Written by Madeleine Speed. Posted by Lucy Ryan, the Pelvic Partnership, October 2017
Did you know that within the UK in April 2017, the role of the Supervisor of Midwives (SoM) has been axed? The SoM used to support each maternity hospital and community area and was available 24-hours a day to pregnant women and to midwives needing advice or support.
The Pelvic Partnership has long encouraged women to make use of their access to a SoM. Traditionally, the SoMs could bring their wealth of experience and expertise to help facilitate discussion between a woman and her midwife to help plan ahead of a birth, particularly to iron out concerns and issues regarding the approach to delivery. Women with Pelvic Girdle Pain (PGP) have often found recourse to a SoM useful where the benefits of a specific birth choice in managing PGP symptoms are not perceived by the midwife or the midwifery team on duty. The fact that the SoM was not directly employed by the hospital and area of operation provided a distance and lack of bias that enabled professional gravitas.
Here are some examples of where the SoM has helped support women and their midwives to work together to resolve concerns about a particular birth option with PGP, which have been shared with the Pelvic Partnership charity:
"I found it useful to involve a SoM when my midwife was concerned about my having a water birth for my first baby. I had severe PGP and she was worried that we wouldn't be able to get me in or out of the pool quickly. The SoM helped us to sort out how to put measures in place to reassure the midwife that we could cope and I got the kind of pain control and delivery I wanted." Kate G.
"My symptoms of PGP stopped me from opening my legs wide and I was worried that trying to give birth would make the PGP worse. My midwife was encouraging me to have a caesarean but I wanted a natural birth. The SoM helped us to work out that I could deliver on my side to avoid opening my legs too far and my midwife recognised the advantages of this to the midwifery team and to me." Ann W.
Changes to maternity services are usually very welcome because they can bring helpful improvements and a sense of progress. The Maternity Transformation Programme grew from the 2016 publication of "Better Births" which set out a list of recommendations designed to radically improve maternity care in England so that it would be kinder, safer and more personalised to meet the needs and wishes of pregnant women. This is an initiative that most women would welcome and celebrate. However, change can also affect practice that seems to be working well so that the process of transformation can threaten to bring unwelcome outcomes as well as beneficial ones. At first glance this seems to be the case with the way midwifery supervision has altered.
Why has the role of the SoM been changed?
Reviewing the way maternity services operate has meant a number of fundamental changes aimed at better care for women and their babies. The change to the important role of SoM is because the Nursing and Midwifery Council (NMC) has decided to remove midwifery supervision and the system supporting it from their legal framework. As a result, with the change of legislation, the system of statutory supervision of midwives will no longer be part of the framework that regulates midwives in all four countries that make up the UK.
The decision was made by the NMC following the publication of two commissioned reports: "Midwifery supervision and regulation recommendations for change" (PHSO 2013) and "Midwifery regulation in the United Kingdom" (The King's Fund 2015). Two key areas for change recommended by these reports, and which have subsequently become law, are that:
- midwifery supervision and regulation should be separated, and
- the NMC should be in direct control of regulatory activity.
The NMC was concerned that these reports and "a number of critical incidents" indicated that the previous arrangements were no longer the best way to offer public protection. The NMC believes that public safety is best served if the NMC is solely responsible for all aspects of the regulation of midwives. As a result, all midwifery referrals will be made directly to the NMC by employers, colleagues and the public; this is already the arrangement for other healthcare professionals.
After the decision to remove supervision was made, the NMC undertook a consultation exercise, and the Pelvic Partnership team responded by raising our concerns about the support women would lose with the removal of SoMs. However, because the decision had already been taken, the only option was to continue with the NMC’s course of action.
Is this change for the better?
The NMC's intention of losing the regulatory aspect of the midwifery supervisor’s job makes sense and seems a very workable way forward. The real concern is about how the supervisory and developmental parts of the role will be retained within the new system. At present it isn't clear whether valuable aspects of the SoM role will be built into the new approach: for example, the ability to identify and support inexperienced midwives and prevent poor practice by encouraging relevant training. There is also the concern that women may not be able to call on a relevant professional who can intervene and help problem-solve if a woman is concerned about the competence or care offered to her by her midwife. Commenting on the NMC decision when it was first suggested, Cathy Warwick, then chief executive of the Royal College of Midwives, said: “This could at a stroke wipe out an important aspect of public protection."
The NMC believes it has answered these concerns
The NMC does not believe that the positive aspects of supervision will be lost with the change to the new system where SoMs no longer exist. The NMC has set out to develop new models of supervision. Each of the four nations of the UK is taking forward its own plans for new models of supervision that are led by employers and each model will focus on supporting and developing effective midwifery practice.
New models of supervision
The NMC suggests that the new models of supervision will pick up the functions that the SoMs previously carried out so that the elements most valued by midwives about supervision will continue across the UK. For example, NHS England has set up a national supervision taskforce which is leading on the proposed new model of supervision, the A-EQUIP Model: Advocating and Educating for Quality Improvement. The plan is that once the A-EQUIP model pilot has been carried out, there will be training provided by Professional Midwifery Advocates and this will deliver the content and ensure that best practice is continued.
Is this reassurance sufficient?
In some respects the NMC gives the impression that the positive aspects of the old SoM will emerge phoenix-like in a new incarnation of midwifery supervision. However, while the new model is piloted in a number of locations around the country, there is bound to be a real gap in what was previously delivered by SoMs. It is impossible at this stage to gauge whether the new models will deliver the complex level of care, support and birth planning that the SoMs provided and the wealth of best practice that SoMs promoted will be lost during the transition. Until we can see evidence that the new model really can deliver, perhaps we should mourn the demise of the SoM and what their existence represented in the care and safety of women and their babies, and ensure that we feed back concerns to the NMC if women are not receiving the support they need when making decisions about their care.
For more information:
You can find out more about the new models of supervision being developed across the UK by visiting the NHS England website.