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rcm.org.uk/midwives 2012 • ISSUE 6 • MIDWIVES 3

Midwives5 ► CATHY WARWICKThe chief executive on the RCM’s commitment to delivering effi cient services to its members.

7 ► NEWSEgg benefi ts, fl exible doctors and funding... Midwifery stories hot off the press.

12 ► GLOBAL NEWSThe latest news from around the world.

15 ► IN FOCUSA look at how the NMC came to its annual fee hike decision.

16 ► RCM NEWSMarching against austerity, new telephone number, membership fees... The latest news.

18 ► COUNTRY NEWSRCM UK latest news for Northern Ireland and England.

19 ► ON POLITICSFinally there’s good news for midwife numbers in England, reports Stuart Bonar.

20 ► WORK LIFEAmy Leversidge considers some surprising disciplinary research results.

23 ► ONE-TO-ONERob Dabrowski talks to Professor Ed Mitchell.

26 ► ON COURSERebecca Warboys discusses developing breastfeeding education.

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Volume 15 ˙ Issue 6 ˙ 2012

EDITORIAL

HEADLINES

OPINIONS

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MIDWIVES • ISSUE 6 • 2012 rcm.org.uk/midwives4

MidwivesThe offi cial magazine of The Royal College of Midwives15 Mansfi eld Street, London W1G 9NHTel: 020 7312 3535

EDITORIAL

Editor and RCM Communities manager: Emma [email protected]: 020 7324 2751Deputy editor: Rob [email protected]: 020 7324 2752Assistant editor: Rebecca [email protected]: 020 7880 7667Sub editor: Helen [email protected]: 020 7324 2773News and features writer: Hollie [email protected]: 020 7880 6210Professional editor: Professor Mary SteenPhD MCGI PGDipHE PGCRM BHSc CIMI RM RGN

General enquiries: [email protected]

EDITORIAL BOARD

Louise Silverton, Sue Macdonald, Barbara Thorpe-Tracey, Val Finigan, Kate Brintworth, Suzanne Truttero, Fiona Donaldson-Myles

PUBLISHERS

Redactive Publishing Ltd17-18 Britton Street, London EC1M 5TP Tel: 020 7880 6200Publishing director: Jason Grant

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DESIGN

Art editor: Carrie BremnerArt director: Mark Parry

COVER

Illustration: Eoin Ryan

PRODUCTION

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Printed by Wyndeham Peterborough Limited. 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.

Midwives ISSN: 1479-2915

27 ► FEEDBACKSonographer registration, commending a male midwife and a language scheme.

28 ► RCM COMMUNITIESMidwives downbanded and undermined.

29 ► TWEETDECKA look at what you’ve been tweeting.

33 ► CUTTING EDGEJan Wallis reviews the latest midwifery-related research.

34 ► HOW TO…Test for glucose intolerance.

36 ► EBMA summary of the latest EBM papers.

37 ► THE NHSWhat will the NHS look like under Hunt?

41 ► RCM AWARDSSafeguarding practice in Plymouth.

42 ► VITAMIN DPromoting supplementation uptake.

44 ► PERFORMANCECould a new approach enhance services?

46 ► LMEsSusan Way explains the developing role.

48 ► AUDITTop tips to best prepare for an LSA audit.

49 ► BENEVOLENT FUNDHelping those who need it most.

50 ► RCM BRANCHESAlice Sorby’s branch success stories.

51 ► MSWsPart two of the MSW scenario.

54 ► RESOURCES

56 ► EVENTS

57 ► COMPETITIONS

58 ► CROSSWORD

ON FOCUS

FEATURES

FOOTNOTES

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Editorialrcm.org.uk/midwives 2012 • ISSUE 6 • MIDWIVES 5

RCM chief executive Cathy Warwick

Serving our members

L ooking through next year’s member diary, which most members will fi nd enclosed with this magazine, you will see how busy the year ahead will be for the RCM team,

delivering diff erent services and opportunities while campaigning on our key fronts. It is always a challenge to keep costs down while increasing our activity, but we have succeeded and I am pleased to announce that we are not increasing subscriptions for the vast majority of our members next year, understanding, as we do, just how tough times are.

Over this past year, we have been reshaping how the RCM works as an organisation and how it is structured. We have been putting the right teams in place to work together, with a focus on our three areas of purpose: supporting our members, promoting midwifery and infl uencing. We have formed three new directorates to be responsible for each of these areas.

One of our new directorates – services to members – will provide leadership and delivery for the full range of professional and trade union support that midwives, students and MSWs expect from us. I see this directorate as a step towards transforming how relevant, helpful and in touch you will fi nd

us, and enabling the RCM to meet the changing expectations of our members. Already, we have set up RCM Connect – a new, single number to make it easier for you to contact us by telephone. We

believe this will deliver a more consistent, modern and responsive level of service. I hope you will notice

the diff erence and fi nd it more convenient to manage your membership and reach help when you need it. Meanwhile, our directorate for midwifery and directorate

for policy, employment relations and communications will be focusing on lobbying and campaigning. There are many challenges for midwives at the moment. Whether you are implementing new maternity strategies in Wales and Northern Ireland, wondering what independence could mean for midwives in Scotland, or adjusting to the Health Act changes in England, I hope you will be able to turn to the RCM for advice and support. I can assure you we are more focused than ever on our campaigning on the critical issues – defending Agenda for Change, insisting on the highest quality maternity services for all and standing up for our members. Our new structure puts us in the best position to do this now and for the future. I look forward to working for you and with you in 2013.�

rcm.org.uk/midwives 43MIDWIVES 42 VITAMIN DMIDWIVES42 VITAMIN D

Vitamin D is an essential nutrient during pregnancy and beyond, but it seems women are not always receiving the information they need, Erin Dean reports.

among children caused by a shortage of vitamin D. He stresses that healthcare staff need to remember that rickets and vitamin D deficiency are not limited to people from low-income backgrounds. Concerns about skin cancer have led to some children being covered in high factor sunscreen and rarely being exposed to enough sunlight to generate vitamin D.

Colin points out that another consequence of increasing vitamin D deficiency is a number of cases where parents may have been wrongly accused of harming their children because vitamin D deficiency has left them with weak bones. This has led to small children being admitted to hospital with suspicious bone breaks.

‘Vitamin D is very cheap to make and those not receiving it will increase costs for the NHS in the future with complications,’ he says. ‘We are not going to know the outcomes of the deficiency for the children of women who are pregnant now for perhaps 50 years. Midwives have a crucial role in talking to pregnant women about supplementation.’�

► For the Healthy Start website, please visit: healthystart.nhs.uk

For references, please visit the RCM website.

bottle-fed babies need not be given vitamin D supplements could impact on the woman’s infant-feeding decision, as she may wrongly believe that formula milk is superior to breastmilk because of the added vitamin D.

‘This is why it is important for midwives to update their knowledge around vitamin D supplementation and breastfeeding and be able to provide parents with simple advice that improves their health, but also support their informed choices and decisions.’

Research has suggested that midwives are not giving sufficient advice to pregnant women on vitamin D. A study published in Archives of Disease in Childhood last year found that only a quarter of 34 midwives in South London who completed a questionnaire said they gave routine vitamin D advice to their clients during pregnancy (Jain et al, 2011). A survey of 73 community midwives and health visitors published in Community Practitioner found that only half were aware of the Department of Health’s recommendations around vitamin D (Lockyer at al, 2011).

Jill Demilew, consultant midwife for public health at King’s College NHS Foundation Trust, says that all midwives should advise pregnant women to take vitamin D supplements in the information they send out before meeting them, and discuss it again when they meet them for the first time. ‘Midwives are shocked that rickets is increasing and it is shocking that a disease of malnutrition is here today,’ she says. ‘Talking about vitamin D should be a routine part of antenatal care. As all women

should be taking supplements, the message is very simple. Education of all healthcare professionals who come into contact with pregnant women and children about the importance of vitamin D and the government’s recommendations is also important.’

Women on low incomes can qualify for the government’s ‘Healthy Start’ programme, which offers free vitamin supplements, including vitamin D. However, the chief medical officers said in their letter that uptake of vitamin D through this is very low. Jill says that midwives need to make sure it is straightforward for women to access these free vitamins locally. When she looked into the availability of the supplements in her area, she found that there was confusion over collection points for the Healthy Start programme. All midwives in the area now have lists of collection points to make it easier for pregnant women to get the vitamins. Midwives should also be giving all women information about the programme to ensure that those who are eligible, which includes all pregnant women under the age of 18, can benefit, according to Ms Demilew.

Colin Michie, a consultant paediatrician at Ealing Hospital in London, has seen increasing cases of bone problems, delays in reaching milestones, such as walking, and seizures SH

UTTE

RSTO

CK

Rickets was believed to have been consigned to the Victorian era, when the bone disease was a sign of poverty and malnutrition in children. However, a resurgence of this

and other conditions caused by a deficiency in vitamin D in recent years has led to a renewed emphasis on the role of midwives in tackling the problem.

Earlier this year, the chief medical officers from the four UK departments of health wrote to some healthcare professionals, although not midwives, to remind them of the recommendations for vitamin D supplementation (Davies et al, 2012). The letter said that evidence suggested that up to a quarter of the UK population could be at risk of vitamin D deficiency.

It told NHS staff that all pregnant and breastfeeding women and children aged between six months and five years should take a daily supplement of the vitamin.

The exception to this is infants who are fed formula milk, who will not need vitamin drops until they are receiving less than 500ml a day, as these products are fortified with vitamin D. This echoes recommendations from NICE, which stress the importance of midwives

THE UK DEPARTMENTS OF HEALTH RECOMMEND (DAVIES ET AL, 2012):

All pregnant and breastfeeding women should take a daily supplement containing 10μg of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.

All infants and young children aged six months to five years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 7-8.5μg of vitamin D per day. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breastfed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.

discussing vitamin D supplementation with pregnant women at the booking appointment (NICE, 2008).

Low levels of vitamin D have long been known to contribute to bone problems, such as rickets. The vitamin is essential for the growth and development of a baby’s bones, by regulating the absorption of calcium and phosphate (NICE, 2012). According to NICE (2008), women should be told that the supplements will increase the vitamin D stores of both mother and baby and reduce the risk of the baby developing rickets. This guidance tells healthcare professionals to take particular care advising those at greatest risk of vitamin D deficiency. These include women from South Asian, African, Caribbean or Middle Eastern descent, as darker skin does not produce as much Vitamin D and who for cultural reasons, may wear clothing that covers them completely. Those who have little exposure to the sun are also at extra risk, as are obese women, as the vitamin is fat soluble and can be stored in fat cells.

A growing body of evidence in recent years has also suggested a link between shortages of the vitamin and a higher risk of other conditions, including heart disease, multiple sclerosis, type 1 diabetes, bowel cancer and breast cancer (Holick, 2004). The vitamin is mainly produced by ultraviolet B (UVB) sunlight rays falling on the skin, but some is also absorbed from food such as oily fish, cod liver oil and egg yolks.

RCM professional policy advisor Janet Fyle says it is important that all midwives are up to date on the latest recommendations regarding vitamin D. ‘Advising on vitamin D is an important part of the public health role of midwives,’ she says. ‘Midwives come into contact with women from early on in their pregnancy and are involved with them throughout their antenatal care and birth. This makes them one of the key people to talk to women about vitamin supplementation and dietary issues in pregnancy.’

She continues: ‘The recommendation that

Tackling the deficiency

COD LIVER OIL

OILY FISH

EGGYOLKS

SUNLIGHTRAYS

rcm.org.uk/midwives 45MIDWIVES 44 PERFORMANCE

In a demonstration of effectiveness, public services – including maternity – are facing increasing pressure to show how well they perform (Seldon and Sowa, 2011). As a result, performance management is an essential part of measuring and monitoring effectiveness

and is undertaken annually within maternity services for all employees through an individual performance review (IPR).

Primarily, the aim of the review and personal plan is to ensure that the individual develops and maintains the knowledge and skills for effective working, by identifying learning needs so the manager can facilitate training and education. Performance management can also be seen as a platform for recognising excellence within the service, though in reality, the term has negative connotations as it is a precursor to the more usual management of poor performance and underachievement.

Already used successfully in the private sector, research suggests that a good performance management system includes indicators of organisational performance (Elzinga et al, 2009), effectively aligning them with organisational strategy and business plan goals (Lawson et al, 2003). Due to the multi-faceted nature of public sector work, however, and especially in maternity practice, there is a challenge to develop effective indicators of measurement (Peng et al, 2007). Based on activity where measurement is difficult, there are still suggestions that expected improvements in performance, accountability, transparency, quality of service and value for money have not yet materialised in many areas of the public sector (Fryer et al, 2009).

In a bid to provide consistency, the Knowledge and Skills Framework (KSF) implemented within the NHS in 2004 is applied in our maternity department. It advertises a single, comprehensive and explicit guide to good people management and promotes equality and diversity for all staff (DH, 2004). With core performance indicators aligned with organisational goals, dimensions are added to further individualise the plan, making it more meaningful.

For a band 6 midwife, this alludes to the completion of nine dimensions, designed to demonstrate the provision of a high-quality midwifery service. While generic dimensions

A new approach to performance management could be what’s needed to gain enthusiasm from staff and change maternity services for the better, says Amanda Lucas.

Hitting performance

targets

allow for individual interpretation, without specific guidance the review can often lack the consistency that it sets out to promote. Since each area within the service requires different approaches towards completion, staff and managers often see the review as only a ‘tick-box’ exercise, considering too many targets as detrimental to performance and quality (Moxham and Boaden, 2007).

Van Sluis et al (2008) believe that an individual, personalised scorecard would encourage employee ownership, with between seven and nine key measures to provide motivation to deliver the target performance. This personal measurement would ensure a unique development plan for each employee in contrast to the ‘one-size-fits-all’ approach, which is unlikely to be effective (Gunawardena, 2011) but is more commonly used within organisations. Advocating that performance management systems are not static but mature as the management style and organisational culture evolves (Bititci et al, 2006), this system would make sense in the ever-changing world of health care, perhaps even challenging the current KSF competencies and questioning the need for a comprehensive overhaul.

The general declining compliance in the completion of annual reviews indicates that any initial enthusiasm of the performance management initiative has waned and been replaced with scepticism and cynicism, which could undermine attempts to enhance organisational performance (Townley et al, 2003).

In the private sector, it could be argued that reward and recognition is used to increase motivation in the form of financial incentives and bonuses. Although deemed unethical within the public sector, it is still a tactic employed by commissioning bodies as a remit to improve patient care through Payment by Results and, adversely, penalties where targets are not met. Caution is advised (Deci et al, 2001), however, about the use of rewards for motivation, and Thomas (2001) strongly suggests more intrinsic rewards, such as sense of meaning, sense of choice, sense of progress and sense of competence, lead to more engaged and committed employees.

I suggest that this sits more comfortably with the ethos of public sector organisations including maternity – for both ethical and financial reasons – although even the

provision of intrinsic rewards requires a change of culture and the requirement of the hierarchical managers to ‘buy in’ and support the process. Effectiveness of any performance management also depends on employee involvement (Verbeeten, 2008), with benefits including increased motivation, job satisfaction and commitment.

For maternity services, the rewards could include improved communication, a clearly articulated culture, improvement of work performance and possibly better employee retention, but support from senior management would be required to ensure resources were available for effective measurement (de Waal, 2007).

In reality, the instrumental value of performance measurement cannot be guaranteed (Halachmi, 2011) and is often dysfunctional, with a loss of credibility among users within the service. The question is whether change can occur within performance management.

A personalised

developmental plan can

encourage the imagination to meet targets

I strongly believe it needs to, and that there is no better time than now, as managers are given the green light to take on more HR activities. Instead of employing performance management systems that are imposed on them from the hierarchy within their organisation (Zigan et al, 2008), the potential is there to learn from past behaviour in order to do better in the future.

Performance management has an important part to play in any maternity service. Used effectively, it can increase understanding of the organisational and departmental vision, as well as raise awareness of the constraints and operational challenges faced by the trust. To accomplish this, however, changes are required to the current practice so that it can improve the productivity and efficiency of the service.

The definition by the Chartered Institute of Personnel and Development (CIPD, 2009) encapsulates the true meaning of performance management, in that it is ‘a process that contributes to the effective management of individuals in order to achieve high levels of organisational performance’.

I believe a personalised developmental plan can empower employees to think ‘outside the box’ and encourage the imagination to meet any goals and targets set. Adopting different methods of measurement could make staff motivated and enthusiastic, instead of viewing the HR process as a paper exercise. Reviews and appraisals will be a continuous process of learning and development that will benefit both the individual and the organisation, rather than an annual interview.

For our maternity services, further research is required, as is the acknowledgement that commitment is needed to gain an understanding of the current practice of performance management. Though interactive communication is essential, an understanding of the purpose and impact of performance management (Radnor and McGuire, 2004) will result in changes that can only enhance the maternity services within our organisations.�

Amanda Lucas Deputy head of midwifery, matron and supervisor of midwives, Macclesfield Hospital


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rcm.org.uk/midwives 39MIDWIVES 38 HUNT

Facing the future

What will the NHS look like under Hunt?

Andrew Lansley was not a popular health secretary.

When David Cameron ousted him from the position, responses ranged from branding him the man who ‘pushed the NHS to brink of destruction’ to ‘one of the worst health secretaries since the NHS was formed’.

After two years dogged by controversy – most notably for his plans for a complete NHS overhaul – the move to replace him was welcomed by many.

While it wasn’t unanimous and the 55-year-old did receive praise – mostly from Conservative colleagues – their voices were drowned out under waves of criticism.

Mr Lansley became best known as ‘the architect of the reforms’. Under his guidance, proposals were pushed through parliament for ‘fundamental changes’ to the NHS and there

The man who controversially steered the NHS reforms through parliament has been ditched by the prime minister. Will the NHS and the

contentious reforms change with Jeremy Hunt at the helm? Rob Dabrowski investigates.

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was vehement criticism that plans were being rushed through and put cost before quality.

Most controversial was – and still is – the move towards ‘privitisation’ of the NHS and the welcoming competition from the private sector.

But now the ‘architect’ has been removed from post and former culture secretary, Jeremy Hunt, has been drafted into the position.

What does this mean for the reforms? Are we expecting a coalition U-turn?

In short, no. The reforms have already gone through parliament and are well on their way to being implemented.

And in his speech at the Tory conference in October, Mr Hunt even went so far as to call Mr Lansley ‘brave’ for ploughing ahead with them.

Shadow health secretary Andy Burnham tells Midwives that he believes Mr Hunt has just been brought in to re-brand the reforms.

‘It is a strange situation,’ he says. ‘I thought Jeremy Hunt would have used the opportunity to make a break with what’s happened, but clearly he has not and I actually think he’s got a more pro-market agenda than Lansley.

‘He’s been brought in because he has a better bedside manner than Lansley.

‘The planning is clear – it’s about the presentation, it’s not about changing the decision, but putting a better face on this and trying to manage the PR of the reforms.

‘I don’t believe that he is a supporter of what the NHS stands for. I think it’s inevitable that we are going to go further towards privatisation – he’s very much a marketer.’

When Midwives requested an interview with Mr Hunt, he was not available for comment.

But health minister Dr Dan Poulter says that the government will push hard to follow

through with Lansley reforms.‘These reforms will make the NHS more

efficient and better for patients,’ he says, ‘not least because they will dramatically reduce bureaucracy and waste – saving £5.5bn before 2015 and saving £1.5bn every year after that. This means more money reinvested into what matters – looking after patients.

‘One of the other crucial things they do is put clinical staff in charge. They open up new leadership opportunities for midwives.

‘I know from my own experience working in maternity that the more midwives are involved, the greater choice we can offer women and the more personalised the care.’

While Dr Poulter may have NHS experience, one of the main concerns voiced about Mr Hunt as health secretary is that he doesn’t have the medical background Mr Lansley had.

‘On a personal level, I’ve always got on well with him,’ says Mr Burnham. ‘But I think the NHS is something that you’ve got to have an instinctive feel for and I think his lack of track record in health is a problem, given that he’s come in to one of the most dangerous situations that the NHS has ever faced.’

But, while he doesn’t have a healthcare background, Mr Hunt does have a reputation of delivering. In his last position he was responsible for the Olympics and oversaw the smooth running of the event this summer.

There were problems – mainly security firm G4S not having enough staff and armed forces being drafted in at the last minute.

But praise after the event was almost universal, with International Olympic Committee boss Jacques Rogge even calling it ‘the most extraordinary event in out lifetimes’.

HUNT VS LANSLEY

Jeremy Hunt Was head boy at

the historic boarding school Charterhouse in Godalming, Surrey

Achieved a first in philosophy, politics and economics at the University of Oxford

Worked as a management consultant, then taught English in Japan

Won the seat of MP for South West Surrey in 2005 election

Married Lucia Liu in China in July 2009. They have a son and a daughter

A self-confessed fan of the zouk lamabada – a ‘sensual fusion’ of salsa and the Lambada

Appointed secretary of state for culture, Olympics, media and sport, following the 2010 general election

Appointed health secretary on 4 September 2012.

Andrew Lansley Was educated at

Brentwood School, which ‘educates boys and girls in the British public school tradition’

Gained a BA in politics at the University of Exeter

Had a ‘promising career in the civil service’ before entering politics

Elected as MP for South Cambridgeshire in 1997

In 1997 Lansley left his first wife, by whom he had three children. He has two children with his second wife

Enjoys cricket, the theatre and is an active member of the Church of England

Appointed health secretary, following the 2010 election, after serving as shadow health secretary

Moved to leader of the house in Cameron’s re-shuffle.

Top picks Examining the future of the NHS under Jeremy Hunt, addressing Vitamin D defi ciency and reviewing performance management

Facing the future (p37) Tackling the defi ciency (p42) Hitting performance targets (p44)

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rcm.org.uk/midwives/news 2012 • ISSUE 6 • MIDWIVES 7

HeadlinesThe latest professional news

Hot off the press / News

Eating eggs during pregnancy may reduce the unborn child’s risk of high blood pressure and mental health problems in adulthood.

Researchers from New York found that a nutrient called choline in eggs could lower the risk of children developing stress-related illnesses and chronic conditions later in life.

In the study of 26 pregnant women in their third trimester, some were given 480mg of choline per day – just above the recommended dose – while others were given 930mg per day.

The choline boost appeared to favourably change how well the baby was able to regulate hormones linked to stress.

Babies whose mothers received the biggest dose of choline had much lower levels of the stress hormone cortisol in their blood at birth.

Professor Eva Pressman, who led the study, said: ‘While our results won’t change practice at this point, the idea that maternal choline intake could essentially change fetal genetic expression into adulthood is quite novel.’

REDUCING THE RISKCAN EATING EGGS HELP UNBORN CHILDREN?

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MIDWIVES • ISSUE 6 • 20128

HeadlinesNews / Hot off the press

The NMC chair has appointed Jackie Smith, currently acting in the role, as the substantive chief executive for one year.

The appointment follows the chair’s decision to stop the current competition for the chief executive post. The competition started in May and had been delayed while a new chair was appointed.

RCM chief executive Cathy Warwick said: ‘The RCM welcomes the continuation of Jackie Smith as chief executive of the NMC in a substantive post for another year.

‘These are diffi cult times for the organisation and we can see the logic of this appointment until the future direction of the NMC is clearer.

‘This is not to deny that there are challenges for midwifery at the NMC, but the RCM is in constructive discussions with the leadership team about these and believes that continuity of the leadership at this time will be helpful.’

She added that the RCM will ‘continue to give Jackie Smith its full support’.

NMC chair Mark Addison said: ‘The NMC plays a vital role in public protection. It is going through a challenging time as it starts to raise its performance, in response to recent critical reviews by the CHRE. It is important that we have a competitive fi eld of candidates for the post from which to choose. In the run-up to interview it was clear this condition was no longer met.’

NMC CHIEF EXEC

JACKIE SMITH TO TAKE REINS FOR 12 MONTHS

BLOOD DISORDERS INFO

NEW LEAFLETS ARE AVAILABLE FOR MIDWIVES

Doctors will need to work in a more fl exible way in the future in order to deliver high-quality, woman-centred care, an RCOG working party has reported.

The document, titled Tomorrow’s specialist, makes recommendations on ways to ensure that women in the UK receive the best care.

Allowing access to qualifi ed obstetricians and gynaecologists at all timesand getting specialists towork in teams are amongthe recommendations.

Baroness Julia Cumberlege, who chaired the working party, said: ‘The way services are organised is no longer aff ordable or appropriate and, as services change, so must those who work in them.

WOMAN-CENTRED CAREDOCTORS MUST BE MORE FLEXIBLE, SAYS RCOG

The Sickle Cell and Thalassaemia (SCT) screening programme has produced a suite of eight adult carrier leafl ets.

They are designed as information support for midwives who are communicating haemoglobinopathy carrier results. The leafl ets come in a resource pack that each midwife will be able to keep for reference.

They are also available

separately to give to people who have been screened during the antenatal period, or tested atany other time.

The leafl ets explain each of the eight carrier states that must be identifi ed by the screening programme in England, except alpha thalassaemia and hereditary persistence of fetal haemoglobin (for which leafl ets will be published at a later date).

‘Women need access to doctors round-the-clock. They should receive the same care if they need medical help at night or in the daytime.

‘The focus of this report is to improve the quality of women’s health care through highly skilled, adaptable doctors.’

RCM chief executive Cathy Warwick echoed the RCOG’s recommendation for better teamwork among specialists.

‘Maternity care must be centred around women and endeavour to meet their needs,’ she said. ‘Midwives are the constant presence in the entire journey through pregnancy. They have a responsibility to use their skills wisely and in a way that enhances care at every opportunity.’

He continued: ‘I am delighted, however, that Jackie Smith, who has been the acting chief executive since January 2012, and who has helped put the organisation fi rmly on the path to improvement, has agreed to accept a one-year appointment as our substantive chief executive. That will help the council move forward and provide us with a stable top team through a critical period.’

A new appointment process will start next year.

According to the SCT screening programme, a total of 723,768 pregnant women were screened for SCT in 2010-11.

The leafl ets complement a range of materials produced by the programme for communicating newborn carrier results.

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rcm.org.uk/midwives/news 9

68%The amount of smokers that want to

quit, according to the DH

72UK midwives taking part in the global

midwifery twinning project

6500 The number of neonatal deaths that occur in the UK every year // /FAST»

FACTS

PARENTS’

DRINKING

IMPACT IS HIGHLIGHTED BY NEW REPORT

NICE GUIDANCE

CALL FOR MORE SUPPORT FOR PREGNANT WOMEN

More than 90,000 babies aged one and under in the UK live with a parent who is a problematic drinker.

The Offi ce of the Children’s Commissioner has made the claim in a report, which says the government should give as much attention to alcohol abuse among parents as it does to drug misuse.

The report is called Silent voices – supporting children and young people aff ected by parental alcohol misuse and highlights the extent of the alcohol problems. It says that 79,000 babies in England are living with a parent who is a problematic drinker.

The report goes on to suggest that the fi gure is an estimated 93,500 for the whole of the UK.

Maggie Atkinson,

children’s commissioner for England, said: ‘The eff ects of parents’ alcohol misuse on children may be hidden for years, while children try both to cope with the impact and manage the consequences for their families.

‘Our research gives a timely reality check but, more importantly, a fresh perspective by drawing attention to what children say about the problems it causes in their own lives now.

‘It does not concern only child protection professionals, though alcohol abuse can put children’s safety at sustained, serious risk. The problem aff ects large numbers of children who never come to the notice of children’s social care.’

Mothers-to-be should be able to see one named midwife throughout their pregnancy, according to new NICE guidance.

The news comes after research found that a third of expectant mothers say they see a diff erent midwife at every check-up.

While RCM research revealed that over a fi fth (22%) of women did not know their midwife ‘very

well’ or knew them ‘not at all well’ during pregnancy.

The new guidance for antenatal care also suggests that obese pregnant women are given special advice for healthy eating and physical activity.

Jane Munro, RCM quality and audit professional advisor, said: ‘Good care throughout pregnancy can have a signifi cant

and positive eff ect on the wellbeing of the woman and the outcomes for her and her baby. This standard will contribute to safer and healthier pregnancies for women and we fully endorse it. We look forward to its

widespread implementation.’The guidance also states that

smokers should be referred to stop-smoking services and special care should be provided for women at risk of diabetes, pre-eclampsia and those who may develop blood clots.

Dr Gillian Leng, director of health and social care at NICE, said: ‘Having a baby is one of the most important times in a woman’s life and healthcare professionals want to make sure this is a good and safe experience.’SH

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‘VERY WELL’

She continued: ‘The RCM encourages the sharing of knowledge and skills withall health professionals inthe maternity team and iskeen to facilitate, build partnerships and work with obstetricians to ensure a collaborative approach to training, research and clinical practice.

‘It also believes that all health professionals in the maternity team should be supported.’

→ Maternity care must be centred

around women and their needs

y y



HeadlinesNews / Hot off the press

An extra £140m in funding has been allocated for NHS midwives and nurses, it has been announced.

The money is hoped to provide access to the latest technology and to help with leadership and community training.

Louise Silverton, RCM director for midwifery, said: ‘We welcome any money if it genuinely reaches frontline midwives and would enhance their skills, services and professional development and improve the quality of maternity care for mothersand babies.’

David Cameron said £100m will be used to ensure ‘brilliant’ midwives and nurses in England

GOVERNMENT FUNDING NEW CASH INJECTION IS ANNOUNCED FOR NHS MIDWIVES AND NURSES

have access to the latest software and other devices.

He said: ‘We’re only able to do this because we’re the only party, the only people, who said “whatever else we have to do, whatever other cuts we haveto make, we are not cuttingthe NHS budget, we’re increasing it”.’

The remaining £40m will be available to help ward sisters and community team leaders develop their leadership skills, with training for 1000 staff .

The news comes after Jeremy Hunt replaced the ousted Andrew Lansley as health secretary in David Cameron’s cabinet reshuffl e.

He said: ‘Most nurses and midwives chose their profession

BLOOD PRESSURE

THE IMPACT WHILE PREGNANT ON CHILDREN

Men born to mothers who have high blood pressure may be ‘less intelligent’, according to the results of new research.

The study looks at blood pressure in pregnancy for the mothers of 398 men born between 1934 and 1944.

Katri Räikönen, study author from the University of Helsinki in Finland, said: ‘High blood pressure and related conditions, such as pre-eclampsia,

complicate about 10% of all pregnancies and can aff ect a baby’s environment in the womb.

‘Our study suggests that even declines in thinking abilities in old age could have originated during the prenatal period, when the majority of the development of brain structure and function occurs.’

Tests measured language skills, mathematic reasoning and visual and spatial relationships

of the men from 20 years old to when they were pensioners.

The study found that men whose mothers had high blood pressure while pregnant scored an average of 4.36 points lower on thinking ability tests at age 69, compared to men whose mothers did not have high blood pressure.

The group also scored lower at the age of 20 and had a greater decline in their scores over the decades than those whose mothers did not have problems with blood pressure.

The fi nding was strongest for maths-related reasoning. SH

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out paperwork. New technology can make that happen.

‘That’s better for nurses and patients too, who will get swifter information and more face-to-face time with NHS staff .’

Hospitals may have to pay back some of the money ifthey perform badly.

£140mIN FUNDING HAS BEEN

ALLOCATED FOR NHS MIDWIVES

AND NURSES

»

because they wanted to spend time caring for patients, not fi lling



It is thought that soup enriched with vitamin E may be a solution to stopping childhood asthma.

Research has indicated that women lacking vitamin E are more likely to give birth to children who develop asthma by the age of fi ve.

Now scientists have modifi ed a range of soups to give them a boost of the vitamin and a pilot study is underway.

The team added natural ingredients containing the vitamin, such as sun-dried tomatoes, sunfl ower oil, beans and lentils, to canned soup.

Now, 25 women 12 weeks into their pregnancies are being given three bowls of vitamin-E-enhanced soup a week,

while another group of 25 women are eating ordinary soup.

The treated soups contain about 3mg of vitamin E, but neither of the groups know which variety of soup they are consuming.

Following birth, in the fi rst week, lung function tests will be performed on the babies to look for early signs of asthma.

Study leader Professor Graham Devereux, from the University of Aberdeen, said that the aim of the research is to reduce asthma through ‘eff ective’ and ‘inexpensive’ public health dietary intervention.

He added that, if successful, it could form the basis of public health dietary

Progress has been made in reducing child mortality, but targets are unlikely to be hit.

The number of children under the age of fi ve dying globally fell from nearly 12 million in 1990 to an estimated 6.9 million in 2011, according to the latest UNICEF report.

It shows major reductions have been made in under-fi ve mortality rates in all regions. Also, a range of countries have lowered their under-fi ve mortality rates by more than two-thirds between 1990 and 2011.

Anthony Lake, UNICEF executive director, said: ‘The global decline in under-fi ve mortality is a signifi cant success that is a testament to the work and dedication of many.

‘But there is also unfi nished business: millions of children under fi ve are still dying each year from largely preventable causes for which there are proven, aff ordable interventions. These lives could be saved with vaccines, adequate nutrition and basic medical and maternal care.’

The report shows 80% of under-fi ve deaths in 2011 were in Africa and South Asia.

ASTHMA RISK

NEW SOUP HOPED TO REDUCE CASES

Pregnant women are being advised about the implications of eating fi sh and game.

A US study has discovered that eating fi sh twice a week could reduce the risk of their child having ADHD by 60%.

However, high levels of mercury found in some fi sh, such as marlin, can also increase the chance of having a child with ADHD. It is estimated that the increase can be as high as 70%.

In response to the fi ndings, the Food Standards Agency (FSA) said: ‘We’re aware of the paper, which needs to be considered alongside the existing literature on this issue.

‘The European Food Safety Authority is currently reviewing the risks from mercury and

methylmercury and is expected to publish its preliminary opinion later this year.’

It added that pregnant women should not eat more than four medium-sized cans of tuna per week and should avoid eating shark, marlin or swordfi sh.

The FSA has also warned pregnant women not to eatgame that has been killed with lead shot.

It claimed that people who regularly eat more than 100g of meat from wild game birds, such as grouse, duck and pheasant, are at greater risk of health problems than others.

However, supermarket game is believed to be safe, as it is likely to have been farmed and killed in a safe way.

FISH AND MEAT

ADVICE ON WHAT PREGNANT WOMEN SHOULD EAT

CHILD MORTALITY

GLOBAL RATES DROP, SHOWS LATEST REPORT

/NEWS»BRIEFS

Pregnancy badges‘Bab on Board’ badges have been launched for mothers-to-be in Birmingham. National Express West Midlands

is behind the badges.Film’s global debutThe fi lm Freedom for birth has made its debut. There were more than 1000

screenings on its launch day. Help for homelessA new training package has been launched by the charity Shelter

Scotland and the RCM to alert midwives to homelessness in all its forms. It also covers the duties that local authorities have.

Drama scoops awardCall the midwife won ‘best new drama’ at the TV Choice Awards. Miranda Hart took ‘best actress’.

↖— reduction in

ADHD risk by eating fi sh twice a week

↖— increase in ADHD

risk from eating fi sh with high mercury levels

— Research looks at the ADHD risks associated with pregnant women who eat fi sh

advice to pregnant women that ‘could reduce the prevalence of childhood asthma by 15% to 20% within fi ve years’.

During the study, the researchers will keep track of the women’s diets with food diaries and blood tests.

If successful, the pilot trial will be followed by a much larger study, which will involve around 1500 pregnancies, said Professor Devereux.

60%

70%


Global news / Headlines around the world

Headlines

Global News stories

making headlines around the world

news

MIDWIVES • ISSUE 6 • 2012 rcm.org.uk/midwives/news12

HUNGARY1 PARDON PLEA REJECTED

A request by Ágnes Geréb for charges in a new procedure against her to be dropped has been rejected. Hungary’s president Janos Ader has refused the midwife’s plea. He said he will decide whether to grant clemency to the home birth midwife once ongoing criminal procedures against her have been concluded. She is serving a sentence under house custody on two counts of ‘professional negligence in connection with supervising home births that ended in death and disability’. The more recent procedure launched against her includes charges of ‘professional negligence, instigation to forgery and quackery’. In February this year, the court of appeal of Budapest found her guilty of professional negligence, causing death on one count and a permanent disability on another. The court gave her a two-year prison sentence and a 10-year ban on assisting births.

US2 BIRTH RATE CONTINUES TO FALLThe number of births in the US has dropped for the fourth year in a row. New fi gures show that the birth rate was down 1% in 2011, following drops of 2% to 3% over the previous three years. Experts in the US believe that the fall is mirroring economic troubles in the country, with the rate still falling as the eff ects of the recession continue

to linger. The four-year drop in births comes after the fi gure had been on the increase since the late 1990s. There were four million births in the country last year, which is the lowest number since 1998. The fi gures show steep declines in the rate among Hispanic communities, which experts say have been hardest hit by the troubled economic times.

IRELAND3 REDUCTION IN BREASTFEEDING RATESIreland is lagging behind the rest of Europe when it comes to breastfeeding rates, according to new statistics. Just over half of mothers currently initiate breastfeeding in the country, compared with 81% in the UK, while in Sweden, Norway and Denmark, initiation rates are as high as 98%. Professor Richard Layte presented the fi gures at the Economic and Social Research Institute conference in Dublin. He went on to claim that

women resident for less than fi ve years in Ireland are 10 times more likely to breastfeed than Irish women. His analysis of data from the Growing Up in Ireland study also shows non-Irish male partners increase the chance that Irish women will breastfeed.

UGANDA4 PHONE TECH TO SAVE LIVESSoftware developers from Uganda are

designing a smartphone app that is hoped to radically change antenatal care. Technology for Tomorrow is behind the move, which is believed will save hundreds, if not thousands, of lives. The app, called WinSenga, can monitor the heartbeat of unborn children, and is being designed for those who live in remote areas and may fi nd it hard to reach clinics. Aaron Tushabe, who is leading the project, said: ‘We don't want this application to address the problems just today, we want to make this solution viable for the future. That’s why we used a smartphone platform.’ WinSenga uses a Pinard, which is modifi ed by inserting an internal microphone and allowing it to connect to a smartphone. The app’s developers say it needs more testing in the fi eld before it can be fully implemented.

AUSTRALIA5 MISCARRIAGE SLEEPING RISKPregnant women who sleep on their backs may increase the risk of miscarriage, according to research from Australia. The results of the Sydney Stillbirth Study show that women who sleep on their backs are six times more likely to have a stillborn baby. The fi ve-year study looked at the pregnancies of 295 women from eight hospitals around Australia. Previous research had suggested prolonged periods in this position restricted blood fl ow to the baby. Lead researcher Dr Adrienne Gordon, from Sydney’s Royal Prince Alfred Hospital, said sleeping on the right side or on the back reduces blood fl ow through a major vein from the legs to the heart, which aff ects the supply to the womb. Studies have shown that three-quarters of pregnant women sleep mostly on the left side – higher than the rate in women who are not pregnant.�

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rcm.org.uk/midwives/news 2012 • ISSUE 6 • MIDWIVES 15

NMC / In focus

ALAMY

NMC HIKES ANNUAL FEE TO £100

In May, the NMC revealed plans to increase its registration fees. Six months later, Midwives was there when the hike was voted through.

THE NMC COUNCIL HAS voted to increase its annual registration fee to £100.

The unanimous decision to hike the fee by 32% was made at a meeting of its council on 25 October. It also agreed to accept £20m from the government and it was decided that an annual review of the registration fee fi gure would be carried out.

Members of the council voiced their disappointment over the increase, but called it ‘the least bad option’.

Louise Silverton, RCM director for midwifery, was at the meeting as events unfolded.

‘The RCM has worked hard to get the best possible result for its members,’ she said.

‘We are pleased that we’ve achieved something by lobbying for the £20m grant from the government that the NMC has accepted. Many of the NMC council members took on board our concerns about the eff ects the fee increase will have, particularly on those who only work a few hours a week and on newly qualifi ed midwives.

‘No one is happy to see an increase, but the NMC has committed to an annual review of the situation, which will allow us to see if the NMC’s assumptions about its fi nances are accurate.

‘The NMC’s suggestion that fees could go down if predictions

aren’t as they expect is welcome.’In the three-hour meeting,

Louise asked the council if the impact of the increase on part-time and student members had been considered.

Members agreed that, at future meetings, the council would discuss whether a tiered fee system could be considered.

The £100 increase was one of four options on the table.

The fi rst option was for thefees to stay at £76 and for the £20m from the government to be accepted.

But members agreed that this would mean the NMC would not be able to clear its backlog of cases and would eat further into its already low fi nancial reserves.

Another option was for the fee to be increased to £120 a year and for the government grant to be rejected.

In the NMC consultation – to which there were 26,373 responses – 96% of respondents voted against this £120 hike.

Members of the council agreed that the increase was completely unacceptable.

The fi nal rejected option was to raise the fee to £95 for one year, then consult on increasing it to £105 the following year.

However, this would mean that just three months after the fi rst increase, a new consultation would have to begin on the following year’s increase.

Members agreed that this would take up too much time, too many resources and it was stressed that there was a fi nancial cost involved in the consultation process.

At the end of the meeting, NMC chair Mark Addison spoke of the council’s regret over pushing the fee increase through.

‘It seems that we have a consensus. Not an enthusiastic consensus, but a consensus,’ he said. ‘Everybody has said that this is a diffi cult decision to take and it’s tough in the current economic context. It is a decision that we take reluctantly, but confronted with the information that we’ve got, I don’t think that we have any choice.’

The new fee is set to come into force on 1 February next year.�

32%THE HIKE IN

REGISTRATION FEES THAT THE NMC'S COUNCIL

VOTED THROUGH IN OCTOBER

»

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HeadlinesRCM news / The latest stories

MARCH AGAINSTAUSTERITYMORE THAN 150,000 JOIN TUC RALLY

The largest RCM contingent yet marched together through London under the blue banner on the TUC march, A Future That Works, on 20 October. An estimated 100 members took part in the march, which started on Victoria Embankment and fi nished at Hyde Park.

The RCM was not only seen, but heard, thanks to Eulalie Brennan and Anna Kent from the Nottingham branch, who invited the lively Nottingham Samba Band to join the group. RCM members from across the UK joined more than 150,000 supporters showing their opposition to the government’s planned austerity measures.

One member tweeted: ‘The music may be lighthearted but the message certainly isn’t.’

RCM director for policy, employment relations and communications Jon Skewes said: ‘Our lively presence on the march made sure our Protect Maternity Services message stood out amid the overwhelming show of action to defend NHS staff and services from cuts which will aff ect us all.

‘It was great to see so many members take part. I’d like to thank everyone for their support.’

RCM members also took part in the simultaneous marches and rallies in Glasgow and Belfast.

A new, single contact telephone number for the RCM has been launched to make it easier and cheaper for members to access help and services from the RCM, wherever they are in the UK. The RCM Connect number

– 0300 303 0444 – will cost the same to call as a local number.

‘The RCM receives a large number of calls each day from members needing information, wanting to change their membership status or seeking our help in serious diffi culties,’ said Chris Truman, RCM director for business services.

‘We want to make our service more consistent and responsive and to improve how we manage our contact with individuals, so that they are not passed from pillar to post and can rely on being able to speak to someone trained to deal with their enquiry.

‘RCM Connect is part of an overhaul of our systems to deliver a better service. The fi rst point of contact when you have diffi culties at work is still your RCM workplace representative, but this single number means that you can make enquiries about anything, from your membership status to practice guidance information, or if you need to reach your local RCM offi cer.

‘We hope members will, in time, become familiar with RCM Connectand like the more responsive and professional service this will provide.’

RCM CONNECT

NEW SINGLE CONTACT NUMBER FOR RCM

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RCM NEWS AND DATES

The RCM has announced that membership subscriptions will cost the same next year for the majority of members. There will be no increase in 2013 to the full, joint agreement, student, newly qualifi ed and MSW category fees.

‘I know our members will be pleased we have been able to freeze the cost of membership this year,’ said RCM chief executive Cathy Warwick. ‘Especially with the steep increase to NMC fees, we know our members will be feeling the pinch and it is ever more important that our members can aff ord to remain covered for practice with us, up to date in practice developments andcan rely on representation.’

Members will be receiving their membership renewal packs in the post during November.

The RCM has published the fi fth edition of Evidence based guidelines for midwifery-led care in labour, a comprehensive update of the available evidence on which midwives should rely in practice, including research published since the last edition in 2008. The full publication is now available to download from the RCM website and is accompanied by the shorter Practice points booklet, which provides a useful summary for midwives to keep to hand wherever they work. Midwife RCM members will receive a free copy of the booklet with their next issue of Midwives in January.

Maternal emotional wellbeing and infant development, which will be launched at the RCM conference, provides midwives with recent evidence about the impact of women’s emotional wellbeing

NEW PUBLICATIONS

NEW RCM RESOURCES TO SUPPORT PRACTICE

MEMBERSHIP FEES

SUBSCRIPTION COSTS TO REMAIN THE SAME

TWINNING VOLUNTEERSThe fi rst RCM global midwifery twinning project midwife volunteers have now completed their two-week visits to Cambodia, Uganda and Nepal. The eight midwives from the UK attended workshops and visited training centres, birth units and hospitals to form an understanding of the needs and specialisms in each country. Each team used the MACAT

framework created by the countries’ midwifery associations as a capacity assessment tool to look at the needs and opportunities for future knowledge and skills sharing. The global midwifery twinning project will be recruiting the next tranche of midwife volunteers in early 2013.► For information on taking part, please visit: rcm.org.uk/globaltwinning

ELECTION NOTICESix positions on the RCM board will be open for election by members during 2013. The new members will take up offi ce on 1 September 2013 to ensure that the RCM is viable and properly governed, and to set the strategic direction for the RCM. The current board will be holding a drop-in meeting during the RCM conference for anyone interested in standing. The session takes place at 1.15pm on 14 November at the Brighton Centre.► To attend, book a free

conditions, which include reducing unsocial hours payment, increasing working hours and reviewing pay levels. The RCM has been holding meetings throughout the South West to inform members of the latest developments and explaining how these proposals would aff ect their working conditions if they were implemented.► Write to your local MP across the South West to defend Agenda for Change by using the template letter at: rcm.org.uk/swpay

17 DecRCM study day for WPRs at

Birmingham Women’s Hospital

24 JanThe RCM Annual Midwifery

Awards 2013

4 FebDeadline to stand for election

to the RCM board // /QUICK

LOOK DATES»

during pregnancy and the transition to parenthood. It suggests practical ways to support healthy parent-infant relationships, with an overview of current theory and research.

Also recently published is the Midwifery leadership competency framework, which complements the RCM leadership programme and describes the leadership competences that midwives need to demonstrate to become more actively involved in the planning, delivery and transformation of the health and social care services off ered to women and families.

conference exhibition pass at: rcm.org.uk/annualconference► For information on standing, please visit: rcm.org.uk/boardelection2013 (the deadline is 4 February 2013)

NO TO LOCAL PAY Members in south-west England are increasingly concerned as NHS trusts in the region pursue their attack on Agenda for Change. The 20 trusts are attempting to establish their own regional terms and

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HeadlinesCountry news / Northern Ireland and England

MATERNITY STRATEGYThe eagerly-awaited six-year maternity strategy for Northern Ireland (NI) has been launched by health minister Edwin Poots. The Public Health Agency (PHA) is responsible for its delivery.

The PHA is now recruiting a project manager to discuss with trusts and other stakeholders how to ensure the eff ective implementation of this wide-ranging strategy. There is a major focus on improving public health and reducing inequalities, an emphasis on the need for collaboration and teamworking, and a commitment to further developing midwifery-led care in NI. This includes the establishment of additional community midwifery units (CMUs), where appropriate.

NEW CMUThe Belfast Health and Social Care Trust board has confi rmed that a CMU will be developed on the Mater Hospital site in early 2013. The RCM will work with the trust to ensure a seamless transition from obstetric-led to midwife-led services. The trust’s decision was welcomed by Mr Poots when he offi cially opened the joint RCM/INMO conference in Armagh on 18 October. He also praised midwives for their role in normalising birth, promoting

breastfeeding and collaborating in innovative projects, such as the Family Nurse Partnership.

GUIDELINE DELAY The ongoing delay in publishing termination of pregnancy guidelines for NI was brought into focus when Marie Stopes opened its fi rst NI sexual and reproductive health clinic on 18 October.

The opening of the clinic, which will carry out abortions permitted within the legal framework in NI, has led to renewed calls to the DHSSPS to publish guidelines for healthcare staff . They will not only provide a clear exposition of the law, but also guidance for good practice, including recommendations for employers whose staff have a moral or religious objection to participating in abortion. These staff currently have no statutory right to conscientious objection in NI.

The Family Planning Association has been granted leave for a judicial review in January, which will call on the DHSSPS to account for the failure to publish the guidelines.

MARCH AGAINST CUTSAlong with colleagues across the UK, the RCM joined the March Against Austerity in Belfast on 20 October. We will continue striving to ensure health service cuts do not adversely aff ect our members and the women they care for.

Breedagh HughesDirectorRCM Northern Ireland

HAPPY BIRTHDAYThe Maidstone Birth Centre has celebrated its fi rst birthday, with Cathy Warwick as special guest. Midwives there have birthed 390 babies in the fi rst year of operation.Pictured is the fabulous cake baked by midwife Zoe Manclark, with a baby to celebrate every single birth at Maidstone over the last year.

TWINNING UPDATEThe RCM’s global twinning project got off to a fi ne start as two RCM midwife volunteers, Sue Reed and Chantal Winstanley, went to Cambodia. They spent two amazing weeks learning about midwifery practice from the Cambodian Midwives Association. We hope to hear more from them soon.

NEW LONDON SMO Well done to Jess Read on her appointment as local supervising authority midwifery offi cer in London. We look forward to working with her in supporting supervision across the capital.

IOLANTHE WINNERThe RCM was delighted when Elaine Uppal, lecturer at the University of Salford, recently won the Trish Anderson Iolanthe Award for her

outstanding art of midwifery work with student midwives, which promotes normality and teaches the physiology of pregnancy.

WORKING TOGETHERPartnership working in England is developing at a fast pace. We have been invited to work with the Chartered Society of Physiotherapy on bladder care and improving education on advising women in the postnatal period. Also, the Obstetric Anaesthetists Association (OAA) has welcomed me onto their committee. The RCM’s Gail Johnson has been involved with the OAA for some time and has contributed to its pain relief information leafl et and app. A link to the leafl et can be found on the NHS Choices website: tinyurl.com/cy9n49r. It is a useful resource for advising women about pain relief.

EVENT SUCCESSCongratulations to RCM Solihull branch stewards, Carla Jones-Charles and Veronica Morgan, on their excellent learning event. Speakers included coroner Aidan Cotter, RCM regional offi cer Suzanne Miller and Corrine Slingo, partner at the trust’s solicitors. They were joined by the trust chairman, Lord Hunt, as well as the HoM.�

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Stuart Bonar / On politics

I t is very much a mixed picture for midwife numbers across the UK right now.

The number working in the NHS in Wales, for example, fell in 2009, 2010 and 2011 and is down 12% in just three years. In Northern Ireland, the number of midwives is on a high, while in Scotland the situation is a little hazy as the NHS there carries out a data cleansing exercise to make sure that it is counting all its midwives correctly.

In England – always the poor performer when it comes to midwife numbers – we may be seeing something very good happening. I believe this is, in part, thanks to the 76,000-plus signatures on our ‘more midwives’ e-petition, which so many of you signed and promoted, so thank you once again.

Firstly, there were – at the last count in June – more midwives in

post in the NHS in England than at any time in history, with the equivalent of 21,092 working full time. There are also more midwives in training than ever before, with almost 6000 in 2011-12.

And there is more. BBC Radio 5 Live recently reported on maternity services. Our chief executive Cathy Warwick appeared, as did Dr Dan Poulter, the under-secretary of state for health responsible for NHS maternity services in England.

The feature kicked off with the BBC’s statement that ‘the Department of Health says at

→ In England – always the poor performer when

it comes to midwife numbers – we may be seeing something good

Stuart Bonar reports good news on England’s midwife numbers, while the new under-secretary of state for health pledges his commitment to ensuring the upward trend continues.

least 3500 more midwives are needed to cope with the growing number of women having babies in England’. This is an advance, as I don’t recall the government admitting to such a large shortage previously.

Dr Poulter stated several times his commitment to delivering more midwives. He said: ‘Something I am very strongly going to be pushing on as the new minister is to make sure that we support the delivery of more midwives.

‘We’re going to be looking to do some work with Cathy and the RCM that will actually focus on making sure that training always translates into jobs. There is more to do about making sure that the increasing number the government is training fi nd their way into employment locally. That’s something that we are very much looking into and Cathy and I will be working on together.’

He added: ‘We have got to make sure those 5000 additional midwives actually fi nd jobs on the ground and that’s what we

are going to do.’In late September and early

October, the RCM organised health debates at the three main party conferences – Liberal Democrat, Labour and Conservative – attracting speakers including Lib Dem health minister Norman Lamb, Labour shadow health secretary Andy Burnham and Conservative chair of the Commons Health Committee Stephen Dorrell. We did this as a part of the Health Hotel, of which we have beena member for some years.

The debate gave us the opportunity to be heard at the highest political levels and be seen by those key decision-makers who are central to thebig debates occurring in health policy right now. It is just one example of what we do all year round to ensure the voice of midwives is heard by those running the country.�

Stuart BonarRCM public aff airs advisor

MOMENTUM GAINS IN NUMBERS

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HeadlinesWork life / Amy Leversidge

→ The RCM has a commitment to equality and diversity and ensuring that midwives are treated fairly

and equitably at work

Amy Leversidge reports on the surprising fi ndings of recent research into disciplinary proceedings and ethnicity, outlining possible underlying factors and the RCM’s commitment to equality and fairness in the workplace.

THERE IS AN UNCOMFORTABLE and diffi cult issue that we rarely talk about publicly – what happens when midwives are subject to disciplinary proceedings and, when this happens, do trusts treat all staff fairly regardless of ethnicity? The RCM submitted a Freedom of Information (FOI) request last year to investigate the number of midwives involved in disciplinary proceedings, broken down by ethnic group, and the results proved to be quite shocking.

Some of you may have been subject to disciplinary proceedings; it can be a very stressful and emotional time. Some of you will have joined the RCM for the very reason that, if you are in that position, you will be represented by a midwife. RCM stewards are the fi rst port of call, but sometimes cases are escalated to a regional offi cer, who are all midwives and have vast amounts of experience in representing midwives.

Of course, the RCM can never condone bad practice, however, there are many times when mistakes or errors can be dealt with through training and development. Ultimately though, the workplace representative or regional offi cer is there to ensure that the midwife involved is treated fairly.

If you are ever seeking representation from a regional offi cer, you will be asked to complete an anonymous equality monitoring form. These

MIDWIVES AND DISCIPLINARY PROCEEDINGS

are collected and analysed to investigate any equality issues there may be with members seeking representation.

Unfortunately, during the analysis of these forms we have found that in London, there has been a disproportionate amount of black or black British midwives who seek representation.

This is not unexpected. In 2004, the Institute of Employment Studies found that midwives report more incidents of harassment, including verbal and racial abuse, than any other group in the NHS (Robinson and Perryman, 2004). Moreover, in 2009, a report from Aston Business School (Dawson, 2009) linked NHS staff survey data to patient survey data that found high levels of bullying, harassment and

abuse against staff , particularly on the basisof ethnic background, related to negative patient experience.

In March 2010, the University of Bradford published its report, The involvement of black and minority ethnic staff in NHS disciplinary proceedings, which found that black and minority ethnic (BME) staff were almost twice as likely to be disciplined in comparison to their white counterparts (Archibong and Darr, 2010).

Following on from this research and the fi ndings of the RCM’s equality monitoring forms, we sent a FOI request to the 24 trusts in London that provide maternity services, to gather information about the number of midwives subject to disciplinary proceedings broken

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1.3 milliondown by ethnic group. The FOI request revealed that while 32%

of midwives in London were black or black British, 60% of the midwives disciplined were black or black British. Furthermore, the outcomes of the disciplinary proceedings appeared to be harsher – notably, 10 midwives were dismissed during the time period and every midwife dismissed was black or black British.

Unfortunately, numbers can only tell us so much. On their own, the numbers do show that black or black British midwives in London are not being treated equally or fairly, but we believe that the reasons for the numbers are likely to be complex.

It is probable that part of the reason for the stark diff erence will include organisational culture and poor management practice, not just in maternity but across the trust. There could be issues in human resources departments where

there can be a real lack of understanding and awareness of equality and diversity.

We also have to look at the issues of leadership and culture, including a lack of diversity among leaders.

The NHS has almost 1.3 million employees and nearly 15% of these come from a BME background, which equates to around 200,000 employees. However, there are currently only fi ve chief executives from BME backgrounds (NHS, 2009). The NHS has developed a programme called Breaking Through, which seeks to identify talented individuals who have the potential to become senior leaders and develop their skills and confi dence so they can go further in the NHS. This is an excellent move, as it will ensure the talent pool that senior leaders are selected from covers more diverse backgrounds.

NHS Employers have also developed a campaign to ask staff to be ‘equality

champions’. The role doesn’t take up a lot of time and there are no requirements in terms of expertise or experience. All you need is to be passionate about the NHS and care that diverse workplaces make organisations better. You can fi nd out more and sign up to be a champion by visiting the NHS Employers website.

The RCM has a commitment to equality and diversity and ensuring that midwives are treated fairly and equitably at work, and we want to make sure that maternity leaders are diverse, inclusive and refl ective of the workforce and show a commitment to equality and fairness.

The RCM has published the report, which is available to download from the website. We have not identifi ed individual trusts, preferring instead to work with them along with other stakeholders to fi nd solutions to this very serious issue. We are already working with the London Local Supervising Authority and some trusts and we will continue to do so as part of our commitment to ensure that all midwives are treated fairly and with dignity at work.�

Amy LeversidgeRCM employment relations advisor

► To view the RCM report, please visit the RCM website► For details of the NHS Breaking Through programme, please visit: nhsbreakingthrough.co.uk► For the NHS Employers website, pleasesee: nhsemployers.org


PEOPLE ARE EMPLOYED BY

THE NHS.NEARLY 15% COME FROM

A BME BACKGROUND

Illustration: Dale Edwin Murray

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OpinionThoughts, views and your feedback

Professor Ed Mitchell / One-to-one

Professor Ed Mitchell, one of the world’s top authorities on bedsharing, talks to Rob Dabrowski about the sleeping killer. »

Calculating the risk

SHUTTERSTOCK

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OpinionOne-to-one / Professor Ed Mitchell

‘I ’m really trying to avoid saying “thou shalt not bedshare”, as I don’t think that’s helpful to anyone,’ says Professor Ed Mitchell, smiling awkwardly, while

discussing the risk of Sudden Infant Death Syndrome (SIDS) and suff ocation associated with bedsharing.

Professor Mitchell is outlining statistics and discussing the results of numerous academic papers on the subject (the publication dates and author names of which he seems to know off by heart).

But, when the questions turn towards whether he believes it is wrong to bedshare, he changes tack and steers the conversation

towards the results of other academic papers; distancing himself and turning the question away from the personal and into the political.

He doesn’t seem to be evading the question because he doesn’t know the answer. Professor Mitchell, who has over 300 academic papers to his name and has won a handful of awards for his pioneering research, genuinely believes that his personal views should fade into the background, while the statistics and evidence should be brought sharply into focus.

‘Parents have the right to know what the evidence says,’ he tells Midwives, before outlining the stand-out statistics from research into bedsharing. ‘We haven’t published it yet, but we’ve been able to put fi ve data

sets together and have found that, for those mothers that do all the right things, the risk of the baby suff ocating is less than one in 10,000,’ he says.

‘If you put bedsharing into the equation, then it increases the risk by three times, which is still quite a low risk. But add smoking as well as bedsharing and the risk increases seven-or eight-fold.’ He then stresses: ‘If you have smoking, drinking alcohol (more than two units before going to bed) and bedsharing, then the risk is 16 times higher (Mitchell, 2009).

‘So, the good news is, if you follow the advice then the risk to your baby is incredibly low. But sharing with babies, even if you are doing everything right, increases the risk and if you are mixing that with smoking and alcohol, then the risk will signifi cantly increase.’

Professor Mitchell believes there are a number of things that can be done to reduce SIDS and suff ocation in the UK. ‘In New Zealand, the fi rst thing that has been done is that all hospitals have to have a procedure on bedsharing,’ he says (Health Quality and Safety Commission New Zealand, 2012). ‘They’ve got to think about it, and that’s a start and we are putting the emphasis on suff ocation.’

“I think this is

really important

for midwives, as they

have contact with parents

through the whole

process, and how they

advise parents-to-be will have

a profound

effect”


rcm.org.uk/midwives 25

He goes on to say that he thinks the introduction of ‘pepi pods’ has also been a success. These are general-purpose storage boxes that contain a mini mattress and bedding, which the parents can take to bed with the baby inside. ‘People are realising that these can be produced for a few dollars and they’ve been very successful. I’m not saying this is the right solution to bedsharing in the UK,’ he stresses, ‘but it’s an option.’

He believes the most important factor in the fi ght against SIDS is getting the information on the risks out to the public and ensuring that

professionals are all backing a unifi ed stance. ‘I always like to see an agreement about

what the message should be and even people who disagree with what’s being said should agree to keep quiet,’ he says.

He goes on to discuss the current situation in the UK, where the Department of Health advises against bedsharing (DH, 2009), while UNICEF’s advice is that it is fi ne during breastfeeding, but parents shouldn’t fall asleep with the baby still in their bed (UNICEF, 2011).

‘I think that health professionals need to look at what the evidence shows and what the agreed approach is,’ he says. ‘If you tell someone that they shouldn’t bedshare with their baby and then you leave them together to breastfeed in the bed, then that says something else and you are giving them mixed signals. I believe that parents either don’t get the message, or they get a fragmented message and they are given contradictory evidence.’

He says one of the problems is the manner in which breastfeeding and skin-to-skin contact are promoted. ‘Through breastfeeding, people have been advocating bedsharing to some extent and, while skin-to-skin is

important and is often done immediately after birth, it is fi ne where mothers are awake, but they shouldn’t be doing it at night.’

Such is his strength of feeling about the action that needs to be taken that, as well

All about Ed► Qualifi ed at St George’s Hospital Medical

School in London

► Worked in the UK, Zambia and New Zealand

► Completed his paediatric training inNew Zealand

► In 2001, he was appointed professor of child health research at the University of Auckland

► Published over 300 original papers, particularly on the epidemiology of asthma and SIDS

► In 1996, the University of London awarded him a Doctor of Science for his work

► Received several awards for his infl uential studies of SIDS

► Currently chairs the International Society for the Study and Prevention of Perinatal and Infant Death.

FACT FILE

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as publishing prolifi cally on the subject, Professor Mitchell is now developing innovative technology that could drastically reduce the number of deaths.

He’s currently working on an online tool, where parents can tick boxes relating to their lifestyle – such as whether they smoke or drink alcohol – and it will calculate the risk of the baby suff ocating or SIDS while bedsharing.

‘Most importantly, people need the information,’ nods Professor Mitchell. ‘I’m working to produce a computer programme that can combine all the variables and work out what the absolute risk is.

‘I’m working with a statistician at the moment and, hopefully, in about a year’s time, we will have the programme completed. I think it should be something that all midwives and health visitors should be able to use in order to advise families, as it would help focus their attention on the issue and the high risks.’

He adds: ‘I don’t want to patent or sell this– it is something for the public good. What we will probably end up doing is writing a paper on this and then setting it up on a website. Hopefully it is only a year down the line, but we are probably going to have to get some funding.’

He concludes: ‘This is really important for midwives, as they have contact with parents through the whole process. How they advise parents-to-be will have a profound eff ect.’

At the end of the interview, Professor Mitchell has discussed the risks, looked at potential solutions and he has succeeded in avoiding saying ‘thou shalt not bedshare’.

However, while he hasn’t expressed any personal damning statements on bedsharing, from the case he’s made and the statistics that he’s put forward, the message is loud and clear.�


Professor Ed Mitchell (far left, left); a father in New Zealand using a pepi pod (below, right)ProNe

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OpinionOn course / Rebecca Warboys

A ROUNDED EDUCATION

Rebecca Warboys outlines why developing midwives’ education in

supporting breastfeeding is imperative, both to the profession and to women

and their babies.

R ates of breastfeeding initiation and duration in the UK remain

disappointingly low (McFadden et al, 2007; Renfrew et al, 2005), despite evidence confi rming breastfeeding as the optimum method of infant-feeding (NICE, 2008). One of the reasons cited for these low rates is healthcare professionals’ lack of knowledge and skills in supporting women to successfully breastfeed (Furber and Thompson, 2008; Smale et al, 2006). In addition to the essential skills clusters for breastfeeding outlined in the NMC’s Standards for pre-registration midwifery education (2009), there are other calls for eff ective breastfeeding education programmes for undergraduate midwifery students (Smale et al, 2006; McFadden et al, 2006).

The UNICEF UK Baby Friendly Initiative (BFI) university accreditation programme seeks to further improve breastfeeding education (UNICEF, 2002) by providing universities with a set of breastfeeding learning outcomes, which aim to standardise the level of

competency of newly qualifi ed midwives entering the workplace (Cummings, 2008).

Pre-registration midwifery programmes at the University of Leeds are BFI-accredited and provide students with at least 18 hours of formal breastfeeding education, in addition to minimum requirements that must be achieved in helping women with hand expression, positioning and attachment and assisting them with common breastfeeding issues (UNICEF, 2008).

These benchmarks are to be welcomed, since they undoubtedly provide student midwives with a standardised breastfeeding education. It is important, however, that

students bear in mind that these are only minimum standards. There are other opportunities to develop competence in the facilitation of breastfeeding. At the University of Leeds, knitted breasts are used, with the aim of building student confi dence in demonstrating hand expression, attachment and positioning (Hewett and Henshaw, 2009).

Students at Leeds are also encouraged to explore local voluntary breastfeeding support services and, where possible, gain experience working alongside peer support groups. This provides a quality learning experience, since evidence has found that peer supporters and breastfeeding counsellors are

highly knowledgeable and skilled in working with breastfeeding women (Moran et al, 2005; Dyson et al, 2006; NCT, 2012).

Finally, and perhaps most signifi cantly, students should not underestimate the powerful learning experience that comes from being ‘with woman’ and learning from the breastfeeding women they work with (Cantrill et al, 2003). This not only develops students’ knowledge and skill sets, but helps them understand the emotions of breastfeeding women and thus encourages them to refl ect on their practices when working with them (Hutchings and Taylor, 2012).

Thanks to the university’s BFI accreditation scheme and other innovations, more student midwives are now provided with enhanced breastfeeding education, turning the tide on the numbers of midwives who, it has been suggested, may have been inadequately trained (Furber and Thompson, 2008; Smale et al, 2006; McFadden et al, 2006).

As students, it is our responsibility to embrace this education and to seek other opportunities that will help usto develop our skills.�

Rebecca WarboysStudent midwifeUniversity of Leeds

Rebecca would like to thank her lecturer, Dr Kuldip Bharj, for her help with this article.


18THE NUMBER OF

HOURS OF FORMAL BREASTFEEDING EDUCATION AT

THE UNIVERSITY OF LEEDS

»

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We’ve got

mailMidwives thrives on your letters and emails. Here is a selection of the ones that caught our eye this issue.

Have your say / Feedback

NMC REGISTRATIONThe Society and College of Radiographers administers the Public Voluntary Register of Sonographers, which is available for healthcare professionals working with ultrasound who either cannot obtain statutory registration, or wish to support the possible future statutory registration of sonographers.

We have several voluntary midwife sonographer registrants, most of who are also statutorily registered with the NMC. We have, however, been contacted by a few midwife sonographers who are working full-time within ultrasound departments and have been unable to renew their NMC registration.

It would be appreciated if any midwife sonographer who has had problems renewing their NMC registration because of the nature of their work could contact: [email protected] so that we can gain

a clearer picture of the situation. Any information received will be treated in confi dence and details of individual circumstances will not be passed on without consent.

Nigel ThomsonProfessional offi cer, Society and College of Radiographers

A BRAVE VOICEI want to commend Christopher Butt for his article, A man ‘with woman’ (Midwives Issue 5 :: 2012). I found it shocking that he has been turned away from breastfeeding groups. For one, this attitude feeds the opinion that breastfeeding should be a hidden act, only to be done in the presence of females.

When I was training, I had a male midwife as a mentor and, I have to say, he was one of the most passionate and empowering midwives I’ve had the pleasure

The course, which runs over six weeks, is delivered by an English tutor and a midwife and uses tools we have devised to enable learning. In post-course evaluations, the women are always very positive about how much better informed and less anxious they feel, while midwives comment on how much easier it is to assist women who have completed the course.

If you would like to know more, please contact: [email protected]

Judith HansfordESOL English teacher Joanne ForsdikeRegistered midwife

On 3 December, a commemorative event will be held at the University of Manchester to celebrate the life of Baroness McFarlane of Llandaff . The ceremony will take place at Whitworth Hall, Oxford Road, Manchester at 2.30-3.30pm. Refreshments will be available afterwards in the ground fl oor of the Jean McFarlane Building. If you would like to attend, please contact Daniel Macauley at: [email protected]

More of your letters can befound at: rcm.org.uk/midwives/your-views

WRITE»TO US

Send your comments by email to: [email protected] (the editor reserves the right to edit letters)

of meeting. His breastfeeding enthusiasm and advice was also second to none.

A massive well done to Christopher – he clearly has huge passion and enthusiasm for our profession, and I wish him all the best with his training. He will make a superb midwife.

Rachael JamisonMidwife

LOST IN TRANSLATIONI would like to highlight the successful scheme that we have been running for four years at the Royal Berkshire NHS Foundation Trust in Reading to improve maternal care for women with limited English. Many midwives will experience the frustration in caring for such vulnerable women and be aware of the risks to both mother and child of poor communication. Interpreters are expensive and sometimes unavailable.

Having a baby in easy English teaches parentcraft in simple English to groups of women from many diff erent countries. It allows them to learn what to do in an emergency, how to manage their labour and how to breastfeed, with the English words and phrases they will need to communicate with midwives and doctors.

FEEL PASSIONATELY ABOUT AN ISSUE RAISED IN MIDWIVES OR WITHIN YOUR CLINICAL PRACTICE?Then email us your thoughts. The next cracking correspondence wins Touched by a Midwife. Your letter will be published if you win!

CRACKING CORRESPONDENCE WINS...

—CRACKING

LETTER—

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OpinionRCM Communities / Latest discussions

LINKSTo post your response to this discussion, please visit:

DOWNBANDING ANDUNDERMINING OF MIDWIVEStinyurl.com/9net3jc

If you have a topic to raise or need advice from fellow RCM members, join the conversation at: communities.rcm.org.uk

DOWNBANDING AND UNDERMINING OF MIDWIVES

I keep hearing stories about the downbanding and undermining of

midwives, who are being penalised for being frontline clinical practitioners, instead of offi ce workers or ‘managers’. Why do we have a campaign to improve numbers when we set new midwives the example of seeing senior midwives undermined and virtually disenfranchised by being told they are not working to grade when they are? Agenda for Change is easy to interpret, misinterpret and ignore, as we are now seeing in certain parts of the country. Midwives will not be truly valued as professionals if they accept these changes. We need clear, legal advice, expert industrial relations support and a commitment that something will be done to stop midwives being used as a soft option when a bit of money needs to be saved. Yes, there was a march in London – now what? Back to work as usual?

AI agree that we need clear legal advice. The only example of downbanding in our

health board (HB) was of community midwives. In one area of the HB they are a band 7 and in another they are a band 6. I have concerns regarding the apparent growing acceptance of midwives not getting meal breaks. I work mostly in the community, however, I have heard from colleagues that they are routinely too busy

Members have been discussing all things midwifery. Why not create a profi le and have your say?

Are you involved?

► The RCM’s Stuart Bonar reports positivity in Northern Ireland’s maternity policies and midwife numbers.► A blog entitled Whose life is it anyway? attempts to shed light on the abortion debate, which was refuelled by health secretary Jeremy Hunt’s recent comments favouring a reduction of the 24-week time limit by half.

LATEST BLOGS

for meal breaks. This is surely against their legal rights? Where can I fi nd information to advise them and inform them? Our workplace representatives are fl at out supporting midwives involved in serious incidents and, therefore, I don’t like to bother them. More and more midwives are involved in serious cases, but surely not getting meal breaks is a factor in this.POSTED BY: A community midwife

AThe downgrading of posts is a serious issue. In the recent consultation with NHS

Staff Side on proposed changes to Agenda for Change terms and conditions, 63% stated that downbanding of posts was either happening or being talked about. We had a similar situation in the 90s, when there was no job evaluation scheme in place, so employers were able to downband midwives and expect them to do exactly the same job. Theoretically, this shouldn’t happen now but where it does, it could be subject to legal challenge. However, this can be diffi cult where the application of bands was infl ated under Agenda for Change, rather than applying recruitment and retention premia. It could be argued that the RCM should have intervened at this stage but we would have found little support. Many trusts are now experiencing a review and withdrawal of these premia, where recruitment into posts is no longer a challenge. Where there is a downbanding threat, you need to involve your RCM steward, who will contact the national or regional offi cer. I also request that you lodge the threat at: protect.rcm.org.ukPOSTED BY: Denise Linay, RCM head of organising and engagement

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twitter.com/MidwivesRCM 29

TweetdeckA look at what you’ve been tweetingA look at what you’ve been tweeting

Do you have a Twitter account? If you do, why not follow your professional organisation and keep abreast of the RCM’s latest news?

@MidwivesRCM Working hard on my paper presentation for the RCM conference – can’t wait to present! :D

From: @SallyPezaro

Just applied for my fi rst job as a registered midwife! Amazing feeling! #exciting #nervous #fi ngerscrossed @MidwivesRCMFrom: @delleteresa

@MidwivesRCM my cohort of 10 post reg trainees areall in the same situation. Why train us if no hope of a job :o(From: @nurse_jenni

@MidwivesRCM I’m really disappointed. 9 of our cohort applied, 5, including me were trust students, 1 has an interviewFrom: @NewMidwifey

Utterly thankful for my @MidwivesRCM rep. Making a very stressful time a little easier to cope with. Never underestimate your #union!From: @ofallpositions

Brilliant day in Leeds @MidwivesRCM policy seminar! Lots of food for thought!

From: @clareluby

@MidwivesRCM Can I just remind you that the job situation for NQMs was the same back in 2007, 2008

etc #domoreforNQMsFrom: @MrsB020811

#healthdebate @MidwivesRCM: J Hunt’s comments on abortion do not indicate a secretary of state for health

in favour of choice and control.From: @IndependentAge

Who’s talking about us on Twitter and what are they saying? Follow us at: twitter.com/MidwivesRCM

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Awards ceremony

Thursday 24 January 2013The Brewery | London

Award sponsors:

www.rcmawards.com

Join us in congratulatingour shortlist

RCM Alliance partners:

2013Awards

AnnualHeadline Sponsor:

030-031_mid_awards advert.indd 1030-031_mid_awards advert.indd 1 02/11/2012 14:4502/11/2012 14:45

For ticket enquiries, please contact:Charlotte Bogaert E: [email protected] T: 020 7324 2764

For sponsorship enquiries, please contact: Ben NelmesE: [email protected] T: 020 7880 6244

For further information or to book your tickets now, please visit:

www.rcmawards.com

SHORTLISTJohnson’s Baby Award for Excellence in

Midwifery Education Developing midwifery practice through

work-based learning Dr Jayne Marshall

The University of Nottingham

Developing a bereavement care initiative for student midwives within pre-registration

midwifery educationKaren Hatch and Christine Rospopa

The University of Northampton

Maternal AIM in undergraduate midwifery education

Rosemary McCarthy and Janet Nuttall University of Salford

Mothercare Award for Excellence in Maternity Care

‘Did we deliver’Julie Jenkins and Carole Bell

Hywel Dda Health Board

Introducing a PGD for BCG vaccinationPaula Clarke

Birmingham Women’s NHS Foundation Trust

Heads up! breech clinic Shawn Walker and Ann Walker

James Paget University Hospitals NHS Foundation Trust

Promoting Normal BirthValley team

Guy’s and St Thomas’ NHS Foundation TrustJuliet May and Laura Bridle

Your birth in our home Kathryn Gutteridge and Helen Giles

Sandwell and West Birmingham Hospitals NHS Trust

Sterile water injections for pain relief in labour Wendy Beagles and MLU team/matron/HoM

York Teaching Hospitals NHS Foundation Trust

NMSF Award Supporting Training and Rewarding Excellence in

Bereavement CareBereavement team counselling service

Claire Waters, Diane Bellanca and Elizabeth Dorey

Barking, Havering and Redbridge University Hospitals NHS Trust

Training and excellence in bereavement careSharon Hurst, Kerry Bardoe and Ursula Marsh

Darent Valley HospitalDartford and Gravesham NHS Trust

Maternity and paediatric support servicesRebecca King

Great Western Hospitals NHS Foundation Trust

Pampers Award for Excellence in Postnatal and Neonatal Care

Newborn examiners group Carol-Ann Brown and Nicky Berry

NHS Borders

Newborn track and trigger chart Isabel Phillips

Burton Hospitals NHS Foundation Trust

Adapting to fatherhood Lorraine Bowen

Nottingham University Hospitals NHS Trust

Philips Avent Award for Innovation in Midwifery

A sustainable maternal obesity serviceCarolyn Garland and Alison Williams

Doncaster and Bassetlaw Hospitals NHS Foundation Trust

Yummy mummy Kathryn Rees

Torfaen Sure Start

QIPP in a snipDr Valerie Finigan

The Pennine Acute Hospitals NHS Trust

Slimming World Award for Initiatives in Improving Public Health and

Reducing InequalitiesDrug and alcohol liaison midwives

Elizabeth Maddran and Louise SlaterEast Lancashire Hospitals NHS Trust

BOP programme Diane McDowell and Elizabeth O’ConnorSouthern Health and Social Care Trust

Reducing the prevalence of smoking in pregnant women and their families in line with

the public health agenda Lorraine Frith and Lynda Moorcroft

East Cheshire NHS Trust

Perinatal mental health in pregnancy Rebecca Beggan and Lesley Tones

Tameside Hospital NHS Foundation Trust

Student Travel Scholarship AwardRachel Brooks

University Campus Suff olk

Josephine FrameUniversity of Cumbria

Lucy-Ann Short and Kara Cina-LewisDe Montfort University

Bio-Oil Team of the Year Engaging hearts and minds of all for a positive

sustainable transformation Fiona Laird and Kanta Patel

North Middlesex University Hospital NHS Trust

Flu vaccination programme Julie Estcourt and Valerie Clare

Stockport NHS Foundation Trust

The management of substance misuse for pregnant women

Pauline Tschobotko and Lisa ElliottBlackpool Teaching Hospitals

NHS Foundation Trust

030-031_mid_awards advert.indd 2030-031_mid_awards advert.indd 2 02/11/2012 14:4502/11/2012 14:45

On focusCurrent and completed midwifery research

Jan Wallis / Cutting edge


Fear of childbirth and duration of labour

PAPERFear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery.

AUTHORSAdams S, Eberhard-Gran M, Eskild A.

PUBLICATIONBritish Journal of Obstetrics and Gynaecology 2012; 119(10): 1238-46.

► The mean duration of labour wasone hour and 32 minutes longer in women with fear of childbirth.► Improved communication withhealth personnel may help to allayfear of childbirth.

T he objective of this study, undertaken in Norway, was to assess the association between fear of childbirth and duration of labour.

A total of 2206 women with a singleton pregnancy and intended vaginal delivery were studied from 32 weeks’ gestation through to birth. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire. Information on labour duration, use of epidural analgesia and mode of delivery was obtained from the maternity ward electronic birth records. Data were obtained by a self-administered questionnaire. Labour duration was defi ned from start of the active stage of labour, 3cm to 4cm cervical dilatation, until the birth of the infant.

The mean labour duration was one hour and 32 minutes longer in women with fear of childbirth than those without. Nulliparity, use of epidural analgesia, augmentation of labour and instrumental vaginal delivery were more common in women with fear of childbirth. In women both with and without epidural analgesia, the mean duration of

labour was longer in women with fear of childbirth. In both nulliparous and parous women, those with fear of childbirth had a longer labour duration than those without fear. After adjustment for other factors, the association between fear of childbirth and labour duration remained statistically signifi cant in nulliparous women only.

Women with fear of childbirth more often had an instrumental vaginal delivery (17.0% versus 10.6%) or emergency CS (10.9% versus 6.8%). In total, 25.5% (42 women) with fear of childbirth and 44.4% (906 women) without fear of childbirth had a vaginal delivery without any obstetric interventions. A vaginal birth was achieved by 89.1% (147 women) with fear of childbirth and 93.2% (1902 women) without fear of childbirth, with corresponding fi gures for an operative delivery (instrumental delivery or CS).

The authors comment that fear of childbirth may be associated with poor communication with, for instance, health personnel.�

Jan WallisRetired midwife and senior lecturer

→ Labour was longer in women with fear of childbirth

OVERVIEW

033_MID_FOCUS_Cutting_edge.indd 33033_MID_FOCUS_Cutting_edge.indd 33 02/11/2012 14:4502/11/2012 14:45


On focusHow to... / test for glucose intolerance

—HOW TO...

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T he defi nition and, therefore, recognition and treatment of gestational diabetes have changed somewhat over the years (McCance et al, 2010).

Current literature describes the condition as varying degrees of glucose/carbohydrate intolerance that is fi rst diagnosed during pregnancy, usually resolving after birth. In addition, it is now noted that glucose intolerance in pregnancy may represent undiagnosed type 2 diabetes or, rarely, type 1 diabetes (Bothamley and Boyle, 2009). Since untreated gestational diabetes mellitus (GDM) can increase the risks of fetal macrosomia, birth trauma to mother and baby, the need for induction of labour or CS,

...test forglucose

intoleranceGestational diabetes represents a serious health risk to both mothers and babies, so early recognition is crucial. Noreen Dunnachie describes the correct way to administer the oral glucose intolerance test.

8- TO 12-HOUR FAST PRIOR TO TEST

perinatal death, transient neonatal morbidity and even childhood obesity and diabetes (NICE, 2008), appropriate diagnosis and timely treatment are paramount.

Although controversy remains around the most appropriate techniques for screening and diagnosing GDM, the benefi t of using the oral glucose tolerance test (OGTT) is acknowledged by the Scottish Intercollegiate Guidelines Network (SIGN) (2010), which recognises the signifi cant relationship between maternal glucose levels and pregnancy outcomes. Since the majority of women with GDM are asymptomatic (Robson and Waugh, 2008), it is important to identify and recognise the risk factors as advised by both SIGN (2010) and NICE

(2008), which include a booking BMI of greater than 30, previous GDM, previous delivery of a macrosomic baby (4.5kg or more), a family history of diabetes and a family origin with a high prevalence of diabetes. All women should be assessed for the presence of these risk factors at their booking visit and the signifi cance of the OGTT explained.

The testThe test is usually carried out at around24 to 28 weeks’ gestation, unless there is a history of previous GDM, in which case an OGTT may be performed earlier. Following an overnight fast, a venous blood sample is obtained for the measurement of fasting blood glucose levels and glycated haemoglobin (HbA1c), as well as routine haemoglobin assessment. The woman is then given a drink of a 75g glucose load dissolved in 150ml of water, which she should be encouraged to drink within 10 minutes. A further blood glucose sample should be obtained at a two-hour interval.

As this test is assessing the physiological reaction to a measured dose of glucose, it is imperative that the midwife advises the woman to remain fasted until the test is complete. Although local guidelines may vary, it is generally recommended that the woman also refrains from smoking and rests within the unit until a light diet is off ered prior to discharge. In addition, the midwife should take this opportunity to off er advice and generate discussion with the woman regarding exercise and her diet.

ResultsThe woman should be informed of the timescale involved in receiving her results

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(normally within 24 to 48 hours), and be given a brief overview of follow-up, should her results be impaired. The adoption of internationally agreed criteria for GDM is recommended by SIGN (2010). Impaired glucose tolerance results suggestive of GDM are a fasting blood glucose level greater or equal to 5.1mmol/l, or a two-hour result greater than or equal to 8.5mmol/l. Consequently, SIGN (2010) advises that a fasting result greater than 7.0mmol/l, or a two-hour result greater than 11.0mmol/l, is indicative of pre-existing type 1 or type 2 diabetes and, therefore, should be managed within a multidisciplinary clinic.

When considering the results of the HbA1c level, it is noted that although this

measurement generally refl ects average blood glucose levels over the previous two to three months, NICE (2008) does not advocate using this test routinely in the second and third trimesters of pregnancy. This is due to diffi culties with the interpretation of results and is further highlighted by Nielsen et al (2004), who found that pregnant women have slightly lower HbA1c concentrations than non-pregnant women. This is of clinical importance when considering an appropriate reference range in pregnancy.

Follow-upFollowing an impaired OGTT, the woman will be required to monitor her blood glucose levels at

home and record them in a diary, so adequate training in how to use a blood glucose meter must be given. Although there is no established standard as to how frequently a woman should check her blood glucose level, the ultimate goal is to maintain a level within acceptable glycaemic targets (Conway, 2012).

It is recognised that for the majority of women with GDM, optimal glycaemic control can be achieved through dietary and lifestyle changes alone. Therefore, appropriate information and education needs to be off ered and tailored to meet the needs of women on an individual basis (Bothamley and Boyle, 2009; Conway, 2012). In addition, women with GDM should be reassessed in the postnatal period (generally around six weeks postpartum) in order to clarify the diagnosis and exclude existing diabetes (SIGN, 2010). This opportunity is paramount, as many women with GDM will go on to develop type 2 diabetes in later life. Early identifi cation and adoption of therapeutic measures can delay and even prevent onset (Conway, 2012).�

Noreen DunnachieMidwife, Ayrshire Maternity Unit,University Hospital Crosshouse


CORRECTIONIn the last issue’s How to... page on performing an episiotomy, the text correctly described the incision of the mediolateral approach as beginning ‘at the midpoint of the fourchette’; however, the images did not depict the start of the incision exactly at the midpoint. We apologise for any confusion caused.

DRINK GLUCOSE

MONITOR BLOOD GLUCOSE

BEN

HAS

SLER

TWO HOURS LATER – BLOOD TAKEN

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MIDWIVES • ISSUE 6 • 2012 rcm.org.uk/ebm36

On focusEBM / December 2012

Editorial: Pregnancy: the battle against hidden harm from chemicals, viruses, bacteria, pollutants and chipsMarlene Sinclair

The author digests news and research looking into the dangers that everyday household items – from microwaves and electric blankets to the chips on a dinner plate – pose to pregnant women. She urges midwives to be vigilant in the crusade against these ‘hidden enemies’.

Exploring women’s experiences of smoking during pregnancy and the postpartumCathy Ashwin, Jayne Marshall and Penny Standen

By conducting interviews with 27 women who stopped smoking during pregnancy, this paper looks at reasons why women may take up the habit again postpartum. It found that those who returned to smoking often yearned for a return to their pre-pregnancy identity, while those who did not viewed motherhood as ‘a new start’. Cigarette smell also played a role in whether or not a woman relapsed.

Intention and attitudes towards breastfeeding among undergraduate female students at a public Jordanian universityNahla Al-Ali, Reem Hatamleh and Yousef Khader

For this paper, a survey was carried out to discover what young women thought about breastfeeding. The 496 participants were asked to respond to a series of statements on attitudes towards breastfeeding, including popular misconceptions, and their intention to breastfeed. Overall, students responded positively, with 73% stating they would be happy to try it.

The experiences of women from three diverse population groups of immediate skin-to-skin contact with their newborn baby: selected outcomes relating to establishing breastfeedingValerie Finigan and Tony Long

This paper looks at whether uninterrupted skin-to-skin contact (SSC) immediately after birth has an impact on the effi ciency and productivity of breastfeeding. By studying three diff erent ethnic groups – Bangladeshi, Pakistani and English – the authors disovered that the overwhelming experience among mothers who practised SSC was that the current recommended time period of 30 minutes was too short to be fully benefi cial.

Jordanian women’s perceptions of intrapartum vaginal examinationReem Hatamleh, Huda Gharibeh and Ala’ All Bnayan

The eff ectiveness of vaginal examination has been called into question as the procedure may cause pregnant women distress. This paper looks at the outcome of a survey of women who experienced the procedure, and fi nds that nearly half of those questioned reported negative perceptions of the procedure.

Interventions to reduce domestic abuse in pregnancy: a qualitative systematic reviewSusan Leneghan, Patricia Gillen and Marlene Sinclair

It is estimated that up to 21% of pregnant women experience domestic abuse (DA). For this paper, the authors examined fi ve studies into DA to assess the eff ectiveness of diff erent methods of intervention. Mentoring and counselling for victims of DA were reported to be the most eff ective methods.�

The latest research

Evidence Based Midwifery is the RCM’s quarterly journal featuring in-depth research. Here is the summary of contents from the most recent issue – December 2012.

► RCM members have free access to EBM and the full archive online. To subscribe to the hard copy, visit: rcm.org.uk/ebm

FREE ACCESS

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FeaturesIn-depth midwifery reportage and articles

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MIDWIVES • ISSUE 6 • 201238 THE NHS

Facing the future

What will the NHS look like under Hunt?

Andrew Lansley was not a popular health secretary.

When David Cameron ousted him from the position, responses ranged from branding him the man who ‘pushed the NHS to brink of destruction’ to ‘one of the worst health secretaries since the NHS was formed’.

After two years dogged by controversy – most notably for his plans for a complete NHS overhaul – the move to replace him was welcomed by many.

While it wasn’t unanimous and the 55-year-old did receive praise – mostly from Conservative colleagues – their voices were drowned out under waves of criticism.

Mr Lansley became best known as ‘the architect of the reforms’. Under his guidance, proposals were pushed through parliament for ‘fundamental changes’ to the NHS and there

The man who controversially steered the NHS reforms through parliament has been ditched by the prime minister. Will the NHS and the

contentious reforms change with Jeremy Hunt at the helm? Rob Dabrowski investigates.

REX/

GET

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AGES

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was vehement criticism that plans were being rushed through and put cost before quality.

Most controversial was – and still is – the move towards ‘privatisation’ of the NHS and welcoming competition from the private sector.

But now the ‘architect’ has been removed from post and former culture secretary, Jeremy Hunt, has been drafted into the position.

What does this mean for the reforms? Are we expecting a coalition U-turn?

In short, no. The reforms have already gone through parliament and are well on their way to being implemented.

And in his speech at the Tory conference in October, Mr Hunt even went so far as to call Mr Lansley ‘brave’ for ploughing ahead with them.

Shadow health secretary Andy Burnham tells Midwives that he believes Mr Hunt has just been brought in to rebrand the reforms.

‘It is a strange situation,’ he says. ‘I thought Jeremy Hunt would have used the opportunity to make a break with what’s happened, but clearly he has not and I actually think he’s got a more pro-market agenda than Lansley.

‘He’s been brought in because he has a better bedside manner than Lansley.

‘The planning is clear – it’s about the presentation, it’s not about changing the decision, but putting a better face on this and trying to manage the PR of the reforms.

‘I don’t believe that he is a supporter of what the NHS stands for. I think it’s inevitable that we are going to go further towards privatisation – he’s very much a marketer.’

When Midwives requested an interview with Mr Hunt, he was not available for comment.

But health minister Dr Dan Poulter says that the government will push hard to follow



through with Lansley’s reforms.‘These reforms will make the NHS more

effi cient and better for patients,’ he says, ‘not least because they will dramatically reduce bureaucracy and waste – saving £5.5bn before 2015 and saving £1.5bn every year after that. This means more money reinvested into what matters – looking after patients.

‘One of the other crucial things they do is put clinical staff in charge. They open up new leadership opportunities for midwives.

‘I know from my own experience working in maternity that the more midwives are involved, the greater choice we can off er women and the more personalised the care.’

While Dr Poulter may have NHS experience, one of the main concerns voiced about Mr Hunt as health secretary is that he doesn’t have the health background Mr Lansley had.

‘On a personal level, I’ve always got on well with him,’ says Mr Burnham. ‘But I think the NHS is something that you’ve got to have an instinctive feel for and I think his lack of track record in health is a problem, given that he’s come in to one of the most dangerous situations that the NHS has ever faced.’

But, while he doesn’t have a healthcare background, Mr Hunt does have a reputation of delivering. In his last position he was responsible for the Olympics and oversaw the smooth running of the event this summer.

There were problems – mainly security fi rm G4S not having enough staff and the armed forces being drafted in at the last minute.

But praise after the event was almost universal, with International Olympic Committee boss Jacques Rogge even calling it ‘the most extraordinary event in our lifetimes’.

HUNT VS LANSLEY

Jeremy Hunt Was head boy at

the historic boarding school Charterhouse in Godalming, Surrey

Achieved a fi rst in philosophy, politics and economics at the University of Oxford

Worked as a management consultant, then taught English in Japan

Won the seat of MP for South West Surrey in the 2005 election

Married Lucia Liu in China in July 2009. They have a son and a daughter

A self-confessed fan of the zouk lambada – a ‘sensual fusion’ of salsa and the lambada

Appointed secretary of state for culture, Olympics, media and sport, following the 2010 general election

Appointed health secretary on 4 September 2012.

Andrew Lansley Was educated at

Brentwood School, which ‘educates boys and girls in the British public school tradition’

Gained a BA in politics at the University of Exeter

Had a ‘promising career in the civil service’ before entering politics

Elected as MP for South Cambridgeshire in 1997

In 1997 Lansley left his fi rst wife, by whom he had three children. He has two children with his second wife

Enjoys cricket, the theatre and is an active member of the Church of England

Appointed health secretary, following the 2010 election, after serving as shadow health secretary

Moved to leader of the house in Cameron’s re-shuffl e.


rcm.org.uk/midwives40 THE NHSMIDWIVES • ISSUE 6 • 2012

But, with Mr Hunt emphasising his willingness to listen, he is setting himself up in opposition to the ‘steamroller’ Lansley.

‘We are not going to dictate what’s needed,’ says Dr Poulter. ‘We want to increase the profi le of the work midwives do, and highlight that it is a great career. Leadership opportunities for midwives in the NHS are changing and increasing – there will be opportunities to infl uence clinical commissioning and to lead improvements to services so women have more choice and personalised care.’

Cathy Warwick, RCM chief executive, says: ‘The RCM is pleased to hear that the new health secretary has a keen interest in maternity services. We understand that he and his new ministerial team are committed to the maternity pledges made by the previous ministerial team.

‘We are also pleased to hear from Dan Poulter that there is interest in talking to the RCM about a minimum staffi ng standard for maternity services and we have written to Jeremy Hunt saying that, while we are delighted at the government’s decision to maintain student midwife numbers, we are very concerned that they are starting to fi nd diffi culty getting posts after qualifi cation.’

With Mr Lansley having pushed through the reforms, is Jeremy Hunt the right person to oversee their implementation? Is a willingness to listen enough?

‘I think Lansley has a more instinctive feel for the NHS, for all his faults,’ admits Mr Burnham. ‘I don’t think Jeremy Hunt has that. When big, diffi cult issues arise, I don’t think people know which way he’s going to turn. I was tempted in my conference speech to say “come back Lansley, all is forgiven”, but I didn’t go that far. I think we need a safe pair of hands; someone who knows the department, and I don’t think Hunt ticks those boxes.’�

After the success of the Games, Mr Hunt hasn’t had the smoothest start in his new post.

He has already come under fi re following claims that he previously ‘called for the NHS to be dismantled’.

The latter statement follows a book he co-authored in 2005, called Direct democracy: an agenda for a new model party. It says: ‘Instead of tinkering with a fundamentally broken machine, it [the Conservative Party] should off er to update the model.’

But a DH spokesperson sweeps aside these claims and calls them ‘nonsense’.

‘In fact, the book in question says that “we can hold to the ideals of the NHS, guaranteeing care for all, irrespective of their ability to pay”,’ the spokesperson says. ‘That is a view widely accepted across the political spectrum.’

Mr Hunt has also come under fi re over the last couple of months over his views on abortion and homeopathy.

Mr Burnham says the fact that Mr Hunt has spoken out in favour of homeopathy ‘will raise a few eyebrows’ and that there are better areas for resources to be channelled into.

Mr Hunt’s views on abortion have also caused controversy after he backed reducing the limit to 12 weeks in a ‘free vote’ on abortion.

In free votes, usually granted on issues of conscience, such as capital punishment and Sunday trading, MPs can vote as they wish and are not under instruction from their party.

‘When this came to light, Hunt said that he was guided by evidence,’ says Mr Burnham. ‘I don’t believe that such evidence exists. I found that statement troubling, as the evidence would point you in the opposite direction.

‘You’d like a health secretary to be evidence based in approach and I’d question whether he

is driven by the evidence or the ideology.’But David Cameron backed his new head of

health and said: ‘He is absolutely entitled to hold an individual view, a view of conscience.’

But there was good news in October, with the prime minister and Jeremy Hunt pledging £140m for midwives and nurses to ‘improve care and beat bureaucracy’.

The money will be invested in technology and leadership and Mr Hunt says ‘the government’s role is to listen to the NHS and support these leaders and that’s what we’re doing’.

The notion that the government will ‘listen to the NHS’ has left Mr Hunt’s lips more than once over recent months. It comes after one of the main criticisms levelled at Mr Lansley was that he didn’t listen.

As soon as Mr Hunt was in post, Unison said ‘Jeremy Hunt has an opportunity to listen to patients’, while Unite blasted Lansley’s ‘unlistening and steamroller mindset’.

‘One of the things I’ve heard a lot is Lansley would not listen to people and that’s not a good trait to have in the NHS,’ Mr Burnham says.

‘Hunt has been brought in because he has a better

bedside manner. The planning is clear – it is about the

presentation’


rcmawards.com 2012 • ISSUE 6 • MIDWIVES 41RCM AWARDS

In response to the concerns highlighted by the Baby P case and following the results of a number of serious case reviews locally, we undertook an in-depth review of safeguarding practice in maternity and neonatal services. In November

2009, the safeguarding midwifery team was introduced. A number of areas were identifi ed where improvements could be made, both to practice and to services for families with vulnerabilities.► Process – There was no clear process in place, meaning a lack of robust evidence that assessment had taken place. Families would often be referred to social care late on in pregnancy, thus causing stress and anxiety. A lack of clear planning also led to confusion for both staff and families. ► Training – Although staff were trained to the required level in child protection, there was a lack of structured support. There was also variation in the standard of report writing, and staff lacked knowledge of preventative measures to support vulnerable families, their default being to refer to social services.► Guidelines and policies – These required updating and communicating to all involved. There were none advising on domestic abuse or drug-using mothers. ► Working relationships – There was a lack of knowledge of the local agencies off ering support to families. There was minimal use of the Common Assessment Framework process and insuffi cient communication between maternity and other agencies. ► Team approach – Agencies were not always working closely with expectant mothers. Plans were often poorly communicated to the mother and her family, resulting in the late and unexpected involvement of social services.

A number of actions were taken to address these issues. Our main objectives were to:► Ensure a robust assessment throughout pregnancy► Implement a clear, standardised process for the identifi cation, referral and

Nicola MacPhail and Susan Hancock explain the review of safeguarding practice that

won them the RCM award for excellence in initiatives in improving public health.

documentation of vulnerable families► Ensure all staff in maternity and neonatal services are trained in the process and provided with appropriate supervision ► Ensure all relevant current guidelines and policies were updated and communicated ► Develop strong relationships and referral pathways with local agencies ► Develop a team approach to supporting families through child protection procedures.

Over the past two years, we have implemented unborn baby records for any family where vulnerabilities or safeguarding concerns are identifi ed. All information regarding the assessment of need, ongoing communication between agencies, notes from social care meetings and case conferences are stored in this record and any staff member contributing to care can add to it.

Templates for midwives attending safeguarding meetings have facilitated clear, concise note-taking. Key information about

security issues, postnatal care planning while in hospital and clear procedures for discharge are now in place and documented in a universal way. A discrete sticker placed on records alerts staff to information regarding safeguarding concerns.

The achievement of our objectives has resulted in a number of benefi ts for parents, staff and, most importantly, babies. Where concerns exist, early intervention and engagement with other agencies can often prevent the need for child protection proceedings. A clear pathway, appropriate guidelines and a universal documentation system have provided staff with the necessary structure to embrace their responsibilities in safeguarding children.�

Nicola MacPhailMaternity matron Susan HancockSafeguarding midwifePlymouth Hospitals NHS Trust

Safety in service

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MIDWIVES • ISSUE 6 • 201242 VITAMIN DMIDWIVES • ISSUE 6 • 201242 VITAMIN D

Vitamin D is an essential nutrient during pregnancy and beyond, but it seems women are not always receiving the information they need, Erin Dean reports.

SHUTTERSTOCK

Rickets was believed to have been consigned to the Victorian era, when the bone disease was a sign of poverty and malnutrition in children. However, a resurgence of this

and other conditions caused by a defi ciency in vitamin D in recent years has led to a renewed emphasis on the role of midwives in tackling the problem.

Earlier this year, the chief medical offi cers from the four UK departments of health wrote to some healthcare professionals, although not midwives, to remind them of the recommendations for vitamin D supplementation (Davies et al, 2012). The letter said that evidence suggested that up to a quarter of the UK population could be at risk of vitamin D defi ciency.

It told NHS staff that all pregnant and breastfeeding women and children aged between six months and fi ve years should take a daily supplement of the vitamin.

The exception to this is infants who are fed formula milk, who will not need vitamin drops until they are receiving less than 500ml a day, as these products are fortifi ed with vitamin D. This echoes recommendations from NICE, which stress the importance of midwives

discussing vitamin D supplementation with pregnant women at the booking appointment (NICE, 2008).

Low levels of vitamin D have long been known to contribute to bone problems such as rickets. The vitamin is essential for the growth and development of a baby’s bones, by regulating the absorption of calcium and phosphate (NICE, 2012). According to NICE (2008), women should be told that the supplements will increase the vitamin D stores of both mother and baby and reduce the risk of the baby developing rickets. This guidance tells healthcare professionals to take particular care advising those at greatest risk of vitamin D defi ciency. These include women from South Asian, African, Caribbean or Middle Eastern descent, as darker skin does not produce as much vitamin D and who for cultural reasons, may wear clothing that covers them completely. Those who have little exposure to the sun are also at extra risk, as are obese women, because the vitamin is fat soluble and can be stored in fat cells.

A growing body of evidence in recent years has also suggested a link between shortages of the vitamin and a higher risk of other conditions, including heart disease, multiple sclerosis, type 1 diabetes, bowel cancer and breast cancer (Holick, 2004). The vitamin is mainly produced by ultraviolet B (UVB) sunlight rays falling on the skin, but some is also absorbed from food such as oily fi sh, cod liver oil and egg yolks.

RCM professional policy advisor Janet Fyle says it is important that all midwives are up to date on the latest recommendations regarding vitamin D. ‘Advising on vitamin D is an important part of the public health role of midwives,’ she says. ‘Midwives come into contact with women from early on in their pregnancy and are involved with them throughout their antenatal care and birth. This makes them key people to talk to women about vitamin supplementation and dietary issues in pregnancy.’

She continues: ‘The recommendation that

Tackling the defi ciency

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among children caused by a shortage of vitamin D. He stresses that healthcare staff need to remember that rickets and vitamin D defi ciency are not limited to people from low-income backgrounds. Concerns about skin cancer have led to some children being covered in high factor sunscreen and rarely being exposed to enough sunlight to generate vitamin D.

Colin points out that another consequence of increasing vitamin D defi ciency is a number of cases where parents may have been wrongly accused of harming their children because vitamin D defi ciency has left them with weak bones. This has led to small children being admitted to hospital with suspicious bone breaks.

‘Vitamin D is very cheap to make and those not receiving it will increase costs for the NHS in the future with complications,’ he says. ‘We are not going to know the outcomes of the defi ciency for the children of women who are pregnant now for perhaps 50 years. Midwives have a crucial role in talking to pregnant women about supplementation.’�

► For more information about the Healthy Start programme, please visit: healthystart.nhs.uk


bottle-fed babies need not be given vitamin D supplements could impact on the woman’s infant-feeding decision, as she may wrongly believe that formula milk is superior to breastmilk because of the added vitamin D.

‘This is why it is important for midwives to update their knowledge around vitamin D supplementation and breastfeeding and be able to provide parents with simple advice that improves their health, but also support their informed choices and decisions.’

Research has suggested that midwives are not giving suffi cient advice to pregnant women on vitamin D. A study published in Archives of Disease in Childhood last year found that only a quarter of 34 midwives in South London who completed a questionnaire said they gave routine vitamin D advice to their clients during pregnancy (Jain et al, 2011). A survey of 73 community midwives and health visitors published in Community Practitioner found that only half were aware of the Department of Health’s recommendations around vitamin D (Lockyer at al, 2011).

Jill Demilew, consultant midwife for public health at King’s College NHS Foundation Trust, says that all midwives should advise pregnant women to take vitamin D supplements in the information they send out before meeting them, and discuss it again when they meet them for the fi rst time. ‘Midwives are shocked that rickets is increasing and it is shocking that a disease of malnutrition is here today,’ she says. ‘Talking about vitamin D should be a routine part of antenatal care. As all women

should be taking supplements, the message is very simple. Education of all healthcare professionals who come into contact with pregnant women and children about the importance of vitamin D and the government’s recommendations is also important.’

Women on low incomes can qualify for the government’s Healthy Start programme, which off ers free vitamin supplements, including vitamin D. However, the chief medical offi cers said in their letter that uptake of vitamin D through this is very low. Jill says that midwives need to make sure it is straightforward for women to access these free vitamins locally. When she looked into the availability of the supplements in her area, she found that there was confusion over collection points for the Healthy Start programme. All midwives in the area now have lists of collection points to make it easier for pregnant women to get the vitamins. Midwives should also be giving all women information about the programme to ensure that those who are eligible, which includes all pregnant women under the age of 18, can benefi t, according to Ms Demilew.

Colin Michie, a consultant paediatrician at Ealing Hospital in London, has seen increasing cases of bone problems, delays in reaching milestones, such as walking, and seizures

THE UK DEPARTMENTS OF HEALTH RECOMMEND (DAVIES ET AL, 2012):

All pregnant and breastfeeding women should take a daily supplement containing 10μg of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.

All infants and young children aged six months to fi ve years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 7-8.5μg of vitamin D per day. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of formula a day, as these products are fortifi ed with vitamin D. Breastfed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.

COD LIVER OIL

OILY FISH

EGGYOLKS

SUNLIGHTRAYS

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MIDWIVES • ISSUE 6 • 201244 PERFORMANCE

In a demonstration of eff ectiveness, public services– including maternity – are facing increasing pressure to show how well they perform (Seldon and Sowa, 2011). As a result, performance management is an essential part of measuring and monitoring eff ectiveness

and is undertaken annually within maternity services for all employees through an individual performance review (IPR).

Primarily, the aim of the review and personal plan is to ensure that the individual develops and maintains the knowledge and skills for eff ective working by identifying learning needs so the manager can facilitate training and education. Performance management can also be seen as a platform for recognising excellence within the service, though in reality the term has negative connotations as it is a precursor to themore usual management of poor performance and underachievement.

Already used successfully in the private sector, research suggests that a good performance management system includes indicators of organisational performance (Elzinga et al, 2009), eff ectively aligning them with organisational strategy and business plan goals (Lawson et al, 2003). Due to the multifaceted nature of public sector work, however, and especially in maternity practice, there is a challenge to develop eff ective indicators of measurement (Peng et al, 2007). Based on activity where measurement is diffi cult, there are still suggestions that expected improvements in performance, accountability, transparency, quality of service and value for money have not yet materialised in many areas of the public sector (Fryer et al, 2009).

In a bid to provide consistency, the Knowledge and Skills Framework (KSF) implemented within the NHS in 2004 is applied in our maternity department. It advertises a single, comprehensive and explicit guide to good people management and promotes equality and diversity for all staff (DH, 2004). With core performance indicators aligned with organisational goals, dimensions are added to further individualise the plan, making it more meaningful.

For a band 6 midwife, this alludes to the completion of nine dimensions, designed to demonstrate the provision of a high-quality midwifery service. While generic dimensions

A new approach to performance management could be what’s needed to gain enthusiasm from staff and change maternity services for the better, says Amanda Lucas.

Hitting performance

targets

sacing

on

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dual nd

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es

.Illustrations: Brett Ryder

044-045_MID_Performance.indd 44044-045_MID_Performance.indd 44 02/11/2012 14:4902/11/2012 14:49


allow for individual interpretation, without specifi c guidance the review can often lack the consistency it sets out to promote. Since each area within the service requires diff erent approaches towards completion, staff and managers often see the review as only a ‘tick-box’ exercise, considering too many targets as detrimental to performance and quality (Moxham and Boaden, 2007).

Van Sluis et al (2008) believe that an individual, personalised scorecard would encourage employee ownership, with between seven and nine key measures to provide motivation to deliver the target performance. This personal measurement would ensure a unique development plan for each employee in contrast to the ‘one-size-fi ts-all’ approach, which is unlikely to be eff ective (Gunawardena, 2011) but is more commonly used within organisations. Advocating that performance management systems are not static but mature as the management style and organisational culture evolves (Bititci et al, 2006), this system would make sense in the ever-changing world of health care, perhaps even challenging the current KSF competencies and questioning the need for a comprehensive overhaul.

The general declining compliance inthe completion of annual reviews indicates that any initial enthusiasm of the performance management initiative has waned and been replaced with scepticism and cynicism, which could undermine attempts to enhance organisational performance (Townley et al, 2003).

In the private sector, it could be argued that reward and recognition is used to increase motivation in the form of fi nancial incentives and bonuses. Although deemed unethical within the public sector, it is still a tactic employed by commissioning bodies as a remit to improve patient care through Payment by Results and, adversely, penalties where targets are not met. Caution is advised (Deci et al, 2001), however, about the useof rewards for motivation, and Thomas (2001) strongly suggests that more intrinsic rewards, such as sense of meaning, sense of choice, sense of progress and sense of competence, lead to more engaged and committed employees.

I suggest that this sits more comfortably with the ethos of public sector organisations including maternity – for both ethical and fi nancial reasons – although even the

provision of intrinsic rewards requires a change of culture and the requirement of the hierarchical managers to ‘buy in’ and support the process. Eff ectiveness of any performance management also depends on employee involvement (Verbeeten, 2008), with benefi ts including increased motivation, job satisfaction and commitment.

For maternity services, the rewards could include improved communication, a clearly articulated culture, improvement of work performance and possibly better employee retention, but support from senior management would be required to ensure resources were available for eff ective measurement (de Waal, 2007).

In reality, the instrumental value of performance measurement cannot be guaranteed (Halachmi, 2011) and is often dysfunctional, with a loss of credibility among users within the service. The question is whether change can occur within performance management.

A personalised

developmental plan can

encourage the imagination to meet targets

I strongly believe it needs to, and that there is no better time than now, as managers are given the green light to take on more HR activities. Instead of employing performance management systems that are imposed on them from the hierarchy within their organisation (Zigan et al, 2008), the potential is there to learn from past behaviour in order to do better in the future.

Performance management has an important part to play in any maternity service. Used eff ectively, it can increase understanding of the organisational and departmental vision, as well as raise awareness of the constraints and operational challenges faced by the trust. To accomplish this, however, changes are required to the current practice so that it can improve the productivity and effi ciency of the service.

The defi nition by the Chartered Institute of Personnel and Development (CIPD, 2009) encapsulates the true meaning of performance management, in that it is ‘a process that contributes to the eff ective management of individuals in order to achieve high levels of organisational performance’.

I believe a personalised developmental plan can empower employees to think ‘outside the box’ and encourage the imagination to meet any goals and targets set. Adopting diff erent methods of measurement could make staff motivated and enthusiastic, instead of viewing the HR process as a paper exercise. Reviews and appraisals will be a continuous process of learning and development that will benefi t both the individual and the organisation, rather than an annual interview.

For our maternity services, further research is required, as is the acknowledgement that commitment is needed to gain an understanding of the current practice of performance management. Though interactive communication is essential, an understanding of the purpose and impact of performance management (Radnor and McGuire, 2004) will result in changes that can only enhance the maternity services within our organisations.�

Amanda LucasDeputy head of midwifery, matron and supervisor of midwives, Macclesfi eld Hospital


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MIDWIVES • ISSUE 6 • 201246 LMEs

Susan Way explains how the role of the LME has developed over the last 10 years, and why

midwifery education is more important than ever.

An evolving

role

In April 2002, the NMC came into being. Soon after, the role of the lead midwife for education (LME) emerged from the previously approved midwife teacher function set out by the English National Board for Nursing, Midwifery and Health Visiting (Barrell, 2006), and became fi rmly established in

the NMC’s Standards of profi ciency for pre-registration midwifery education (2004). The standards set out the role and function of the LME, stating it is a requirement for approval of midwifery education programmes that lead to applications to the midwives’ part of the register or a recordable qualifi cation. With the role embedded in the NMC standards, its strategic importance was clearly established.

LMEs are based at and employed by the educational institutes, of which there are 60 across the UK. They are experienced practising midwife teachers leading the development, delivery and management of midwifery education programmes; an essential part of the quality assurance process for high standards of education. LMEs are an important conduit between the NMC and the university, ensuring the NMC standards for midwifery programmes are met and maintained.

Since LMEs were formally recognised by

the NMC, they have become an established group of educationalists under the leadership of Maria Barrell (the fi rst chair) and, subsequently, Professor Diane Fraser. I became the third chair following Diane’s retirement.

The fi rst 10 years of the role of the LME have been very productive, primarily in informing the work of the regulatory body, as well as the RCM, as part of its education advisory group.

The NMC has established a number of strategic reference groups, of which LMEs are one. Within the group, which meets three times a year, LMEs play an important role in off ering advice and guidance to the midwifery committee – a statutory committee of the NMC – on regulatory matters relating to midwifery education, practice and statutory supervision. Examples of such input include the development of the Essential Skills Clusters for midwifery education, giving a view on student indexing, helping inform the direction of the new midwives’ rules and standards (soon to be published), and contributing to the quality monitoring tool to assess the compliance of the local supervising authorities with the NMC’s Midwives rules and standards (2004).

Once a year, a joint meeting of all the midwifery strategic reference groups provides an opportunity to hear the views of others in the early development of NMC policy and

standards. It is also an excellent opportunity to network and gain support for the various challenges each group may face.

Although the LMEs are spread widely across the UK, they keep in regular contact by email. Topics such as recruitment and selection, fi tness-to-practise procedures for professional programmes in the university and midwives’

LMEs have an important role in off ering

advice and guidance

to the midwifery committee

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exemptions are often discussed. It has been a helpful forum to provide mutual support, as often the LME’s voice is a lonely one within the university and the role can be challenging. For example, despite the NMC standards requiring the LME to have a strategic role within the university, unfortunately decisions about midwifery programmes are being made without consultation with the LME. It is, therefore, important that when the NMC undertakes its annual monitoring of approved programmes at the university, questions are asked about the input the LME has had in quality monitoring its midwifery education.

Communicating with other LMEs about these challenges in a timely manner enables support and guidance to be off ered. Newly appointed LMEs often require support to become established in their role, so are off ered a ‘buddy’, who usually works within their region.

Recently, the LME group has seen the need to meet outside of the regulation-focused NMC agenda and has started to get together twice a year to discuss wider issues impacting on midwifery education. For example, our last meeting, held at Birmingham City University, included items on the Midwifery 2020 report and its implications for midwifery education, the impact of the Midwives in Teaching report commissioned by the NMC and the changing role of the midwife, and the eff ects it may have on student midwives achieving the required competencies. The group also recognised the need to raise the profi le of LMEs, so the voice of the midwifery profession, as it relates to education, can be heard and consulted on.

There are many challenges ahead facing midwifery education; not least the retirement crisis, where 51% of midwife teachers are aged 50 and over and only 6% are aged under 40 (RCM, 2011). Qualifi ed midwifery teacher numbers are also down (RCM, 2011), so the challenge is for midwives to see teaching as an attractive and viable career option.

The RCM is helping to raise this issue and others within relevant forums, in order to ensure that the profession remains in control of its own education. LMEs can then continue to safeguard the care women receive by making sure newly qualifi ed midwives have completed a high-quality, contemporary midwifery programme that is relevant to the needs of the population they serve.�

Susan WayLME, Bournemouth University

For contact details of LMEs, please visit: nmc-uk.org

SHUTTERSTOCK

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MIDWIVES • ISSUE 6 • 201248 AUDIT

Do you shudder when the time comes to get organised for the annual local supervising authority (LSA) audit? Perhaps you are one of a number of midwives who wonder what the audit (and the fuss) is about. I’d like to share my experience of a recent audit in my trust, in order to demystify the preparation surrounding the event.

The annual audit is not as traumatic asyou might expect or be led to believe; thatis, if all supervisors of midwives (SoMs) actively engage in the process. An audit team, including the LSA midwifery offi cer (LSAMO), visited NHS Fife for our annual audit. Midwives and the women we caredfor were interviewed to elicit their viewson supervision.

The standards for statutory supervisionare set within the context of the NMC Midwives rules and standards (2004). Evidence of the achievement of these rules and standards (see box) is used by the LSAMO to demonstrate that standards for the LSA are met.

Some examples of good practice highlighted within NHS Fife following theaudit include:► The commitment and enthusiasm ofSoMs and their involvement at all levelswithin the organisation► Involvement of SoMs in the support and

The prospect of a local supervising authority audit need not be daunting. Annette Lobo

shares how best to prepare for it.

Under the spotlight

development of midwives when their practice has given cause for concern► Involvement of SoMs in ensuring that good practice within NHS Fife is showcased nationally► The contribution of SoMs in relation to patient safety and innovative practice is clearly evident► The notifi cation process of serious untoward incidents to the LSAMO.

Clear, robust evidence was provided to confi rm that NHS Fife is meeting the standards. While the majority of users continue to be unaware, at present, of the role of SoMs, it was clear that the input of users was valued to obtain opinions on improving maternity services within Fife. It was also noted that the executive team and senior clinical team continue to support and encourage SoMs within NHS Fife.

Of course, every audit requires an action plan, and ours includes gathering evidence of active user participation to shape the future of maternity services, a complaints analysis to be progressed through the supervisory network, an accurate record of supervisory activity by SoMs, and a trends analysis regarding supervisory reviews and investigation outcomes.

On a general level, the audit stimulates professional development and decentralises power, creating awareness of personal accountability and giving us a voice that, in

other circumstances, would not easily be heard. It provides an opportunity to ensure that all guidelines, policies and protocols are updated – no mean feat when they are generated by diff erent departments.

The audit also encourages a review of our ways of working, not only in relation to our supervisory work, but in ensuring we provide a quality service that is safe, eff ective and client-centred. We analyse trends and act on fi ndings, which is crucial to the delivery of a responsive, dynamic service.

In today’s climate of effi ciency savings, healthcare provision can be severely aff ected, often to our cost, as some of us know. By becoming a SoM, you can contribute to ensuring your NHS trust continues to deliver a high-quality, clinically eff ective service.

If you’re interested, speak to a SoM, your trust or board’s contact or link SoM, or the LSAMO, who will be able to answer any questions you have. The role will require commitment from you and can be challenging, but it is stimulating, motivating and extremely rewarding, especially if you care about the service provided to women you care for.�

Annette LoboSupervisor of midwives, NHS Fife


STANDARDS FOR STATUTORY SUPERVISION (NMC, 2004)► Standard 1. SoMs are available to off er guidance and support to women accessing a midwifery service that is evidence based in the provision of women-centred care.► Standard 2. SoMs are directly accountable to the LSA for all matters relating to the statutory supervision of midwives and a local framework exists to support the statutory function.► Standard 3. SoMs provide professional leadership and nurture potential leaders. ► Standard 4. SoMs are approachable and accessible to support midwives in their practice.► Standard 5. SoMs support midwives in providing a safe environment for the practiceof evidence-based midwifery. (The new Midwives rules and standards will come into eff ect from January 2013.)

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rcm.org.uk/midwives 2012 • ISSUE 6 • MIDWIVES 49BENEVOLENT FUND

Following the breakdown of my marriage, I found myself in an impossible fi nancial situation, especially with two young children. My employer at the time was unable to off er me set shifts and my childcare could not off er fl exibility. Something had to give, and in this case, it was my career. I was facing a breakdown and decided I had no option but to take some time out. My confi dence was at a low – everything I had worked so hard for in my career was being put on hold and I was uncertain of being able to return to midwifery.

A colleague told me about the benevolent fund at the RCM and encouraged me to apply. I wrote a letter explaining my circumstances, with little hope that I would be eligible for any assistance. I submitted the letter and got on with life, putting the application to the back of my mind.

A helping hand

enabled me to pay long overdue bills and replace essential items in the home, but most importantly, it relieved the fi nancial pressure I was feeling at the time. I had received some help from friends and family, but I never expected to receive such a generous gift; especially one that would have such an impact on my life.

My story is not one of self-pity and I would not wish to be seen as a victim, but I found myself in incredibly diffi cult circumstances, which can happen to all of us at some pointin our lives. The assistance I received from the RCM eased the enormous stress levels I was feeling at the time.

I am still working hard and juggling the pressures of being a midwife with a young family – something that is no diff erent for many other midwives – but I will always be immensely thankful to the RCM for its help during a period of great stress and personal diffi culty.�

AnonMidwife

For more information on the RCM benevolent fund, please call: 020 7312 3535 or email: [email protected]

SHUTTERSTOCK

This account from a midwifetells how an award from the RCM

Trust’s benevolent fund helpedher through fi nancial diffi culty.

I continued to support myself and my children fi nancially with my divorce settlement and subsequently moved house.

Several months passed and I decided that, with both of my children at school, I had the confi dence to return to midwifery. I started a new job in a wonderful maternity unit, making new friends and fi nding a new approach to life. I was also able to make childcare arrangements that allowed me to work in the fl exible manner that midwifery dictates.

I could not believe the kindness and generosity of the RCM when, shortly after, I received a cheque for £1000. The money

THE BENEVOLENT FUND

The benevolent fund of the RCM Trust is there for all midwives, not just RCM members. Student midwives, MSWs and anyone eligible who feels they need fi nancial help during a diffi cult time should apply. Having said that, the fund only has a small income compared to need, so donations are especially welcome. To ensure the benevolent fund is able to provide this vital support in future years, please consider making a donation (which can be gift aided), fundraising or leaving a legacy to the fund in your will.

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MIDWIVES • ISSUE 6 • 2012 rcm.org.uk/midwives50 RCM BRANCHES

As a London project worker I have become increasingly involved in helping RCM branches in the capital merge or be revitalised. My role was created to help recruit and engage RCM members in this low-density area. I have been working with trusts across London that have no workplace representatives (WPRs) or branch offi cers to garner interest in relaunching their branch by visiting maternity units, organising workplace meetings and setting up elections.

We all know that midwives are incredibly busy, so I have been supporting branches to make use of email and online communities to keep in touch with RCM members and to recruit activists. Since WPRs are highly important to recruitment, I have helped to appoint several, as well as branch offi cers, and have supported branches to either merge or split off from larger ones to become employer based.

Many members tell me they are frustrated by low attendance at branch meetings, but I believe that even if day-to-day activities fall to

The activities of RCM branches can be overlooked, but they are still going strong, says Alice Sorby, who has seen many success stories in her role.

Branching outbranches are still going strong.

One such example, and a branch I have worked with closely, is South London, which was formed when three separate branches merged to become one. It has been a great success due to the hard work and dedication of its activists.

Generally speaking, active branches like to engage in fundraising activities, and South London has proved no exception. Despite forming only last year, the branch has supported the charity Life for African Mothers by raising more than £3000, sending two midwife members to Sierra Leone and hosting a spring ball with live music.

If you feel inspired to get involved with your branch, or if you already are and just want some ideas for events, please contact me or a local representative.�

Alice SorbyLondon project workerAlice can be contacted at: [email protected] or on: 020 7312 3421.

a small number of dedicated activists, having the branch structure in place means the RCM has a strong presence in the workplace and is well supported. An active branch will receive the funds to which it is entitled, to reimburse expenses that WPRs incur in representing members, attending training days, hosting study days and supporting members to attend the RCM annual conference.

In order to make funding for branches fairer and to encourage activity, we are increasing their entitlement and allocating a set amount of money to each ‘signifi cant workplace’ rather than just by branch. This will be communicated to branch offi cers in more detail soon, but we hope this will allow members to get more out of their local branch.

When talking to RCM offi cers about branch success stories, I am inundated with examples of fundraising, study days, branch conferences, union learning events, celebrations and the supporting of members. It’s amazing what RCM members have achieved this year alone, showing that

An active branch will receive

the funds to which it is entitled

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rcm.org.uk/midwives 2012 • ISSUE 6 • MIDWIVES 51MSWs

We posed questions about a midwife who had asked an MSW to undertake a set of maternal observations and start a cardiotocograph (CTG) on a woman in early labour. Half an hour later, there were no fetal heart recordings on the CTG and the woman was taken to theatre for an emergency CS.

The development of the role of the MSW in supporting midwives has been largely welcomed. There is an increasing amount of evidence that MSWs contribute positively to the experience of mothers and their families, particularly in postnatal care (Griffi n et al, 2011). It is recognised that care is enhanced where midwives and MSWs work as a team and both understand their responsibilities and sphere of competence (RCM, 2010). It could be argued that this is brought into sharp focus on the labour ward, due to the legal and statutory responsibilities of the midwife in childbirth.

Midwives need to be cognisant of the NMC’s Midwives rules and standards (2004) and The Nursing and midwifery order 2001 (HMSO, 2002), which states: ‘No person other than a registered midwife or a registered medical practitioner shall attend a woman in childbirth, unless in an emergency or in supported recognised training.’ You may have considered that the actions of the midwife in this scenario resulted in a breach of these obligations.

What are the responsibilities of both the midwife and the MSW where there is a delegation of task(s)?

In an MSW’s shoes: part two

but not so in the labour ward, particularly if the observations are the baseline for all subsequent care. Where the CTG is concerned there is less ambiguity. This is a task that must not be delegated to an MSW, as the skills and knowledge required are within the role and competence of the midwife or medical practitioner.

Should the MSW have accepted the delegated tasks? Despite being competent in undertaking observations – temperature, pulse and blood pressure – in this scenario, the context is an issue as the woman is in labour and care should be provided by a midwife. The MSW should have refused to start the CTG as this was outside the competence expected of an MSW and her role.

Ultimately, who is responsible?In the eyes of the regulator (NMC), it will be the midwife, but the MSW could also be called to account by their employer for accepting a task that they are not competent to perform.�

RCM COMMUNITIESWhat do you think about the advice given? Have you ever been in this situation? Join the discussion at: communities.rcm.org.uk

For a reminder of the original scenario from Issue 5, please see: tinyurl.com/c337pzh


SHUTTERSTOCK

In the last issue of Midwives, readers were asked to refl ect on a fi ctitious scenario set in the labour ward. Here we

look at the responsibilities of the midwife and the MSW.

The midwife is responsible for ensuring that the tasks are appropriate for an MSW to perform and that the MSW is competent to carry them out. In turn, the MSW must be confi dent that they are competent because, once accepted, they could be held responsible if the tasks are carried out in a negligent way.

Where observations are concerned, the context also has to be considered. In the postnatal period, it would be appropriate for an MSW who is trained and understands the issues around reporting to carry out observations,

The MSW must be confi dent

that they are competent

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FootnotesResources / Bookmark

Resources reviewed by Midwives’ expert reviewers

Midwifery survival guideEDITED BY: Jacqui WilliamsPUBLISHER: Quay BooksPRICE: £19.99REVIEWER: Gill Gosling

Welcoming babyAUTHOR: Debby GouldPUBLISHER: Fresh HeartPRICE: £21REVIEWER: Jenny Patterson

An informative insight into the third stage of labour and the midwife’s role in its management, this book looks at recent studies and questions the routine use of uterotonic drugs.

Wider issues are also detailed, including the negative and positive aspects to each method of delivering the placenta.

The book points out the lack of informed choice women are given as oxytocin drugs are seen as a normal or safe approach.

Since giving a uterotonic drug is the only intervention many hospitals still off er routinely, the book makes an interesting point that although midwives continue to promote normality in every other aspect of pregnancy and birth, we are still continuing to intervene with the natural process of the third stage.

Overall, it is a detailed and interesting read and I now feel more knowledgeable with regards to informing women of the benefi ts of a physiological third stage.

This practical survival guide has lots of information to prompt newly qualifi ed midwives on the basics of midwifery practice. However, it would also come in handy for student midwives, due to the breadth of subjects covered.

The guide is sectioned into six balanced chapters. I especially liked the chapter ‘Dealing with challenging situations’ and I think if student midwives were to read this prior to going into practice, then they may feel more confi dent about possible complications and challenging situations, enabling them to further their learning.

I found the chapter ‘Promoting normality’ particularly useful as it reinforces Midwifery 2020.

I feel the book would benefi t from some illustrations, as the amount of information written in such a compact way can be overwhelming. Despite this, I found the book extremely informative and believe it would be suitable to use from the beginning of training through to qualifi cation and beyond.

This book captivated me from the fi rst page, as Debby explores the signifi cant issues facing the maternity system in England and the impact on women-centred care. She explores the implication of increased institutionalised care and intervention, not only on mothers, but on babies and their care providers.

Debby examines evidence around newborn development in the fi rst few hours and the importance of getting this right for the lifelong wellbeing of both mother and baby. She suggests we may be missing the big picture and asks why we continue routine procedures that are still not evidence based.

Debby also emphasises the need for us all to critique our individual motivation, attitude and core values, personally incorporating small changes in our workplace to inspire change slowly but surely.

Practical and thought-provoking, it gives the reader opportunities to refl ect. I highly recommend it for all maternity care providers.

Birthing your placentaAUTHORS: Nadine Pilley Edwards and Sara WickhamPUBLISHER: AIMSPRICE: £8REVIEWER: Kyle Baikie

BOOK BOOKBOOK

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Catching babiesAUTHOR: Sheena ByromPUBLISHER: HeadlinePRICE: £6.49REVIEWER: Kirsty Burfot

As a pre- and antenatal exercise professional, I am always stressing the importance of exercise during pregnancy.

The book is broken down into easy-to-follow chapters and begins with the benefi ts of Pilates and how it can help as the body changes during pregnancy. There is clear explanation of the science with the right amount of detail, but I did feel that the text was a little ungracious in places, which could generate apprehension for those who are both new to pregnancy and exercise.

The fundamentals of Pilates are explained next, followed by several chapters detailing exercises and plans for the diff erent stages of pregnancy.This enables people at any level to benefi t from the book. There is also a postnatal chapter, which I feel is especially useful, as many mothers want to return to exercise quickly after giving birth and this chapter provides information on how to do it safely, using in a positive tone of voice.

All moves have been specially selected for pregnancy and can be adapted to the level and stage of the student, enabling them to tailor their own plan.

There are plenty of pictures and an action guide, as well as watch points to ensure the move is being performed safely and eff ectively. This book would also benefi t those off ering advice to pregnant women, as practising Pilates in the recommended ways can help to reduce stress levels and improve breathing techniques during pregnancy and, hopefully, during labour.

I thoroughly enjoyed reading the stories as Sheena retold them; it was like listening to an experienced aunt retelling her memories. However, at times the train of thought was not always clear and the timeline and events jumped around. While the author has attempted to draw the reader into the event as it unfolds, I often felt I was left wanting for that little bit more.

Reading the modern history of midwifery, much of it spanning my own childbearing years, is fascinating and I found myself smiling at a lot at the similarities in our own training and experiences, even though they are decades apart. I think everyone in a similar position will have a fond memory about an austere consultant, which surprised them but remains with them.

It is an easy-to-read biography, full of many lovely memories put down on paper by someone who was a pioneer in her day and who obviously cares deeply about her career. Sheena’s dedication and warmth came through with every page turned and the genuine care she feels for her clients is a breath of fresh ai r.

Pilates for pregnancyAUTHOR: Lynne RobinsonPUBLISHER: Kyle BooksPRICE: £15.99REVIEWER: Claire Muscutt

BOOKBOOK

If you’ve enjoyed the recent explosion of all things midwifery related lately, then you won’t be able to put this book down.

Tales of a midwife charts Maria’s career, spanning from a frightened student nurse unable to stop fainting in the delivery room during her maternity placement, right through to her current senior position as a consultant midwife.

Once I opened this book, I couldn’t put it down. As a fellow midwife, I was nodding along to some of the events described, although I can honestly say I’ve never broken my hand during a delivery!

My only criticism is that, as a fairly modern midwife, I felt many of my colleagues might have similar, if not more exciting stories to tell, particularly those who have practised midwifery abroad. I would have also liked Maria to describe more about her own experiences of motherhood, in particular what it feels like to be on the other side, as this was the last chapter in the book and it felt rushed.

I thoroughly recommend this book as a poignant and honest account of what it’s really like to be a midwife.

Tales of a midwifeAUTHOR: Maria AndersonPUBLISHER: HeadlinePRICE: £6.99REVIEWER: Samantha Faulkner

BOOK

Want your book/DVD/CD reviewed?Please send a review copy to Hollie Ewers at Midwives, Redactive Media Group, 17-18 Britton Street, London EC1M 5TP. We are unable to return these copies.

Would you like to be a reviewer?Please email your name, address and your area of expertise to Hollie Ewers at: [email protected]

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FootnotesEvents / Dates to remember

If you would like to advertise on this page, please contact sales executive James Condley on: 020 7880 7661 or email: [email protected]

DiaryyThis page aims to inform readers of courses,

training and events relevant to midwifery.

Hypnobirthing practitioner training course19-22 November22-25 April This UK-based course is run by midwives for midwives and led by an experienced midwife and hypnobirthing practitioner with guest speakers.Location: LondonCost: £400 (plus £40 registration)T: 07591 070474E: judithfl [email protected]: ahbm.co.uk

Doctoral Midwifery Research Society (DMRS) launch of the Welsh branch23 November This one-day research conference, held for the fi rst time in Wales to launch the Welsh branch of the society, will include speakers such as the chief nursing offi cer for Wales Professor Jean White. Location: Glamorgan Building, Cardiff UniversityCost: £10T: 020 7312 3540E: [email protected]: doctoralmidwiferysociety.org

UNICEF UK Baby Friendly Initiative annual conference5-6 December In its 15th year, this conference off ers a mixture of innovative, entertaining and challenging presentations on a wide range of issues associated with supporting successful breastfeeding.Location: Cardiff Cost: Both days: £210; single day: £120 T: 0844 801 2414E: bfi @unicef.org.ukW: unicef.org.uk/babyfriendly/conference

Hypnobirthing teacher training diploma course17-20 January 7-10 March Become a registered practitioner with Katharine Graves. ‘It was a life-changing experience and will enhance my midwifery career amazingly.’Location: London (January); West Midlands (March)Cost: £697T: 01264 731437E: [email protected]: thehypnobirthingcentre.co.uk

RCM annual midwifery awards 201324 January These awards celebrate achievements and excellence in midwifery. For this year’s shortlist, please see pages 30-31 of this issue.Location: The Brewery, LondonCost: RCM member single ticket: £89 (plus VAT) or a full table of 10: £875 (plus VAT)T: 020 7324 2764E: [email protected]: rcmawards.com

Healthcare records on trial25 February, 11 and 25 MarchDelegates will complete a record-keeping exercise, scrutinise notes and carry out role-plays. Common errors and how to create, maintain and use records that are fi t for purpose will be highlighted through trainer-led discussions and case studies.Location: RCM headquarters, LondonCost: £100 (plus VAT)T: 020 7549 2549E: [email protected]: bondsolon.com

Deborah Robertson’s breastfeeding specialist courseApril/May 2013 – April 2014The format for this course is 12 study days (70 hours) plus optional homework (50 hours). Suitable for professional breastfeeding practitioners, lay volunteers or IBLCE lactation consultant exam candidates.Location: London or ExeterCost: On applicationT: 01634 814275 E: [email protected]: breastfeedingspecialist.com

Nutrition and nurture in infancy and childhood conference10-12 JuneThe fourth international interdisciplinary conference is being organised by the University of Central Lancashire’s maternal and infant nutrition and nurture unit. Location: Lake DistrictCost: Three days: £375 (plus VAT); daily rate: £125 (plus VAT)T: 01772 893809E: [email protected]: uclan.ac.uk/healthconf

RCM legal birth conference11 JulyNow in its fi fth year, this unique conference takes a dynamic look into the current legal issues and challenges facing healthcare professionals involved in providing maternity care. Location: London (TBC)Cost: Early booking rate: £100 (plus VAT) before 31 December 2012. Standard rate: £120 (plus VAT)T: 020 7549 2549E: [email protected]: bondsolon.com/midwives-conference-london

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2012 • ISSUE 6 • MIDWIVES 57

UP FOR GRABSHere’s a chance to get your hands on some great giveaways with our free prize draws.

COMPETITIONS

rcm.org.uk/midwives

WIN ONE OF FIVE COPIES OF NORMAL MIDWIFERY PRACTICEFor new students, the language and concepts of midwifery care can be daunting at fi rst. This book, by Sam Chenery-Morris and Moira McLean, helps in the understanding of the expectations of midwifery training in relation to normal practice. It covers the basics of care, including professional practice, frameworks informing care, key concepts and philosophies of care, communication and care skills, antenatal care,

WIN ONE OF 10 BOTTLES OF ORGANIC GOLDEN CAMELLIA NATURAL MOTHERAND BABY OILExtracted from the seeds of the camellia oleifera plant, Organic Golden Camellia is one of the fi nest natural plant oils for human skin. Containing vitamins A, B, D and E, polyphenls and other antioxidants, Organic Golden Camellia acts as a perfect sebum substitute, mirroring the skin’s sebum production to help replenish lost moisture. Suitable for use on the face, hair and body, this multi-purpose oil can also be used during and after pregnancy to reduce stretch marks, as well as a baby massage oil. It’s a 100% natural product, which has been approved by the Vegan Society and certifi ed organic by the Soil Association.

Midwives has two pairs of tickets to skate at the twinkling Royal Pavilion Ice Rink in Brighton. The prize includes a glass of mulled wine or hot chocolate with a festive mince pie at the rink’s stunning ‘pop-up’ restaurant and bar, created by Jamie Oliver’s Fabulous Feasts.

Known by many as the most beautiful winter rink in the South East, it has the former royal pleasure palace as a backdrop and 800 square metres of real ice, with space for 250 skaters. The facility off ers penguin stabilisers for children and a learners’ area, as well as boots available in sizes from ‘just walking’ to adult.

Whether a skater or not, everyone is welcome to enjoy delicious food and drink

HOW TO ENTER

► To enter these competitions, please email your name, address, telephone and membership number, clearly stating which competition you are entering to: [email protected]

► The closing date is 20 December. Winners are drawn at random. Only one entry per household accepted. The editor’s decision is fi nal.

by day and night at Jamie Oliver’s Fabulous Feasts rinkside restaurant and bar.

Terms and conditions: Open from 10 November until 20 January. Tickets are valid during off peak times, subject to availability. For more details, please visit: royalpavilionicerink.co.uk

WIN ONE OF TWO PAIRS OF TICKETS TO BRIGHTON’S ROYAL PAVILION ICE RINK AND JAMIE OLIVER’S ‘POP-UP’ RESTAURANT

normal labour and birth, postnatal and neonatal care and breastfeeding, as well as a brief introduction to medicines

management in normal midwifery care. The book is designed to work alongside fi rst taught modules and underpin training in subsequent years.

—WORTH £18.99 EACH

—

—WORTH £24.99

EACH —

—WORTH

£20EACH

—

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FootnotesCrossword / Puzzle

1. Diameter measured between the sacral promontory and the iliopectineal eminence (13)

8. Exact copy of a person (5)

9. Coral reef enclosing a lagoon (5)

10. Follow immediately afterwards (5)

12. The present time (5)

14. One of two, situated in the scrotum (5)

15. Proprietary antiseptic, used to sterilise babies’ feeding bottles (5)

17. Folds in the vagina (5)

20. ----- bifi da, incomplete closure of the spine (5)

22. Substance which causes changes, as in ‘chemical -----’ (5)

23. Indicates glands (5)

24. Located outside a cell (13)

1. Accessory lobe of placenta (13)

2. Coagulated blood (5)

3. Extremely overweight (5)

4. Excess of tissue fl uid (6)

5. For example, candida albicans (5)

6. Egg shaped (5)

7. Prolongation, especially of the fi rst stage (5, 2, 6)

11. Beyond a specifi ed limit (5)

13. Flower, similar to the primrose (5)

16. Contains outlets for themilk ducts (6)

ACROSS

DOWN

18. ‘-----’ vein of Galen, within fetal skull (5)

19. Additional (5)

20. ----- for gestational age or ‘light for dates’ (5)

21. Highly satisfactory (5)

Last issue’s answers

Test your wits on this midwifery-focused puzzle... How many did you get right? Look out for the answers in Issue 1 :: 2013.

1. 2. 3.

9

15

21

4. 5. 6. 7.

8.

8.8. 6. 9.

16

22. 23.

24.

23.

16. 18.

19.

16.

20. 21.

10. 11.

17. 18. 19.

15.14.

11.

13.

13.12.

Crossword 05: Jan Wallis

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