• Helen Shallow

The time to shape the future of midwifery is now

So much seems to have been happening recently. On the 5th February I spoke about the politics of midwifery at the London Maternity Festival. Generally, my talk was well received but one delegate’s comments crystallised why, despite our efforts to implement models of care that we know will improve outcomes for women, we appear unable to undo the crisis facing maternity services. In short, one delegate’s comments caused me to reflect further on the crisis in midwifery. She advised me to ‘use caution’ when recommending a feminist approach to explore solutions. She said it ‘could put people off’ in the same way, she said, that using the term radical has put midwives off joining the Association of Radical Midwives (ARM) over the years. Having welcomed her comments, I nevertheless reiterated that I stood by what I said. Midwifery would be far better served if midwives and managers addressed the crisis in our profession and the childbirth arena by analysing the issues through a feminist lens.

Incidentally the Lancet February edition, is dedicated to feminist authors as it too acknowledges the ongoing inequities in medicine and science.


Just as the term radical, which simply means back to roots, has been misunderstood and misappropriated by those who wish to undermine women, so too is feminism, as it presents a threat to the order and legitimacy of continued patriarchy. However, as bell hooks said,

To be ‘feminist’ in any authentic sense of the term is to want for all people, female and male, liberation from sexist role patterns, domination, and oppression.” (hooks 1981)

Is that not what all of us are campaigning and working to achieve when we work with women from all strata of society? Could not a feminist endeavour be embraced by midwives in the UK and if not why not?

Why do we not question the dominant narrative that we are fed by the media and politicians? The narrative that women are older, fatter and more complex these days and that is why the intervention rates are increasing? These claims are not supported by the evidence. On the other hand, we have good evidence to show an increase in poverty and poor health, as well as increased medicalisation, which causes both mental and physical ill health. It is with the architects of these socio-health-economic policies that any blame should really lie.

Surely this dominant narrative is the very stuff that undermines women’s confidence in themselves and renders them anxious and helpless, reminding me of Jane Austen’s writings three centuries ago, in which she courageously challenged the notion of female frailty (see ‘Pride and Prejudice’ for example). That poverty and inequalities in health are increasing is an indictment of this and recent Governments and we should be challenging policy, not blaming individual women and placing ever more restrictions on women’s potential to give birth well.

A further example of the ongoing crisis is highlighted in the following letter to the Guardian this week about the continuing closure of birth centres. https://www.theguardian.com/society/2019/feb/11/concerns-over-birthing-options-as-nhs-shuts-midwife-led-centres-england

Crucially, the naked truth is that birth centres are wrongly viewed by many as ‘the icing on the cake’, a luxury the NHS cannot afford, despite the evidence that birth centres are safe for women and babies, increase normal birth rates, decrease ill health and costs and are liked by women, their families and midwives. Trusts do not want to talk about these benefits as they struggle with too few resources and then conceal the truth behind the safety debate. A midwifery friend recently confirmed that in areas like Southmead, they do not even have enough ingredients for the cake, let alone the icing.

A swift response to the reasons for birth centre closures was published this week also in the Guardian by those who understand why more women are choosing obstetric services and not birth centres. Women’s decisions are not made on best-evidence - information; but more on faulty narratives about their ever-increasing risk factors. Such is the narrative of frailty issued to 21st century women.


At the same conference on the 5thFebruary at the London Maternity Festival my talk was preceded by Professor Mary Renfrew. On behalf of the Nursing and Midwifery Council (NMC), Mary announced the opening last week of the public consultation for the standards of proficiency for registered midwives. The overall project entitled ‘Future Midwife’ is a first draft of new standards that aim to encompass standards that will be the vision for the future, in which midwives hold a case load and provide continuity of care (CoC). It includes standards that also meet the additional needs of women, who will require more complex technical care in obstetric units as well as ongoing midwifery support.

This work comes at a pivotal time for maternity services. There are serious tensions and barriers to implementing full scale CoC, not least the cost of investing in new models of care that will in time prove to have more health benefits and be cost effective. The NHS has been seriously underfunded for many years. Privatisation was first put forward by Thatcher in 1979 and persisted with successive governments especially after the last financial crash in 2008. Latest Government ideology is accelerating this process. We, the people, are still paying the price of the ineptitude and greed of corporate businesses and bankers. The hidden and inexorable privatisation of the NHS advances apace and a closer examination of ‘Better Births’ reveals that policy makers are widening access for private enterprises to tender for Continuity of Care, (CoC), services.

So, what of our new standards? What will the shape of our future midwives be? I implore anyone who cares about midwifery CoC for women, to read the standards closely and comment on them. Don’t just tick the survey question boxes but use the open spaces to put forward your views. Join the webinars or sign up to the open sessions round the country. You will find a programme of events on the NMC website. There are questions we need to ask of the standards, and questions we need to consider as we respond to the consultation and where we want midwifery to be in the future.

In our next blog I will discuss the standards in more detail and suggest the kinds of issues midwives, women, birth workers and the public might want to consider when filling in the NMC survey about the proposed standards. To view the standards, go to the NMC website www.nmc.org.uk follow the education link and there you will see New Standards for the Future Midwife.