Chapter 1
To Be a Midwife

Nicky Clark

University of Hull, Hull, UK

Carol Paeglis

Former Supervisor of Midwives and Local Supervising Authority Midwifery Officer, Yorkshire and the Humber, UK

Learning Outcomes

By the end of this chapter the reader will be able to:

• understand how midwifery has evolved as a profession
• examine how midwifery as a profession is regulated in the united kingdom
• identify the support processes available to student midwives undertaking a pre-registration midwifery programme
• be cognisant of the demands working within the midwifery profession
• identify factors that can facilitate successful course completion.

Introduction

Midwifery is a dynamic profession that is responsive to change. In recent years, the social, economic and technological forces have altered the context of midwifery significantly. The scale of healthcare provision has changed greatly; philosophies and values have been adjusted and the restructuring of healthcare provision has been dramatic. Public expectation regarding involvement in care and opportunities for informed choice has increased; consequently women and their babies expect more than ever before to be partners in the care process.

Midwives provide high-quality professional care to women and their families, acting autonomously, accountably and responsibly within their sphere of practice. This chapter aims to explore the development of midwifery and its professional regulation with the subsequent evolution of the role and responsibilities of a midwife. The quality of midwifery education and the supervision of midwifery will also be examined.

Activity 1.1

Ask yourself why you wanted to become a midwife. It will be useful to revisit this as you progress on your programme. At difficult times within your programme these statements can be very helpful.

To be a midwife is to understand the role and responsibilities of being a midwife. The midwifery profession is recognised globally and is defined by the International Confederation of Midwives (ICM) (2011) as:

.A midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title 'midwife'; and who demonstrates competency in the practice of midwifery.

This definition is complex; therefore the professional status and regulation of midwifery nationally and internationally will now be clarified.

The Professional Status and Regulation of Midwifery

Historically the professional status of midwifery in England and Wales began with The Midwives Act 1902. This enabled the state enrolment of midwives and established the Central Midwives Board (CMB) for England and Wales. The Midwives Institute was established in the 1880s and was instrumental in the application of the Midwives Act. The Midwives Institute became known as the Royal College of Midwives (RCM) in 1941. All practising midwives were enrolled with the CMB by 1910. A Midwives Act was not passed in Scotland until 1915, which built on the experience of the CMB for England and Wales when setting up the CMB for Scotland.

The CMB produced an annual Roll of Midwives, which was a list of qualified midwives, indicating which were practising. The CMB was independent from nursing, although many midwives were nurses. In 1983 the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) replaced the General Nursing Council (Nursing) and the CMB (Midwifery), which brought the nursing, and midwifery records together for the first time. The Nursing Midwifery Council (NMC) was established under the Nursing and Midwifery Order 2001 ('the order') (SI:2002/253) and came into being on 1 April 2002, abolishing the UKCC and its four National Boards.

Midwifery, as a profession is recognised globally, although there are wide variations in education and scope of practice between the different continents. Currently, in the United Kingdom, the NMC is the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands. The aims of the NMC are outlined in Box 1.1.

Box 1.1    Aims of the NMC

• Exist to safeguard the health and wellbeing of the public.
• Set standards of education, training, conduct and performance so that nurses and midwives can deliver high quality healthcare consistently throughout their careers.
• Ensure that nurses and midwives keep their skills and knowledge up to date and uphold the professional standards.
• Have clear and transparent processes to investigate nurses and midwives who fall short of the standards.

The NMC

The NMC are governed by legislation approved by the Houses of Parliament and this is detailed in what is known as the Statutory Instruments (SIs). SIs allow an Act of Parliament to be brought into force or altered. The Statutory Instrument 2002 No. 253 is The Nursing and Midwifery Order 2001, and replaced the Nurses, Midwives and Health Visitors Act 1997.

The main objective of the NMC in exercising its functions under The Order is to safeguard the health and wellbeing of persons using or needing the services of registrants. The principal functions of the Council are to establish from time to time standards of education, training, conduct and performance for nurses and midwives and to ensure the maintenance of those standards.

Part VIII of the Nursing and Midwifery Order is specific to Midwifery and is concerned with:

• The Midwifery Committee.
• Rules as to midwifery practice.
• Local supervision of midwives.

Since 1 December 2012, following the Health and Social Care Act (2012) the NMC has been regulated by the Professional Standards Authority for Health and Social Care (PSA). The PSA replaced the Council for Healthcare Regulatory Excellence (CHRE). The PSA's function is to ensure that the NMC and other healthcare regulators promote the best interests of patients and the public and ensure consistency across the professions (Yearley and Dawson-Goodey 2014).

European Union

The UK became part of the European community in 1973, and after the Maastricht Treaty was signed in 1992, the European Union (EU) was formed. As a member state of the EU, all EU legislation must be enforced and UK law must adhere to the EU framework and refer to the European Court of Justice. The NMC maintains close partnerships with colleagues and decision makers in Europe to ensure they can influence EU legislation in the interests of patients and the public in the UK.

There are three main institutions involved in EU legislation:

• The European Parliament, which represents the EU's citizens and is directly elected by them.
• The Council of the European Union, which represents the governments of the individual member countries. The Presidency of the Council is shared by the member states on a rotating basis.
• The European Commission, which represents the interests of the Union as a whole.

Together, these three institutions produce the new policies and laws that apply throughout the EU. In principle, the Commission proposes new laws, and the Parliament and Council adopt them. The Commission and the member countries then implement them, and the Commission ensures that the laws are properly applied and implemented.

EU Directives

The purpose of the EU is to facilitate the freedom of movement of people, goods and services. In the case of seven professions who have to be registered to practice (doctors, nurses, dentists, midwives, veterinarians, opticians and architects); specific sectarian directives were developed as the EU recognised that the purpose of the registration is first and foremost the protection of the public. To ensure the protection of the public throughout the EU, directives were developed so that a minimum standard of education and practice could be identified. Midwifery education and practice are determined by the Directive 2005/36/EC of the European Parliament and of the Council (2005). This Directive has just been amended on 20 November 2013 to ensure greater efficiency and transparency with the recognition of professional qualifications and has placed value on the use of a European Professional Card (Directive 2013/55/EU, 2013).

The NMC set standards for education and practice and give guidance to professionals. The latest standards for pre-registration midwifery education (NMC 2009) are guided by the international definition of a midwife and the requirements of the European Union Directive Recognition of Professional Qualifications 2005/36/EC Article 40 (training of midwives) and amendments to the EU Directive as stated above. These directives stipulate the experience that students must demonstrate before registering as a qualified midwife and are listed in Box 1.2.

Box 1.2    The European Union Article 40 (Training of Midwives) of Directive 2005/36/EU

• Advising of pregnant women, involving at least 100 antenatal examinations.
• Supervision and care of at least 40 women in labour. (The student should personally carry out at least 40 deliveries; where this number cannot be reached owing to the lack of available women in...