The Birth of the Consultant Midwife

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The Birth of the Consultant Midwife in Practice
Debby Gould Consultant Midwife Queen Charlottes
and Chelsea Hospitals, London.
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Consultant Midwife

• Expert Practice
• Professional Leadership and Consultancy
• Education, Training and Development
• Practice and Service Development, Research and
  Evaluation
• DOH Health Service Circular 1998

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Diverse Roles

• Championing Normality
• Labour wards
• Post natal
• Birth centres
• Community / Home birth / Waterbirth
• Health promotion
• Targeting inequalities i.e.teenage pregnancy,
  travellers

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Background to QCCH Consultant Midwife Role

• Largest Neonatal Unit
• Birth place of walking epidural (65)
• Tertiary Referral Centre
• Nationally Renowned Fetal Medicine Unit
• 33 Caesarean section rate
• Status (Imperial College)
• Birth Centre

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Consultant ? Specialist ? Advanced Practitioner ?
Whats in a name?

• Everything!!
• Challenges existing hierarchies
• Opens doors
• Breadth and depth of organisational exposure is
  crucial to success in achieving change

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Damned if you do! Damned if you dont!

• Most want
• Carry a case load
• Help when busy, co ordinate labour ward
• Teach practical skills, cannulation, suturing
• Lead and develop midwifery practice

• Least want
• Carry a caseload
• Not make up numbers to ease staffing
• Fill role of Practice Development Midwife
• Attend lots of meetings

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Must dos

• Professional leadership
• Promote evidenced-based, woman-centred autonomous
  midwifery practice
• Champion normality
• Encourage and support professional development in
  others
• Avoid becoming a manager

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Must dos

• Be seen as an approachable role model
• Know midwives individual, strengths, weaknesses
  and support their aspirations
• Challenge medical model model
• Treat everyone with respect no favourites
• Provide support and training

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Must nots

• Give up on trying to reduce medicalisation
• Become too prescriptive or a dictator
• Go on doctors rounds or do own rounds
• Have a nice time with low risk women while other
  midwives are struggling with high risk women

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Is it just practice development?

• Update guidelines
• Skills and drills
• Caseload / work in unit / community
• Individual sessions with midwives
• Education and reflective practice sessions
• In house practical training

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More than that!

• Leads (from the front, back and sides)
• Promotes midwifery led care and midwifery ethos
  in all areas
• Unravel decision making
• Act as a buffer to midwives from the system
  to help them better support women
• Resource of knowledge and support

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Must Be Seen

• Clinically
• Personally
• Nationally

• Personal is political
• Isolation if people do not understand role
• Preparation of all staff essential
• Support Mechanisms

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What midwives want!!

• Strong confident leadership which empowers women
  and midwives and creates mutual respectful
  partnerships with medical colleagues
• Dont work on your own work with other midwives
  too
• Champion normality of midwifery against
  medical intervention

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Growing into the role ?

• Stop personal caseload hidden work
• Research
• Stronger strategic input
• Existing hierarchies (out of loop)
• Teeth
• Budget

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Midwife to the midwives

• Consultant midwife role gives a career Structure
  for midwives which allows influence on larger
  scale whilst staying on the ground and improves
  the quality of care women receive
• Sullivan 2000

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Influenced Practice?

• Supports birth centre, midwifery led care and
  1-1 midwives
• Provides options for women with unusual
  circumstances
• Provides options for midwives struggling with
  inappropriate protocols

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Influenced Culture?

• Moving us away from outdated but entrenched
  practices
• Empowered and raised profile of midwives
• Labour ward consultant more user friendly but
  still needs more work

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Influenced nationally?

• Consultant Midwives Group
• Networking
• Registered Key Stake Holders NICE
• Resource for Royal College of Midwives