly arrived in the UK who may present with issues that have not hitherto been familiar to NHS staff.
We now have a shortage of midwifery staff, with many experienced midwives near retirement age and many more leaving the NHS due to burnout. This is well documented by a press hungry to highlight the problems of the maternity services, leading to a poor perception of midwifery that can affect recruitment, It is not that midwives want to stop caring for expectant and birthing parents, but that they can no longer tolerate long hours and unpaid overtime, lack of gratitude and incessant demands on their energy that leave many unable even to find time to go to the toilet or have a drink, let alone take the statutorily required breaks in their working days.
Midwifery education must also take some of the blame for the current issues in the maternity services. There is a “bums on seats” approach by universities accepting students, coupled with lecturing staff redundancies, leading to lack of support for student midwives who are then unable to cope with the rigours of midwifery theoretical learning and clinical practice. Students are required to pay exorbitant fees for education that may still not provide them with jobs and preceptorships at the end of their pre-registration period. I am sceptical about preceptorships which, in the NHS are a management strategy to ensure that all midwives are capable of working in all clinical areas to fill staffing gaps. However, for newly qualified midwives (NQMs), it is certainly advisable to consolidate their learning, yet there appear to be fewer and fewer opportunities to do so immediately after qualifying. The gap between obtaining registration and actually starting clinical work often leads to loss of momentum, with some NQMs never practising.
All these factors discussed so far have resulted in a deplorable lack of experience of physiological birth for student and NQMs who are then fearful of caring for parents wanting a more natural birth because they do not understand it in practical terms. This only perpetuates and strengthens the argument for intervention. Further, there is little career development support to enable midwives to specialise in a specific area of midwifery, coupled with a “dumbing down” of expertise by employing more support workers.
There is also, in both education and practice, a culture implying that students are being trained for the NHS, with an overall political refusal to accept midwifery as a profession which enables midwives to work in any setting, anywhere, both NHS and privately, at home and overseas, subject to local requirements. Further, there remains difficulty in obtaining professional indemnity insurance cover for those who wish to work in a self-employed capacity, although some steps have been taken in more recent years to address this.
Further, there is a totally unacceptable culture of bullying within NHS maternity services, both midwifery and medical, from management and between clinical colleagues, with an element of multi-professional tensions adding to the problem. The overall attitude within the maternity services is punitive and threatening, with staff afraid to speak out – it is easier to fit with the system than to be seen as a maverick. All of this leads to high sickness and absence rates, resignations and significant mental health issues for individuals concerned.
And so, we get to finance, which the government seems to think is one of the primary issues. Perhaps there is a shortage of funding for maternity services, but more likely it is the inappropriate allocation of resources and the need to fund interventionist practice which impacts on maternity, anaesthetic and paediatric services, as well as bed capacity and other services eg domestic and portering. Yes, we could do with more money in the NHS generally, but it is not the sole answer.
Throwing money at the issue of the maternity services is not going to solve the problems. Neither will yet another government sponsored review, which already adds political bias, be the answer, nor the appointment of a Minister for Maternity Services.
Evidence-Informed Education In Complementary Therapies
Every day, midwives hold an extraordinary position of trust.
Women come to you not only for clinical expertise, but for reassurance, interpretation, and guidance - especially when they’re exploring complementary or natural approaches alongside conventional care.
That’s why I believe so strongly that midwives deserve robust, evidence-informed education in complementary therapies.
Not to replace clinical practice - but to enhance it.
To help you answer questions with confidence.
To support women safely, ethically and within your scope.
At Expectancy, everything we teach is grounded in midwifery values: safety, professionalism, critical thinking and woman-centred care.
Happy New Year !!
The start of a new year often brings a moment to pause and reflect on where we are - and where we’d like to grow.
For many midwives, that growth comes from deepening knowledge, building confidence, and finding new ways to support women with care that is both evidence-informed and compassionate.
Complementary therapies can play a valuable role in that journey when they’re integrated safely and professionally.
If you’re considering developing your skills this year - whether for your clinical role or for a future private practice - I’d love to support you in exploring what’s possible.
A new year can be the beginning of a very rewarding next chapter.
Reflections
I’ve been reflecting on our first practical weekend of the Acupuncture course back in October, taught by our lovely Amanda.
It’s always such a memorable point in the programme - that moment when midwives begin actually placing needles for the first time!
There’s usually a mix of excitement and a little apprehension, which is completely natural. But the group handled it brilliantly, supporting one another as they developed their confidence and technique.
Acupuncture is a wonderfully effective tool in maternity care, and watching midwives lean into new skills with such enthusiasm is one of the joys of teaching. 💜
Previous articles
What Is Happening In Midwifery?
Evidence-Informed Education In Complementary Therapies
Happy New Year !!
Reflections
The Parlous State Of The UK Maternity Services – Is Midwifery Education To Blame?
What Should You Learn on a Midwifery Aromatherapy Course?
In Support of Home Birth
The Power of Essential Oils
Worldwide Midwifery Friendships
Ginger in pregnancy
