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SUMMER 2016 The Royal College of Midwives MIDWIVES / SUMMER 2016 Rolling the dice for maternity services e next generation game MIDWIVES

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  • SUMMER 2016

    The Royal College of Midwives

    MIDW

    IVES / SUM

    MER 2016

    Rolling the dice for maternity services

    Th e next generation

    game

    MIDWIVES

    001_MID_Cover.indd 1001_MID_Cover.indd 1 17/05/2016 10:1917/05/2016 10:19

  • From the publishers of Emma’s Diary®, ‘A Guide to Labour & Birth’ is a FREE resource designed for you to give to expectant mums in your care from 34 weeks.

    The publication is written by a team of medical experts in association with the RCGP and is available to midwives to support their work.

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    • All content is BFI compliant• Content is reviewed and updated

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    MID.Iss2.16.002.indd 2MID.Iss2.16.002.indd 2 11/05/2016 14:3911/05/2016 14:39

  • 3rcm.org.uk/midwives

    MIDWIVES

    CONTENTSVOLUME 19 | Summer 2016

    7 Editorial

    RCM chief executive Cathy Warwick

    discusses the future for maternity services

    9 Letter

    Cathy’s response to the media coverage on

    the RCM’s position on abortion

    10 News

    Student bursaries; immigration; research

    18 Your RCM news

    New Alliance partner; charity bike ride; i-learn

    11, 13, 15 Country news

    The latest from the RCM’s country directors

    19On politics

    The changes set to aff ect midwifery in the UK

    14 Th e big story

    The EU referendum

    16 Call to action

    A message from Cathy about regulation

    21 On employmentThe RCM’s new series of publications about equality and diversity

    News

    30Student voicesHow to keep going on the midwifery

    journey, and a look at the language

    used by midwives

    26Feedback

    Members’ letters: incontinence, and a research request

    33Research

    Two lead authors summarise their

    latest work

    36How to...

    build and develop a birth centre

    Practice

    23One-to-one

    Greta Beresford on teaching midwives in former Soviet states

    3028Voice of

    a motherRefl ecting on the loss

    of a baby and the invaluable support

    from midwives

    immigration; res

    20 Your student news

    Rebozo techniques; society funding; webinars

    Opinion

    25MSW voice

    An award-winning MSW explains her

    role in the NNU

    2

    03-04_MID_Contents Summer 2016.indd 303-04_MID_Contents Summer 2016.indd 3 18/05/2016 12:5818/05/2016 12:58

  • 4 rcm.org.uk/midwives

    Features

    MIDWIVESVOLUME 19 | Summer 2016

    88 Diary

    Upcoming courses, training

    and events

    89CompetitionsGet your hands on some great

    giveaways

    90 Crossword

    Test your wits on this midwifery

    puzzle

    64Technology

    Using technology to help prepare student midwives for practice

    84CMV

    The facts about cytomegalovirus

    72Stillbirth

    A look at what needs to change to tackle

    the stillbirth problem in the UK

    70Healthy eating

    Slimming World explores the eff ects of shift work

    on staff eating habits and wellbeing

    60Revalidation

    Learning from midwives who have completed

    their revalidation

    Cover

    storyFeatures

    38Th e next

    generation gameExtensive coverage of the

    report of the National Maternity Review for England

    44Kangaroo care

    A group of midwives and an international

    charity take kangaroo mother care to China

    48Powys midwifery

    Looking at the emergency obstetric

    training off ered to midwives in rural Wales

    44

    54Infertility

    The issue of infertility in a profession dedicated

    to birth and babies

    58Public health

    The second model of the RCM’s new

    public health project

    ontce

    68Benevolent FundDame Lorna Muirhead

    highlights the help provided by the fund to midwives in need

    76Global midwifery

    An update on the RCM’s global work

    78Preterm birth

    Improving outcomes for babies born too early

    50RCM campaign

    The new RCM campaign focusing on the health, safety and wellbeing of

    midwives and MSWs

    82Better births

    Introducing the new Better Births summaries

    03-04_MID_Contents Summer 2016.indd 403-04_MID_Contents Summer 2016.indd 4 18/05/2016 13:0018/05/2016 13:00

  • DELIVERING ESSENTIAL PRACTICAL AND PROFESSIONAL SUPPORT

    CLINICAL

    Keep up-to-date with changes in clinical practice which will help you provide

    first-class support for both mother and baby

    EDUCATION

    Explore teaching methods and innovative ways to educate student midwives to ensure

    a new generation of competent maternity professionals

    RESEARCH

    The latest research findings that will

    have implications for your clinical practice, now and in the future

    PROFESSIONAL

    Essential information on the issues and concerns facing all midwives, together

    with advice about career development

    RESEARCH STUDENT FOCUS INTERNATIONAL RECRUITMENT

    Promoting excellence in midwifery and women’s healthPromoting excellence in midwifery and women’s health

    www.britishjournalofmidwifery.com

    Assessing in-utero activity

    Intimate partner violence and pregnancy

    June 2015

    Importance of timing of deinfibulation for women with type 3 FGM

    Peripartum cardiomyopathy

    Visit www.magsubscriptions.com/bjm or call 0800 137 201 (UK ONLY)

    RESEARCH STUDENT F

    Intntimatatete papartner vand preregegngnancycy

    ofof deinffibulatation fofowith tytyppe 3 FGFGM

    U

    e

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    NAAATIO

    Helping subscribers provide first class

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    MID.Iss2.16.005.indd 2MID.Iss2.16.005.indd 2 05/05/2016 15:3205/05/2016 15:32

  • www.unahealth.co.uk 01782 575 180 | [email protected] 3, Scotia Road Business Park, Stoke on Trent , ST6 4HG

    Reduce Repeat Oral Glucose Tolerance Testing with Rapilose

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    egurgitation.

    MID.Iss2.16.006.indd 2MID.Iss2.16.006.indd 2 05/05/2016 10:1405/05/2016 10:14

  • 7rcm.org.uk/midwives 7

    Chie

    f exe

    cutiv

    eCA

    THY

    WAR

    WIC

    K

    As Midwives goes to press, the RCM has come under attack for our position statement on abortion, which we have published on our website - bit.ly/RCMAbortionStatement. Contrary to the distorted and sensationalist accounts touted by certain newspapers and lobbyists, the reality is that our position restates the RCM’s long-standing support for women to have choice over their fertility and over all aspects of their maternity care, including whether to have a baby or not. Our position also reaffi rms our support for midwives to hold a position of conscientious objection. I would urge you all to read our position statement and the message to members on page 9.

    Th is edition also includes extensive coverage of the report of the National Maternity Review for England, which the RCM has strongly welcomed. I hope you are as delighted as I am with its vision of a service in which women are at the centre of care and in which maternity staff are supported to care for them.

    Th ere is so much to be pleased about in the report, with its focus on improving the quality of local maternity services for all women, for making care more personalised and for ensuring women are cared for by a small team of midwives they know and trust. Women want more continuity and the evidence supports it

    producing better outcomes. Be assured that change will be phased, local services will have the freedom to develop their own models for supporting continuity and the RCM will develop advice and guidance to support implementation.

    I believe the report provides an opportunity to shape services diff erently and ensure that every maternity service achieves the very best standard. However, the climate in which midwives work today is often a diffi cult one, and change will only happen if it is accompanied by better consideration of the support that all maternity services staff need if they are to give their best.

    Th at is why the RCM is launching ‘Caring for You’, our campaign to improve RCM members’ health, safety and wellbeing at work. Th is campaign will raise awareness of the links between healthy workplaces and high-quality care, champion organisations that promote staff wellbeing and encourage NHS organisations to do likewise by signing up to our Caring for You charter. Please take a look at page 50 for more information.

    Th e referendum on the UK’s continuing membership of the EU is only weeks away. Th is is a once-in-a-generation decision and I would encourage you to read the RCM’s view on page 14 and to make sure you vote on 23 June.

    A vision for future service provisionSupport for women and the National Maternity Review are top of the agenda.

    The offi cial magazine of The Royal College of Midwives15 Mansfi eld Street, London W1G 9NH0300 303 0444

    EditorialEditor: Emma [email protected] editor: Rob [email protected] and features writer: Hollie [email protected] editor: Professor Mary SteenPhD MCGI PGDipHE PGCRM BHSc CIMI RM RGN

    Editorial boardLouise Silverton, Jon Skewes, Carmel Lloyd, Val Finigan, Kate Brintworth, Suzanne Truttero, Natalie Linder

    PublishersRedactive Publishing Ltd17-18 Britton Street, London EC1M 5TP 020 7880 6200Director: Jason Grant

    AdvertisingSales manager: Ben [email protected] Sales executive: Beth Fifi eldbeth.fi fi [email protected] 7324 2735

    DesignSenior designer: Carrie Bremner

    CoverIllustration: Bett Norris

    ProductionSenior production executive: Aysha [email protected]

    Membership0300 303 0444

    Magazine subscription rates(For non-members only, per annum) UK: £130 European Union: £175Rest of the world: £185

    Magazine subscription queriesAbacus e-Media, Chancery Exchange, 10 Furnival Street, London EC4A 1YH+44 (0)20 8950 [email protected]

    Printed by Precision Colour Printing.Mailed by Priority, Salisbury.

    All members and associates of the RCM receive the magazine free.

    The views expressed do not necessarilyrepresent those of the editor or of The Royal College of Midwives.

    All content is reviewed by midwives.

    Full article references can be found in the ‘Midwives magazine feature articles’ section of the RCM website.

    Midwives ISSN: 1479-2915

    007_MID_editorial_Cathy.indd 7007_MID_editorial_Cathy.indd 7 18/05/2016 13:0118/05/2016 13:01

  • ANNOUNCES

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    Who is it for?• Midwives and midwifery managers • Obstetricians and paediatricians • Individuals interested in exploring China

    Professional visits include:• Shanghai paediatric clinic • Beijing AN TAI Maternity Hospital• Chang An Government Hospital

    maternity department in Xian• Yangshuo rural maternity hospital

    Cultural highlights include:• Walk along the legendary

    Great Wall of China• Discover the famous Terracotta Warriors• Enjoy a cruise along the picturesque

    Li River• Join in a traditional Chinese cooking

    class with local chefs in Yangshuo

    To receive a tour brochure that includes a full itinerary,

    please call 02075016741, email [email protected] or visit our website www.mastertravel.co.uk

    Master Travel Study Tours

    MID.Iss2.16.027.indd 2MID.Iss2.16.027.indd 2 05/05/2016 10:1605/05/2016 10:16

  • 9rcm.org.uk/midwives 9rcm.org.uk/midwives

    To: all RCM membersChief executive Cathy Warwick responds to the media coverage of the RCM’s position on abortion.

    According to some newspapers, the RCM is campaigning to legalise abortion on demand, at any time during pregnancy, for any reason. Furthermore, it has been alleged that I have signed up the RCM to this campaign without consulting members and that I have a confl ict of interest because I am also chair of the British Pregnancy Advisory Service (BPAS).

    I want to put the record straight and to give you the facts about the RCM’s position on abortion. Contrary to the distorted and sensationalist accounts touted by certain newspapers and campaigners, the reality is that our position:1) Restates the RCM’s long-standing support

    for women to have choice over their fertility and over all aspects of their maternity care, including whether to have a baby or not.

    2) Calls for every woman to be given the necessary information to make an informed choice as to whether or not to continue with her pregnancy.

    3) Recommends that abortion procedures be regulated in the same way as all other procedures relating to women’s health care.

    4) Advises that midwifery practice must always comply with the legal framework relevant to the provision of services for the termination of pregnancy.

    5) Reaffi rms our support for midwives to hold a position of conscientious objection.

    In keeping with this position, the RCM does not believe it is right that in the 21st century it is still the case that women who choose to have an abortion can be criminalised and jailed. Accordingly, the RCM believes that abortion should be removed from the criminal law and that is why we took the decision to support the ‘We Trust Women’ campaign, which is calling for the decriminalisation of abortion across the UK.

    Th e RCM believes that if we are to be advocates for women, then we must advocate for choice on all aspects of their care. Th is is not about being for or against abortion; it is about being for women and respecting their choices about their bodies.

    Th e RCM Board is fully aware that the RCM has supported the BPAS campaign. Th e Board are all practising midwives who have been elected by you, the members of the RCM, to set our strategic goals and objectives, and protect the reputation and values of the RCM. I can assure you that your elected Board has been regularly advised of any member’s reaction to us joining the campaign in February 2016 and will be kept informed of further reaction.

    As to the charge that a confl ict of interest exists because I am chair of BPAS, since both organisations support and advocate choice for women, I cannot see where such a confl ict arises. Again the RCM Board, to whom I have to declare any potential confl icts, has supported me taking on this role.

    Th e RCM is a diverse organisation and a broad church, which accommodates a range of views and opinions. I accept that not all members will agree with the position that the RCM has taken on abortion. I do, however, want to ensure that every RCM member has the opportunity to form their opinion based on what the RCM has actually said, rather than on the partisan and misleading reporting of certain journalists. I would therefore urge you all to read and consider the arguments that we set out in our position statement. Visit bit.ly/RCMAbortionStatement to take a read.

    009_MID_NEWS_Letter_Cathy.indd 9009_MID_NEWS_Letter_Cathy.indd 9 18/05/2016 13:0118/05/2016 13:01

  • THELATEST NEWSYour professional

    midwifery news

    10

    IMMIGRATION

    Lords vote to end detention of pregnant immigrantsThe House of Lords voted in April to end the immigration detention of pregnant women in a result of 274 to 215.

    The vote came after Labour peer Ruth Lister proposed an amendment to the Immigration Bill.

    In the debate, Lord Alton of Liverpool quoted the RCM to support his argument that the detention of pregnant women should end.

    He quoted the RCM as saying that the detention of pregnant asylum-seekers increases the likelihood of stress, which can risk the health of the unborn baby.

    He also described the conditions at Yarl’s Wood detention centre and cited a 2015 report from the Inspectorate of Prisons, which found 99 pregnant women had been detained at Yarl’s Wood.

    The report found more than half of women who were detained there felt depressed or suicidal when they fi rst arrived, and that there had been 72 incidents of self-harm in the previous six months – a huge rise from the previous inspection.

    The bill will return to the House of Commons for approval before it becomes law.

    A consultation has been launched on planned changes to the student funding system for midwifery, nursing and allied health professional pre-registration training places.

    Th e consultation will run until 30 June and allows everyone – from relevant organisations to interested members of the public – to have their say on how the changes should best be implemented.

    Th e proposals to reform healthcare education funding, which were fi rst announced as part of the government’s spending review in November 2015 will,

    if implemented, remove bursaries and replace them with loans.

    Th e Department of Health says that the proposed changes will create up to 10,000 more midwifery, nursing and allied health professional training places by the end of this parliament, allowing universities to accept more appropriately qualifi ed applicants than they currently do.

    It is claimed that the changes will also off er students around 25% or more fi nancial support while they study.

    However, the RCM is opposed to the changes, which it says will result

    A new network has been launched to increase the availability of midwife-led care for women, including birth centres and home births.

    The Midwifery Unit Network

    (MUNet) was launched by Baroness Cumberlege

    and is in response to the fi ndings of

    the National

    Maternity Review, which said that clinical commissioning groups ‘must make available maternity services that off er women the choice of home birth, birth in a midwifery unit and birth in an obstetric unit’.

    The MUNet website will be a hub for resources and information sharing.

    The aim is to have a one-stop-shop collecting best practice and the learning and knowledge that exists in midwife-led birth centres.

    It will enble resources and information to be accessed quickly and easily, and shared by midwives, midwifery managers and commissioners.

    MUNet has been co-founded by midwifery consultant and RCM board member Sheena Byrom, consultant midwife Felipe Castro Cardona, lecturer and researcher Lucia Rocca-Ihenacho, and service user advocate Mary Newburn.

    midwiferyunit network.com

    THE MIDWIFERY UNIT NETWORK

    New network to promote MUs

    rcm.org.uk/midwives

    HEALTH EDUCATION FUNDING

    Student bursaries consultation

    NewsMidwives / Summer 2016

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  • Country news

    11rcm.org.uk/midwives

    RESEARCH

    STUDY GETS FUNDINGThe Health Service and Delivery Research arm of the National Institute of Healthcare Research has funded Nottingham University to explore ‘Facilitators and barriers to the availability and utilisation of midwifery units (MUs) in England’.

    The research is being led by Professor Denis Walsh and a team of researchers from Nottingham University, City University and De Montfort University over 26 months.

    It will map the current confi guration of MUs across England, how they are run and staff ed, and then undertake case studies of high-performing services (>20% of all women birthing in MUs), lower-performing services (

  • 12 rcm.org.uk/midwives

    Midwives / Summer 2016News

    NEWSIN BRIEF The Smokefree Action Coalition

    has published its new strategy for 2016 to 2020. It is an update

    of the previous policy, which ran from 2011 to 2015.bit.ly/SFAC_2016-20

    Health Foundation fellowshipsThe Health Foundation has launched the fourth round of its Improvement Science Fellowships programme. The deadline for applications is 5 July.bit.ly/HF_ISF-round4

    Pertussis vaccine updatePublic Health England has changed its recommendation for the timing of the pertussis vaccine for pregnant women, which can be given as early as 16 weeks.bit.ly/Pertussis_April2016

    REPORT FINDINGS

    Benefi ts of continuity of carerTh e medical benefi ts to women of receiving continuity of care from a midwife they know, rather than receiving medical-led or shared care, has been highlighted in a new report.

    Jointly produced by King’s College London and Green Templeton College, Oxford, the report reveals that women are 24% less likely to experience preterm birth, 19% less likely to lose

    their baby before 24 weeks’ gestation, and 16% less likely to lose their baby at any gestation.

    Women were also more satisfi ed with the information and advice they received, the place where they gave birth, their preparation for labour, their choice of pain relief, and their overall birth experience.

    Th e report also suggests

    NMC LEGISLATION

    CONSULTATION INTO NMC CHANGESThe Department of Health has launched its consultation on the proposed changes to NMC legislation for midwives and nurses.

    The proposals include removing statutory midwifery supervision provision, which will result in a separation of the roles and purpose of the supervision and regulation of midwives.

    Also on the table are the removal of the statutory midwifery committee from the NMC’s governance structures, and improvements to the NMC’s fi tness-to-practise processes.

    The NMC has provided the RCM with assurance that the proposed changes do not aff ect: the separate registration of midwives; direct entry to the register as a midwife; the protected title of a midwife; the protected function of attendance on a woman in childbirth (this applies to labour only); or separate competencies and pre-registration education standards for midwives.

    RCM chief executive Cathy Warwick said: ‘On the introduction of a system of non-

    statutory supportive supervision and leadership in midwifery, the RCM is supportive of this work, led by the Department of Health and the four chief nursing offi cers in the UK; although we remain concerned about the system being able to sustain a non-statutory framework of supervision for midwives in the long term.

    ‘The RCM is also concerned that the statutory midwifery committee is currently the only voice of midwifery within a nursing-dominated council. What is worrying is that without this voice, regulation for midwives will be largely determined by another profession.’

    The NMC has recently appointed a midwifery adviser and a midwifery panel to provide advice on midwifery matters.

    But the RCM has concerns they can be dismantled as quickly as they were created.

    NMC chief executive and registrar Jackie Smith (pictured) said: ‘We are delighted that the government has opened its consultation around changes to our legislation and would encourage anyone interested to respond to it.

    To read a message from Cathy urging members to respond to the consultation, which closes on 17 June, turn to page 16.

    bit.ly/NMCchanges

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  • Country news

    13rcm.org.uk/midwives

    RCM DIRECTOR, HELEN ROGERS

    WALES

    RCM WALES MANIFESTO: We were delighted to launch our manifesto for the National Assembly for Wales’ elections in May. We have four ‘asks’ of Welsh Government, which focus on supporting student midwives through student bursaries and ensuring that those who are prepared to give a lifetime of service to the NHS do not have to pay for the privilege of doing so. Secondly, that student midwife numbers continue to rise and that appropriate numbers are brought into the health service to replace those who retire. Thirdly, that the recommendations of the NHS Pay Review Body are honoured and, lastly, that there is a review of maternal mental healthcare provision in Wales, with a clear action plan for the development of services. We will continue to highlight these ‘asks’ with the new assembly to ensure that we have safe, sustainable maternity services in Wales.

    WORKING TOGETHER: The fi rst Welsh maternity conference ‘Better Together’ took place in March and was jointly organised by the Maternity Network, RCM Wales and the RCOG. It was a huge success with delegates from all areas of maternity. Deputy minister for health and social services Vaughan Gething provided an opening address before key messages were delivered on culture and relationships, human factors and resilience. Speakers included Dr

    Bill Kirkup, RCOG vice president of UK aff airs Ian Currie and RCM Scotland director Gillian Smith.

    Concurrent sessions focused on multidisciplinary teamwork and working together to transform maternity services. Health boards in Wales showcased quality improvement projects and initiatives that have been making a positive impact in their service. NHS Wales chief executive and director general for health and social services Dr Andrew Goodall addressed delegates in the afternoon.

    WULF: RCM Wales was successful in receiving funding for another Wales Union Learning Fund project, lasting for two years. The project is to support personal and professional learning for midwives and MSWs across Wales. If there are any events you would like to arrange, or you’re interested in becoming a learning rep, contact learning organiser Nicola James at [email protected]

    NE W MEMBERS: RCM Wales is delighted to welcome Annmarie Thomas to the team. Annmarie joins us as an organiser and will be meeting members at engagement events this year. We are also pleased that Sarah Fox, consultant midwife at Abertawe Bro Morgannwg University Health Board, has been appointed part-time RCM professional policy advisor.

    New MBRRACE-UK reportThe fi ndings of the UK perinatal mortality surveillance report for 2014, from MBRRACE-UK, have been published.bit.ly/MBRRACE-UK_PMSR

    A project to get new mothers and pregnant women healthy

    is being run by midwives and psychologists from The University of Manchester.

    bit.ly/1VmPdhY

    IMAG

    E: IS

    TOCK

    that although there are start-up costs associated with introducing a new model of care, the result – shorter hospital stays, and fewer tests and interventions – means that it will cost no more than current services, as well as leading to improved job satisfaction for midwives.

    Th e report came out of a symposium held at Green Templeton College in October 2015, which was curated by RCM president Lesley Page, and held in honour of the life of social anthropologist Sheila Kitzinger, who campaigned on

    these issues.Lesley said: ‘Th e

    symposium brought together health service leaders, academics and patient groups to help understand how the NHS might implement, scale-up and sustain continuity in maternity care, and ensure that more women in the UK have access to this type of care.’

    Th e report follows the publication in February of the National Maternity Review in England, which also identifi ed continuity of carer as a priority.

    bit.ly/Relationships_report

    It will cost no more than current services, as well as leading to improved job satisfaction for midwives

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  • 14 rcm.org.uk/midwives

    Midwives / Summer 2016News

    storyTHE BIG

    14 rcm.org.uk/midwives14 rcm.org.uk/midwives

    T he term ‘Brexit’ fi rst appeared in 2012, when a columnist in Th e Economist coined the word, inspired by the potential Greek exit from the Eurozone, or ‘Grexit’, as it was known.What started out as a tongue-in-cheek reference

    snowballed in usage and there is now a daily volley of news stories when anyone speaks out.

    While many are voicing opinions, there is widespread uncertainty about what being a member of the European Union (EU) actually means.

    What does the EU do?Th e RCM has stated that it will not be advising members to vote one way or another.

    ‘A lot of people don’t actually know what the EU does,’ says Stuart Bonar, RCM public aff airs advisor. ‘But the fact that we are having this referendum means that the information is getting out there.

    ‘As an organisation, we believe we are better off in the EU. It does a lot of important things, however, because they aren’t very exciting, they don’t get much media coverage, so people don’t know about them.’

    Among the things that the EU is responsible for is the legal defi nition of the midwife. Th is guarantees recognition of professional competence based on minimum training requirements and allows for testing of language skills and exchange of information by national regulators.

    Th e EU is also responsible for a range of other related areas,

    including ensuring safe working conditions and rules to prevent needlestick injuries (see right for more).

    Negotiating termsIf the UK was to leave, new terms would have to be drawn up and renegotiated in these areas and Jon Skewes, RCM director of policy, employment relations and communications, thinks midwives and MSWs would end up in a worse position.

    ‘Th ese are derived from the EU and are things that the RCM campaigned on. We wouldn’t have secured all this if we were dealing with UK legislation,’ he says. ‘Our fear is that a Conservative government, which has been prone to deregulation, is unlikely to maintain all this in the same way that the EU does.

    ‘Th e RCM is an internationalist body and we operate through lobbying for members and ensuring that we aff ect policy. We have good working relationships with the EU and have found it open and transparent.’

    It is a sentiment echoed by Frances O’Grady, general secretary of the TUC, to which the RCM is affi liated. ‘Th ese rights can’t be taken for granted,’ she says. ‘Th ere are no guarantees that any government will keep them if the UK leaves the EU. And without the back-up of EU laws, unscrupulous employers will have free rein to cut many of their workers’ hard-won benefi ts and protections.’

    Asked whether there would be any implication for regulation, Jackie Smith, NMC chief executive and registrar, says she ‘would not speculate on the

    With a vote on whether the UK remains in Europe just weeks away, we look at the implications for midwives.

    SHOULD I STAY OR SHOULD I GO?

    ILLU

    STRA

    TIO

    N: A

    DAM

    AVE

    RY

    If people voted in favour of leaving, there would be a

    large scale economic impact that would

    harm the NHS

    Midwives / Summer 2016News

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  • Country news

    15rcm.org.uk/midwives

    RCM DIRECTOR, BREEDAGH HUGHES

    NORTHERNIRELAND

    ICTU AFFILIATION: The RCM attended the Northern Ireland Committee (NIC) of the Irish Congress of Trade Unions (ICTU) conference in Derry in April and had productive discussions with the ICTU regarding affi liation. This will help us to avail of ICTU services, such as the Nevin Economic Research Institute, NIC-ICTU training for our workplace reps and the opportunity to infl uence trade union policy in Ireland.

    PAY: All remains quiet on the pay front, despite the health minister’s announcement that he would implement the Pay Reviw Body’s recommendation of a 1% consolidated pay rise across the board in NI. This still leaves us just 1% better off than in 2013 and there has not, as yet, been any consultation with the trade unions to discuss the off er, nor a formal announcement from the DHSSPS that the 1% will be imposed.

    ELECTION: The NI Assembly election has had some surprise outcomes, including a 50% increase in the number of female members of the legislative assembly. Two members of the health committee (including the chairperson) have lost their seats and we are waiting with bated breath to see who the next health minister will be.

    Irrespective of which party the new minister is from, we shall continue to campaign

    on behalf of midwives and women in NI on the issues in our manifesto, which can be found on the RCM website.

    TERMINATION GUIDANCE:The long-awaited guidance on termination of pregnancy in NI has been published by the DHSSPS. While it is broadly welcomed by the RCM, there are reservations about the section that describes how healthcare professionals should respond to women who disclose that they have taken abortion pills purchased on the internet. We will meet with the DHSSPS to discuss the implementation of the guidance, and have already expressed our concerns.

    REVIEWS: As the maternity strategy for NI covers a six-year period, a mid-point review is currently being carried out and the report is expected shortly.

    A review is also being carried out of the services provided by Downpatrick and Lagan Valley midwifery units, which will assess both user and staff satisfaction, among other things.

    FUNDING: We have been successful in our bid for monies from the Union Learning Fund and will shortly be appointing a project worker to join the NI RCM team with the remit of recruiting and arranging training for locally based ULRs. If you’re interested in becoming an RCM ULR, email [email protected] at the NI offi ce.�

    outcome of a future political decision’. She adds: ‘We will keep abreast of the referendum and consider the implications for regulation if necessary.’

    Wider implicationsAside from the ramifi cations for the profession, whatever decision is made on 23 June will also have implications for the wider NHS and UK’s economy.

    Th e head of the Bank of England Mark Carney says that if the UK does exit, the bank will ‘do everything in our power to discharge our responsibility to achieve monetary and fi nancial stability’. But he adds that a departure would be ‘the biggest domestic risk to fi nancial stability,’ and that the UK would ‘without question’ lose fi nancial sector activity.

    While there is no way of knowing what the fi nancial impact of an exit would be and what terms the UK would be able to negotiate with the EU and the rest of the world, if there was a negative economic impact, there would be inevitable knock-on eff ects.

    ‘Th e NHS does not function in isolation,’ says Jon. ‘It depends on a vibrant economy and the more tax the government collects, the more resources for the NHS.

    ‘One of the greatest fears if people voted to leave is the economic impact, which would harm the NHS. It would be likely to damage the pound. After the banking crisis, the last thing that the UK needs is

    another economic shock.’Th ere are counter

    arguments – the UK could forge its own terms of employment and trade agreements and would not be restricted by a regulatory burden from abroad.

    However, a letter in Th e Times, signed by top health professionals, delivers a stark message. ‘Our health services, health-research collaboration and public health protection are more robust within the EU. Leaving would damage the progress we have made.’ Ending on a note about the recently coined term ‘Brexit’, they state that it ‘should carry a health warning’.

    EU-DERIVED RIGHTS INCLUDE:► 20 days’ paid annual

    leave a year.► Not be forced to work

    longer than 48 hours a week on average.

    ► Paid time off for antenatal appointments.

    ► Up to 18 weeks’ parental leave per child and time off for urgent family reasons.

    ► Equal pay for work of equal value between men and women.

    ► High standards of health and safety at work.

    ► Protections from discrimination in the workplace on grounds of sexual orientation, gender reassignment, age, religion or belief.

    (TUC, 2016)

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  • 16

    News

    CALLTO ACTION

    Midwives / Summer 2016

    Iwould like to encourage you to respond to the DH consultation regarding changes to regulation, as it is important that the voice of the midwife is heard. Th e original intention of the legislative change was to decouple the supervision of midwives from regulation, so the wide-ranging proposal to remove all of the ‘midwifery’ section from the Nursing and Midwifery Order has serious implications for the profession.

    Th e RCM is particularly concerned about the removal of the statutory midwifery committee (MC). Th is was recommended by the previous report of the Law Commission, but was a part of wider changes, including a separate register for midwives. Th e MC is the formal route for the midwifery voice to be heard within a nursing-dominated organisation – 95% of the register are nurses. Th is is unlike other regulators, which are either single professions or have more proportionate numbers of each profession. Without the voice of the MC, regulation for midwives will be largely determined by another profession. Th is runs counter to the ICM Global standards for midwifery regulation (ICM, 2011). Midwifery and the separate regulation of midwives is seen worldwide as

    an essential solution to reducing maternal and infant mortality and morbidity. Th e removal of the MC, without a wider review of regulation and the setting up of a separate register, is a retrograde step, which will undermine the profession and impact on the safety of women and babies.

    Although not explicitly stated, the changes will also involve the removal of the Midwives rules and standards (NMC, 2012). While the NMC has provided

    rcm.org.uk/midwives

    30 DAYS TO SAVE YOUR MIDWIFERY COMMITTEE

    assurance that the proposed changes do not aff ect the separate registration of midwives; direct entry to the register as a midwife; the protected title of a midwife; the protected function of attendance on a woman in childbirth or separate competencies and pre-registration education standards for midwives, there are some well-used elements that will no longer exist. Th e ICM states that regulation must defi ne the role of the midwife and the loss of Rule 5 will mean that the specifi c description of the UK role of the midwife will no longer be in these documents. We consider this is a major loss that could lead, over time, to substitution of midwives, or midwives only being used for birth. We will all need to be vigilant that removal of the rule does not erode the function of a midwife, nor the role as the provider and coordinator of care in the antenatal and postnatal, as well as intrapartum periods. Midwives must also adhere to the code (NMC, 2015) in respect of delegation.

    Th e removal of statutory supervision will take away the regulatory elements, including supervisory investigations and development programmes for midwives. Th e supportive elements, while important for midwives and women, were not a part of the regulation as overseen by the NMC. While we are supportive of the work led by the DH and the four UK chief nursing offi cers to introduce a system of non-statutory supportive supervision and leadership, we are extremely concerned about the commitment to its implementation within a non-mandated environment. Already we are hearing that a number of employers will not be supportive of the new framework, so by removing midwifery supervision from statute, will this result in its eventual demise?

    I hope this will assist you in providing a response to this important consultation. To add your views, visit bit.ly/NMCchanges

    Cathy Warwick, RCM chief executive

    Th e removalwill undermine

    the professionand impact on the

    safety of womenand babies

    016_MID_NEWS_Letter.indd 16016_MID_NEWS_Letter.indd 16 18/05/2016 10:0118/05/2016 10:01

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  • 18 rcm.org.uk/midwives

    Midwives / Summer 2016News

    YOURRCMNEWSWhat’s going on at the RCM?

    Here’s the latest updates...

    RCM SUPPORTS CHARITY’S NEW BIRTH CHARTER Birth Companions, a charity specialising in the support of pregnant women and new mothers in prison, has launched its new Birth Charter.

    Th e Birth Charter, which is supported by the RCM and has been produced with guidance from Unicef UK’s Baby Friendly Initiative, has been developed to help inform the government’s ongoing review of the treatment of vulnerable women and their babies.

    Th e charter provides recommendations for the government and the prison service on improving care for the 600 pregnant women and 100 new mothers held in prisons in England and Wales each year.

    It aims to improve current practice on aspects ranging from antenatal care and birthing partners to breastfeeding, family visits and counselling.

    Birth Companions director Naomi Delap said: ‘Many pregnant women and new mothers in prison are incredibly vulnerable, and yet despite several pieces of national and international legislation protecting their health and wellbeing, many do not get the care and support to which they are entitled.

    ‘Th at must change, so we’ve developed the Birth Charter, with input from a wide range of professionals and service users. We have focused attention on the elements that have the biggest practical impact to ensure these women get the support they need, and are able to give their children the best possible start in life.’

    Equality and diversityTh e RCM has published a series of documents for workplace reps and members for dealing with equality and diversity.

    Th e publications include BME midwives, disciplinary proceedings and the workplace race equality standard, Equality essentials, Pregnancy and maternity rights at work, Working with the menopause, and Work-related stress.

    Th e RCM believes that investing in a diverse NHS workforce allows the NHS to deliver a more inclusive service and improve care for service users.

    Members can access the publications on the RCM website.

    rcm.org.uk/equality-and-diversity

    Bullying at workHaving previously worked collaboratively with the RCOG to try to address the problem of undermining and bullying behaviours in maternity services, the RCM has created a module on i-learn and a YouTube video, which challenges poor behaviours and provides tips to improve the working environment.

    With statistics showing that one in four people have experienced bullying in the workplace, there is a chance this could include you.

    Other modules available on i-learn include Intrahepatic cholestasis in pregnancy, Involving fathers in maternity care, and a revised format for MaternityPEARLS – perineal repair and suturing.

    rcm.org.uk/ilearn

    IDM CAKE COMPETITION 2016Th e RCM has received some fantastic entries this year for its annual cake competition to celebrate International Day of the Midwife – the internationally recognised day for highlighting the work of midwives.

    Th e entries can be viewed on the RCM website. rcm.org.uk/idm

    EMA EARLY BIRD OFFERTickets for the RCM and the European Midwives Association fi fth international education conference are available at an early-bird rate.

    Until 30 June, tickets will cost £280 compared to the standard price of £335.

    Th e conference, titled ‘Midwifery education for the 21st century – innovations in education, practice and regulation’, will run from 2 to 3 December and take place in London, so book your place now.

    bit.ly/RCM-EMA-2016

    EMA Ticketsfi fthea

    016

    te. challenges mprove the

    ure

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  • On politics

    RCM PUBLIC AFFAIRS ADVISOR

    STUART BONAR

    19rcm.org.uk/midwives

    THE POLITICAL ENVIRONMENT ISchallenging for midwives. In England, changes to student midwife fi nance mean those training to enter the profession will be loaded down with colossal levels of new debt, while changes at the NMC mean that the voice of UK midwifery in the regulation of the profession risks being lost.

    The changes that ministers are proposing for student midwives in England will be devastating. Free tuition scrapped, replaced by £9000 per year in fees. Bursaries paid to help cover their costs scrapped, replaced entirely by loans. Debt upon debt upon debt.

    Newly qualifi ed midwives could soon be weighed down by over £60,000 of debt. Those who have already graduated with another degree before midwifery could fi nish their training over £100,000 in the red.

    It is our fear that this will not only hit the fi nances of student midwives and newly qualifi ed midwives hard, but that it will also deter people from applying for midwifery. With England already very short of midwives – thousands short, in fact – this has the potential to make things worse, far worse.

    These plans are now out for consultation. Please respond to it if you can and let the government know what you think about their plans. It can be found online at bit.ly/healthedfund

    Right now these changes only apply in England. Decisions aff ecting

    student midwives in Scotland, Wales and Northern Ireland are made by the administrations in those parts of the UK, and at present none are following London’s lead.

    Ministers are also planning changes to midwifery regulation that we believe will be a big step back. They want to axe the NMC’s midwifery committee, which runs the risk of extinguishing the voice of midwives from decision-making at the profession’s regulator. This is a particular problem because, in terms of the number of registrants, nurses massively outnumber midwives. In circumstances like this, the voice of the minority group would normally be expected to be given special protection.

    The NMC has appointed a midwifery adviser and a midwifery panel to provide advice on midwifery matters. While it is welcome, there is still a risk that these arrangements could be dismantled as quickly as they were created.

    These changes are UK-wide, and are currently being consulted on. If you want to let them know what you think, please do so at bit.ly/NMCconsult7

    Now is the time for midwives to speak out. The future for student midwives in England looks bleak unless we can get ministers in London to change their mind. The future for all midwives looks challenging if their voice at the regulator is lost. Please have your say, and let those in power know what midwives want.

    Challenging times ahead

    CHARITY BIKE RIDERCM staff have cycled 230 miles across France to raise money for Women’s Aid – the RCM’s charity of the year.

    A total of eight staff , including chief executive Cathy Warwick, participated in the ride that took place from 5 to 8 May.

    So far, over £10,000 has been raised via donations from generous members and staff , and the team has gained £6000 in sponsorship from its amazing suppliers.

    Th e RCM would like to say a big thank you to its gold sponsors Impact Results, RAMSAC, Glamorgan Telecom, and RK Harrison, as well as its bronze sponsors Jon Baines Tours, SOS Stationary Suppliers, Willis Towers Watson, Soprano Solutions and Th ompsons Solicitors.

    Read more about the individual suppliers on the RCM website.

    rcm.org.uk/cycleride

    New Lansinoh partnership Th e RCM is pleased to announce the launch of a new Alliance partnership with Lansinoh, to support breastfeeding.

    Th rough the partnership, Lansinoh hopes to extend its support for health professionals, invite member feedback to inform the development of new resources and products, and work with the RCM to develop breastfeeding information and resources.

    Lansinoh will be running sessions for MSWs at the RCM MSW conference in June and will be exhibiting at both the annual conference in October and the EMA conference in December.

    Lansinoh’s healthcare and consumer marketing director Paul Day said: ‘Th is is a great opportunity for Lansinoh to work with members of the RCM to really understand their breastfeeding practice, so we can better support all UK health professionals.’

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  • 20 rcm.org.uk/midwives

    Midwives / Summer 2016News

    ALL WALESSTUDENT CONFERENCESwansea Student Midwifery Society hosted the second annual All Wales Student Midwives Conference on 21 May.

    Celebrating the ‘Six Cs’, speakers included Sheena Byrom, Mark Harris, Kate Evans and Hollie McNish.

    Key messages and sessions including a self-care lunch with massage, meditation, book stalls and, of course, cake.

    YOURSTUDENT NEWSWhat’s new in the student world?

    Your chance to tell us where you’ve been and what you’ve been up to...

    4

    REBOZO TECHNIQUESPRACTICAL WORKSHOPQueen’s University Belfast Midwifery Society

    held a rebozo workshop run by Doula UK registered doula Nikki Mather. Participants included students, midwives, doulas from Northern and Southern Ireland, and even physiotherapists, who were keen to learn rebozo techniques in order to help women during pregnancy and in the early stages of labour. Techniques, such as the hip squeeze and ‘shaking the apples’, were demonstrated and practised during the day. Th ere was defi nitely plenty of laughter and oxytocin fl owing.

    Society successNUMBERS ON THE UPTh e Canterbury Christ Church Students’ Union (CCSU) Midwifery Society has had some wonderful success, with 70 members at present. Th e society has held some inspiring and educational events, including screenings of the fi lm Microbirth, a domestic violence workshop, an infant loss study day, a ‘Facilitating ultimate choice’ event led by Virginia Howes, and its BirthChoices16 conference.

    At the recent CCSU Student Activities Awards, the midwifery society won ‘Society of the year’ and ‘Best society event’, and were runners-up in the ‘Best fundraising event’ category.

    2

    1

    3

    STUDENT BURSARIESCONSULTATION LAUNCHEDStudent midwives in England are set to lose their bursaries and face tuition fees, if the government gets its way. Th e plans are now published, and ministers are consulting on them.

    Th e RCM is disappointed with how the consultation is written. Th ey are not asking, for example, if these plans should go ahead. Th e RCM is fi rmly opposed to them, and would like to see the idea dropped. You can read the RCM’s full response at bit.ly/1TE7TrR

    Be assured, outside of England, that the RCM is lobbying against the plans being rolled out in Scotland, Wales and Northern Ireland.

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  • 21rcm.org.uk/midwives

    On employment

    RCM EMPLOYMENT RELATIONS ADVISOR

    AMY LEVERSIDGE

    IN APRIL, THE RCM RELEASED BME midwives, disciplinary proceedings and the workplace race equality standard – the fi rst in a new series of publications about equality issues. The document follows up on the RCM’s 2012 report Freedom of information request: midwives and disciplinary proceedings in London, and sadly replicates the fi ndings of that report, revealing signifi cant issues with BME midwives and disciplinary proceedings in the NHS.

    The new publication provides the fi ndings of fi ve years of freedom of information requests the RCM has made to NHS trusts in London about the numbers of BME midwives involved in proceedings and the outcomes. The key fi ndings highlighted that from July 2010 to June 2015, BME midwives were disproportionately more likely to face disciplinary proceedings. Of the midwives employed in London, 44.1% were from a BME background, and 66.4% of those facing such proceedings were from a BME background.

    During the same fi ve-year period, a higher proportion of BME midwives than white midwives were dismissed during these proceedings. A total of 38 were dismissed – 37 of whom were from a BME background. Overall, 13.2% of the BME midwives who faced disciplinary proceedings were dismissed, compared with 0.7% of the white midwives.

    The high levels of discrimination against BME staff in the NHS have been widely evidenced in the report The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on

    patient care in London and England by Middlesex University, and in the report Making the diff erence: diversity and inclusion in the NHS by The King’s Fund. Both reports led to the introduction of the Workplace Race Equality Standard in the NHS that aims to tackle discrimination.

    Investing in a diverse workforce allows the NHS to deliver a more inclusive service and improve care for service users. Equality is about creating a fairer society where everybody has the opportunity to achieve their potential. Diversity is about recognising and valuing diff erence in its broadest sense. Inclusion is about an individual’s experience within the workplace, and in wider society, and the extent to which they feel valued.

    The new RCM report can be downloaded from rcm.org.uk/equality where you can also fi nd the other publications in the equality series.

    The RCM also presented a motion to the TUC Black Workers’ Conference in April about this issue. More information about the delegation is available at rcm.org.uk/tuc

    If you are interested in discussing this topic, you can join us in London for an evening debate titled ‘Are the snowy white peaks in the NHS too high to climb?: a debate about the experiences of BME midwives working in the NHS,’ which will be held at Congress House in London on 16 June at 6.30pm. More details about the event can be accessed at bit.ly/RCM-events

    If you have any questions about this publication, or others in the series, email [email protected]

    5FUNDING FOR SOCIETIESGROWING STUDENT NETWORKSTh e RCM is keen to support student midwifery societies and to help them grow and develop student midwife networks across the UK. It is hoped that the societies will consider affi liation with the RCM and form strong collaborative links with their local branches.

    To encourage the growth and success of student midwifery societies, the RCM is introducing an annual grant of £250, payable to any student midwifery society that can meet the required criteria. Find more information at bit.ly/RCM-MidSocs

    Equality issues

    BETTER BIRTHS WEBINARSGET INVOLVEDHave you heard of the RCM’s Better Births webinars? Th ey are free online presentations by healthcare professionals and researchers, covering key topics for practice and policy.

    You can join in with the webinars and listen to the live content and even get involved in the conversations.

    Previous webinar topics have included setting up a home birth service, pregnant women’s experiences in prison, and VBACs in water pathway.

    Find out more at bit.ly/BBWguide

    6

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  • OPINIONTh oughts, views and your feedback

    23rcm.org.uk/midwives

    READ ONMSW voice

    FeedbackVoice of a mother

    Student voices

    ‘Th ey were so conditioned

    against thinking for themselves,

    because the penalties were

    so severe’ Greta Beresford has spent her retirement teaching midwives in

    former Soviet states how to improve their midwifery practice. She explains

    what it has been like.

    Retirement for many may conjure up images of lazy afternoons in the garden, long holidays and cosy armchairs. For Greta Beresford, a safe childbirth coordinator and former RCM offi cer, it has involved travel to former Soviet countries and other challenging nations to help further the midwifery profession. In April, she was awarded an MBE for her services in improving midwifery overseas for the past two decades.

    ‘Sometimes my work is frustrat ing but it’s also enormously rewarding. I feel slightly guilty that I’m getting an MBE for it,’ she says.

    Greta worked as a senior professional offi cer at the RCM before leaving in the early 1990s to move to Herefordshire when her husband took early retirement. She was in her 50s in 1995, when she received a call asking if she’d be interested in a week’s work overseas. She

    ONE-TO-ONE

    023-025_MID_OPINION_121_MSW Voice.indd 23023-025_MID_OPINION_121_MSW Voice.indd 23 18/05/2016 13:0418/05/2016 13:04

  • 24 rcm.org.uk/midwives

    OpinionONE-TO-ONE

    jumped at the chance, with the work coming via charity HealthProm, which had established a UK-USSR medical exchange programme in 1984, and had a focus on reducing maternal and infant mortality.

    Greta, now 76, explains that there was more contact with the West after Perestroika, the political reform associated with Soviet leader Mikhail Gorbachev that brought more openness.

    ‘Th ey realised that their neonatal and maternity death rates were akin to that of Africa. Th e fi rst time I went, it was with a paediatrician for a week at their invitation – it always had to be by their invitation – and they realised that we could help them,’ she says.

    Cultural diff erencesAccompanied by a local interpreter, Greta glimpsed cultures and political systems very diff erent from the UK. It was a peek behind the iron curtain. Healthcare professionals worked and thought diff erently to those in the UK; they followed rules without thinking.

    For example, Greta recalls a woman coming to hospital with severe pre-eclampsia and the doctor in charge of drugs had gone on holiday with the key that gave access to all of the medicine, because she had been told that she must keep it with her at all times.

    ‘Th ey were so conditioned against thinking for themselves, because the penalties were so severe if you didn’t do what you were told. Th ey were not used to thinking independently and followed the rules at all times,’ says Greta. She adds that it took time for this to change.

    ‘Although Gorbachev had realised that professionals needed to be without political diktat and able to draw up their own guidelines, people had been dominated for generations and it takes a long time for them to do something diff erently. Th ey always felt like someone was looking over their shoulder. Th at changed a lot over the years,’ she says.

    Th e change was evident in many ways. Partograms were used, for example, but the information noted would be in the same handwriting because the doctors would complete it from memory at the end of each day, asking midwives to remember what the blood pressure had been hours before.

    Armed protectionVisits would be for one or two weeks at a time and, together with her medic colleague, often an obstetrician, Greta would teach straightforward good midwifery practice during multidisciplinary workshops. She says that there were an abundance of staff and all of them were highly educated, but usually with very little professional education. Many of the pre-Soviet ideas, though, were clever.

    Greta recalls asking midwives in Azerbaijan what their grannies had told them of maternity care before Soviet rule. Th ere had been no antenatal care then, and women would book in to a hospital while pregnant and reappear only when the baby was due. So the midwives came up with their own means of monitoring for pre-eclampsia.

    ‘Th ey’d give a woman a ring to wear and told them, “If it gets tight, come

    FAST

    FAC

    TS

    1963Greta trained in Oxford and

    qualifi ed in 1963.

    £325kShe was involved in a three-year project

    in Azerbaijan that was sponsored by GlaxoSmithKline who gave £325k.

    PaymentShe never received payment for her overseas work but her travel and accommodation was paid.

    TrainingThat project involved training

    midwives who then went to villages and ran workshops themselves.

    OpinionMidwives / Summer 2016

    Opinion

    Above: Greta holding an Armenian baby; Left: Greta with staff in Nagorno-Karabach

    023-025_MID_OPINION_121_MSW Voice.indd 24023-025_MID_OPINION_121_MSW Voice.indd 24 17/05/2016 17:1317/05/2016 17:13

  • 25rcm.org.uk/midwives

    VOICE

    MSW

    back to hospital”. A ring was cheap and women understood it,’ says Greta. ‘It was very imaginative.’

    Although many of the countries where Greta worked were former Soviet nations, not all were. She has worked in Afghanistan where she needed an armed guard to accompany her everywhere she went, as she did in Chechnya. Greta says that she was unconcerned about being shot – ‘Th ey’re such a good aim that I’d be dead before I knew anything’ – but the fear for her hosts was that, as a Westerner, she’d be kidnapped.

    Achievements Although the challenges could be immense, and the bureaucracy was often frustrating, Greta is proud of her achievements, such as suggesting that the Soviet system whereby a baby’s care was handed over to nurses might change. Th e belief was that mothers were infection risks, but nurses did not wash their hands, so there was a high infection rate among infants. When Greta suggested leaving the babies with their mothers, the infection rate plummeted.

    She also feels that the midwifery profession benefi ted from the work.

    ‘I have a pride that we raised the profi le of midwives. Th ese people were educated women but they had no responsibility. We managed to get them better educated in professional terms and more responsibility,’ says Greta.

    Th is was evident when the health minister for Russia sent her a message while she was working in Moscow to say that women could choose whether their lead professional was a midwife or doctor. Greta also helped to set up a professional association for midwives there and says there is no shortage of highly motivated health professionals, who may have had limited and parochial training, but their dedication to their clients is beyond reproach, and they want the same for their clients as staff in the West: respect, choice, education and freedom.

    Sharing expertise to improve midwifery and health care has been an honour, she says: ‘I feel enormously privileged.’

    I AM A BREASTFEEDING SUPPORT SERVICE assistant in Wishaw General Hospital where I work in the neonatal unit (NNU). This year, I was fortunate to win the MSW of the year award.

    I became a mother myself at the age of 18 and, with support, I breastfed both of my children. As it was always my intention to breastfeed, I am very grateful for the help I received. As a result, I acknowledged the

    importance of this guidance. This is what made me become a volunteer in 2007 – to give back the invaluable support I received.

    For over eight years, I have been supporting mothers and families and I take great pride in my role and great satisfaction knowing that I have given care to the best of my ability. Since I’ve come into post, this care is refl ected in the increased NNU initiation rates and the numbers feeding at discharge. On average, 83% of mothers to babies

  • 26

    Midwives / Summer 2016Opinion

    rcm.org.uk/midwives

    FEEDBACKFEEFEE Incontinence advert gripe

    JULIE SPENCER, COMMUNITY MIDWIFEWestern Sussex Hospitals NHS Foundation Trust

    LETTER ONE

    LETTER TWO

    and saying ‘oops!’ is acceptable simply is not good enough.

    REPLY FROM RCM DIRECTOR FOR ENGLAND JACQUE GERRARD:Urinary incontinence is a common condition aff ecting women of all ages and following the birth of a baby (NICE, 2013). In an eff ort to improve health outcomes for women, the RCM teamed up with the Chartered Society of Physiotherapy (CSP), with the aim of working together to promote the importance of pelvic fl oor muscle training across the midwifery profession. Both professional organisations were concerned about the evidence showing the impact that

    childbirth has on a woman’s pelvic fl oor in terms of incontinence. A joint statement was published and can be accessed at bit.ly/RCMCSPstatement

    In addition, an information leafl et Personal training for your pelvic fl oor and an RCM i-learn module were introduced to help midwives learn the pelvic fl oor muscle exercises and teach them eff ectively in the antenatal period. The RCM hopes to address the issue of incontinence by preventive public health information and education, and not lead women down the route of expecting incontinence as a side eff ect of childbirth.�

    I’m sure I’m not alone in being appalled at the content of the recent advertisements on television for products on sale for women with ‘sensitive bladders’. The women in the advertisements are young, and the message would appear to be that 1) stress incontinence is to be expected, and 2) that it is to be viewed as a funny experience. While I applaud the fact that these transmissions may help aff ected women to feel that they are not alone in suff ering the condition, I do feel that portraying stress incontinence as a natural consequence of having children, or ageing, is counter-productive when we, as health professionals, are trying to encourage women to do their pelvic fl oor exercises in an attempt to prevent the condition in the fi rst place, or to improve the bladder control of women who are already suff ering. To suggest that giggling

    Research requestSUSAN GLEN, UNIVERSITY LECTURER

    I am researching baby abandonment in the early post First World War years (1918-20) for a script/novel. I would like to ask if any retired midwives recall stories told to them by older midwives about this topic. I’m interested in hearing

    about the social and economic issues that would lead a mother to abandon her baby. I know of a situation where the mother left the baby with a mature communist couple, and she never returned. I’m wondering why she might have

    done this rather than leave the baby with a children’s home or orphanage. Similar accounts or scenarios interest me.

    Email [email protected] with any information to be passed on to Susan.�

    Reference: NICE. (2013) Urinary incontinence in women: management.

    Clinical guideline CG171. See: nice.org.

    uk/guidance/cg171 (accessed 22 March 2016).

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  • Midwives / Summer 2015Competitions

    27rcm.org.uk/midwives

    Midwives / Summer 2016Readership survey

    Win one of two

    £50 M&S vouchers

    MIDWIVES MAGAZINE READERSHIP SURVEY 2016

    WHY NOT TAKE A FEW MOMENTS TO COMPLETE A SHORT SURVEY AND PLAY AN INSTRUMENTAL ROLE IN SHAPING THE FUTURE OF THE PUBLICATION.If you complete your details at the end of the questionnaire, you’ll be entered into a prize draw to win one of two £50 M&S vouchers too. To access the online survey, visit bit.ly/Midwivessurvey2016

    Th e deadline is 24 June.

    Th anks very much in advance. Th e Midwives team

    It’s been a year since we relaunched Midwives with a fresh look and new content. We would really like to know what you, the members, think.

    DOES THE CONTENT WORK FOR YOU? IS IT INTERESTING AND USEFUL?

    WHAT WOULD YOU LIKE TO READ ABOUT?

    DO YOU LIKE THE DESIGN?

    IS THERE ANYTHING YOU WOULD CHANGE?

    027_MID_readershipsurvey.indd 27027_MID_readershipsurvey.indd 27 17/05/2016 17:1617/05/2016 17:16

  • 28

    OpinionVOICEof a mother

    Th ey don’t tell you that their heart is breaking too,

    but you can see it in their faces

    Initially, they say: ‘Dopplers are unreliable, don’t worry’... Th ey don’t tell you it’s almost certain your baby has gone...Th ey can’t prepare you; they can’t say it softly. ‘I’m afraid your baby has died.’ Th ey don’t tell you it’s ok to scream when they confi rm your worst nightmare. Th ey hold your hand as you make a sound that could only come from someone broken beyond repair; a scream that carries so much pain and sorrow, it breaks all hearts who hear it.

    Th ey don’t tell you you’ll be thankful they didn’t give you the CS you’re begging for. Th ey don’t say you’ll be so proud of yourself for bringing her into the world the way you always intended, or that it’ll make you excited for future births, not more scared. Th ey constantly tell you how amazing you’re doing.

    Th ey don’t tell you they’re experienced in this, that they have

    baby and they hate what is happening. Th ey’re the only people in the world who know your baby too.

    Th ey encourage you to make memories: ‘It is your choice but don’t regret anything.’ You’ll listen to them because you trust them; you would do anything they say. Th ey tell you everything you need to hear and help with everything you decide to do.

    Th ey don’t talk as they walk you to the chapel of rest; they hold your hand as your partner carries her. Th ey don’t talk as you say your fi nal goodbye; they’re right beside you to hold you up when you shatter. Th ey don’t say anything when you lock eyes with them at the funeral; they just nod knowingly as tears stream down their faces.

    Nobody tells you how incredible and invaluable your midwives are. I thank mine every chance I get.

    Elizabeth Martin is an event manager from Stourbridge. She also writes a blog at elizabethrosemartin.wordpress.com

    to deliver a sleeping baby every week. Th ey don’t tell you how common it is – every one in 216 babies (ONS, 2013).

    Th ey don’t tell you what she’ll look like; that she’ll be discoloured and her skin may be torn. Th ey don’t tell you how hard it will be to look at the baby you have longed for. Th ey don’t say you will love her more intensely despite her absence, because you only have a matter of hours before you have to say goodbye. Th ey tell you how beautiful she is, how cruel this is. You can see the love and regret in their eyes; they’re wishing with everything they are that things were diff erent, just like you are.

    Th ey don’t tell you that their heart is breaking too, but you can see it in their faces. Th ey were expecting a shift full of happiness and excitement. Th ey don’t want to have to deal with this, but they do and they do it tremendously. Th ey don’t tell you they’re grieving too, but you see the tears fall down their faces, you see them collapse as they leave the room, you hear them sobbing outside. It’s comforting. Th ey care about your

    rcm.org.uk/midwives

    Elizabeth Martin refl ects on the loss of her baby, Beatrice, and the invaluable support provided by her midwives.

    THEY DON’T TELL YOU

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  • Enter nowIt’s easy and free to enter. Entry deadline is 19 September 2016

    For full entry criteria and further information, visit rcmawards.com/march17

    For entry enquiries, please contact:

    Emilia TosnerE: [email protected] T: +44 (0)20 7880 6226

    For sponsorship enquiries, please contact:

    Ben NelmesE: [email protected]

    T: +44 (0)20 7880 6244#RCMAwards

    rcmawards.com/march17

    RCM Alliance partners:

    RCM AnnualMidwifery Awards

    2017AWARDS CATEGORIES

    • EuroKing Award for Better Births

    • JOHNSON’S® Award for Excellence in Maternity Care

    • Pregnacare® Award for Maternity Support Worker of the Year

    • Midwifery Service of the Year Award

    • Slimming World Award for Partnership Working

    • Policy into Practice Award NEW FOR 2017

    • JOHNSON’S® Student Midwife Award

    • Lansinoh Award for Team of the Year

    • Members’ Champion Award

    • RCM Caring for You Award NEW FOR 2017

    • Reducing Inequalities Award NEW FOR 2017

    CELEBRATING

    EXCELLENCE IN MIDWIFERY

    1. RCM Awards_new versionV2.indd 1 17/05/2016 14:30MID.Iss2.16.029.indd 2MID.Iss2.16.029.indd 2 17/05/2016 14:5217/05/2016 14:52

  • 30 rcm.org.uk/midwives

    Midwives / Summer 2016Opinion

    STUDENT VOICES

    Even when you lose sight of it, there’s a reason why you wanted to become a midwife. When the facts don’t echo what the heart feels, hang on. If you shut your eyes for a second, what kind of midwife do you aspire to be? What do you see in your mind’s eye? What is your vision? Answering these questions and reviewing your responses may be what helps you to keep going at the hardest parts of the journey.

    You had vision and purpose to get you onto your course, the bones of it is wrapped up in your UCAS personal statement. But if that vision seems a bit fuzzy just now, know that it will be fl eshed

    out over time if you keep focused on the right things. Easier said than done, right?

    Th e journey can be so all-consuming that even when we’re sitting still, our heads are still motoring through an endless ‘to do’ list. We encounter knock-backs and discouragement and soon our aspirations can turn to cynicism. When I have had uncertainties, I sometimes refl ect on my application process and my determination to secure a place. However, when we roll back too far, we lose momentum and can struggle to get through whatever it is we’re facing.

    One of my favourite Bible characters is Jacob. On his journey, he set up stones following signifi cant events in signifi cant places. If he was ever tempted to give up and go home, he would encounter one of these obstacles, reminding him of how far he had come and, more importantly, why. We can take a leaf from his book and lay down markers on our journey, so we never have to reverse too far to get back on track and reclaim our vision.

    Some of my markers include academic work that I have been particularly happy with, or a thank you card from a mother and father along with a photograph of the fl owers that came with it. A silly post on social media about making it to second year received so many positive reactions from friends and family, I felt like I had my own personal cheerleading squad. Maybe you can identify with some of these examples? Maybe you keep a journal, or your best friend can remind you of all the times you were brimming with enthusiasm and felt invincible?

    Whatever form they take, like Jacob’s stones, our own markers need to be immutable and immovable. So when you hit the point(s) of your degree where the question is ‘why am I putting myself through

    this?’, take time to revisit the markers you have laid down. Th e stones are there to remind us of what we’re doing and why we’re doing it, they resound with the story of our journey and show the direction to take. Th ey can reignite our vision, align our heart with our head and provide encouragement to carry on.

    Karen Hagan, third-year student, Queen’s University Belfast and former RCM SMF member

    WHEN IT GETS TOUGH

    Record events, encounters and conversations signifi cant to you, which have encouraged and re-energised – your ‘stone markers’.

    When you lose sight of where you’re going, don’t give in to cynicism, revisit these markers and be reminded of your story and your direction.

    Keep going! There are more wonderful events, encounters and conversations yet to come.

    Hang on to your visionStudent Karen Hagan on keeping going when you think you’ve lost your way.

    IMAG

    E: E

    AMO

    NN

    BRO

    WN

    030-031_MID_OPINION_Student_Voice.indd 30030-031_MID_OPINION_Student_Voice.indd 30 17/05/2016 17:1617/05/2016 17:16

  • 31rcm.org.uk/midwives

    One of the best things about being a student midwife is meeting the women and their families. I enjoy making a connection and developing relationships with them, whether in the community or on the delivery suite. I hope that I always speak to them in a way that makes them feel respected and cared for, as set out in the code (NMC, 2015).

    So when I was pulled up for referring to a woman as ‘my lady’, I was taken aback. Why would anyone take off ence at that term? It transpired that both words – ‘my’ and ‘lady’ – were an issue. I was told that ‘the woman’ would have been more appropriate.

    Lady? Th e word ‘lady’ has a somewhat chequered history in the English language. Initially, the title signifi ed those of high birth. To be called a ‘lady’ was seen as a compliment and to be referred to as a ‘woman’ was deemed insulting. Indeed, a letter to Th e New York Times in 1887 describes it as such an insult that a gentleman was forced to strike a cab driver for calling his wife a ‘woman’.

    Yes, my ladyWhen student Kate Munson was told off for describing a woman she was caring for as ‘my lady’, it made her think about what constitutes off ensive language.

    MIND YOUR LANGUAGE

    It goes without saying to always be courteous when addressing someone for the fi rst time.

    Be sensitive to others’ preferences – just because you like being called ‘darling’ doesn’t mean everyone will.

    When in doubt – ask! Don’t assume that the name on the notes is what someone likes to be called.

    However, during the 20th century, ‘lady’ evolved into a more derogatory title, often used to demean and belittle women’s position in society. It was also became a moniker for sex workers, those ‘ladies of the night’.

    Given its history, perhaps it isn’t surprising that some do fi nd the word ‘lady’ off ensive but, as a feminist, I would argue that those negative connotations, which persisted until after the sexual revolution of the 1960s and 1970s, have been largely eroded. Today, I believe the word provides a warmer alternative to the cold and functional ‘woman’. Incidentally, I also fi nd the word ‘man’ to be very clinical and would rather use ‘gentleman’ instead.

    All mineAnd my use of the word ‘my’? I was not referring to the lady as my or mine in a possessive sense. I did not mean to imply that I owned her in the way I own ‘my’ shoes or ‘my’ car. I was using the word to imply a connection and a relationship, albeit a professional one. It was used in the same way I would use it to refer to ‘my’ colleagues.

    I spoke to several ladies/women in practice regarding this matter. On the whole, they had no issues with the term ‘my lady’, as long as the person saying it was being respectful. One even commented: ‘I like “my lady” – it shows you care.’

    It is ironic that midwives love being called ‘my midwife’, rather than ‘the midwife’ by those they care for. Quite rightly, they take pride in the good working relationship they have developed. Seen in this context, ‘my’ implies partnership rather than ownership – and isn’t that what midwifery is about?

    Shakespeare sums it up best: ‘A rose by any other name would smell as sweet.’ Ultimately, it is not the words we use, but the way we use them that matter most.

    Kate Munson, second-year student, Canterbury Christ Church University

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  • RCM BonSolon HPH.indd 1 04/05/2016 12:32

    The Zepherina Veitch Memorial LectureEncountering stressful events in practice: supporting the midwifery workforce

    This event presents the best and most topical in midwifery evidence and thought leadership from a distinguished midwife academic. Professor Helen Spiby (Professor of Midwifery, The University of Leeds) will discuss the evidence of the impact on midwives of exposure to traumatic perinatal experiences and the prevalence of posttraumatic stress symptoms. The talk will be followed by the presentation

    of The RCM Honorary Fellowship and the inaugural presentation of the new RCM Fellowship.

    Free for members. Book now www.rcm.org.uk/rcmlecture

    The RCM Annual Lecture 20162pm · 25 July 2016 · The Royal Armouries · Leeds

    MID.Iss2.16.032.indd 2MID.Iss2.16.032.indd 2 16/05/2016 12:1416/05/2016 12:14

  • 33rcm.org.uk/midwives

    Practice

    What’s happening in the world of midwifery research? Two authors summarise their work.

    Midwives / Summer 2016

    and our research attempted to address this. Th is study was commissioned by the RCM as the fi rst of a three-part programme of work to develop a new model of PH for midwifery. We conducted a qualitative study using Facebook to obtain the views, knowledge and experience of midwives, student midwives and MSWs.

    Th ere was agreement among participants regarding the complexity and enormous breadth of the midwife’s role in PH, where initiatives were predominantly focused on either the antenatal and postnatal periods. Th ey acknowledged that midwives were ideally placed to provide PH advice and support, and that MSWs were involved in assisting midwives to deliver this. It was also recognised that other professionals (such as GPs and health visitors) could also be utilised in delivering PH messages, most notably, the advice relating to pre-conception care, and

    Midwives are considered to be ideally placed to provide public health (PH) messages to women and their families. Th is is because pregnancy is often seen as the optimum time for two reasons.

    Firstly, for many, this period in their life will be the fi rst time that they are actively engaged in health care for a prolonged period. Secondly, pregnancy is thought to be a time when women are particularly receptive to receive and act upon PH messages motivated by their wish to provide the best start for their off spring. Both these factors have meant that there is a drive to capitalise upon this opportunity and to expand on the PH remit within maternity services.

    In recent years, the PH role of the midwife, which was traditionally centred upon maternal health in pregnancy, infant feeding and early parenting, has expanded rapidly to include many other areas. Th e addition of MSWs to the service provision has meant that they too have seen this aspect of their role develop and are expected to be engaged in many diverse PH initiatives.

    Given the rapid expansion of this remit, little is known regarding the current knowledge and PH involvement of midwives and MSWs within the NHS

    PAPER ONE

    Exploring midwives’ experience of public health in maternity care

    Sanders J, Hunter B, Warren L. (2016) A wall of information? Exploring the public health component of maternity care in England. Midwifery 34: 253-60.

    MOREREADING

    READ ONHOW TO...

    RESEARCH

    033-034_MID_PRACTICE_Research.indd 33033-034_MID_PRACTICE_Research.indd 33 17/05/2016 17:1717/05/2016 17:17

  • 34 rcm.org.uk/midwives

    Midwives / Summer 2016Practice

    Universal maternity care is central to the NHS ethos of providing care ‘from the cradle to the grave’. However, with around 800,000 UK births each year, the cost is over £2.5bn annually (National Audit Offi ce, 2013). In a climate of continuing fi nancial constraints, UK service providers are challenged to increase effi ciency without loss of quality of care.

    Decisions about service reconfi guration must be made to enable cost savings. However, such decisions are complex. Even relatively simple changes may have unforeseen consequences and anticipated cost savings may not be

    general lifestyle behaviours. A number of barriers to fulfi lling the PH role adequately were described and, unsurprisingly, lack of time was identifi ed as the most signifi cant. Other barriers cited were lack of adequate training, lack of continuity of care, an indiscriminate ‘one-size-fi ts-all’ approach to messages, and women’s lack of PH education.

    It was clear that midwives and MSWs viewed engagement with PH as a core aspect to their role, and that increasingly they were being expected to deliver a complex and growing PH agenda. However, despite their commitment, they felt that their eff orts to deliver this were often thwarted by the constraints of time, training and resources. Our paper concluded that these barriers will need to be addressed if midwives and MSWs are able to eff ectively deliver the growing PH remit.

    Lucie Warren, midwifery lecturer and research fellow, Cardiff University

    Reducing the length of postnatal hospital stay

    Bowers J, Cheyne H. (2016) Reducing the length of postnatal hospital stay: implications for cost and quality of care. BMC Health Services Research 16: 16.

    MOREREADING

    �Has your research been published recently? Would you like your summary to appear on these