Where is the Supervision? Virginia Hewitt - Head of Safeguarding Children ABMU Health Board South Wales UK

1. The Safeguarding Role of the
Midwife
Where is the Supervision?
Virginia Hewitt - Head of Safeguarding Children
ABMU Health Board South Wales UK
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2. Background
 MA in Medical Humanities 2011
 Named Midwife for Safeguarding Children
 Acknowledged the impact of the midwife’s
safeguarding role and a potential lack of support
 Identified the subtle nature of the ‘midwife – woman’
relationship and how this may conflict with protecting
the newborn
 Set out to evaluate whether statutory supervision
supports the midwife’s role in safeguarding children
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3. Methodology
 Literature Search using humanistic principles
 The role of the midwife was explored using literary and
historical references
 The midwife’s safeguarding role includes ethical and
legal dilemmas such as the removal of the baby at
birth
 Aspects of safeguarding supervision were considered
as well as statutory supervision of midwives
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4. What is a Midwife?
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5. ‘As Old As the Hills!’
An ancient profession
- Anthropological evidence
- Ancient Greece
- Biblical references
 Originally female – myd wyf – with woman
 Other terms – priestesses, wise women, gamps,
witches, god-sips, hags
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6. The Professional Midwife
 End of C19 – need for social reform, improve health of
poor
 Medicalisation of birth
 Sairy Gamp image ‘dirty drink-sodden
old hag without skill or conscience’
(Leap and Hunter 2003)
 Midwives became professionalised in 1902
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7. Early Safeguarding Role
 Biblical reference - Protecting Hebrew baby boys from
death
 Babies baptised during or straight after birth to prevent
being ‘firebrands of hell’ (Thomas 1971)
 Testifying in court with regards to infanticide
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8. Midwife’s Safeguarding Role Today
 Often first professional to work with potential new
parents so need to recognise early signs of neglect
and abuse
 Public health role - smoking/domestic
abuse/substance use/mental health – impact on
unborn & baby
 Teenage Pregnancy
 The younger they are the more vulnerable they are
 Midwives have a responsibility up until 28 days after
birth
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9. Unique role of the midwife
 Cares for mother and baby together not as two separate entities
 Works in partnership with women
(International Confederation of Midwives 2005)
 Professional Accountability to keep mother and baby together
 Supports mother re choices - refuses antenatal care, birth at
home, free birth, lotus birth
‘Balance the need to act in the best interests of people at all times
with the requirement to respect a person’s right to accept or
refuse treatment’ (NMC 2015)
 Caring for the woman when the baby dies – stillbirth/miscarriage
BUT also when baby is removed from mother due to child
protection concerns
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10. Conflict in Responsibilities
 A legal requirement to ‘safeguard and promote the
welfare of children’ (Children Act 2004)
 Responsibility to report issues that could affect unborn
and/or baby
 Unborn has no legal rights – Birth Plans to remove
 Removal at birth is unlawful unless instructed by court
of law
 The safeguarding role of the midwife is not widely
recognised
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11. Comments
‘ I have felt a great responsibility re child protection, but
at the same time feeling quite inadequate to meet that
responsibility.’
‘ The amount of time we spend ensuring that we fulfil our
duty to these women AND their babies not to mention
their often abusive partners by far outweighs the
actual time spent with the woman.’
(Midwives on RCM Forum 2010)
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12. The origins of Midwifery Supervision
 Following professionalisation of midwives in 1902 –
Inspectors of Midwives were introduced
 Punitive Role
 ‘Usually ‘respectable’ women such as clergymen’s
daughters’ - some suggest ‘patronising and
judgemental’ (Heagerty 2006)
 1937 – renamed supervisors – more supportive and
to have ‘sympathy and tact’ (Rutherford 2009)
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13. Supervision of Midwifery Today
 To protect the public from malpractice
 Statutory Requirement – Midwives’ Rules
 Not clinical supervision
 Some supportive elements mainly practice related
 Safeguarding Children issues not acknowledged in
midwifery supervision training material
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14. Two Hats
Managed or Supported?
‘To root out bad practice is very different from
the support skills needed to foster the
confidence in the face of uncertainty’
(Kirkham 1996)
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15. Safeguarding Supervision
 Focus on practitioner
 Developed from models of clinical supervision
 Restorative – listening, challenging, supportive
 Allows practitioner to identify & clarify situations which
have legal, professional and ethical components
 Managerial aspect to reduce risk
 Recommended as essential protective factor in child
protection work (Laming 2003, 2009)
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16. Findings
 Professionals working within the safeguarding children
arena find the work emotionally demanding
 Midwifery work - high emotional content
 The safeguarding role of the midwife is not always
acknowledged in comparison for example to the health
visitor
 An assumption that supervision of midwifery provides
appropriate support
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17. Recent Changes
 Serious failings - Maternity Unit Morecambe Bay
 Ombudsman – Review of Midwifery Regulation 2013
‘ Midwifery supervision and regulation should be separate as it led
to a conflict of interest between midwives and supervisors’
 Kings Fund Review of Midwifery Regulation 2014
‘The additional layer of regulation...for midwives and the extended
role for the NMC over statutory supervision should end’
 Morecambe Bay Report 2015
‘Urgent response to King’s Fund findings with effective reform’
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18. Recommendations
Royal College of Midwives are determined to retain the supportive
aspect of supervision and the responsibility of the future of
midwifery supervision now sits with the chief nursing officers
 Ideal opportunity to explore the safeguarding role of
the midwife
 Further research to understand some of the dilemmas
midwives face within this important role
 Devise a model of supervision that will empower and
support the midwife
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19. Conclusion
 It has been argued that the relationship between
mother and baby is the most powerful relationship
human beings experience (Taylor 1996)
 Midwives sometimes become part of a process that
breaks that bond.
 This can cause emotional distress for a midwife whose
prime focus is the mother
 Good safeguarding supervision is needed to support
the midwife and to ensure the safety of the baby.
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20. Thank You
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