This is the third post in the series 'What the national maternity review team should know' blog posts, my action for #FlamingJune #MatExp.
Hannah Tizard is an exceptional student midwife, and has already made her mark by highlighting the importance of optimal cord clamping at birth, in response to research evidence. You can find Hannah on Twitter, and below read her insightful perspective.
For the best part of thirty years evidence based medicine has been an important and expected part of midwifery practice and it provides a way of integrating clinical expertise with the best evidence from research. Government strategies (Midwifery 2020) and standards for ethics and practice (The Code, 2015) provide an underpinning framework. UK midwifery sits within the structure of the NHS which is of course bound by governance, hierarchical relationships, policy and guidelines. That is not to insinuate these things are bad, they are necessary and signify our responsibility to safe practice, however, they also often present one of the challenges to moving practice forward in line with evidence.
As budding student midwives entering the world of midwifery we also enter the world of medicine, some of us for the first time. For me this is significant and whilst it represents a challenge it is also defines our commitment to provide care in a diverse and ever changing field of work, adapting practice to suit. In my opinion there is no room for complacency, we accept through practice we develop experience but that experience must never over shadow a requirement to continually develop skills and understanding. The way we are taught today will be different from those who enter the profession following us. Indeed that’s part of the appeal – new research innovates, illuminates understanding and highlights improvements for the future – it’s exciting!
As students we are fortunate in our position to be privy to this plethora of new research, we have access to well respected informed lecturers, university research clusters and expensive databases full of papers, some of which cement previous understanding while others challenge practice. We do take for granted the accessibility of knowledge, having the internet at our fingertips, flicking through threads on social media, stumbling across a new article that blows your mind. For us the ‘light bulb’ moments happen on a weekly basis! And we have a desire to share.
We are very privileged but equally bringing new research to the table can pose difficulties. In 2005 Billie Hunter wrote a paper about emotion work of midwives in hospital based settings, it emphasized the importance of colleague relationships in midwifery which provided feedback on individual practice, but also highlighted these relationships were often difficult to manage and a major source of emotion for midwives and students. Hunter (2005) found senior and junior midwives frequently held contradictory models of practice, resulting in competing claims for occupational authority and senior midwives attempted to maintain their position through unwritten rules and sanctions. We are now ten years on but I believe Hunter’s claims are still relevant today, differing paradigms of practice and professionalism create conflicts, cause barriers and are part of the maternity workplace, perhaps they will still be relevant 10 years from now, but I sincerely hope not.
Certainly, there is much going on in midwifery today which attempts to change culture, to give everyone a role, working together with service users and practitioners to promote communication and collaboration rather than foster unhealthy competition and barriers. It is always fantastic to hear about midwives and students helping to change routine, inspire each other and develop more efficient ways of working – social media is the best place to find these stories.
At a recent conference consultant midwife Tracey Cooper discussed her midwifery journey characterised by her determination to challenge boundaries to try to improve outcomes for women. Tracey has been confronted, her practice has at one time or another been scrutinised but Tracey says “using the evidence makes us strong”. I’m always impressed by her ability to use quiet questioning and her advice, which is, when unduly challenged ask politely for the statistics which are proposed to contradict your work, as often there aren’t any!
Obviously all new research must be independently reviewed and extensively critiqued before being accepted into practice and institutional structures should operate efficiently to ensure the newest evidence is included into policy before it becomes out of date. Practice development midwives must also ensure evidence based guidelines are implemented effectively so health outcomes are achieved. Michie (2005) states a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals may be to blame when this fails. Midwives need to understand why new policies exist, be informed about the evidence and be able to translate that to the women we care for. It’s a complicated process.
Questioning our current delivery of care, day to day ingrained practices and interventions, some of which cause harm and are used without a sound evidence base is of the utmost importance and easily overlooked. Sheena Byrom explores the use of language in care, Amanda Burleigh has challenged the lack of evidence behind the practice of immediate cord clamping and its damaging effects, Denis Walsh proposed birth centre model and Sheila Kitzinger fought against the medicalisation of childbirth. These are just a handful of individuals who have shaped a profession, developed and enhanced women centred care and improved outcomes for women and babies. They listened, questioned and sought answers, they are importantly passionate about ensuring maternity care is protected and delivered with compassion. It only takes one enquiring mind and a little courage to set the wheels in motion, find those who will support you, collaborate and enjoy celebrating achievements, no matter how big or small.
As discussed by Mary Steen (2012) in her paper, teamwork and motivation make systems work and together we can make a difference, enjoying the adventure and having creative ideas and vision along the way helps - “the journey is the reward”.
Hunter, B. (2005). Emotion work and boundary maintenance in hospital-based midwifery. Midwifery,21(3), 253-266. doi:10.1016/j.midw.2004.12.007
Michie, S. (2005). Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality And Safety In Health Care, 14(1), 26-33. doi:10.1136/qshc.2004.011155