by Mia Davies

Although many lay claim to being the ‘oldest profession in the world’, midwifery, in one form or another, has undoubtedly been an integral part of society for as long as we have been giving birth. The word 'midwife' comes from the old English 'mid' meaning with, and 'wife' meaning woman. Traditionally, this was the role of the local ‘handywoman’ - a woman who despite a lack of formal training, was experienced at assisting birthing women and often had several children herself.

All this changed in 1902, when Parliament passed the Midwives’ Act. This established a formal qualification which it was necessary for midwives to achieve before they were allowed to practise, effectively transforming midwifery into the profession it is today. Nowadays, the route into midwifery is strictly controlled by the Nursing and Midwifery Council (NMC) who regulate the training that must be undertaken and provide a code of professional conduct to which midwives must adhere.

The most common misconception about midwives is that they just ‘deliver babies’. In fact, for many midwives, this is only a small proportion of their work. Who is there to provide the antenatal care, advice and support that women need as they prepare to become mothers? If complications arise at any point in the pregnancy, who is there to recognise it and ensure the appropriate referral is made? After the birth, who is there to support women with establishing feeding, learning about and bonding with their babies, checking the woman’s body is returning to its pre-pregnancy state and discussing contraceptive choices? The midwives!

In addition to this, many midwives also become involved in issues which impact on, but are not directly related to, a woman’s pregnancy. For example, if a pregnant woman finds herself homeless, a victim of domestic violence, seeking asylum or becoming depressed, it is often the midwife who is best placed to recognise this and to find the right support for her. Some midwives work exclusively with the most vulnerable groups in society, such as teenagers, women with disabilities, drug misusers, bereaved couples or mothers with HIV, using specialist knowledge to try to improve outcomes. Not to mention midwifery managers, supervisors of midwives, practice development midwives and even consultant midwives, who have a vital role to play in improving the care midwives are able to provide to women, as well as the working lives of midwives themselves.

Officially, midwives are responsible for women from the time that they book into a particular service, until 28 days after the birth of the child. Nonetheless, this, like so many aspects of midwifery, is subject to some degree of flexibility. For example, some midwives choose to become involved in family planning and the provision of pre-pregnancy advice, and more and more midwives are providing care until six weeks - or even in some cases three months - after the birth.

Midwives are the bastions of normal pregnancy and birth and, if all is going well, there is no need for a woman to see any other health care professional during her pregnancy. However, if some aspect of the woman’s pregnancy appears to fall outside the realm of ‘normal’, the midwife is duty bound to refer her to an appropriate colleague, such as an obstetrician or a physiotherapist. Thankfully, the majority of women require midwifery care only. After the birth, the midwife will eventually hand over care to a health visitor, who will help women to negotiate all aspects of early childhood, such as decisions surrounding immunisations and how to wean their child onto solids.

Whilst the NHS is undoubtedly the biggest employer as far as midwifery is concerned, it is certainly not the only option. In fact, a myriad of ways to work as a midwife exist, both within and outside of the NHS. Most hospitals will have an antenatal clinic, an antenatal and postnatal ward, as well as a labour ward and midwives may work in just one of those areas, or rotate from one area to another. Depending on the size of the hospital, there may be other departments too, such as a Centre for Fetal Care, where couples whose baby may have been identified as having a problem antenatally will go to obtain specialist care, or a Day Assessment Unit, where women can have potential problems closely monitored without having to be admitted to the ward.

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