The portrayal of midwives often suggests that all midwives do is deliver babies, and often the entire focus of maternity services policy seems to be on the time of birth and the need to ensure that at this point we keep mothers and their babies physically safe.
This is, of course, of critical importance, but it is by no means the whole story, and if we are to help the public with the challenges of raising children, public policy needs to take a much broader view.
Three important points that public policy needs to take into account are:
- That the midwife has a responsibility to look after women during the entire period of pregnancy, labour and after the birth;
- That virtually all pregnant women access maternity services and for some of them this will be their first or one of their very few encounters with health services;
- That women trust midwives, who are generally seen as people who are there to help them.
Public policy needs to recognise the huge opportunity that exists if the country invests in high-quality antenatal and postnatal care for women. The midwife should be supported to work in partnership with women to help women maximise their ability to mother. Antenatally the midwife can help a woman to understand how to look after herself in order to maximise her baby’s potential even when still in the womb. She can discuss many public health issues which impact on the future of the child such as smoking, obesity, infant feeding. She can help the mother to think her mental health. Postnatally again the midwife can support the mother and the whole family, including fathers, as they cope with the transition to becoming a family. She can detect and get treatment for those problems that may impede the ability to cope such as the development of postnatal depression.
Policymakers may of course argue that current maternity policy supports high-quality antenatal and postnatal care. However, all the evidence suggests otherwise.
First of all, resources are not adequate. There are not enough midwives to ensure cover for all women throughout the entire childbearing period and our midwifery leaders report that they frequently have to move midwives from antenatal and postnatal work to cover the labour ward. A starting point for any Labour government has to be to commit to not only training but also employing enough midwives.
However, it is not all about resources. Antenatally women report in surveys that they do not receive the kind of personalised continuous care throughout their pregnancy that allows constructive discussion about a multitude of important issues. Women report that they see a different midwife at every antenatal visit and postnatal care is currently rated poorly compared to the rest of maternity services with women struggling to see midwives or seeing different midwives and getting conflicting advice.
What women want is to know and trust their midwife. When this is the case midwives are enabled to play a constructive part in supporting women to raise their children. When it is not the case the opportunity is lost and sadly it is those women who need help most – the socially disadvantaged, the women who find services hard to access, the women with mental health problems – who suffer the most. A Labour government needs to commit to the provision of services that deliver personalised women centred care rather than the institution-centred fragmented care we see at present.
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Cathy Warwick is general secretary of the Royal College of Midwives. She tweets @cathywrcm
She was speaking at The politics of motherhood: How does public policy shape families and can it do it better? at Labour party conference, an event by bpas and Progress. To see details of the other speakers please see here, and catch up on what was said with the Storify of the event, here