Conception of the Consultant Midwife and Midwifery Led Care

1
Conception of the Consultant Midwife and
Midwifery Led Care

• Maggie Elliott
• Queen Charlottes and Chelsea Hospital

2
Department of Health Service Circular 1998

• Expert Practice
• Professional Leadership and Consultancy
• Education, Training and Development
• Practice and Service Development, Research and
  Evaluation

3
Nursing and Midwifery Strategy - Making a
Difference

• Lead significant practice,education and service
  development
• Masters or Doctorate level
• Higher level of practice

4
Royal College of Midwives

• Embraced the concept of the Consultant Midwife
• Rejected the link between the Consultant Midwife
  and Higher Level of Practice
• Said - the Consultant midwife must provide
  expertise in midwifery, as opposed to obstetric
  practice

5
Perceived Problems

• Take away the autonomy of the midwife
• Threaten the role of the Head of Midwifery
• Create an elitist group

6
Examples of Consultant Midwife roles

• Lead normality in all environments
• Public Health
• Link with Universities to lead and develop
  midwifery research
• Lead and develop post natal care and support

7
Consultant Midwife Job Description

• This pioneering post is designed to strengthen
  the expert midwifery contribution to women in
  every setting and especially for those cared for
  within the midwifery led Birthing Centre

8
ContThe Consultant Midwife will
provide inspirational leadership to experienced
midwives and act as an exemplary role model to
hospital and community staff, pre-registration
student nurses and student midwives for all
issues relating to midwifery.
9
ContThe main element of the post
will be the provision of expert midwifery care to
women booked for midwifery led care at the Birth
Centre.The Midwife Consultant will exercise a
high degree of personal and professional autonomy
and make critical judgements of the highest order
to satisfy the expectations of the job.
10
Philosophy of One to one Midwifery

• To put into practice the principles of Changing
  Childbirth, choice, continuity and control
• To provide a service sensitive to the needs of
  childbearing women and their families

11
Principles of One to One Midwifery

• Carry a personal caseload of 40 women per year
• Care of women who are both high and low risk, for
  all stages of care
• Provide a named midwife for each woman
• Are the lead professional where pregnancy is low
  risk
• Are organised in partnerships and group practices

12
Benefits of One to One

• Continuity of carer
• Improved maternal satisfaction and confidence
• Improved job satisfaction for midwives
• Reduction in interventions
• Caseload consists of both high and low risk women

13
Midwifery Requirements

• Autonomous practice
• Midwifery motivation
• On call commitment
• Organisational skills
• Able to practice in all areas of midwifery

14
Prioritising those in need

• Previous stillbirth/neonatal death/congenital
  abnormality
• VBAC
• History of post natal depression
• Previous traumatic birth experience
• Disadvantaged groups

15
Obstacles to Overcome in the Implementation of
Midwifery Led Care

• Midwives confidence - particularly in units that
  have a strong medical influence
• A belief that a birth is only normal in
  retrospect
• Difficulty in putting women at the centre of care
• Opposition from medical staff

16
Essential Requirements for the Implementation of
Midwifery Led Care

• Strong midwifery leadership
• Expert clinical support i.e Consultant Midwife
• Development programmes for midwives
• Inter professional respect
• Agreed definitions of high and low risk
• Sound guidelines and referral systems