The Magazine of The Royal College of Midwives · The Magazine of The Royal College of Midwives ISIISSSUSE EE 2 22 | 2 201 B i r t h f o r e c a s t i n g i n t u r b u l e n t i m

Midwives

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rcm.org.uk/midwives 2012 • ISSUE 2 • MIDWIVES 3

Midwives5 ► JON SKEWESThe RCM’s director of employment relations looks at pensions and pay.

7 ► NEWSCall the Midwife success, fetus parties, investigation into the NMC, and autism risk... Midwifery stories hot off the press.

12 ► RCM NEWSThe RCM’s e-petition, tribunal win, the recent pensions off er and a trade union rally... The latest news.

14 ► WORK LIFEAmy Leversidge speaks to three workplace representatives about their roles.

17 ► ON POLITICSDespite the goverment’s boasts of record numbers, Stuart Bonar argues that maternity units are still short of staff .

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

20 ► IN FOCUSFindings revealed from the RCM and RCOG’s FGM event.

21 ► GLOBAL NEWSThe latest news from around the world.

23 ► ONE-TO-ONERob Dabrowski talks to the new RCM president Lesley Page.

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Volume 15 ˙ Issue 2 ˙ 2012

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EDITORIAL

HEADLINES

OPINIONS

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MIDWIVES • ISSUE 2 • 2012 rcm.org.uk/midwives4

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

EDITORIAL

Editor and RCM Communities manager: Emma [email protected]: 020 7324 2751Deputy editor: Rob [email protected]: 020 7324 2752News and features reporter: Hollie [email protected]: 020 7880 6210Digital media executive: Rhea [email protected]: 020 7324 2773Professional 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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Divisional sales director: Steve [email protected]: 020 7880 6220Sales manager: Giorgio [email protected] Tel: 020 7880 7556 Senior sales executive: Ben [email protected] Tel: 020 7880 6244

DESIGN

Art editor: Carrie BremnerArt director: Mark Parry

COVER

Illustrator: Hattie Newman

PRODUCTION

Production executive: Aysha [email protected]: 020 7880 6241

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

MAGAZINE SUBSCRIPTION QUERIES

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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

26 ► RCM COMMUNITIESWhich group are you a member of? You’re not? Why not take a read of the latest blogs and get involved.

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

28 ► FEEDBACKMistakes spotted on Call the Midwife, views on acupuncture treatment, and success at the Blackburn Birth Centre.

30 ► UPFRONTLabour ward midwife Estella King explains why a brisk walk could be the best way to speed things along.

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

34 ► HOW TO…Encourage a woman to remain in active labour.

36 ► EBMA summary of the latest EBM papers.

37 ► BIRTH FORECASTINGCould the midwifery crisis have been spotted earlier?

41 ► GUIDE TO MONEYThe Money Advice Service has revamped the Parent’s guide to money.

42 ► AQPSimon Popay investigates the impact of AQP on maternity services.

44 ► RCM ALLIANCEThe RCM’s Louise Silverton looks at the RCM’s partnership programme.

46 ► RCM AWARDSKangaroo care has proved an award-winning success at a Kent hospital.

48 ► EVENTS

49 ► COMPETITIONS

50 ► CROSSWORD

ON THE COVER

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ON FOCUS

FEATURES

FOOTNOTES

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EditorialRCM director of employment relations Jon Skewes


Your pension, your pay, your NHS

T he NHS is engulfed in turmoil, cuts and assaults on your pay, pensions and conditions. The threats to the living, working and professional standards of midwives and MSWs

are lining up in multiple waves.I write this on the day that the prime minister chose

to exclude 95% of health professional bodies from his summit on the Health and Social Care Bill. The bill creates more bureaucracy, costs more and will privatise services. Still it must, it seems, be forced through against the wishes of NHS professionals and the public. At least the governments are less capricious in Scotland, Wales and Northern Ireland.

Midwives and MSWs are facing ever-increasing threats to Agenda for Change. At a UK-wide level, we are reviewing the agreement to try to ensure it is resilient in the long term. In England, we face a host of regional and trust-based challenges – all aimed at cutting terms and conditions. The chancellor has asked the pay review body to examine regional pay variations and imposed pay restraint at the same time as high infl ation. The RCM is clear – we support a UK-wide system of pay and

conditions common to all in the NHS.The fi nal insult has been the three-pronged attack

on your pensions. Pay more, work longer and receive less has been the battle cry of the government. A

promise of far-reaching austerity into old age. The RCM has, alongside other unions, been negotiating hard

on this. We should soon complete a ‘Heads of Agreement’ upon which we can consult with you. We will not be able to claim that higher contributions or the link to the ever higher state pension age have been defeated. We have, however, been able to secure protection for those in their last 10 to 13 years before retirement and the value of the pension in payment. To get a better deal in the long term, serious and sustained industrial action would be necessary.

We know that members fi nd the thought of being forced by economic circumstance to work up to the age of 68 anathema. We will continue to campaign on this issue, but decision time on the future pensions package is upon us. You will shortly receive a briefi ng and consultation on the potential agreement on pensions this month. Please make your decision on the way forward. We live in tough times, but the RCM is there for you.�

MIDWIVES 38 FORECASTING BIRTHS rcm.org.uk/midwives 39

More babies were born in England in 2010 than in any year since 1972. The baby boom isn’t a new revelation - the statistic is almost a year old.

The 32,000 plus who have signed the RCM’s e-petition will know that this is the reason it is calling for ‘urgent action’, demanding 5000 more NHS midwives and pushing for a Commons debate on the issue.

But a revelation that Midwives can report is that the baby boom is likely to last until at least 2016.

It is only then that it will gradually begin to tail off, according to research by healthcare forecaster Dr Rod Jones.

It is worrying news for maternity services that are already under-staffed, under-resourced and over-stretched. And with the government’s grip due to tighten on NHS coffers under Andrew Lansley’s contentious reforms, the future allocation of midwifery resources is facing turbulent times.

To calculate the duration of the baby boom, Dr Jones charted previous years’ birth rate statistics for England and Wales.

The jagged line in Figure 1 shows the peaks and troughs in birth rate from 1938 to 2010. The first big spike – and the highest by some way – comes after the end of the Second World War.

Before this period, in which the red line almost shoots off the top of the chart, it plummets into a deep trough for the years when Europe was torn apart by war.

‘It’s not surprising there was a baby boom after the war; the same thing happened after the First World War too,’ says author and war historian Simon Fowler. ‘It wasn’t just England, of course – it was a phenomenon that happened all over the world.

‘People came back from the war to their sweethearts and there was work and employment for them.

‘While social and economic conditions were still fairly grim, there was a feeling of prosperity and people naturally wanted to start families, so the birth rate shot up.’

There are numerous examples of the birth rate peaking after natural disasters, believed to be due to a subconscious biological drive for the survival of the species.

For example, nine months after an 8.8 magnitude earthquake devastated Chile, the health minister reported ‘a marked increase

Illustrations: Hattie NewmanWords: Rob Dabrowski

Midwifery is in crisis

The birth rate is sky-high and resource planning is struggling to

cope. Midwives talks to Dr Rod Jones about his future forecast and asks

why the dark clouds weren’t spotted looming on the horizon.

see from where the population increase is coming’.

Before going on to claim: ‘The schoolyard is where the changing population makeup is most evident. As these children grow up and have children of their own, we will become a minority across the board.’

However, such claims are swept aside by Dr Jones’ analysis of the statistics.

‘It is important to point out that the influx

71% rise in births since 2001, meaning it is at its highest since 1948.

As birth for older women is more likely to involve complications, demand on midwives and maternity services is even higher.

Some have claimed that the influx of immigration from Eastern Europe over recent years is behind the high birth rate in the UK.

The extreme right-wing nationalists the BNP recently trumpeted, ‘we can clearly

average number of children per mother. ‘Obviously, this main cycle applies to white

British families and additional mini-cycles will commence in times of influx of immigrants.

‘However, the key point is that these cycles lead to periods of higher and lower demand for maternity beds and midwives.’

His analysis of Figure 1 reveals that the length of time from trough to peak after the Second World War has steadily increased.

It lasted six years in the 1940s, 10 years in the 50s-60s and 14 years in the 70s-90s.

If this rate of increase continues, then the present rise in birth rate, which started in 2002, should last 14 years, or more.

‘The current cycle of high births could continue to somewhere around 2016 before heading into the downward part of the cycle,’ says Dr Jones. ‘The basic message here is that current pressures could continue for at least another four years, plus a few more years on the other side of the peak.’

Recent figures released by the Conservatives show a 4.4% increase in the number of NHS midwives since the coalition came to power in 2010. But, with the current baby boom not set to tail off for a number of years, according to Dr Jones’ results, there are urgent appeals for more resources.

Along with the e-petition piling pressure on the government, there are also demands that David Cameron honours his pre-election promise for 3000 more midwives.

Cathy Warwick, RCM chief executive, said: ‘Once David Cameron was safely inside Number 10 the pledge was dropped.

‘The excuse was that the number of births was no longer rising.

‘This is bizarre in the extreme given that in 2010, the latest year for which we have figures, the number of births in England was actually at its highest level for 40 years.

‘For too long, maternity services have been denied the resources they desperately need.

‘England is in the midst of a baby boom. David Cameron should reinstate his personal pledge for 3000 more NHS midwives and crack on with the job of delivering them.’

The situation is made even worse by the fact that women are starting families later in life. As revealed in last year’s groundbreaking Birthplace study, there has been a dramatic rise in women over 40 giving birth.

Its results show this age-group has seen a

in obstetric consultations in the most damaged areas’.

While after floods hit Gloucestershire in 2007, the county’s birth rate increased from 5946 to 6730, and Tewkesbury – where the floods hit hardest – experienced a two-decade high.

Unsurprisingly, with 3.5m British serving in the war, there were very few babies born in November 1940 – 14 months after Germany invaded Poland.

But, almost two years after VE Day, with the troops settled back into British life, the

birth rate shot up and was 80% higher by March 1947.

Dr Jones says this post-war boom is the reason for both the boom in the 1970s and the current birth rate increase.

‘Depending on when these babies grow to become women and choose to have their first and subsequent babies, a repeating cycle is set up,’ he says.

‘The distance between the peaks is roughly set by the average age at which women choose to have their children and the width of the peaks is roughly determined by the

FIGURE 1: BIRTHS PER DAY (MONTHLY) FROM 1938 TO PRESENT

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Data kindly provided by the Office for National Statistics

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MIDWIVES 42 POLICY rcm.org.uk/midwives 43

Imagine if buying a muffin from your local café was like using the NHS. You’ve just met with a dietician. She advised you to eat a low-fat blueberry muffin every morning for the next six weeks. The catch is there’s only one café in your local area where you can get your muffin. Unfortunately, you’ve heard some not-so-good things about it. It seems that they don’t mix the ingredients well, and the muffins tend to be slightly burnt. The muffins will meet your dietary needs for sugar, but you’re not going to enjoy eating them. A friend says there’s a café a little further away from your home that does really good blueberry muffins. But, to your dismay, because the café is in another commissioning area, you won’t be able to go there.

Now turn that idea on its head. Imagine if using NHS maternity services was more like buying a muffin from your local café. Let’s say that you are pregnant. Fortunately for you, in your area, there are several different providers to choose from. You can use NHS Choices to see user reviews on each of them, just the same as using Google Maps to compare nearby cafés. You can talk to your GP and friends about which providers have the friendliest midwives and offer the best antenatal classes. There is even one in the area that keeps a stock of fresh blueberry muffins in its waiting room. You consult with your

Illustrations: Eoin Ryan/Agency Rush

Another Questionable Procedure

for maternity services

The RCM is calling on the government to scrap the Health and Social Care Bill in England.

The policy of ‘Any Qualified Provider’ is at the heart of

this. But what is it? And what impact could it have on

maternity services? The RCM’s Simon Popay investigates.

providers of community-based services in limited areas. These organisations face a further challenge of setting up agreements with local hospitals for access to facilities. These organisations will be operating under the current structure of the NHS and before AQP takes effect. AQP will make it easier for such private providers to become part of the NHS in England.

AQP policy is at the heart of the controversy around the government’s healthcare reforms, and is a major concern for the RCM. But what makes it so controversial? The problem, as with many major public service reforms, is that AQP is essentially a big gamble. By creating an open, market-based playing field, the government is leaving the future direction of the NHS up to its patients and providers. Even if the policy and regulatory framework that the government puts in place gets all the incentives and rules right, the eventual outcome remains uncertain.

Whatever happens, AQP will likely result in significant changes to the NHS in England. As a market-based approach, it will rely on competition to not only encourage better performance within organisations, but to close poor-performing providers and allow better-performers to take over. NHS employment will probably be less stable as a result.

There is a possibility that AQP will lead to improved outcomes for patients and more efficient services, but it is only a possibility. If patients are less discerning, or providers less scrupulous than the government anticipates, the reforms could seriously undermine the quality and efficiency of health care in England.

On weighing up the pros and cons, the RCM decided earlier this year to oppose AQP and call for the Health and Social Care Bill to be scrapped. Not only do we think that the bill is unnecessary, but we believe that it creates a serious distraction from the need to make £20bn in efficiency savings by 2015. Most crucially, the focus on competition that AQP creates runs directly counter to the ethos of collaboration that is so essential for safe, responsive and high-quality maternity care.

The RCM is far from the only organisation to oppose the bill. We are all waiting with great anticipation to see what the government will do in the face of growing opposition.�

RCM COMMUNITIES

14:00 and 16:00 on 3 April

http://communities.rcm.org.uk

PROS► Patients get to make more decisions about their own care ► Providers improve their services in response to competition ► Midwives get a wider range of employers to choose from ► Providers are more accountable to their patients.

CONS► Less integrated care as providers are reluctant to support competitors► Greater variation of care quality between regions► Profit-driven providers will drive up costs for the NHS► Instability (for both patients and staff) as providers are forced to close by competition.

Under AQP, patients in England will be able to choose from any providers of health care that meet certain standards set by the Care Quality Commission and Monitor, the independent regulator of foundation trusts, who is set to become the sector regulator for health and adult social care in England. Providers could include foundation trusts, not-for-profit organisations and for-profit businesses. All will be subject to the current rigorous quality standards as the NHS currently uses.

AQP could eventually apply to most aspects of NHS care, though the Department of Health (DH) has identified some areas as unsuitable, such as accident and emergency. In maternity services, the DH has said antenatal education and breastfeeding support could be subject to AQP from 2013/14. Beyond this, AQP could be extended to all aspects of maternity services.

The RCM expects that, for the foreseeable future, NHS providers (such as NHS and foundation trusts) will continue to deliver the bulk of maternity services. This is predominantly because of the high capital costs involved in setting up birth units and the challenges in getting insurance against clinical negligence claims. However, we have already seen some private providers applying to become qualified

By creating an open, market-based playing field, the government is leaving

the future direction of the NHS up to its patients and providers

GP and you make your own decision.Two years later, you’re pregnant again. Things

have changed though, as maternity service providers have been competing with each other over the years. There are now two major maternity service franchises operating in your area – think the healthcare equivalents of Pret and Eat. Additionally, there’s a local independent group of midwives specialising in home births. You’re disappointed that you don’t have quite as many providers to choose from, but talking to your GP and browsing NHS Choices shows the quality of services has improved significantly. Once again, you make your own decision.

At its heart, it is this sort of health care that the government’s ‘Any Qualified Provider’ (AQP) aims to achieve. The policy is at the core of the healthcare reforms that aim to stimulate quality and service improvements through competition.

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CONS► Less inare reluc► Greatebetween► Profit-for the N► Instabprovider

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MIDWIVES 24

OpinionOne-to-one /

25

S he has published more than 200 journal articles, served on three national committees and worked and lectured in 13 countries around the world.

She has also written three books, racked up more than 32 years practising and has a 24-page long CV.

But for Professor Lesley Page, who has been elected the RCM’s next president, midwifery is not about qualifications and prestigious titles.

‘I think my background is probably quite unique,’ she tells Midwives. ‘I’ve managed to integrate clinical work, with managerial and academic work.

‘I’ve got a lot of experience in different

areas, and in different ways of practising and working, and I feel I have a great deal to offer this position.

‘But I’ve always prided myself on knowing exactly what it is like to be a midwife in practise, which is something that gives me a huge amount of joy.’

It is her passion for grassroots midwifery that she hopes will come to the fore in her new position with the RCM.

‘I believe that when the baby is born, the mother is also born and I think that, as midwives, we can help women learn their own strength,’ she says.

‘I think that the most important thing is that we are flexible and responsive to the needs of women – we need services in which

midwives can provide care that is sensitive and safe for women.’

Lesley, who currently practises for Oxford Radcliffe Hospitals NHS Trust, was sitting at her computer replying to emails when she found out she had been elected.

‘I saw an email from the RCM and as soon as I opened it and saw the news, I was over the moon,’ she smiles. ‘Over the following days, I had hundreds of emails and Facebook messages and I spent a couple of days just replying to them.

‘I think, once the intense excitement had subsided, the feeling I had was that it was such a great honour to be elected by midwives into such an important role, in the profession I love.’

Lesley has been involved in midwifery since 1966, when she qualified after training as a nurse.

She joined the profession when the second wave of feminism was gathering momentum and calls for equality were echoing across the Atlantic.

‘The women’s movement was underway and I started to discover how important good midwifery was, and how closely it was linked to feminism,’ she says.

‘I started to challenge routine practices within the hospital when I found that they weren’t good for women.

‘Like the fact that women weren’t allowed to eat anything during labour, in case they needed a caesarean section, which I thought was just ridiculous and not in any way evidence-based practice.’

Then, in 1977, she travelled across the Atlantic to challenge not just routine practices, but national preconceptions about the midwifery profession.

‘I was about 30 years old when I moved over to British Columbia and midwifery wasn’t legal in Canada at the time,’ she says. ‘So I became involved in the work to establish midwifery.

‘I worked closely with midwives and senior obstetricians and we set up a project that became the first legally recognised midwife service in Canada, which is something I’m incredibly proud of.

‘I’ve travelled to 13 different countries

and my travels have made me realise how precious the midwifery and maternity services are in the UK,’ she continues.

‘There are challenges at the moment, but we have a midwifery service that is respected and that people care about a great deal. It’s a profession seen with fondness and it is part of our culture.’

But it is these challenges that Lesley will have to face in her role as president, when she takes over from Liz Stephens on 2 April.

‘I think that the major challenge for me is a political one – we’ve got a lot of evidence that midwife-led care is safe and we need to make that a default option, but it’s often not easy to have evidence accepted,’ she states.

‘The results of the Birthplace study show that midwifery-led care is very safe and that midwives can practise in a number of different ways and I think that we have a really important role to play.

‘I plan to work with the other medical

‘There are

challenges at the moment, but we

have a midwifery service

that is respected. It’s a profession

seen with fondness and it is part of our

culture’colleges to move that forward. I’d like to see every woman in the UK have a genuine choice of place of birth and I’d like midwives to be able to choose where and how they work and be supported in that choice.’

At the end of her term, Lesley hopes to have made a genuine difference – the position means far more to her than another line on an already bulging CV.

‘I would like people to say that when Lesley Page was president of the RCM, she understood the situation, worked to help develop and maintain the profession and move it forward so that midwives could choose the way they would practise and deliver sensitive, women-centred care.

‘I love the academic side of things, but I love the practical side too and through the presidency of the RCM I will help midwives wherever they work to give their best so that we can provide really good care around the time of birth.’�

Lesley Ann PagePhD MSc BA RN RM

► Served on national committees for the Department of Health, the House of Commons and The King’s Fund

► Deputy chair of the English National Board for Nursing Midwifery and Health Visting (1993-99)

► Appointed professor of midwifery in 1992 – the first such appointment in the UK

► Academic focus on the development and evaluation of one-to-one midwifery, using evidence in practice and evaluation of place of birth

► Influential book The new midwifery: science and sensitivity in practice has been translated into French and Japanese

► Involved in establishing midwifery programmes at universities in Canada

► Visiting professor at King’s College London, the University of Technology, Sydney, and the University of Sydney

► Involved in clinical practice and experienced in every area of practice including hospital, community, birth centre and home birth

► Honorary fellow of the RCM, in recognition of considerable contribution to the profession

► Awarded the degree of Doctor of Philosophy in 2005 by the University of Technology, Sydney

► President of the Maternity and Newborn Forum section of the Royal Society of Medicine

► Member of the Association of Radical Midwives and Medical Justice

► Vice chair of Scientific Committee at the Humanization of Birth Conference in Brazil

► Extensive experience of externally examining PhDs for universities around the world

► Has written forewords for nine books.

FACT FILE

Top picks The new RCM president on her story so far, birth forecasting, and the impact of AQP on maternity services

Meet the president (p23) Midwifery is in crisis (p37) Another Questionable Procedure? (p42)

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rcm.org.uk/midwives/news 2012 • ISSUE 2 • MIDWIVES 7

HeadlinesThe latest professional news

Hot off the press / News

The runaway success of Call the Midwife has had a positive knock-on eff ect for midwifery.

University applications board UCAS has revealed there have been 37,081 requests to train for the profession this year – an increase of nearly a fi fth from 31,783 in 2011.

Sue Jacob, RCM student services advisor, said: ‘This can only be a good thing for the profession. But people should not have a rose-tinted view based on a TV show set in the 1950s.’ Cathy Warwick, RCM chief executive, added: ‘The series is having a very positive eff ect, it is encouraging women to see midwifery as a potential career.’

A second series of the hit show was commissioned after just a couple of episodes.

It has now been named the BBC’s most successful new drama for a decade, after it averaged 8.7m viewers per episode. The second series will run for eight episodes and production is due to start later this year.

SERIES SUCCESSTV ADAPTATION PROVIDES BOOST FOR PROFESSION

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MIDWIVES • ISSUE 2 • 20128

HeadlinesNews / Hot off the press

20.2%

30.3%

6.1%

A charity has called for action on stillbirths, claiming that over 1200 lives a year could be saved.

Sands launched a report at the House of Commons in which it says more research, improved care and greater awareness are needed.

The report calls for improved use of scans and more education about health for mothers-to-be.

Neal Long, the charity’s chief executive, said: ‘A third of stillborn babies – about 1200 every year – are born late in pregnancy, at gestations when they might safely be delivered.

‘But routine antenatal care is failing to detect far too many babies who need help.

‘We want to see real national commitment to tackling this ignored tragedy

and preventing all avoidable baby deaths in the future.’

Gail Johnson, RCM education and professional development advisor, agreed that it is important that work continues to explore how stillbirth can be reduced.

‘Ensuring that all mothers have access to high-quality antenatal care delivered by midwives is the fi rst step towards having a healthy mother and baby at the end of pregnancy,’ she said.

‘Midwives are in a position to provide women and families with information and support to minimise risks and poor outcomes.

‘However, to ensure that antenatal care and parenting education is appropriately delivered, we need to have enough midwives to deliver the care.’

BABY DEATHS

CHARITY CALLS FOR ACTION

FETUS PARTIES

WORRIES OVER THE ‘COMMERCIALISATION’ OF PREGNANCY, ACCORDING TO RCM CEO

There is concern that women in the North East are around three times more likely still to be smoking at the time of birth than women in London.

Figures released by the NHS Information Centre reveal that one in fi ve women (20.2%) in

Concerns have been voiced about the growing US ‘fetus party’ craze, which has hit the UK.

Cathy Warwick, RCM chief executive, has said that the parties, where people show off 3D

SMOKING DIVIDEPREGNANT WOMEN IN NORTH LIGHT-UP MORE

and 4D scans, raise ethical issues. In a BBC column, she called

it a ‘worrying trend towards the commercialisation of pregnancy’.

‘There is a worry that supposed diagnostic scans are now being used for entertainment. Across the country, services for “fetus” parties are popping up,’ she wrote.

‘Some companies provide a champagne celebration scan package – this is a far cry from the original purpose of ultrasound.’

It raises particular concern because many women now give birth later in life, when it is more likely there will be complications.

UK law allows the mother-to-be to make decisions on behalf of her unborn baby. Cathy wrote: ‘Using technology in this way seems to have the potential to upset this position and raises the issue of women being accused of doing wrong by their fetus, as happens in the US.’

the North East class themselves as smokers when they give birth.

Blackpool has the highest rate for a primary care trust, with a fi gure of 30.3%.

The London Strategic Health Authority has the lowest rate, with just one in 16 (6.1%) classing themselves as smokers.

Louise Silverton, RCM deputy general secretary, said: ‘The North-South divide revealed in these statistics highlights the gaping health inequalities in access to appropriate public health services.

‘The RCM believes midwives play a vital role in promoting public health, therefore, we urge all strategic health authorities and local authorities to invest in midwives to support smoking cessation programmes.

‘We need more midwives to deliver the public health agenda and signpost parents to the most appropriate services.’

The results show that, across England, 13.4% of women were smokers at the time of giving birth. This has gradually fallen from 15.1% in 2006/7.

The results also reveal that Brent Primary Care Trust had the smallest proportion of women who smoked at the time of delivery, with just 2.8%.

The NHS Information Centre chief executive Tim Straughan said: ‘The statistics highlight stark regional variation in the proportion of women smoking at the time of giving birth.’ SH

UTTE

RSTO

CK/A

LAM

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North East ↙

↖ Blackpool

↗London

%Pregnantsmokers

008-009_MID_HEAD_news.indd 8008-009_MID_HEAD_news.indd 8 7/3/12 12:21:447/3/12 12:21:44

rcm.org.uk/midwives/news 9

8%»

3000Extra midwives Cameron

promised before the 2010 general election, but has not delivered

87%Institute of Healthcare Management members who think the health bill is

‘fundamentally fl awed’

9.2MViewers that tuned in to watch

the fi nal episode of the TV adaptation of Call the Midwife

// /FAST»FACTS

GENETIC TREATMENT

DEBATE RAGES OVER PIONEERING GENETIC TREATMENT

DIABETES RISK

CONDITION IN MOTHERS LEADS TO INCREASED CHANCE OF DEFECTS IN BABIES

Researchers have been awarded £6m in funding to develop a groundbreaking treatment, in a bid to prevent genetic conditions.

It is hoped it could stop heart, muscle or brain conditions being passed on to future generations. But it is causing controversy as it involves transferring the parents’ DNA into a donor egg, meaning the child would inherit 0.2% of the genetic coding from the egg donor.

This makes it against current scientifi c regulations, which the health minister has the power to change.

The research is aimed at tackling diseases passed down through families via mutated mitochondria, which supply power to cells.

Faults in the mitochondria

aff ect about one in 200 children in the UK each year, causing diseases such as muscular dystrophy.

Professor Doug Turnbull, who is leading the research, said: ‘If this technique proves to be as safe as IVF and as eff ective as the preliminary studies, I think we could totally prevent the transmission of these diseases.’

A spokesperson from Comment on Reproductive Ethics branded the procedure ‘very, very far removed from nature’.

But Sir Mark Walport, of the Wellcome Trust, said the genetic impact would be as minimal as changing the batteries in a camera.

The Department of Health has now ordered a public consultation on the issue.

One in 13 babies born to a woman with diabetes is aff ected by a defect, such as heart disease.

For women without diabetes, the risk is one in 50, a study has found.

The researcher suggests the higher a pregnant woman’s blood sugar levels, the higher the risk.

Doctors at Diabetes UK are urging women with diabetes to take advice on glucose control before starting a family.

However, they also stressed that, despite the increased risk, the vast majority of women with diabetes do not go on to have babies with birth defects.

The study analysed the outcomes of 401,149 pregnancies, including 1677 pregnancies in women with diabetes.

Researcher Ruth Bell said: ‘With help before and during pregnancy, most women with diabetes will have a healthy baby.’ She added

→ Blackpool has the highest rate of women who smoke at the time

of birth at 30.3% ‘any reduction in high glucose levels is likely to improve the chances of a healthy baby’.

Previous research had shown that having diabetes increases the chance of birth defects. But this is one of the fi rst studies to

quantify the eff ect of glucose levels on risk.

Researchers at Newcastle University and the Regional Maternity Survey Offi ce carried out the study between 1996 and 2008 in the North of England.

THE PERCENTAGE OF BABIES BORN TO A WOMAN WITH

DIABETES WHO HAVE A DEFECT



HeadlinesNews / Hot off the press

Children have a greater chance of suff ering from autism if either parent is older than 35 at the time of their conception, claim researchers.

The risk is up to 27% higher than it is for those with younger parents, according to their results.

The study looked at 1.3 million children born in Denmark over a period of more than 20 years.

It was conducted by researchers from Denmark, working with Cambridge University, and the results imply that the risk posed by the mother’s and father’s age is about the same.

Previously, it was widely thought that the age of the mother had a greater impact than the age of the father.

The researchers also say

AUTISM RISKCHANCES ARE HIGHER FOR BABIES OF OLDER PARENTS

the results show that if both parents are in their late 30s, the risk is no higher than if it is just one parent.

Autism is often thought to be associated with natural changes that occur to both eggs and sperm as people age.

However, the new study suggests that, while age is a factor, there may also be another explanation, which is not yet known.

Caroline Hattersley, of the National Autistic Society, said that the research suggests a link between parental age and autism, but that little is known about the biological chain that leads to the condition.

She said that ‘more studies are needed’ before fi rm conclusions are reached.The study looked at births between 1980 and 2003.

QUADRUPLETS BORN

ALL WERE DELIVERED WITHIN SIX MINUTES

11 weeks

before they were due

A woman has given birth to quadruplets, who came 11 weeks early and were all born on the leap day.

Emma Robbins from Bristol gave birth to four boys by caesarean section within six minutes of each other.

Zachary, Rueben, Joshua and Samuel were all born on 29 February at St Michael's Hospital and are all believed to be well.

The babies range in weight from 2lb 8oz to 3lb 1oz, two are identical and they were conceived naturally. They were born after 29 weeks and one day of pregnancy.

Emma has set up a blog called Emma’s Quad Diary to document her experiences. Her husband, Martin, wrote an entry the day after they were born. It says: ‘They are all healthy and happy and doing really well.

‘Rueben and Zachary have been given a few doses of surfactant to help their lungs cope being with being born premature, which makes breathing easier and prevents the lungs from collapsing.

‘They have also been on mechanical ventilation to avoid respiratory distress and maintain oxygen levels and air pressure, which they will be weaned off within 48 hours after birth.

‘Otherwise the hospital is really happy with their condition and we have been told to expect them to be in care for 6/8 weeks. They are so small yet so perfect!’

35CHILDREN HAVE A GREATER CHANCE OF SUFFERING FROM AUTISM IF EITHER

PARENT IS OLDER THAN 35

CORB

IS/R

EX F

EATU

RES

The four babies were

born



The strategic review of the NMC will be completed by the end of May, it has been revealed.

The Council for Healthcare Regulatory Excellence (CHRE) was asked to conduct the review by MP Anne Milton.

Harry Cayton, chief executive of the CHRE, is overseeing the review and admitted that there have been instances at the NMC where things have ‘gone quite badly wrong’.

He said: ‘We are trying to do this as quickly as possible and we need better regulation, not more regulation.’

The fi nal report will be made public in May, although an exact date has not been confi rmed.

It is being conducted because of ongoing concerns over the performance of the NMC, which receives more than 4000 complaints a year.

The wide-ranging review is looking into organisational structure, resource allocation and operational management, among other areas.

Louise Silverton, the RCM’s deputy general secretary, was at the briefi ng.

She said: ‘I hope that this will be a defi nitive review of the NMC and that it is an opportunity to get the NMC working eff ectively and effi ciently, so that it can concentrate on its core roles and functions and maintain and improve its services.’ The fi nal trust has been announced for a pilot

study into the late diagnosis and treatment of children’s conditions.

United Lincolnshire Hospitals NHS Trust has become the 17th in England to sign up to take part in the study, which is being undertaken as part of the NHS Newborn and Infant Physical Examination Programme.

Professor Adrian Davis OBE, director of the programme, said: ‘I am delighted that so many hospitals and maternity sites are helping us with this national pilot, which, I believe, could really have a dramatic impact.’

It involves staff using a specially designed IT system to capture information from the newborn physical examination.

The system highlights late or missed examinations and will also enable timely referrals, should further monitoring, investigation or treatment be needed.

During the course of the trial, it is expected that the examinations of 29,000 babies across England will be recorded on the system.

The quality of this screening test has, in the past, varied across the country, sometimes resulting in late diagnoses.

After the pilot study has been completed, a formal evaluation will be carried out.

If it is found to be successful, then the programme will off er the same improvements to all other newborn physical screening services throughout England.

REGULATOR REVIEW

INVESTIGATION INTO THE NMC IS NOW UNDER WAY

Health professionals have more infl uence than anyone else when it comes to weight loss and healthy eating, according to a new survey.

In contrast, the results of the poll show that politicians, celebrities and the media have very little impact.

The RCM’s new Alliance partner Slimming World is behind the poll, which was conducted to coincide with its Let’s Beat Obesity Together campaign.

A total of 22% of those surveyed said health professionals were the group most able to infl uence them to adopt a healthier lifestyle. However, 20% of people said they would choose family and 15% selected friends.

Only 1% chose politicians, and 5% said celebrities or sports stars were most likely to have an impact on their behaviour.

Dr Jacquie Lavin, Slimming World’s head of nutrition and research, said: ‘Our research clearly shows that people look for advice, support and solutions from those close to them, such as their GP, family and friends, rather than politicians and celebrities.

‘When it comes to losing weight, having the support of people who are close to you, who care about how you feel and who can truly understand what you’re going through is key to success. That’s because trust is hugely important when it comes to infl uencing change.’

WEIGHT LOSS

WOMEN TRUST HEALTH PROFESSIONALS MOST FOR ADVICE ON LOSING WEIGHT

DIAGNOSING

BABIES

PIONEERING TRIAL HOPED TO HAVE ‘DRAMATIC IMPACT’

— Health professionals

↙

—Celebrities ↙

—Friends ↙

—Family ↙

/NEWS»BRIEFS

‘Diet infl uences babies’Women who are picky eaters during pregnancy may have children who are fussier. Research found

babies whose pregnant mothers ate aniseed were attracted to it.

Pilot stage fi nishedThe fi rst stage of a study

exploring the impact of traumatic birth on midwives has been completed. The main phase of the research project has now begun.

Questionnaires are being sent out to a random sample of midwives.

Tobacco packagingThe Smokefree Action

Coalition has launched a new website, calling for the standardised, generic tobacco packaging. The RCM is a member of the coalition.

15%

20%

5%

22%



HeadlinesRCM news / The latest stories

PENSIONS OFFER

MAKE YOUR VOICE COUNT IN CONSULTATION ON FINAL OFFER

RCM PETITION MORE THAN 30,000 SUPPORTERS

The RCM’s offi cially lodged government e-petition to address the shortage of midwives in England is going from strength to strength.

The petition, which is calling for 5000 more NHS midwives, now has over 30,000 signatures.

But we still have a long way to go to reach our 100,000 target by August.

The petition, which demands ‘urgent action’ from the Department of Health, was set up by RCM chief executive

The election to be president of the RCM has been won by Professor Lesley Page.

The new president elect will take up offi ce on 2 April 2012 and become the RCM’s ceremonial fi gurehead and ambassador at national and international events.

Lesley said: ‘It is such an honour to be elected as president of the RCM.

‘There are huge challenges for maternity services ahead but also great opportunities and I look forward to working with Cathy Warwick, the Board and the RCM team in helping our members to both overcome the obstacles and embrace the opportunities.’

Lesley currently practices in Chipping Norton, Oxon, for the Oxford Radcliff e Hospitals NHS Trust.

To read a full interview with Lesley about her plans for the role, please turn to page 23.

NEW PRESIDENT

RCM WELCOMES LESLEY PAGE TO HER NEW ROLE

The RCM is consulting with members on the government’s fi nal off er on pensions.

We will be sending out the consultation papers by post during March, which will ask whether the RCM should accept or reject the off er.

It is important that you think carefully about the proposals – please read

through all the information that is sent to you in your consultation pack and also on the website.

You should be aware that this is the best off er that we can achieve in negotiations.

If you choose to reject the off er, you must be prepared to take serious and sustained industrial action.

And the government can still impose a new scheme, which may be worse than the off er we have negotiated.

The RCM Board will make the decision on whether the RCM accepts or rejects the off er, based on the results.

Make sure you respond to the consultation and have your say on your pension.

5000THE PETITION, WHICH DEMANDS A DEBATE IN

PARLIAMENT CALLING FOR 5000 MORE MIDWIVES, NOW HAS OVER 30,000 SIGNATURES

»

Cathy Warwick. It states: ‘The NHS is desperately short of midwives, and the shortage aff ects every region of England.

‘We need urgent action from the government, including a target to recruit the equivalent of 5000 more full-time midwives.’► For more information, visit the campaigns and events page on the RCM website: rcm.org.uk/protectcampaign

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RCM NEWS AND DATES

RCM staff and members joined forces with other trade unions and health professionals in the TUC’s All Together for the NHS campaign rally.

The rally at Westminster took place on 7 March and demonstrated deep concerns and the breadth of opposition to the controversial Health and Social Care Bill.

The following day women from around the world joined the RCM and Women for Women to celebrate the 101st International Women’s Day.

It was the third anniversary of the Join Me on the Bridge campaign, which is aimed at raising support and solidarity locally, as well as globally, for women’s issues around the world. ► Further information on the TUC campaign can be found at: action.goingtowork.org.uk/rally-to-save-our-nhs

The RCM supported members to achieve a landmark judgement in an employment tribunal against Central Manchester University Hospitals NHS Foundation Trust.

The trust was ruled to have unlawfully deducted pay of some employees by attempting to link sickness to the withholding of incremental progression.

It has now been ordered to pay the 83 claimants any money that they have lost out on as a result.

Jon Skewes, RCM director of employment relations, said: ‘The RCM, which supported this crucial test case and had members involved, thoroughly welcome this ground-breaking judgement.

‘This test case sends a stark legal

LANDMARK

JUDGEMENT

RCM MEMBERS’ SUCCESS IN TRIBUNAL OVER PAY

RALLY AND

MARCH

MEMBERS OUT CAMPAIGNING

RCM ANNUAL EVENT AND LECTURE This year’s RCM Annual Event takes place at the University of York on 14 June. This RCM-accredited CPD event includes the Zepherina Veitch memorial lecture: ‘Hospital birth: a riskier choice for healthy women and babies?’ This year’s speaker, Dr Mary Stewart of King’s College London, will be discussing the results of the pioneering Birthplace in England study.

The event will include an address from RCM chief executive Cathy Warwick as well as the chance to hear from the new RCM president and to meet the RCM board of directors and staff . The event is free for RCM members and includes a buff et lunch and a drinks reception, but places are limited, so early booking is recommended. ► Members wishing to attend should book at: rcm.org.uk/annualevent

BREASTFEEDING AWARENESS WEEK Are you interested in an opportunity to promote and support breastfeeding in your community? The RCM is working with Alliance partner Mothercare to provide opportunities for midwives and MSWs to hold information sessions. These will be situated within Mothercare stores across the UK during breastfeeding awareness week, which will take place from 18 to 24 June. ► To fi nd out more, email: [email protected]

ANNUAL CONFERENCE CALL FOR PAPERS Do you have a research or best practice project to share with your profession? Abstract submissions are open until 4 May for the chance to present in the concurrent sessions at the 2012 RCM Annual Conference. The session themes for member contributions at the conference include: supporting disadvantaged groups, newborn care, public health, entrepreneurship and midwifery history. There are also opportunities to

submit posters. The event will be held at the Brighton Centre again this year on 13-14 November.► For more information, and guidance on how to submit, please visit:tinyurl.com/76ysagu

I-LEARN – SIGN UP FORA CHANCE TO WIN Sign up to i-learn, our online learning platform, and if you are lucky enough to be our 3000th member to join, you will win an M&S voucher worth £50. ► Sign up at: rcm.org.uk/ilearn to start learning online today

18-24 June Breastfeeding

awareness week

4 MaySubmission deadline for annual

conference papers

14 JuneRCM Annual Event to be

held in York// /QUICK

LOOK DATES»

warning to the NHS and the government that they cannot take midwives for granted and ride roughshod and trample on the employment contracts and conditions of our members.

‘Central Manchester chose to unilaterally impose their policy on sickness absence against the negotiated contract (Agenda for Change) for NHS staff and have been clearly found to be acting illegally by the tribunal.’

SAM

KES

TEVE

N/A

LAM

Y

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HeadlinesWork life / Amy Leversidge

→ What are you waiting for? Your colleagues need you,

so get involved and then you can make a diff erence

The RCM’s Amy Leversidge, in the fi rst of her regular employment relations articles, speaks to three workplace representatives about their roles.

W ORKPLACE REPRESENTATIVES are the backbone of the RCM. They represent and support members in satisfying roles.

They also have the vital responsibility of ensuring that midwives and MSWs have a voice in the workplace, while gaining valuable skills and experiences for themselves.

The RCM has about 800 UK workplace representatives in three roles: steward, health and safety and union learning representative.

Here, a representative from each fi eld shares their thoughts on their role and reveals the reasons why they wanted to get involved.

ROSEMARY GOSDEN, STEWARDAdvocacy has always been important to me. It is often considered an essential element when providing midwifery care, particularly while working in the setting of a high-risk birth centre, where helping women to achieve the birth they want can be challenging.

A few years ago, I was asked by some colleagues if I would consider being an RCM steward, I said ‘yes’ – women need advocates, midwives do too.

I've done some great things in the role, including recording a song with other public sector workers, which was then released to raise money for charity, and marshalling on the picket line at the TUC Day of Action.

Being a steward is important to me because

THE PIVOTAL ROLE OF WORKPLACE REPRESENTATIVES

there are many issues in our increasingly demanding roles as midwives that put colleagues under pressure.

There are relentless shifts – when there is little time to have a cup of tea, never mind an hour-long break – staffi ng shortages, the rising birth rate and the lack of equipment. The recent attack on NHS pensions is yet another blow to an already over-stretched, deeply committed workforce. All these things make the role of a workplace representative crucial to the wellbeing of our members.

ANNE HODGSON, HEALTH AND SAFETY REPRESENTATIVEI have always had a passion for representing the interests of colleagues and being a health and safety representative has enabled me to

make a diff erence. The job is about looking at issues that aff ect my colleagues, clients and, inevitably, the trust.

Our department had an issue when a product used to clean up bodily fl uids was causing irritation to some staff . They voiced concerns and we looked into how staff were preparing and using the product. We held informative sessions, used posters to cascade information and included notes in our catch-up fi le for all staff to read. There is now no staff sickness caused by this product, which has inevitably benefi ted the trust.

As a health and safety representative, you have the right to paid time off work to carry out your role and attend training courses and you are well supported. I would encourage anyone who gets satisfaction from making a

014-15_MID_HEAD_workplace.indd 14014-15_MID_HEAD_workplace.indd 14 7/3/12 12:36:227/3/12 12:36:22


800THE NUMBER OF WORKPLACE

REPRESENTATIVES THE RCM HAS IN THE UK

diff erence for colleagues – and, ultimately, clients' lives – to take up this role.

JILLIAN IRELAND, UNION LEARNING REPRESENTATIVEI have always been interested in learning and sharing stories. And I like getting people together and the buzz of something new – these factors all seemed to be there in the union learning representative role. The training course was interesting and a project worker told me about National Learning at Work Day. So I negotiated the use of the staff coff ee room and six hours off from my working day.

A tutor from the Open University answered course-related questions, there was a demonstration of RCM i-learn packages and I gave out cupcakes and gathered information about what people want to learn and, indeed, what they could teach other people.

I’ve since booked a free Down’s Syndrome Association study day – which was a fantastic learning experience, organised a driver awareness training session tailored to community midwives, a numeracy workshop and a talk on what members are getting for their RCM fees.

We are electing a second representative very soon. If you want to be a rep, my tips are: be visible, meet with key people, ask colleagues what they want from you, and enjoy yourself.

DOES THIS SOUND INTERESTING?You could be a workplace representative too. You get a lot of support in your role – the RCM provides courses for all workplace representatives throughout the year and all over the country.

These include online courses on i-learn, which give workplace representatives the knowledge, skills and confi dence that are needed in order to carry out their role.

You would also be entitled to paid time off work to undertake activities and duties and to attend training courses. And workplace representatives get their own newsletter to keep them updated on national issues.

There are also regional meetings, a dedicated group on the RCM Communities website and there is even a national conference just for workplace representatives.

If you’re interested in taking on the role, all you need to do is contact your branch secretary to arrange for the election to take place at the next branch meeting.

If you are unsure of who your branch secretary is, or you just want to chat further about the role and responsibilities, you can contact your regional or national offi cer to help you. The contact details for the board offi ces (where the regional and national offi cers are based) are available online.

You can also learn more about the positions by visiting the RCM website and downloading the So you want to be a RCM workplace representative booklet.

What are you waiting for? Your colleagues need you, so get involved and then you can make a diff erence too.�

Amy LeversidgeRCM employment relations advisor

► Anne HodgsonHealth and safety representative

I have always had a passion for representing the interests of colleagues and being a representative has enabled me to make a diff erence

► Rosemary GosdenSteward

A few years ago, I was asked if I would consider being an RCM steward. I said 'yes' – women need advocates, midwives do too

► Jillian IrelandUnion learning representative

I have always been interested in learning and sharing stories. And I like getting people together in the union learning representative role

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rcm.org.uk/midwives/news 2012 • ISSUE 2 • MIDWIVES 17

HeadlinesStuart Bonar / On politics

T he baby boom continues. That is what we found out when we managed

to get our hands on the latest provisional birth fi gures for the fi rst half of 2011, thanks to a parliamentary question asked by Mark Field MP.

There were around 560,000 live births in England in 2001, this rose to a little over 687,000 by 2010, and the latest draft fi gures for the fi rst half of last year now suggest that this climbed by a further 4000 or so in 2011. It is unlikely to stop there; last autumn, the government published offi cial projections that point to births topping 720,000 before the

end of this parliament and then remaining around this fi gure.

That is just England, of course. Births have also risen in Scotland, Wales and Northern Ireland. Offi cial projections suggest the rate will stay high in those places over the coming years as well, although birth numbers outside England will not grow in quite the same way.

Of course, there is much more to measuring a midwife’s workload than just the number of babies being born, but it is clearly very important. And the ever-rising number, especially in England, demands more

WHEN THINGS GO BOOM

→ The ever-rising number of births, especially

in England, demands more and more of the midwifery workforce

The government may be boasting that record numbers of midwives have come into the

profession since the last election, but Stuart Bonar argues that the sharp rise in live births means that

maternity units are still short of staff .

and more of the midwifery workforce. It underlines the need for more midwives.

Indeed, while the number of midwives working in the NHS in England appears to have risen under the coalition government to an all-time record – ministers cite a net rise of 896 midwives since the 2010 election – these new midwives are, to put it bluntly, just swallowed up by the baby boom.

We continue to make these arguments to the government. While ministers seem to like to sidestep arguments about numbers, clearly the message is getting through – as evidenced by the growing number of midwives. It might not have been that way; nurse numbers and health visitor numbers, for example, have fallen since the election, so we are making our case and delivering results.

We also managed recently to get our hands on some fi gures that, in all honesty, we did not know were collected. What were these? We found out that 82% of people across the UK who

graduate in midwifery go on to get jobs as midwives. This was unearthed by shadow health minister Diane Abbott MP. We intend to fi nd out what happens to the other 18%. It might be that many of them continue their midwifery studies, so it does not necessarily mean they have tried and failed to secure work as a midwife. We also want to fi nd out if there is a diff erence between England, Scotland, Wales and Northern Ireland; this might show us the eff ect of Scotland’s one-year job guarantee for newly qualifi ed midwives. I will see what we can extract further and report back. Watch this space.

Meanwhile, as I type, the RCM’s e-petition to the government calling for 5000 more midwives for the NHS in England now has over 32,000 signatures. We need 100,000 to qualify for a debate in the house of commons, so please sign and encourage others to do so.�

Stuart BonarRCM public aff airs offi cer

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MIDWIVES • ISSUE 2 • 2012 rcm.org.uk/midwives/news18

HeadlinesCountry news / Northern Ireland & England

ENGLAND

MATERNITY SERVICES STRATEGYConsultation on the long-awaited draft maternity services strategy for Northern Ireland closed on 22 January. The strategy will set out a blueprint for the future of maternity services in Northern Ireland and will be very important for those who commission and provide maternity services, as well as the women who use them.

The RCM team visited every maternity unit in Northern Ireland to discuss the content of the document with members and encourage midwives to participate in the consultation. We now eagerly await publication of the fi nished strategy.

The draft strategy focused on the normalisation of birth and further development of midwife-led care, including the potential to establish additional community midwifery units. It complemented the fi ndings of the Ministerial review of health and social care (the Compton report), which recommended that: women should be provided with information to enable them to make an informed choice about place of birth; preventative screening programmes should be in place; services should be available in consultant-led and midwife-led units; midwives should be leading care for women with straightforward pregnancies, and that there should be continuity of care throughout the maternity pathway. The review also recommended that a regional plan should be developed for

supporting mothers with serious psychiatric conditions, and the RCM will continue to campaign for a robust outpatient perinatal mental health service in each trust, with the aim of developing an in-patient service for women who require this level of care.

By the time you read this, we will have held our second Normal Birth Conference, in collaboration with the DHSSPS, PHA and the RCOG. Planning is also well under way for the annual joint RCM/SANDS conference, which will be held on 14 June at Dunsilly Hotel, Antrim.

ON YOUR BIKESIn the meantime, Anne-Marie O'Neill and I will continue with fundraising eff orts ahead of the RCM cycle from London to Paris in May in support of the National Maternity Support Foundation. All contributions most welcome!

Breedagh HughesDirectorRCM Northern Ireland

OPEN FOR BUSINESSMidwives at Maidstone and Tunbridge Wells NHS Trust have a lovely new birth centre. The opening was attended by RCM chief executive Cathy Warwick. The centre is going from strength to strength, and is very much supported by a really committed team of midwives.

A BIG HEARTGuildford midwife Clare Cardu, an RCM steward, has won Mother and Baby magazine's Big Heart award for her care to women experiencing stillbirth. Huge congratulations, Clare.

A BRANCH REBORNEast Lancashire's RCM branch is working with enthusiasm and commitment to re-establish its branch activities. All of its branch offi cers are now in place and it has student midwife representatives too. Members are planning a summer ball and will donate the proceeds to the RCM benevolent fund, which provides support to midwives in times of need.

SAFER BIRTHThe RCM is delighted to report that The King's Fund is launching the Safer births toolkit on the

morning of the Delivering Better Maternity Care Conference on 29 March. There were 12 NHS maternity services involved in this work and I, along with RCM colleagues, played a key role. This toolkit is highly recommended and much learning can be gleaned from the case studies, too.

STEPPING DOWNA sad farewell to RCM regional offi cer Judy Slessar, who has retired from her post after 13 years. Judy leaves a legacy of commitment, passion and hard work for members in the South West of England region.�

Jacque GerrardDirector RCM England

NORTHERN IRELAND

SHUT

TERS

TOCK

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HeadlinesIn focus / FGM

ZERO TOLERANCE NEEDED TO WIPE OUT FGM

More than 120 health professionals attended an RCM and RCOG event held for International Day of Zero Tolerance to Female Genital Mutilation. The subject was debated and here are the issues and fi ndings.

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TENS OF THOUSANDS of women in the UK are believed to have suff ered from the horrifi c practice of female genital mutilation (FGM).

A total of 66,000 are estimated to have been subjected to FGM and up to a further 24,000 more are thought to be at risk.

It is illegal to perform the practice in the UK – as it is for girls to be taken abroad for FGM – yet it is still worryingly widespread and, while people have been found guilty of carrying out FGM in other European countries, there has never been a single prosecution in the UK.

At the RCM and RCOG’s joint conference on the devastating practice, the consensus was that more detailed information and data is needed if the inhumane practice is to be wiped out.

Jane Ellison MP is the chair of an all-party group that is investigating FGM and includes 52 members of parliament.

She said: ‘We must get up-to-date statistics [so] there can be no denial that this is going on.’

She said the Home Offi ce has allocated a small amount of funding to see how a large-scale FGM study could be carried out.

Efua Dorkenoo, a senior public health specialist and women’s rights advocate, agreed that up-to-date statistics are needed and said FGM is ‘a violation of the rights of girls and women, [but] we don’t have very good data’.

A recent poll conducted by the RCM shows that a third of UK midwives have cared for women who have suff ered from FGM.

The survey of over 1700 midwives also shows that there is a lack of training and awareness of the practice.

The results reveal that over half (55%) of those surveyed did not know where to refer women with FGM for specialist services.

They also show that a large majority (84.7%) of respondents had not received any training on FGM in the previous year.

Cathy Warwick, RCM chief executive, said: ‘It worries me greatly that so many UK midwives are seeing cases of FGM, and I am concerned about the scale and extent of it in this country. We must take a zero tolerance line on FGM and do all we can to see it stopped in the UK and elsewhere.

‘It is a violation of a woman’s human rights, and there is a real need to raise awareness about the damage that FGM can do to women within the communities that practise it.

‘We must focus on protecting the current generation of girls and young women.’

Cathy has also recently stressed that it is ‘important that we don’t see this as a simple issue’.

Many people believe that a major reason why FGM has not been tackled more eff ectively in the UK is because of concerns over singling out specifi c ethnic groups and communities.

Nimco Ali is one of the founders of Daughters of Eve – a non-profi t organisation set up to help girls at risk of FGM. ‘It happens in the UK and we need to stop walking on cultural egg shells,’ she said. ‘It is not racist to tackle FGM – it’s racist to ignore it.’�

66 000THE TOTAL OF WOMEN ESTIMATED TO

HAVE BEEN SUBJECTED TO FGM

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Headlines around the world / Global news

Global News stories

making headlines around the world

news

MALAWI 1 MIDWIVES ALLOWED TO WEAR HIJABS

Muslim midwives in Malawi can wear hijabs while on duty, the country’s regulator has ruled. The 2008 population census shows that 13% of Malawians are Muslim. And the agreement was reached to encourage more Muslim women to join the profession, which is severely understaff ed – with only 17 midwives for every 100,000 people. Martha Mondiwa, of the country’s Nurses and Midwives Council, said that black hijabs will not be allowed, and colours must be in keeping with those approved for the country’s health workers, which are predominantly white and green. The development comes after a year of talks on the issue and after the authorities in the country allowed Muslim women to have their passport photos taken with the hijab.

PHILIPPINES 2 BOOST IN MIDWIFE NUMBERSThree thousand extra midwives are being deployed in the Philippines, it has been announced. They will work in the country’s provincial hospitals and health facilities. The move is being made as part of the government’s Registered Nurses for Health Enhancement and Local Service project, which seeks to address the country’s inadequate health workforce. Prior to placement and deployment, the midwives underwent

a week of general orientation at the beginning of March. Health secretary Enrique Ona said: ‘We recognise the importance of the availability of competent health workers in our hospitals and communities.’ The posts last one year, after which some will be considered for full-time employment by the government.

US 3 HOME BIRTHS ON THE UPHome births in the US are now at their highest level since data collection on place of birth began in 1989. The level rose by 29% from 2004 to 2009, after 14 years of falling. While the increase looks dramatic, the number of home births in the US is still very low and rose from 0.56% in 2004, to 0.72% in 2009. The increase is widespread across the country, but there are

large regional variations, believed to be partly due to diff erences in state laws on births outside hospital. Home births are more common among women aged over 35 and those with several previous children. The American College of Obstetricians and Gynecologists claims ‘hospitals and birthing centers are the safest setting for birth’. But, in a statement released last year, it said it ‘respects the right of a woman to make a medically-informed decision about delivery’.

AUSTRALIA4 FISH OIL REDUCES ECZEMA RISK CLAIMTaking fi sh oils during pregnancy can reduce the risk of a baby having eczema, Australian researchers claim. In tests, children born to mothers who took omega 3 supplements were a third less likely to develop the skin condition. They were also 50% less likely to develop an intolerance to eggs before their fi rst birthday, the results show. The researchers from Adelaide University believe omega 3 fatty acids, passed on to the unborn baby, protect against eczema. The study included 706 pregnant women with family histories of allergies. Half were given fi sh oil supplements to take three times a day from 21 weeks into the pregnancy until the birth, and the other half were given vegetable oil.

INDIA5 EXPERTS LOOK AT INFANT MORTALITYAn expert team from the US has travelled to India to devise an action plan to cut infant mortality in the Medak district. The offi cials from Columbia University have arrived in the region, where it is claimed that the mortality rate is as high as 46%. It has visited primary health centres and talked to women about medical services and food at medical centres.The team has suggested streamlining midwives’ responsibilities, so that they can focus on delivering babies. Among the reasons for the area’s high infant mortality rate is a lack of nourishment for pregnant women and a shortage of suitable medical facilities.�

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OpinionThoughts, views and your feedback

Lesley Page / One-to-one

Rob Dabrowksi talks to Lesley Page, the accomplished

midwife, campaigner and academic, who is starting a new

chapter in her career as RCM president »

Meet the president

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OpinionOne-to-one / Lesley Page

S he has published more than 200 journal articles, served on three national committees and worked and lectured in 13 countries around the world.

She has also written three books, racked up more than 32 years practising and has a 24-page-long CV.

But for Professor Lesley Page, who has been elected the RCM’s next president, midwifery is not about qualifi cations and prestigious titles.

‘I think my background is probably quite unique,’ she tells Midwives. ‘I’ve managed to integrate clinical work with managerial and academic work. I’ve got a lot of experience in diff erent areas, and in

diff erent ways of practising and working, and I feel I have a great deal to off er this position.

‘But I’ve always prided myself on knowing exactly what it is like to be a midwife in practice, which is something that gives me a huge amount of joy.’

It is her passion for grassroots midwifery that she hopes will come to the fore in her new position with the RCM.

‘I believe that when the baby is born, the mother is also born and I think that, as midwives, we can help women learn their own strength,’ she says.

‘I think that the most important thing is that we are fl exible and responsive to the needs of women – we need services in which

midwives can provide care that is sensitive and safe for women.’

Lesley, who currently practises for Oxford Radcliff e Hospitals NHS Trust, was sitting at her computer replying to emails when she found out she had been elected.

‘I saw an email from the RCM and as soon as I opened it and saw the news, I was over the moon,’ she smiles. ‘Over the following days, I had hundreds of emails and Facebook messages and I spent a couple of days just replying to them.

‘I think, once the intense excitement had subsided, the feeling I had was that it was such a great honour to be elected by midwives into such an important role, in the profession I love.’

Lesley has been involved in midwifery since 1966, when she qualifi ed after training as a nurse.

She joined the profession when the second wave of feminism was gathering momentum and calls for equality were echoing across the Atlantic.

‘The women’s movement was under way and I started to discover how important good midwifery was, and how closely it was linked to feminism,’ she says.

‘I started to challenge routine practices within the hospital when I found that they weren’t good for women.

‘Like the fact that women weren’t allowed to eat anything during labour, in case they needed a caesarean section, which I thought was just ridiculous and not in any way evidence-based practice.’

Then, in 1977, she travelled across the Atlantic to challenge not just routine practices but also national preconceptions about the midwifery profession.

‘I was about 30 years old when I moved over to British Columbia, and midwifery wasn’t legal in Canada at the time,’ she says. ‘So I became involved in the work to establish midwifery. I worked closely with midwives and senior obstetricians and we set up a project that became the fi rst legally recognised midwife service in Canada, which is something I’m incredibly proud of.

‘I’ve travelled to 13 diff erent countries and my travels have made me realise how

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precious the midwifery and maternity services are in the UK,’ she continues.

‘There are challenges at the moment, but we have a midwifery service that is respected and that people care about a great deal. It’s a profession seen with fondness and it is part of our culture.’

But it is these challenges that Lesley will have to face in her role as president, when she takes over from Liz Stephens on 2 April.

‘I think that the major challenge for me is a political one – we’ve got a lot of evidence that midwife-led care is safe and we need to make that a default option, but it’s often not easy to have evidence accepted,’ she states.

‘The results of the Birthplace study show that midwifery-led care is very safe and that midwives can practise in a number of diff erent ways, and I think that we have a really important role to play. I plan to work with the other medical colleges to move that forward.

‘I’d like to see every woman in the UK have a genuine choice of place of birth and I’d like midwives to be able to choose where and how they work and be supported in that choice.’

At the end of her term, Lesley hopes to have made a genuine diff erence – the position means far more to her than another line on an already bulging CV.

‘I would like people to say that when Lesley Page was president of the RCM, she understood the situation, worked to help develop and maintain the profession and move it forward so that midwives could choose the way they would practise and deliver sensitive, women-centred care.

‘I love the academic side of things, but I love the practical side too and, through the presidency of the RCM, I will help midwives wherever they work to give their best so that we can provide really good care around the time of birth.’�

Lesley Ann PagePhD MSc BA RN RM

► Served on national committees for the Department of Health, the House of Commons and The King’s Fund

► Deputy chair of the English National Board for Nursing Midwifery and Health Visiting (1993-99)

► Appointed professor of midwifery in 1992 – the fi rst such appointment in the UK

► Academic focus on the development and evaluation of one-to-one midwifery, using evidence in practice and evaluation of place of birth

► Infl uential book The new midwifery: science and sensitivity in practice has been translated into French and Japanese

► Involved in establishing midwifery programmes at universities in Canada

► Visiting professor at King’s College London, the University of Technology, Sydney, and the University of Sydney

► Involved in clinical practice and experienced in every area of practice, including hospital, community, birth centre and home birth

► Honorary fellow of the RCM, in recognition of considerable contribution to the profession

► Awarded the degree of Doctor of Philosophy in 2005 by the University of Technology, Sydney

► President of the Maternity and Newborn Forum section of the Royal Society of Medicine

► Member of the Association of Radical Midwives and Medical Justice

► Vice chair of Scientifi c Committee at the Humanization of Birth Conference in Brazil

► Extensive experience of externally examining PhDs for universities around the world

► Has written forewords for nine books.

FACT FILE



OpinionRCM Communities / Latest discussions

LINKSTo post your response to these discussions, please visit:

DOES EXPERIENCING CHILDBIRTH MAKE A BETTER MIDWIFE?http://community.rcm.org.uk/groups/midwives/conversations/does-experiencing-childbirth-make-better-midwife

DELIVERING A COLLEAGUE’S BABYhttp://community.rcm.org.uk/groups/midwives/conversations/delivering-colleagues-baby

Watch out for RCM chief executive Cathy Warwick’s live web chat on 3 April, 14:00-16:00. (See pages 42-43 for more details).

DELIVERING A COLLEAGUE’S BABY

Have you ever been in the situation where you’ve had to deliver a

colleague’s baby?

A I accidentally delivered a colleague’s baby while relieving another colleague for a break!

It was lovely. I have also cared for another colleague when she had her last two caesarean sections. The fi rst was quite emotional, as she required a general anaesthetic due to failed spinal. The post-op care was bizarrely scary for me, and it made me realise that I wouldn’t want to off er to care for friends as a matter of course. For some reason, the responsibility of our job becomes all too apparent when you are caring for someone you love.POSTED BY: A rotational midwife

A I’m due in May and have very mixed views about having it at work – I’m very anxious at the idea

of colleagues seeing me in this situation!POSTED BY: A rotational midwife

A I was privileged to be asked to be the midwife for a colleague and friend four years ago. That

was the fi rst time and I was aware of the diff erent expectation I had of myself! There did seem to be a diff erent degree of responsibility, but I was honoured that she trusted me enough to ask, and she went on to have her second baby with me two years ago. POSTED BY: A Communities member

DOES EXPERIENCING CHILDBIRTH MAKE A BETTER MIDWIFE?

Do you think if a midwife has experienced childbirth it makes them a

better midwife?

A �I don’t think it is necessary to have experienced childbirth to be a good midwife,

although mothers often ask if you’ve children. I have children, but I know loads of excellent colleagues who haven’t, but still have empathy and sensitivity.POSTED BY: A birth centre midwife

A I didn’t become a midwife until I was already a mother but then went on to have two more as

a midwife. I know many excellent midwives without children, but being a mother of four defi nitely gives me credibility with women. As a labour ward midwife, gaining trust very quickly with a stranger is easier when they know I have been in the situation they have. I never talk in detail about my experiences though, it’s about them, not me.POSTED BY: A hospital/labour ward midwife

A I recently had my fi rst child. Previously, I always felt having not experienced childbirth

gave me an awesome respect for those who go through it and that this, along with eight years’ experience, made up for any lack of empathetic understanding. I think I’ve learned more about my job in the last year than in the last ten. I’ll defi nitely be an improved version of myself once back at work.POSTED BY: A rotational midwife

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

Are you involved?

—DISCUSSION

ONE—

—DISCUSSION

TWO—

► Blog from Cathy Warwick discussing her recent trip looking at maternity services in Cuba and the new RCM president Lesley Page.► There are other blogs on the RCM’s exclusion from the Downing Street summit on the Health and Social Care Bill meeting, midwife numbers, vitamin D and FGM.

LATEST BLOGS

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http://twitter.com/MidwivesRCM 27

TweetdeckA 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 Just signed your #epetition expecting my 5th baby in April. You all do a fantastic job!!

From: @claireol29

Been at @MidwivesRCM awards. Inspiring stories from midwives making childbirth better for mums. From: @Janehug

@MidwivesRCM hope young people have a better chance! I know if NHS midwives & doctors were not here my baby and I would have died in childbirth.From: @LifebyLizzy

At the @MidwivesRCM awards. Great to see fantastic practice in the workplace recognised and celebrated.From: @Unions21

Thanks to the @MidwivesRCM today for some great advice regarding pool temperature and pregnancy! It’s so important to speak to experts.From: @BabySwimExpert

@LouW81 @MidwivesRCM It’s not just #MidwifeRecruitment that needs addressing but

#MidwifeRetention. Lots of #experiencesmidwives not practising.

From: @JayneDillon1

@MidwivesRCM Anyone peddling rumour that RCM backing down on health bill is having a laugh.

RCM opposition rock solid.From: @Seanjosullivan

@MidwivesRCM Have asked my MP, Philip Hammond, to sign – would love his support. Will make sure I’m on

his radar :-)From: @MAMAAcademy

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

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OpinionFeedback / Have your say

We’ve got

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

MISTAKES SPOTTED ON CALL THE MIDWIFE

I enjoyed the drama Call the Midwife but couldn’t help noticing some technical mistakes.

I qualifi ed as a midwife in 1974 and we didn’t start using the tapes they used to measure the height of the fundus until somewhere around the 1980s or 90s. We also didn’t measure in centimetres until much later too.

Also, in the 1950s, the gestation period would have been referred to in months, but in the fi rst episode, they were talking about it in weeks.

I can remember my sister being born at home in 1954 and the district midwife doing her visits on her bike in a rural part of Northern Ireland.

Muriel WilsonRetired midwife

I have been a midwife for 27 years and midwife acupuncturist since 2003. I feel the discussion on the actual acupuncture points for the treatment of hyperemesis (Midwives, Issues 6 & 7 :: 2011) refl ects diff ering approaches between acupuncturists coming from a traditional Chinese medicine (TCM) or a western medical (WM) background.

The Cochrane review on the use of acupuncture for sickness states: ‘There is a lack of high-quality evidence to support that advice’ (Matthews, 2010). However, many women, in my experience, do fi nd it helpful. It is a pity the lack of good-quality evidence prevents it from being promoted – partly because the diversity in acupuncture treatment approaches makes the

BLACKBURN BIRTH CENTRE

After reading The maternity maze in Issue 6 :: 2011, I wanted to share the experience of working at the freestanding Blackburn Birth Centre.

It was established in September 2010 and by November 2011, almost 1000 births had taken place.

Antenatal transfer rates are low and the intrapartum transfer rate is around 12.55%. Just four women have been transferred for epidural anaesthesia.

One of the reasons behind its success is the integrated staffi ng model. Midwives in community teams work shifts in the birth centre. In the event of a quiet day, midwives work where women require care. This fl exible approach ensures cost eff ectiveness and promotes communication.

The feedback has been overwhelming. Midwives have risen to the challenges and are looking with eager anticipation to the year ahead.

I hope this story will inspire others who are establishing a freestanding birth centre.

Caroline BroomeLead midwife

WRITE»TO US

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

ACUPUNCTURE TREATMENT FOR HYPEREMESIS GRAVIDARUM

available studies diffi cult to use within meta-analysis.

I can understand that the student midwife and qualifi ed TCM acupuncturist fi nd the use of points suggested by the writer in Issue 6 unusual, as in TCM acupuncture some of the points used are classed as ‘forbidden points’ fearing they may stimulate contractions. The WM acupuncturists would say there is no evidence of this.

Studies, to date, agree that acupuncture does not seem to put pregnancy at increased risk.

In our midwifery acupuncture clinic, acupuncture can off er help and relief for many minor ailments of pregnancy, some of which may be causing severe problems – particularly pelvic girdle pain, headaches, carpel tunnel syndrome and more. As acupuncturists, I feel we need to learn to work together, to respect each other’s skills, develop guidelines for safe practice and work together to promote the use of acupuncture in pregnancy.

Jeanne LythgoeLecturer in midwifery and supervisor of midwives

FEEL PASSIONATELY ABOUT AN ISSUE RAISED IN MIDWIVES OR WITHIN YOUR CLINICAL PRACTICE?Then email us your thoughts. The next cracking correspondence wins this Tales of a midwife book. Your name will be published here if you win!

CRACKING CORRESPONDENCE WINS...

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OpinionUpfront / Induction of labour

Keeping up the pace

Every woman who comes into the antenatal ward hopes for a quick, uncomplicated labour.

Estella King, an experienced labour ward midwife, has discovered that a brisk walk can

often be the best way to speed things along.

think we have all seen this at some point in our working lives: you walk into the antenatal ward, or the ward used for induction of labour (IOL), at the start of your shift and are greeted with the scene of women lying woefully on their beds. Their partners are sat next to them, reading the paper, and they’re all looking at you expectantly (excuse the pun!), as if you can free them from this endless wait for labour to begin.

When you speak to them to introduce yourself, they will tell you that they are experiencing contractions, irregularly and painfully, or that nothing is happening at all. They are all at diff erent stages, ranging from having had one or two doses

of prostaglandin gel over the course of the day, or they are able to have an artifi cial rupture of membranes (ARM) and are awaiting admission to the labour ward. Some may be waiting for a syntocinon infusion, as they had ruptured their membranes over the previous day or so.

Often the labour ward is too busy to take them immediately, so this means more resting in bed and longing looks in the midwife’s direction, that eventually become pretty hostile in some cases. We monitor them and their babies and continue to wait. Very occasionally,

a fetus will become distressed by a hypertonic uterus and the woman will be rushed over to the labour ward, while the other women look on with jealousy, little realising that this is a serious situation for the baby, and not a necessarily pleasant one for the mother either.

But there is something that can be done to help nature, or prostaglandins, along – although the suggestion will probably not be greeted very enthusiastically. That suggestion is to get up and get walking. I don’t mean the usual slow amble of the heavily pregnant woman, but a brisk, energetic walk with her partner, and not just for ten minutes either; it should last for at least half an hour, then back for a rest and a listen to the fetal heart, and if no change, then send them off for another walk.

As long as the woman is well and the fetal heart is normal there is no risk in this, and it stimulates labour in many women. We are also all familiar with the positive action of ambulation on fetal positioning and descent.

I looked after a woman while she awaited syntocinon, as her membranes had ruptured the night before. She was very unhappy, and was getting the odd, painful tightening, which she was feeling far more intensely than she should because she was becoming anxious. After doing observations on her and her baby, I encouraged her to go out for a walk. I was caring for other women, and she kept coming back to the unit for auscultation of the fetal heart and her observations. When I started the shift she was 2cm and when I left, she was labouring well, contracting four in 10, using Entonox alone for pain relief and had progressed to 8cm. The fetus was OA and +1 below the spines. She had a normal birth, with no IV syntocinon, no cannula, no continual fetal monitoring, and she was hardly ever on the bed. She was thrilled with her birth experience.

Another woman came to me on the labour ward for ARM at 2cm and syntocinon. After performing the ARM,

s and hileg

t

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→ There is something that can be done to help nature or

prostaglandins along – a brisk, energetic walk

midwife in the room with her – and I tried to encourage a quick assessment as everything was progressing well.

The consultant spoke to her, telling her that she may need a ‘hormone drip’ to speed up contractions. I couldn’t help feeling amused and politely pointed out that she had been having contractions six in 10 for quite a while with absolutely no fetal distress – something I had never seen before without IV syntocinon or prostaglandin IOL, usually resulting in a stressed fetus – and asked if the medical team wanted eight in 10 instead! When the consultant realised this, he laughed and asked where she went for her walk, so he could send other women there who need IOL.

The titration of syntocinonAnother interesting refl ection is the titration of syntocinon in IOL. We have probably all been in the frustrating situation of increasing the titration to obtain adequate contractions, but also fi nd that this level induces fetal distress, often in the form of a bradycardia, which necessitates the syntocinon being stopped, then re-started gradually when the fetus is no longer distressed, thus prolonging the labour and often resulting in rebound fetal tachycardia.

I asked a senior consultant if we, as midwives, could bypass the prescribed titrations, and increase the dosage by half the particular titration that resulted in fetal distress – making it somewhere in the centre of the lower and upper doses? He replied that he saw no problem with this, as long as we got a consultant’s approval fi rst. I wonder if this could be done on a wider scale, what the outcomes would be? We would be able to use our skilled judgment more eff ectively, as midwives are the professionals who are most aware of the wellbeing of the fetus we are caring for, and the progress of the labour.

It would be very interesting to perform a controlled trial on midwife-led titration of syntocinon, to keep the dosage as low as possible while ensuring eff ective contractions, and to assess its eff ectiveness on a wider scale than just refl ection, and any positive eff ects on lessening fetal distress, and subsequent caesarean section rates.

I would love to hear what other midwives have to say about using fast walking to help induce labour, and the titration of syntocinon, and how much control they have with this in their particular unit.�

Estella KingLabour ward midwife

RCM COMMUNITIESWhat are your experiences of using a brisk walk to help induce labour? Join the discussion at: http://communities.rcm.org.uk

I did 20 minutes of CTG to ensure fetal wellbeing and – you guessed it – sent her off walking. She came back after about three quarters of an hour experiencing good, regular contractions. I continued with intermittent auscultation throughout labour and left her in the capable hands of the night midwife. The woman was thrilled to be 9cm dilated.

The highlight of this shift was when my client was having 10 minutes on the CTG to assess fetal wellbeing and the medical team came round to review. My client was very disturbed by fi ve people crowding into the tiny room – she’d written in her care plan that she only wanted one

Illustration: Nicole Jarecz/Colagene.com

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On focusCurrent and completed midwifery research

Jan Wallis /Cutting edge


Hand expression versus breast pumping

PAPERRandomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly.

AUTHORSFisherman V, Gay B, Scott C, Avins A, Lee K, Newman T.

PUBLICATIONArch Dis Child Fetal and Neonatal Ed 2012; 97: F18-F23

► Pain scores, breastfeeding confi dence and breastmilk expression experience did not diff er between the two groups.► Hand expression in the early postpartum period appears to improve eventual breastfeeding rates at two months.

I n this randomised controlled trial in San Francisco, researchers compared bilateral electric pumping of breasts to hand expression among mothers of healthy term infants who were

feeding poorly. A total of 68 mother-infant pairs were assigned to either breast pumping or hand expression, 12 to 36 hours after birth. The groups were similar at baseline. The main outcome measures were milk transfer, maternal pain, breastfeeding confi dence and breastmilk expression experience immediately after the intervention and breastfeeding rates at two months. The entire expressed milk volume was measured by syringe and the babies fed with a syringe, cup or spoon.

The median volume of expressed milk was 0.5ml for hand expressing mothers and 1ml for pumping mothers. The median change in weight of infants before and after all feeding, including breastfeeding and feeding of expressed milk, was 0g (-3 to 5) for the pumping group and 0g (-1 to 2) for the hand expression group.

Mothers assigned to electric pumping were more likely to agree that they did not want anyone to see them expressing, than

mothers who hand expressed. Pain scores during and after intervention diff ered little and breastfeeding confi dence and breastmilk expression experience did not diff er.

At one week, 17 babies in the pump group and 18 babies in the hand expression group had received formula. The 40 (78.4%) mothers expressing milk at one month included 16 (72.7%) from the pump group and 24 (82.8%) from the hand expression group. Final outcome assessment at two months was obtained for 48 mothers (70.6%) and those assigned to hand expression were more likely to be breastfeeding than mothers assigned to breast pumping; 41 (85.4%) mothers were still breastfeeding and seven had stopped breastfeeding. All the mothers who were expressing at two months were using a pump.

The authors state that hand expression in the early postpartum period appears to improve breastfeeding rates at two months compared with breast pumping and providers should consider recommending hand expression.�

Jan WallisRetired midwife and senior lecturer

→ Teaching hand expression might improve breastfeeding rates

OVERVIEW

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On focusHow to... / Remain active in labour

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—HOW TO...

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H istorically, women have been active during birth for centuries and frequently adopted squatting, kneeling or sitting positions. During

the 17th century, it became fashionable for women in many European countries to labour horizontally and this coincided with a trend towards medical supervision in childbirth. Pain relief methods introduced during the 19th and 20th century contributed to reduced mobility and drowsiness of women in labour (Steen, 2012). This led to an expectation and acceptance that during childbirth women lay passively in bed (RCM, 2008).

...encourage a woman to remain active in labourThere are signifi cant benefi ts to remaining active during labour. The University of Chester’s Professor Mary Steen describes these benefi ts and the ‘dry land’ positions women can adopt to maximise the opportunity of achieving them.

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EvidenceThere is substantial evidence of benefi ts for women who remain active during their labours, such as the reduced need for medical interventions and the likelihood of shorter labours (Lawrence, 2009). Midwives, therefore, need to encourage women to adopt diff erent postures and positions while they are in labour.

Good preparationDuring pregnancy, opportunities to discuss and demonstrate how to remain active and adopt diff erent positions in labour will help the woman and her partner to prepare. Good preparation will assist women to become confi dent in their ability to be active during labour. It is hoped that explaining how pressure from the baby’s head on her cervix and pelvic fl oor will stimulate the release of oxytocin and good contractions, so labour will progress as nature intended, will encourage a woman to remain active (Russell, 2008). Using props such as a chair, bean bag or birth ball can help her to remain active during labour and women should be advised of the benefi ts of these (Steen, 2007; Steen, 2012). The impact of water immersion in labour should also be highlighted as an eff ective birthing option.

First stageIdeally women should be encouraged to adopt upright positions during the fi rst stage of labour, as there are signifi cant advantages to this. These include gravity, reduced risk of aorto-caval compression, better alignment of the fetus, more effi cient contractions and increased pelvic outlet (Frye, 2004). Diff erent positions can assist women to progress. Leaning forward is particularly helpful for women who have a baby in an occipitoposterior (OP) position. Many fi nd sitting astride a chair and even sitting on the toilet helps. Some women fi nd relief from pelvic rocking and others fi nd walking around, walking on the spot or just standing helpful.

Second stageUpright positions should also be encouraged in the second stage. These include sitting (more than 45 degrees from the horizontal),

squatting or kneeling, being on hands and knees. Diff erent positions can assist women to progress and cope. Squatting or being in a ‘knees and leaning forward’ position have the advantage of increasing the pelvic outlet. However, many women are not able to squat comfortably and fi nd the ‘knees and leaning forward’ position more comfortable. Some women opt for the squatting position and get their partners to support and hold them up. Just like in the fi rst stage of labour, upright positions are gravity assisted and some

women will prefer to adopt a high sitting position, be semi-recumbent, kneel or squat on a birthing cushion in order to assist them to give birth.

ConclusionRemaining active and using a range of diff erent positions in labour has been shown to be benefi cial to women.�

For article references, please visit: rcm.org.uk/midwives

FIRST STAGE SECOND STAGE

BEN

HAS

SLER

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MIDWIVES • ISSUE 2 • 2012 rcm.org.uk/ebm36

On focusEBM / March 2012

Editorial: Artistic approaches to data collection: illustrations and collageMarlene Sinclair

A look at how artistic approaches, particularly illustration and collage, are being used in midwifery research. The author argues these can be used to enrich research data collection in situations where words are not enough and sometimes it is too painful for interviewees to talk.

Skilled help from the heart: the story of a midwifery research programmeSoo Downe

This paper sets out the story of one route to undertaking midwifery research. It starts with a vocational call to be a midwife, and describes a subsequent research programme that has evolved over 25 years. The key theme that characterises this is the understanding and promotion of physiological birth.

Midwives and the time: a theoretical discourse and analysisLesley Choucri

Choucri aims to gain an understanding of time and its impact on midwives’ working lives. She critically discusses various theories of time and looks at the pertinence of such theories when applied to midwives’ work. She fi nds there appears to be a lack of value of midwifery time and believes it is possibly indicative of the dominance of linear models of time – such as clock and calendar time – over cyclical time.

Postnatal care across the Northern Ireland and Republic of Ireland border: a qualitative study exploring the views of mothers receiving care, and midwives and public health nurses delivering careJill Stewart-Moore, Christine M Furber and Ann M Thomson

A study that looks into whether professional home postnatal care in Northern Ireland and the Republic of Ireland meets mothers’ expectations and needs. It explores mothers’ experiences of diff erent models of postnatal care from each side of the border.

A qualitative exploration of women’s experiences and refl ections upon giving birth at homeRuth McCutcheon and Dora Brown

Women’s choice over their birth location is a subject that has come to the fore in the public’s attention. In this study, a grounded theory method was applied to the experiences of nine women who had undergone, or had knowledge of, a home birth.

Understanding the phenomenon of dikgaba and related health practices in pregnancy: a study among the Batswana in the rural North West Province in South AfricaAntoinette du Preez

This study aims to understand the South African phenomenon of dikgaba – when a person evokes evil spirits to harm a pregnant woman or fetus – and looks at the way it is treated and the related cultural beliefs and healthcare practices. It draws on 20 in-depth individual interviews the author conducted.�

royalcollegeof midwives

evidencebasedmidwifery

ISSN: 1479-4489 March 2012 Vol.10 No.1

The latest research

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

036_MID_FOCUS_EBM.indd 36036_MID_FOCUS_EBM.indd 36 7/3/12 12:50:557/3/12 12:50:55


FeaturesIn-depth midwifery reportage and articles

CORB

IS

Weatheringthe stormBirth forecasting in turbulent times »

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MIDWIVES • ISSUE 2 • 201238 FORECASTING BIRTHS

More babies were born in England in 2010 than in any year since 1972. The baby boom isn’t a new revelation - the statistic is almost a year old.

The 32,000 plus who have signed the RCM’s e-petition will know that this is the reason it is calling for ‘urgent action’, demanding 5000 more NHS midwives and pushing for a Commons debate on the issue.

But a revelation that Midwives can report is that the baby boom is likely to last until at least 2016.

It is only then that it will gradually begin to tail off , according to research by healthcare forecaster Dr Rod Jones.

It is worrying news for maternity services that are already under-staff ed, under-resourced and over-stretched. And with the government’s grip due to tighten on NHS coff ers under Andrew Lansley’s contentious reforms, the future allocation of midwifery resources is facing turbulent times.

To calculate the duration of the baby boom, Dr Jones charted previous years’ birth rate statistics for England and Wales.

The jagged line in Figure 1 shows the peaks and troughs in birth rate from 1938 to 2010. The fi rst big spike – and the highest by some way – comes after the end of the Second World War.

Before this period, in which the red line almost shoots off the top of the chart, it plummets into a deep trough for the years when Europe was torn apart by war.

‘It’s not surprising there was a baby boom after the war; the same thing happened after the First World War too,’ says author and war historian Simon Fowler. ‘It wasn’t just England, of course – it was a phenomenon that happened all over the world.

‘People came back from the war to their sweethearts and there was work and employment for them.

‘While social and economic conditions were still fairly grim, there was a feeling of prosperity and people naturally wanted to start families, so the birth rate shot up.’

There are numerous examples of the birth rate peaking after natural disasters, believed to be due to a subconscious biological drive for the survival of the species.

For example, nine months after an 8.8 magnitude earthquake devastated Chile, the health minister reported ‘a marked increase

Illustrations: Hattie NewmanWords: Rob Dabrowski

Midwifery is in crisis

The birth rate is sky-high and resource planning is struggling to

cope. Midwives talks to Dr Rod Jones about his future forecast and asks

why the dark clouds weren’t spotted looming on the horizon.

in obstetric consultations in the most damaged areas’.

While after fl oods hit Gloucestershire in 2007, the county’s birth rate increased from 5946 to 6730, and Tewkesbury – where the fl oods hit hardest – experienced a two-decade high.

Unsurprisingly, with 3.5m British serving in the war, there were very few babies born in November 1940 – 14 months after Germany invaded Poland.

But, almost two years after VE Day, with the troops settled back into British life, the

birth rate shot up and was 80% higher by March 1947.

Dr Jones says this post-war boom is the reason for both the boom in the 1970s and the current birth rate increase.

‘Depending on when these babies grow to become women and choose to have their fi rst and subsequent babies, a repeating cycle is set up,’ he says.

‘The distance between the peaks is roughly set by the average age at which women choose to have their children and the width of the peaks is roughly determined by the



see from where the population increase is coming’, before going on to claim: ‘The schoolyard is where the changing population makeup is most evident. As these children grow up and have children of their own, we will become a minority across the board.’

However, such claims are swept aside by Dr Jones’ analysis of the statistics.

‘It is important to point out that the infl ux from the Accession Eight countries, which

71% rise in births since 2001, meaning it is at its highest since 1948.

As birth for older women is more likely to involve complications, demand on midwives and maternity services is even higher.

Some have claimed that the infl ux of immigration from Eastern Europe over recent years is behind the high birth rate in the UK.

The extreme right-wing nationalists the BNP recently trumpeted, ‘we can clearly

average number of children per mother. ‘Obviously, this main cycle applies to white

British families and additional mini-cycles will commence in times of infl ux of immigrants.

‘However, the key point is that these cycles lead to periods of higher and lower demand for maternity beds and midwives.’

His analysis of Figure 1 reveals that the length of time from trough to peak after the Second World War has steadily increased.

It lasted six years in the 1940s, 10 years in the 50s-60s and 14 years in the 70s-90s.

If this rate of increase continues, then the present rise in birth rate, which started in 2002, should last 14 years, or more.

‘The current cycle of high births could continue to somewhere around 2016 before heading into the downward part of the cycle,’ says Dr Jones. ‘The basic message here is that current pressures could continue for at least another four years, plus a few more years on the other side of the peak.’

Recent fi gures released by the Conservatives show a 4.4% increase in the number of NHS midwives since the coalition came to power in 2010. But, with the current baby boom not set to tail off for a number of years, according to Dr Jones’ results, there are urgent appeals for more resources.

Along with the e-petition piling pressure on the government, there are also demands that David Cameron honours his pre-election promise for 3000 more midwives.

Cathy Warwick, RCM chief executive, said: ‘Once David Cameron was safely inside Number 10, the pledge was dropped.

‘The excuse was that the number of births was no longer rising.

‘This is bizarre in the extreme given that in 2010, the latest year for which we have fi gures, the number of births in England was actually at its highest level for 40 years.

‘For too long, maternity services have been denied the resources they desperately need.

‘England is in the midst of a baby boom. David Cameron should reinstate his personal pledge for 3000 more NHS midwives and crack on with the job of delivering them.’

The situation is made even worse by the fact that women are starting families later in life. As revealed in last year’s groundbreaking Birthplace study, there has been a dramatic rise in women over 40 giving birth.

Its results show this age-group has seen a

FIGURE 1: BIRTHS PER DAY (MONTHLY) FROM 1938 TO PRESENT

2700 —

2500 —

2300 —

2100 —

1900 —

1700 —

1500 —

1300

JAN

-42

JAN

-46

—

JAN

-50

—

JAN

-54

—

JAN

-58

—

JAN

-62

—

JAN

-66

—

JAN

-70

—

JAN

-74

—

JAN

-78

—

JAN

-82

—

JAN

-90

—

JAN

-94

—

JAN

-98

—

JAN

-02

—

JAN

-06

—

JAN

-10

—

JAN

-14

—

Birt

hs p

er d

ay

——

—

—

—— —— —— —— —— —— —— —— —— —— —— —— —— —— —— —— ——

Data kindly provided by the Offi ce for National Statistics

MAR

Y EV

ANS


MIDWIVES • ISSUE 2 • 2012 rcm.org.uk/midwives40 FORECASTING BIRTHS

began in 2004, only added to the upward cycle which had already commenced from mid-2002,’ he says.

‘It is not the immigrants that caused this situation, it was the Second World War – the surge in immigration from Eastern Europe just happened to occur at the “wrong” time.’

There is also the question of seasons to consider and whether, within the larger cycles, there are smaller, annual patterns that have a notable impact.

Up to the 1970s, the month with the minimum number of births per day was typically November. In the mid-80s, it shifted slightly forward, before hitting December in the early 2000s, and the month with the least births is currently January.

Dr Jones tells Midwives seasonal patterns in births can arise from a diverse range of factors, ‘including cultural diff erences, holidays, variation in temperature and climate and social changes’.

However, Figure 2 shows that the range of variation in seasonal birth rates has declined greatly from the 1970s. This is likely to be due to the wider availability of contraceptives, in particular the increased uptake in the pill towards the end of the 1960s.

‘Births are becoming less seasonal as time progresses,’ states Dr Jones. ‘From a planning perspective, this makes the allocation of beds and staff across the year an easier matter.

‘It would seem that planning of midwifery services is very much a case of following the long-term trends.’

So, if the repeated cycle from the Second World War is still the dominant driving force behind the birth rate, then why wasn’t there better advance resource planning in place?

‘Attempts to forecast births get bogged down in arguments around demographic forecasts and trends in fertility rates, hence a fog of confusion leading to inaction,’ says Dr Jones.

‘Simply plotting the data for your local area going back to the early 1970s will usually be suffi cient to give a workable time-trend from which to base a forecast. On this occasion, everyone seems to have missed the obvious

by attempting complex but misleading analysis in the absence of the long-term view.’

Looking to the future, if we are to ensure that the profession is ready for the next boom, Dr Jones believes we have just over a decade before the next surge in births.

‘The broad cycles initiated post-Second World War will continue to dominate the future trends at a national level,’ he says, ‘especially in localities which are predominantly white British.

‘Hence a cycle of midwife training should start somewhere around 2023, with advice from the Offi ce for National Statistics on any new developments in the average age of mothers and births per mother.’

But foundation trusts have no obligation to hire newly trained midwives and, as Dr Jones states, ‘generally have no capacity and staffi ng standards other than to deliver a reasonably safe service at minimum cost’.

He believes ‘some absolute standards need to be introduced’ in order to ensure there are adequate resources and numbers of midwives to match demand.

In the meantime, if 68,000 more people sign Cathy Warwick’s e-petition calling for 5000 more midwives, a debate in parliament must be considered. With the issue discussed by MPs, and brought to the public’s attention, there would be a brighter future for the profession, even when the storm clouds begin to gather once more.�

�► Dr Rod Jones is a statistical adviser at Healthcare Analysis and Forecasting. If you would like to contact him, email: [email protected]

With 3.5m British serving

in the war, there were very few babies born in 1940.

But the birth rate was

80% higher by March 1947

very few 940. as

47

.

FIGURE 2: SEASONAL NATURE OF BIRTHS

Extent of seasonality has been determined as the diff erence between the maximum and minimum births over a 12-month period divided by the average births in that period.

33% —

28% —

23% —

18% —

13% —

8% —

3%

DEC

-42

DEC

-46

—

DEC

-50

—

DEC

-54

—

DEC

-58

—

DEC

-62

—

DEC

-66

—

DEC

-70

—

DEC

-74

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DEC

-78

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DEC

-82

—

DEC

-90

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DEC

-94

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DEC

-02

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DEC

-06

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DEC

-10

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Ann

ual r

ange

in b

irth

s

—

—

—

—

—

—— —— —— —— —— —— —— —— —— —— —— —— —— —— —— ——


rcm.org.uk/midwives 2012 • ISSUE 2 • MIDWIVES 41GUIDE TO MONEY

For many parents, having a baby can be a fi nancially stressful time. Getting the right advice is vital and can make all the diff erence. This is where the Parent’s guide to money booklet can help.

The intention of the booklet is to make it easy for midwives and other health professionals to talk through the ways parents can make the most of their money.

The guide sets out three easy ways for expectant parents to keep their household budget under control before their baby arrives. It shows them how to check what they are entitled to, how to work out how much they’ll need to spend and how to secure their baby’s future. It also directs them towards the updated parents’ section of the website, where they will fi nd a range of information and interactive tools.

Produced by the Money Advice Service (MAS), formerly the Financial Services Authority, the guide is designed to be given to expectant parents by midwives from 16 weeks onwards. It is no longer available in a handbook format, but now comes in a small, pocket-sized booklet, with the majority of previously featured information online.

The new-look guide has been redesigned, in part, from midwives’ feedback and is small enough to fi t in the back of diaries. Also, by putting the bulk of information online, regular updates can be made without the booklets becoming out of date.

‘From now on, we don’t have to warn everyone to keep checking the books because the information is up to date online,’ explains midwife and MAS relationship manager Siobhan Cleary. ‘When anything new comes out, there is a team updating the site regularly and checking everything.’

The MAS has also enhanced its website,

MONEY MATTERSThe Money Advice Service has revamped its Parent’s guide to money handbook and website to help parents be prepared. Here’s what’s changed and how it may affect midwives.

which now includes a ‘baby costs calculator’ to help parents to work out what they will need to spend before and after their baby arrives. It also features a ‘baby timeline’, which highlights what to do and when – for example, when employers should be notifi ed about a pregnancy and benefi ts that may be available during pregnancy and the postnatal period. ‘With purse strings tighter than ever, it is important to make sure families can get free money advice they can trust,’ says Siobhan, who also reassures that help is available to everyone, whether or not they have access to a computer, and that parents can call the MAS to speak to advisers.

Siobhan recommends that existing

handbooks should be distributed until stocks are fi nished. ‘We have streamlined the ordering process to make it as effi cient as possible. All registered and new orders will be dispatched on a quarterly basis,’ she says. Orders can also be made via the website and posters highlighting the booklet and where it is available can be ordered for surgeries or anywhere antenatal clinics are held.�

► For more information, please visit: moneyadviceservice.org.uk/parents, contact the Money Advice Service on: 0300 500 5000 (Mon-Fri, 08:00-18:00, excluding bank holidays) or email: [email protected]

SHUT

TERS

TOCK

/ISTO

CK

Words: Hollie Ewers

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MIDWIVES • ISSUE 2 • 201242 POLICY

Imagine if buying a muffi n from your local café was like using the NHS. You’ve just met with a dietician. She advised you to eat a low-fat blueberry muffi n every morning for the next six weeks. The catch is there’s only one café in your local area where you can get your muffi n. Unfortunately, you’ve heard some not-so-good things about it. It seems that they don’t mix the ingredients well, and the muffi ns tend to be slightly burnt. The muffi ns will meet your dietary needs for sugar, but you’re not going to enjoy eating them. A friend says there’s a café a little further away from your home that does really good blueberry muffi ns. But, to your dismay, because the café is in another commissioning area, you won’t be able to go there.

Now turn that idea on its head. Imagine if using NHS maternity services was more like buying a muffi n from your local café. Let’s say that you are pregnant. Fortunately for you, in your area, there are several diff erent providers to choose from. You can use NHS Choices to see user reviews on each of them, just the same as using Google Maps to compare nearby cafés. You can talk to your GP and friends about which providers have the friendliest midwives and off er the best antenatal classes. There is even one in the area that keeps a stock of fresh blueberry muffi ns in its waiting room. You consult with your

Illustrations: Eoin Ryan/Agency Rush

Another Questionable Procedure

for maternity services?

The RCM is calling on the government to scrap the Health and Social Care Bill in England.

The policy of ‘Any Qualifi ed Provider’ is at the heart of

this. But what is it? And what impact could it have on

maternity services? The RCM’s Simon Popay investigates.

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providers of community-based services in limited areas. These organisations face a further challenge of setting up agreements with local hospitals for access to facilities. These organisations will be operating under the current structure of the NHS and before AQP takes eff ect. AQP will make it easier for such private providers to become part of the NHS in England.

AQP policy is at the heart of the controversy around the government’s healthcare reforms, and is a major concern for the RCM. But what makes it so controversial? The problem, as with many major public service reforms, is that AQP is essentially a big gamble. By creating an open, market-based playing fi eld, the government is leaving the future direction of the NHS up to its patients and providers. Even if the policy and regulatory framework that the government puts in place gets all the incentives and rules right, the eventual outcome remains uncertain.

Whatever happens, AQP will likely result in signifi cant changes to the NHS in England. As a market-based approach, it will rely on competition to not only encourage better performance within organisations but also to close poor-performing providers and allow better performers to take over. NHS employment will probably be less stable as a result.

There is a possibility that AQP will lead to improved outcomes for patients and more effi cient services, but it is only a possibility. If patients are less discerning, or providers less scrupulous than the government anticipates, the reforms could seriously undermine the quality and effi ciency of health care in England.

On weighing up the pros and cons, the RCM decided earlier this year to oppose AQP and call for the Health and Social Care Bill to be scrapped. Not only do we think that the bill is unnecessary, but we believe that it creates a serious distraction from the need to make £20bn in effi ciency savings by 2015. Most crucially, the focus on competition that AQP creates runs directly counter to the ethos of collaboration that is so essential for safe, responsive and high-quality maternity care.

The RCM is far from the only organisation to oppose the bill. We are all waiting with great anticipation to see what the government will do in the face of growing opposition.�

RCM COMMUNITIESRCM chief executive Cathy Warwick will be on Communities between 14:00 and 16:00 on 3 April to answer your AQP questions live. Just sign up at: http://communities.rcm.org.uk. If you can’t make this time, don’t worry. You’ll be able to post your questions from 27 March until 10 April in a discussion thread in the midwives group.

PROS► Patients get to make more decisions about their own care ► Providers improve their services inresponse to competition ► Midwives get a wider range of employersto choose from ► Providers are more accountable to their patients.

CONS► Less integrated care as providers are reluctant to support competitors► Greater variation of care qualitybetween regions► Profi t-driven providers will drive up costsfor the NHS► Instability (for both patients and staff ) as providers are forced to close by competition.

Under AQP, patients in England will be able to choose from any providers of health care that meet certain standards set by the Care Quality Commission and Monitor, the independent regulator of foundation trusts, which is set to become the sector regulator for health and adult social care in England. Providers could include foundation trusts, not-for-profi t organisations and for-profi t businesses. All will be subject to the same rigorous quality standards as the NHS currently uses.

AQP could eventually apply to most aspects of NHS care, though the Department of Health (DH) has identifi ed some areas as unsuitable, such as accident and emergency. In maternity services, the DH has said antenatal education and breastfeeding support could be subject to AQP from 2013/14. Beyond this, AQP could be extended to all aspects of maternity services.

The RCM expects that, for the foreseeable future, NHS providers (such as NHS and foundation trusts) will continue to deliver the bulk of maternity services. This is predominantly because of the high capital costs involved in setting up birth units and the challenges in getting insurance against clinical negligence claims. However, we have already seen some private providers applying to become qualifi ed

By creating an open, market-based playing fi eld, the government is leaving

the future direction of the NHS up to its patients and providers

GP and you make your own decision.Two years later, you’re pregnant again. Things

have changed though, as maternity service providers have been competing with each other over the years. There are now two major maternity service franchises operating in your area – think the healthcare equivalents of Pret and Eat. Additionally, there’s a local independent group of midwives specialising in home births. You’re disappointed that you don’t have quite as many providers to choose from, but talking to your GP and browsing NHS Choices shows the quality of services has improved signifi cantly. Once again, you make your own decision.

At its heart, it is this sort of health care that the government’s ‘Any Qualifi ed Provider’ (AQP) aims to achieve. The policy is at the core of the healthcare reforms that aim to stimulate quality and service improvements through competition.

PROS► Patienabout th► Providresponse► Midwito choos► Providtheir pat

CONS► Less inare reluc► Greatebetween► Profi t-for the N► Instabprovider

Undeto choomeet ceCommisregulato

042-43_MID_FEATURES_aqp.indd 43042-43_MID_FEATURES_aqp.indd 43 7/3/12 12:54:307/3/12 12:54:30

MIDWIVES • ISSUE 2 • 201244 RCM ALLIANCE

The 320 people who attended the 2012 RCM Annual Midwifery Awards at London’s Grand Connaught Rooms all agreed that it was a day to remember. But the event’s success would not have been possible without the support of the RCM Alliance partners – JOHNSON’S® Baby, Mothercare, Pampers and Vitabiotics – who sponsored many of the categories.

During the awards ceremony, we were delighted to announce that we’ll be adding another RCM Alliance partner into the fold. Slimming World, the weight management organisation, has now joined this carefully selected group of companies who work in partnership with the RCM to support midwifery and promote the interests of the RCM, midwives and mothers.

The RCM Alliance was established in 2004 to enable the RCM to manage and develop its corporate relationships within appropriate boundaries. We recognised that maternity-related brands are aware of the relationship between their consumers and midwives and the value of working with us. Our vision was to go beyond ad-hoc sponsorship of projects to work in sustainable long-term relationships to benefi t midwives, mothers and babies.

The companies we select must share our values and ethics. They commit to us because they want to understand how their brand can support midwives and mothers and gain professional feedback about information they wish to distribute to pregnant women and mothers to ensure that it is accurate and appropriate, rather than primarily to drive sales. Agreeing to a new partnership can be a lengthy process, which includes a careful assessment of the ethos and reputation of the company and the compatibility of their products with guidelines, including the evidence behind any scientifi c claims made. We follow strictly the RCM’s corporate

Trusted allies

As Slimming World is announced as the RCM’s latest Alliance

partner, deputy general secretary Louise Silverton explains the benefi ts of joining forces with

reputable brands.

The RCM Alliance works with companies in sustainable long-term

relationships to benefi t midwives, mothers and babies

commercial engagement policy – there would be no question, for example, of considering a formula milk company.

Alliance membership does not mean the RCM is endorsing commercial products. Nor is there any intention or expectation that our individual members will directly promote Alliance partners’ products to women in their care. However, some partners do have our permission to use an Alliance or ‘supported by

the RCM’ badge on their packaging for specifi c products, which have been carefully reviewed by the RCM. As well as highlighting the Alliance relationship, this also raises the profi le of midwives and the RCM among consumers.

The Alliance is a source of funding for the RCM. Each year running the annual awards, RCM student conference and annual conference depends on the support of our partners. We hear time and again from members that you want resources to help engage and inform women in your care. An additional benefi t of the Alliance is the means to help us support members in their practice by the provision of professional resources, while letting us use your subscriptions to provide core membership services.

Most importantly, the Alliance relationships enable us to promote midwifery and provide key messages and information to childbearing women and

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through the whole journey of pregnancy. Increasingly, we see pregnant women and

their partners turning fi rst to these websites for information, support and social networking well before the fi rst booking in appointment. We believe it is essential that midwives are part of this new landscape, so women receive the best advice and understand how midwives will help. For example, we worked with Pampers to create the Guide to the fi rst 12 weeks, off ered online and as a booklet, which provides valuable information and promotes the benefi ts of midwifery care before a woman’s fi rst meeting with her midwife.

While these campaigns help us to reach women directly using our partners’ channels, the communication can also be two-way. The JOHNSON’S® Baby Mums’ Midwife of the Year competition, launched as part of the RCM awards in 2009, is a keystone of our campaign to raise the profi le of midwifery. By giving mothers the chance to describe, in their own words, how their midwives made a diff erence for them, we fi nd outstanding midwives to celebrate across the media. We have also used the words they used most frequently to describe their midwife to form a ‘wordle’ (see image), which is now available on posters and car stickers to promote the role of the midwife.

Our partnership with Mothercare has opened up more opportunities for RCM members to reach women in the community, who may not feel comfortable in a clinical setting. Mothercare runs a number of in-store events where midwives can meet with expectant women and their partners to provide breastfeeding advice and support. Mothercare’s breastfeeding awareness week is supported by the RCM, through the Alliance, and members will again be invited to participate in this, if they wish, from 18 to 24 June.

Going forward, we will be working with Slimming World to help women adopt healthy eating practices and successfully manage their weight in pregnancy and after birth. This partnership will mean that we can raise awareness of the right kind of weight management, improving the health of women, and through them, their babies.�

► For more information about the RCM Alliance and how to access the resources outlined, see: rcm.org.uk/alliance

the wider public. A good example is the Nutrition in pregnancy toolkit, which has been heavily in demand since we delivered this with our partner, Pregnacare, in 2010.

Using the Alliance we were able to capitalise on the RCM audit of midwifery practice published last year. This included some outstanding original illustrations of diff erent positions that women could adopt during a normal birth that were just too good not to make more widely available. We were able to turn to Pampers to help us create a swatch fan of the pictures for midwives to use in discussions with women.

We meet with each Alliance partner several times a year to discuss forthcoming plans and how we can work together to benefi t midwives and mothers. This helps us to understand our common purpose and develop new campaigns. For example, a discussion with

Johnson’s baby about the benefi t of midwives promoting touch in pregnancy, labour and maternal infant interaction led to the Magic of touch resource. This independently written, peer-reviewed booklet presented the research evidence for midwives accompanied by a hand-out for women.

The Alliance gives us infl uence and a stake in how and what these major brands communicate to women. These days, major brands such as our Alliance partners have sophisticated relationships with their customers built on their respected ‘household name’, using the latest social media and direct marketing techniques. Examples include the Pampers Village website (pampers.co.uk), babycentre.co.uk and gurgle.com sponsored by Johnson’s baby and Mothercare respectively. These sites connect, inform and entertain women

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MIDWIVES • ISSUE 2 • 2012 rcm.org.uk/midwives46 RCM AWARDS

—RCM

AWARDS—

During the past 20 years, many studies have found that skin-to-skin contact (Kangaroo care) has signifi cant benefi ts for pre-term babies, including shorter hospital stays (Charpak et al, 1997), more contented babies (Luddinton-Hoe, 1992), fewer infections (Ludington et al, 1992) and better breastfeeding rates (Bier et al, 1996).

However, surprisingly it has not been studied or used in the postnatal and transitional care ward environment, where well premature babies from 34 weeks onwards and small-for-gestational-age babies are cared for.

In 2010, following discussion and agreement with our paediatric colleagues at Maidstone and Tunbridge Wells NHS Trust, the midwifery team introduced Kangaroo care to the postnatal ward as part of a study into its eff ect on length of stay, feeding and parent satisfaction.

Method and interventionWe conducted a cohort study of 214 babies (107 in the study group, 107 in the control group) with a gestation of 34 to 36+6 weeks, or small for gestational age (below second centile) or babies of diabetic mothers.

Following birth, babies in the study group had Kangaroo care up to six weeks of age. The control group had standard care (in a cot next to the mother).

The main outcome measure was length of hospital stay. Secondary outcome measures were breastfeeding at discharge from hospitaland at six weeks, admission to the neonatal intensive care unit and parent satisfaction.

ResultsThere was a signifi cant reduction in mean length of stay – four vs fi ve days (p=0.017, CI 3.93-4.73) – and an increase in exclusive breastfeeding rates on discharge in the Kangaroo group compared to the control group – 72% vs 55% (p=0.01, OR 2.09 CI 1.18-3.69). Qualitative data from mothers’ and fathers’ comments regarding Kangaroo care were overwhelmingly positive in relation to bonding, feeding and how settled the baby was.

Implications for practiceImprovements and innovations in the NHS can be measured against three benchmarks:► 1� Eff ects on patientsMothers and transitional care babies are able to go home quicker and more women are able

Premature and small babies in Kent are being discharged earlier and feeding better, thanks

to the RCM 2012 award-winning Kangaroo care project at Tunbridge Wells Hospital.

to breastfeed exclusively on discharge.► 2 �Eff ects on staff Staff involved with this project report signifi cant benefi ts. Senior midwife Marion Adams said: ‘To witness the sheer amazement of parents when their baby was having Kangaroo care was just so incredible.’► 3� Eff ects on costsThe reduction in the length of stay for transitional care babies (from fi ve to four days) reduces costs and saves staff time.

The project is also helping the developing world. Midwives, working in partnership with Trade4Life – a not-for-profi t organisation run on fair trade principles – have designed the KangaWrap (kangawrap.co.uk), which is lighter and cooler than other wraps and

suitable for performing Kangaroo care in hospital. Any profi ts go to maternal and child health charities in the developing world.

Since the study ended, Kangaroo care has become routine for pre-term and small babies cared for on the postnatal ward at the trust and we are keen to share our fi ndings with other trusts. We believe that the project provides good evidence that Kangaroo care should be adopted as routine practice in hospitals throughout the UK.�

► The Kangaroo care team members are Sarah Gregson, Karen Leeson, Jane Jeal, Marion Adams and Jean Meadows. ► For staff and patient comments and article references, please visit: rcm.org.uk/midwives

Annie Lefevbre and baby

Christopher enjoying

Kangaroo care

Kangaroo care on the postnatal

ward

eyrg e

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FootnotesEvents and courses, competitions and crosswords


Events / Dates to remember

If you would like to advertise on this page, please contact sales manager Giorgio Romano on: 020 7880 7556 or email: [email protected]

Refl exology techniques for midwifery practice23, 24 March, 21, 22 April (4 days) Content includes refl exology for pregnancy symptoms; labour pain; facilitating uterine action; retained placenta; postnatal issues, for example, lactation; professional accountability; safety; evidence-based practice. Location: Sheffi eldCost: £250 (normally £585)T: 08452 301 323E: [email protected]: expectancy.co.uk

Deborah Robertson’s breastfeeding specialist course in the West MidlandsTwelve Fridays starting April 2012 with one every month (except August) AARC approved: 120 hours (study days plus optional homework). CERPs awarded. This is the same course as runs in London. Location: Stoke areaCost: £80 per monthT: 01634 814 275E: [email protected]: breastfeedingspecialist.com

Hypnobirthing teacher training course26-29 AprilBecome a registered hypnobirthing practitioner. Enjoy the privilege of empowering a mother and giving her baby the best start in

life. An inspirational guide to a calm, confi dent, natural birth.Location: LondonCost: £697T: 01264 731 437E: [email protected]: thehypnobirthingcentre.co.uk

RCM annual debate 201230 AprilHas the quest for a graduate education brought about a decline in the profession and lost the essence of being ‘with woman’? Location: LondonCost: Free T: 020 7312 3540E: [email protected]: rcm.org.uk/rcm-events

Newborn behavioural observations training24-25 MayUnderstanding newborn behaviour and supporting early parent-infant relationships – a two-day course organised jointly by the Royal Society of Medicine with the Maternity and Newborn Forum and the Brazelton Centre. Location: LondonCost: £380T: 01223 245 791 E: [email protected]: brazelton.co.uk

RCM annual event and Zepherina Veitch memorial lecture by Dr Mary Stewart14 JuneLocation: YorkCost: FreeW: rcm.org.uk/annualevent

Mothercare breastfeeding awareness week18-24 JuneAre you interested in an opportunity to promote and support breastfeeding in your community? The RCM is working with RCM Alliance partner Mothercare to provide opportunities for midwives and MSWs to hold information sessions within their local Mothercare stores during breastfeeding awareness week (18-24 June). E: [email protected]

Unique aquanatal courses for midwives Various dates from June to November Aquanatal stage 1 – introduction to teaching Location: London (23-24 June); Leeds (6-7 July, 16-17 November)Aquanatal stage 2 – advanced teaching skills Location: Leeds (5 October); London (2 November)Introduction to pilates and abdominals in pregnancyLocation: Leeds (22 June)T: 01943 879 816E: [email protected]: aquafusion.co.uk

DiaryyThis page aims to inform readers of courses,

training and events relevant to midwifery.

—RCM

ACCREDITED—

—RCM

ACCREDITED—

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2012 • ISSUE 2 • MIDWIVES 49

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 PAIRS OF TICKETS TO THE LONDON PET SHOW 2012The London Pet Show is a dynamic live event, packed full of hundreds of diff erent breeds of animals, amazing live animal action displays and fun and informative talks and demonstrations.

The show, which is at Earls Court Two on 12 and 13 May, is the UK’s largest event showcasing creatures both great and small.

It’s a great opportunity for animal lovers to meet and learn about all diff erent types of animals with expert advice on hand. Plus there are lots of goodies and gadgets to buy for both you and your pet.

WIN ONE OF 12 DVDS OF CALL THE MIDWIFE SERIES ONEBased on the best-selling memoirs of the late Jennifer Worth, Call the Midwife is a moving, intimate, funny and, above all, true-to-life look at the stories and friendships of midwifery and family in the1950s East End of London.

The series has been acclaimed by critics and has won over a huge loyal following. Breaking all ratings records at launch for a new BBC drama series, the show’s audience has grown week on week, attracting more than 10 million viewers.

WIN ONE OF 75 PREGNA-PILLOS

The Pregna-Pillo, from Medical Imports Limited, is a new pregnancy support pillow off ering mothers the ultimate comfortduring pregnancy.

It has been designed to help pregnant women who experience growing discomfort and severe back and pelvic pain during their pregnancy. It has been designed by a mother who, during her own pregnancy, became frustrated by the lack of suitable products on the market.

When placed under the bump Pregna-Pillo’s fi rm contoured shape cradles and cups the bump and supports the baby’s

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 15 April 2012. Winners are drawn at random. Only one entry per household accepted. The editor’s decision is fi nal.

—WORTH £20.42

——

WORTH £24.99

—

weight. It prevents the twisting of the spine, which prevents backache. This position also improves the fl ow of blood and nutrients to the placenta that supplies and feeds the baby through the umbilical cord. It also aids comfortable sleep.

—WORTH

£26—

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FootnotesCrossword / Puzzle

1. 2. 3.

10.

4.

9.

5.

7.6.

8.

11.

17.

23.

25.

24.

18. 19. 20. 21.

22.

12.

16.

13.

15.

14.

1. Administration of fl uid into the blood stream (11)

8. Deprivation of oxygen (6)

9. In embryology, development of a gastrula from a blastula (6)

10. An accepted average (3)

11. Used as tools in surgery (6)

13. An excess of fl uid in body tissue (6)

16. In genetics, the opposite of dominant (9)

17. The testes or ovaries (6)

20. A position once favoured in childbirth (6)

22. Ligature (3)

23. ´-- ---- parentis´ (2,4)

24. Becoming mature (6)

25. Administered through the theca of the spinal cord, as in epidural analgesia (11)

2. Labour -----, where hospital delivery takes place (5)

3. The umbilical cord does, if friable (5)

4. ´In -----´, within the uterus (5)

5. Fresh, pure air (5)

6. Method of palpation of lower pole of the uterus (7,4)

7. Treatment of female genital tract (11)

12. Injection of fl uid into the rectum (5)

14. Southern English sea port (5)

ACROSS

DOWN

15. Follicle stimulating hormone (3)

18. Synthetic material, used for suturing (5)

19. An opening into the intestine (5)

20. Termination of life (5)

21. ----- bifi da, congenital malformation (5)

Doodles

Test your wits on this midwifery-focused puzzle... How many did you get right? Look out for the answers in Issue 3.

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Documents

The Magazine of The Royal College of Midwives · The Magazine of The Royal College of Midwives ISIISSSUSE EE 2 22 | 2 201 B i r t h f o r e c a s t i n g i n t u r b u l e n t i m