The Safeguarding Role of the Midwife Where is the Supervision? Virginia Hewitt - Head of Safeguarding Children ABMU Health Board South Wales UK 1
Aug 13, 2015
The Safeguarding Role of the Midwife
Where is the Supervision?
Virginia Hewitt - Head of Safeguarding Children
ABMU Health Board South Wales UK
1
Background
MA in Medical Humanities 2011
Named Midwife for Safeguarding Children
Acknowledged the impact of the midwife’s safeguarding role and a potential lack of support
Identified the subtle nature of the ‘midwife – woman’ relationship and how this may conflict with protecting the newborn
Set out to evaluate whether statutory supervision supports the midwife’s role in safeguarding children
2
Methodology
Literature Search using humanistic principles
The role of the midwife was explored using literary and historical references
The midwife’s safeguarding role includes ethical and legal dilemmas such as the removal of the baby at birth
Aspects of safeguarding supervision were considered as well as statutory supervision of midwives
3
‘As Old As the Hills!’
An ancient profession
- Anthropological evidence
- Ancient Greece
- Biblical references
Originally female – myd wyf – with woman
Other terms – priestesses, wise women, gamps, witches, god-sips, hags
5
The Professional Midwife
End of C19 – need for social reform, improve health of poor
Medicalisation of birth
Sairy Gamp image ‘dirty drink-sodden
old hag without skill or conscience’
(Leap and Hunter 2003)
Midwives became professionalised in 1902
6
Early Safeguarding Role
Biblical reference - Protecting Hebrew baby boys from death
Babies baptised during or straight after birth to prevent being ‘firebrands of hell’ (Thomas 1971)
Testifying in court with regards to infanticide
7
Midwife’s Safeguarding Role Today
Often first professional to work with potential new parents so need to recognise early signs of neglect and abuse
Public health role - smoking/domestic abuse/substance use/mental health – impact on unborn & baby
Teenage Pregnancy
The younger they are the more vulnerable they are
Midwives have a responsibility up until 28 days after birth
8
Unique role of the midwife
Cares for mother and baby together not as two separate entities
Works in partnership with women (International Confederation of Midwives 2005)
Professional Accountability to keep mother and baby together
Supports mother re choices - refuses antenatal care, birth at home, free birth, lotus birth
‘Balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or
refuse treatment’ (NMC 2015)
Caring for the woman when the baby dies – stillbirth/miscarriage BUT also when baby is removed from mother due to child protection concerns
9
Conflict in Responsibilities
A legal requirement to ‘safeguard and promote the welfare of children’ (Children Act 2004)
Responsibility to report issues that could affect unborn and/or baby
Unborn has no legal rights – Birth Plans to remove
Removal at birth is unlawful unless instructed by court of law
The safeguarding role of the midwife is not widely recognised
10
Comments
‘ I have felt a great responsibility re child protection, but at the same time feeling quite inadequate to meet that responsibility.’
‘ The amount of time we spend ensuring that we fulfil our duty to these women AND their babies not to mention their often abusive partners by far outweighs the actual time spent with the woman.’
(Midwives on RCM Forum 2010)
11
The origins of Midwifery Supervision
Following professionalisation of midwives in 1902 – Inspectors of Midwives were introduced
Punitive Role
‘Usually ‘respectable’ women such as clergymen’s daughters’ - some suggest ‘patronising and judgemental’ (Heagerty 2006)
1937 – renamed supervisors – more supportive and to have ‘sympathy and tact’ (Rutherford 2009)
12
Supervision of Midwifery Today
To protect the public from malpractice
Statutory Requirement – Midwives’ Rules
Not clinical supervision
Some supportive elements mainly practice related
Safeguarding Children issues not acknowledged in midwifery supervision training material
13
Two Hats
Managed or Supported?
‘To root out bad practice is very different from the support skills needed to foster the confidence in the face of uncertainty’
(Kirkham 1996)
14
Safeguarding Supervision
Focus on practitioner
Developed from models of clinical supervision
Restorative – listening, challenging, supportive
Allows practitioner to identify & clarify situations which
have legal, professional and ethical components
Managerial aspect to reduce risk
Recommended as essential protective factor in child protection work (Laming 2003, 2009)
15
Findings
Professionals working within the safeguarding children arena find the work emotionally demanding
Midwifery work - high emotional content
The safeguarding role of the midwife is not always acknowledged in comparison for example to the health visitor
An assumption that supervision of midwifery provides appropriate support
16
Recent Changes
Serious failings - Maternity Unit Morecambe Bay
Ombudsman – Review of Midwifery Regulation 2013
‘ Midwifery supervision and regulation should be separate as it led to a conflict of interest between midwives and supervisors’
Kings Fund Review of Midwifery Regulation 2014
‘The additional layer of regulation...for midwives and the extended role for the NMC over statutory supervision should end’
Morecambe Bay Report 2015 ‘Urgent response to King’s Fund findings with effective reform’
17
Recommendations
Royal College of Midwives are determined to retain the supportive aspect of supervision and the responsibility of the future of midwifery supervision now sits with the chief nursing officers
Ideal opportunity to explore the safeguarding role of the midwife
Further research to understand some of the dilemmas midwives face within this important role
Devise a model of supervision that will empower and support the midwife
18
Conclusion
It has been argued that the relationship between mother and baby is the most powerful relationship human beings experience (Taylor 1996)
Midwives sometimes become part of a process that breaks that bond.
This can cause emotional distress for a midwife whose prime focus is the mother
Good safeguarding supervision is needed to support the midwife and to ensure the safety of the baby.
19