Midwifery in the UK is very different to midwifery in Malawi, and to midwifery in many other countries. For those who have grown up in the UK with the NHS, there is a general acceptance that healthcare is freely available, and an acceptance that the system is under a great deal of pressure and there are often significant delays. For those who are new to the UK, navigating the healthcare system can be very confusing indeed. I have many conversations with people who are trying to work out what they need and how to access appropriate services, so thought that it is worth explaining some key points here.
Midwifery in the UK is a well established profession, and the title of “midwife” is restricted to those who have UK recognised qualifications and have current registration with our registering body, the Nursing and Midwifery Council (NMC) https://www.nmc.org.uk/about-us/ . Midwifery and nursing are not the same. They are separate, though closely linked, professions. A midwife may, or may not, also be a nurse. I am dual qualified, being both a nurse and a midwife. I have two separate university degrees – one for each profession. I was a nurse for many years before becoming a midwife, and I find that the skills and knowledge from nursing are very valuable in my practice as a midwife. I regularly draw on my nursing knowledge to help me assess and understand complex situations, and it gives me a broad perspective on health. My nursing background equipped me well to recognise, assess and manage people who are unwell and I feel it developed my instincts for when symptoms might be an indication of a serious problem. The register of midwives in the UK is open for anyone to check, following the link above. You can see when someone qualified and if they are currently on the register as a practitioner. It is illegal for someone to act as a midwife if they are not currently registered and insured. Wherever a midwife works, whether for the NHS or privately, the requirements for qualification and continuing professional updating and development are the same.
The place of midwifery in the UK is important to understand. We are recognised to be the lead professionals for normal pregnancy and birth. This means that if things are assessed to be normal, and remain so, there is no reason for you to be seen by a doctor in pregnancy or during labour and birth. Our “scope of practice” covers the full range of skills needed. The perspective of midwifery and medicine are essentially opposites. We look for, expect, and support normality. The medical perspective is to look for the abnormal, and to intervene and manage that. Both professional groups have the aim of providing safe care. As a midwife I have a duty to identify things which are outside what is seen as “normal”, and to advise clients that referral to a doctor would be appropriate. Multi-disciplinary care can be hugely valuable, bringing two or more sets of professional skills together for an individual client.
The initial meeting with a midwife in pregnancy (commonly known as the booking appointment), is fundamentally a risk assessment. We ask many questions about your health, and that of your baby’s father and wider family if that information is available. If it isn’t explained why these questions are relevant they can feel intrusive or irrelevant. Please do ask if you wonder about the relevance of a question. What we are seeking is any factor which might mean that we need to consider particular additional checks or which mean that the process of pregnancy and birth may challenging for you, so that we can offer appropriate interventions, advice and care. There are a lot of questions! This is so very different to my experience of midwifery in Malawi, where there is little health information available generally, but also because there are very few interventions that can be offered there is not much value in asking the questions. Unfortunately however, healthcare in the UK has reached a point where there are so many issues which can be identified that it often feels like few women start their pregnancy journey without having something flagged as a potential issue. In reality many of the potential issues identified will never actually be a problem for you or your baby – this is the healthcare system taking a risk minimisation approach.
However, when additional factors are identified or the complexity of issues means that medical input can be valuable the pregnancy will be categorised as “high risk”. It doesn’t usually mean that you or your baby necessarily need to have all your care from doctors, or that problems are inevitable. It means that something has been highlighted that warrants further thought/discussion. Sometimes interventions are suggested, which may be specific to your situation or a broad advice for anyone affected by the specific issue. If you haven’t already read my post about interventions, you may want to go there now https://yourmidwife.org.uk/blog/are-interventions-a-bad-thing/ Many of my clients are “high risk” and face these decisions – I’ll write more about this next week.
With the NHS, access to midwifery in the UK is freely available to most people. Knowing how to access it is sometimes the issue. You can access midwifery care directly. You do not need to go to your GP to get referred. A positive home pregnancy test is all that you need, it doesn’t need to be confirmed by anyone else doing a test. Most areas of the UK have an on-line referral system where you can inform the local NHS midwifery team of your pregnancy and request an initial booking appointment. Locally in Sussex, the link is https://www.uhsussex.nhs.uk/services/maternity/pregnancy/book/
If you choose to use a private midwife you do not lose your right to NHS services. You can register with the NHS system and only take up some of the appointments they offer. Even if a client intends to have all their care (including birthing at home with me) I still advise registering with NHS maternity services. Realistically, we never know that there isn’t going to be something unexpected that crops up during this time. I am very keen to work collaboratively with my NHS colleagues and it is very helpful for them to know a bit about you. For many of my clients this means that they will have an initial booking appointment with an NHS midwife, usually including the routine blood tests offered at that point. Most will also take up the standard scans at around 12 and 20 weeks gestation as well as the 28 week midwifery appointment where further routine blood tests are offered. This gives the NHS system some baseline information to work with if anything crops up later on that we decided to seek their input for. I advise that you inform the NHS midwife of your plans, so that they do not worry that you are missing out on good care. With your permission I also write to the local head of midwifery to confirm that I am involved & what our plans our. I believe that this is good professional practice.
The NMC set clear standards for record keeping (amongst many other things) for midwifery in the UK. I use paper records, which for my clients having a package of care is a book which contains information for you alongside the records I make about your care and our discussions. You hold these notes during your pregnancy and I advise that you make them available to any other care provider you consult. It is important that they are retuned to me once baby is born. As part of my professional agreement to access professional support and indemnity insurance with the Private Midwives organisation, I send all notes to them for audit and subsequent safe storage in accordance with legal requirements. I feel that this system provides some quality checking and it also means that I do not have to worry about how to store the notes once I retire. The law concerning healthcare records and midwifery in the UK requires that notes are kept securely for 25 years after the baby’s birth.
Midwifery in the UK is a closely regulated profession. Obviously within the profession there is a range of skills, personalities and levels of experience. Some people are comfortable receiving care from a number of midwives over the course of their pregnancy, birth and postnatal period, accepting that all are qualified to the same standard. Others feel that they want to build a relationship with a single midwife. Realistically, the NHS can rarely provide this level of continuity, although in some areas small teams of midwives may be available and you would expect to see one of the team for each aspect of your care. If you want to choose your midwife, private midwifery is available in most parts of the UK. Those of us who work in this way understand that you will want to find the person who is the best fit with you. I encourage potential clients to have a chat with me on the phone, and also to chat with other private midwives, before you make a decision whether private midwifery is right for you, and if so, who “your” midwife should be.