The Student’s Guide to Becoming a Midwife

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Becoming a midwife in the 21st century.
    The student’s guide to becoming a midwife / edited by Ian Peate, Cathy Hamilton. – 2e
        p. ; cm.
    Preceded by Becoming a midwife in the 21st century / edited by Ian Peate, Cathy Hamilton. c2008.
    Includes bibliographical references and index.

    ISBN 978-1-118-41093-6 (pbk. : alk. paper) – ISBN 978-1-118-41094-3 (epub) – ISBN 978-1-118-41589-4 (epdf) – ISBN 978-1-118-41629-7 (emobi) – ISBN 978-1-118-41638-9 – ISBN 978-1-118-41643-3
    I. Peate, Ian, editor of compilation. II. Hamilton, Cathy, 1962– editor of compilation. III. Title.
    [DNLM: 1. Midwifery. 2. Nurse Midwives–organization & administration. 3. Nurse Midwives–standards. 4. Perinatal Care–methods. WQ 160]
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Cover image: Photo of a moments-old baby being handed to his mother. © iStockphoto / Yarinca.
Cover design by Steve Thompson

Contributors

Laura Abbott MSc BA, BSc(Hons), RGN, RM, is a Senior Lecturer and Admissions Tutor for Pre-Registration Midwifery at The University of Hertfordshire. She is a supervisor of midwives for the East of England Local Supervisory Authority and is linked with the team of supervisors at East and North Herts NHS Trust. Laura has written on a variety of topics for midwifery and nursing journals. Her midwifery practice involved working independently for 6 years. Laura has been a guest speaker at conferences around the UK and internationally and is currently undertaking a Doctorate in Health Research.

Carmel Bagness MA, PGCEA, ADM, RM, RGN is the Midwifery and Women’s Health Adviser at the Royal College of Nursing. The role enables her to develop UK-wide health and social care policy and practice, in both midwifery and various aspects of women’s health. She is a practising midwife who has extensive experience in midwifery education, and worked at the Department of Health on the Midwifery 2020 programme. She uses her experience to channel knowledge and resources to make best use of evidence to influence contemporary practice to contribute to the healthcare requirements of the 21st century.

Emma Dawson-Goodey MA, DipHE, RM, RGN is a Senior Midwifery Lecturer at the University of Hertfordshire. She has worked in midwifery education since 2003 and her key interests have continued to be midwifery and sexual health, health law and professional regulation.

Tandy Deane-Gray MA, BSc, PGCEA, ADM, RM, RGN is a Senior Lecturer Midwifery at the University of Hertfordshire. She has worked in Midwifery Education since 1988. She has attended home births in Bermuda. Her key interests have continued to be midwifery, parenting and communication. She facilitates baby massage, as she is particularly interested in parent infant attachment, and also works as a psychotherapist.

Lyn Dolby BSc(Hons) RGN, DPSM, PGCert is a Senior Midwifery Lecturer at the University of Hertfordshire. She began working in midwifery education at Nottingham University and then joined the University of Hertfordshire in 1996. She is the lead on the Physical Examination of the Newborn and her Masters dissertation relates to this area of her expertise. Her present doctoral research is exploring the experience of student midwives as they complete the Physical Examination of the Newborn module during their pre-registration midwifery programme.

Caroline Duncombe MSc, BSc(Hons), RGN, RM, DipHE Midwifery, PGCert is Midwife, Supervisor of midwives. She is currently an instructor on the ALSO (Advanced Life Saving in Obstetrics) Course. She works as a Diabetes Specialist midwife. Her interests include supporting women with medical complications through their pregnancy and birth and clinical risk management.

Cathy Hamilton MSc, BSc(Hons) RGN, RM, PGDip, PGCert is a Principal Lecturer at the University of Hertfordshire and is also a Supervisor of Midwives working with the supervisory team at West Herts NHS Trust. Her current research interests focus on midwifery care during the second stage of labour.

Annabel Jay BA(Hons), MA, FHEA, DipHE, RM, PGDip(HE) is a Senior Lecturer in Midwifery and is currently the admissions tutor for the pre-registration midwifery programme at the University of Hertfordshire. Annabel has published research into the Objective Structural Clinical Examination (OSCE) and has presented at various conferences. She is currently undertaking doctoral studies, exploring women’s experiences of undergoing induction of labour. Annabel has a particular interest in the involvement of service users in midwifery education and continues to lead parent education classes in Hertfordshire.

Patricia Lindsay RN, RM, MSc, PGCEA, DHC did her nurse training in London then trained as a midwife. She has been a practising midwife since 1974 and a midwifery teacher since 1991. She has worked in the UK and in the Sultanate of Oman. She is currently Lead Midwife for Education at Anglia Ruskin University. Her doctoral thesis was on incident reporting in maternity care and she had presented posters on this topic at national and international conferences. Her interests are patient safety in maternity care, women’s mental health and support worker training.

Jenny Lorimer MA, HDCR is a Senior Lecturer in diagnostic radiography and Lead for Interprofessional Education (IPE) at the University of Hertfordshire. The role at Hertfordshire involves students from 12 different disciplines, in very large cohorts, working and learning together. Jenny’s research interest is the effect of IPE on students’ attitudes.

Kath Mannion BSc Midwifery, MSc Midwifery, RM, RN, ADM is LSA Midwifery Officer for the North East Strategic Health Authority. Kath’s current appointment includes investigating cases of alleged suboptimal practice by midwives and determining the appropriate supervisory action. She is an Advanced Life Support in Obstetrics (ALSO) Advisory Faculty and serves as a trustee on the executive team within that organisation. She regularly teaches on ALSO Provider and Instructor courses throughout the UK and Ireland.

Lisa Nash BSc (Hons), MBA (Herts), RM, PGDip (Learning and teaching), Dip HE Midwifery is Senior Lecturer in Midwifery at the University of Hertfordshire. Lisa has been in midwifery education since 2000 and works at the University of Hertfordshire in the school of Allied Health Professionals and Midwifery.

Maxine Offredy PhD is Reader in Primary Healthcare at the Centre for Research in Primary and Community Care, University of Hertfordshire. She is an editorial board member and book review editor for the journal Primary Health Care Research and Development. Key areas of interest include clinical decision making and qualitative research methodologies.

Marianne Peace MA, BSc(Hons), DipHE, RM, RN is a Senior Midwifery Lecturer at the University of Hertfordshire. Marianne qualified as a midwife in 1997 and has worked both in the UK and internationally, gaining experience as a midwife in the United Arab Emirates. She has been involved in midwifery education since 2005 whilst working as a midwife and she subsequently joined the university as a lecturer in 2007. Marianne’s key interests include learning & teaching, midwifery care, female genital mutilation in relation to childbirth and safeguarding children, health promotion, inequalities in health and breastfeeding.

Ian Peate EN(G) RN DipN (Lond) RNT BEd(Hons) MA(Lond) LLM is Editor-in-Chief of the British Journal of Nursing, Visiting Professor of Nursing with University of West London and Independent Consultant. Ian began his nursing a career in 1981 at Central Middlesex Hospital, becoming an Enrolled Nurse working in an intensive care unit. He later undertook three years student nurse training at Central Middlesex and Northwick Park Hospitals, becoming a Staff Nurse then a Charge Nurse. He has worked in nurse education since 1989. He has published widely. His key areas of interest are nursing practice and theory, sexual health and HIV/AIDS.

Cathy Rogers MA, RN, RMN, RM, ADM, PGCEA, Supervisor of Midwives qualified as a midwife in 1984 and she has worked in all areas of midwifery practice. She is currently employed as a consultant midwife at Barnet and Chase Farm NHS Trust where she is responsible for leading midwifery-led services. She is also an honorary lecturer at the University of Hertfordshire and is specifically involved in the development and delivery of the postgraduate course for the preparation of supervisors of midwives and Newborn infant physical examination.

Celia Wildeman SCM, DipNS, ADM, BEd (Hons), PGDC, PGDSPCF, Supervisor of Midwives is a Senior Lecturer in the Department of Nursing and Midwifery at the University of Hertfordshire. Her special interests include women’s sexual health, teenage pregnancy, domestic violence and abuse, equal opportunities and cultural diversity.

Sandy Wong MSc, ADM, RM, RGN, PGCert(HE), FHEA is a Senior Midwifery Lecturer at the University of Hertfordshire and a Fellow of the Higher Education Academy. Prior to joining the University of Hertfordshire, she was a clinical midwife for many years, largely in the community. Her previous role as a community clinical manager also involved her with child protection at a strategic level. Sandy undertook a qualitative research project on perinatal mental health for her MSc degree. She sees herself as an expert in normality in pregnancy and childbirth, with special interests in diversity and public health.

Carole Yearley MSc, RN, RM, ADM, PGCEA, PGCert, Supervisor of Midwives is a Principal Lecturer in Midwifery. She is part of the team of supervisors of midwives at Barnet, Enfield and Haringey Strategic Health Authority and currently is the Programme Tutor for the Postgraduate Certificate in the Supervision of Midwives at the University of Hertfordshire.

Preface to the Second Edition

In the UK, maternity services have developed significantly with an increasing recognition that midwives should take the lead role in the care of normal pregnancy and labour (DH 2007, 2010). Midwifery-led care has been seen to have good outcomes such as shared care, reports of greater satisfaction from women and a reduction in obstetric intervention rates (Devane et al. 2010).

The first edition of Becoming a Midwife in the 21st Century was published in 2008. Since then the world has changed and the practice of midwifery continues to evolve. This second edition reflects the changes that have occurred but maintains its central aim of helping to prepare the next generation of midwives who are fit for purpose and fit for practice.

Feedback from students and lecturers alike has been instrumental in ensuring that this edition will be as popular as the first one. There are now 20 chapters in this edition arranged around the new pre-registration midwifery standards. The five essential skills clusters have been interlinked within each of the chapters where appropriate.

The new edition builds upon the positive comments made by the reviewers and anecdotal comments concerning the current text’s ‘student friendliness’. Each chapter commences with an aim and a set of 4–6 objectives which will help you to pre-plan learning and understand the rationale for the discrete yet intertwined chapters.

We have reviewed the various elements of pedagogy, developing this further to make it stronger and more engaging. Readers will note that the text layout has been prepared in such a way as to make it more appealing.

Chapter order has been rearranged and we have retained the popular case studies and extended them further. Each chapter has review questions using a variety of formats with answers provided at the end of the book. The aim is to improve retention and enhance learning.

As appropriate, midwifery pearls of wisdom have been provided throughout the text, providing the reader with practical hints and tips. There is a glossary of terms at the end of the book.

Updated evidence to support discussion has been provided. Reference and referral to organisations such as National Institute for Health and a Care Excellence (NICE) and other appropriate government organisations have been retained. Throughout, referral to the Code of Conduct and Guidance on Professional Conduct for Nursing and Midwifery Students has been included.

Various White Papers that have had and will have an impact on the practice of midwifery and the care of women produced by the government have been included. An additional chapter has been included focusing upon public health and the role of the midwife.

We have sincerely enjoyed being able to provide you with an updated version of the first edition. We hope that you will enjoy reading it with the primary intention of providing safe and effective care based upon the best available evidence to those women and their families for whom you have the privilege to care.

References

Department of Health (DH) (2007) Maternity Matters: choice, access and continuity of care in a safe service. London: Department of Health.

Department of Health (DH) (2010) Midwifery 2020: delivering expectations. London: Department of Health.

Devane D, Brennan M, Begley C et al. (2010) A Systematic Review, Meta-analysis, Meta-synthesis and Economic Analysis of Midwife-led Models of Care. London: Royal College of Midwives.

Acknowledgements

We would like to thank all of our colleagues for their help, support, comments and suggestions.

Cathy would like to thank her friends and family for their patience and encouragement.

Ian would like to thank his partner Jussi Lahtinen and Frances Cohen for their continued support and encouragement.

This text is primarily intended for midwifery students, midwifery support workers, healthcare assistants, those undertaking Scottish Vocational Qualifications/National Qualifications Framework level of study or anyone who intends to undertake a programme of study leading to registration as a midwife. Throughout the text, the terms midwife, student and midwifery are used. These terms and the principles applied to this book can be transferred to a number of healthcare workers at various levels and in various settings in order to develop their skills for caring for women and their families throughout childbirth.

The unique role and function of the midwife

Midwives provide individual care to women and their families, encouraging them to participate in their pregnancy and determine how they want it to progress. Each year, over 700,000 women in the UK will give birth, nearly all of whom will have had the majority of their care from a midwife. In women’s homes, birth centres and hospitals, midwives co-ordinate a woman’s journey through her pregnancy, offering her continuity with the aim of ensuring that she experiences safe, compassionate care in an appropriate environment.

Midwife means ‘with woman’ and this highlights the empowering/partnership role of the midwife – the midwife works with the woman rather than telling her what to do. The underpinning philosophy of midwifery care is articulated by Page and McCandlish (2006) who suggest the following:

The essence of being a midwife is the assistance of a woman around the time of childbirth in a way that recognises that the physical, emotional and spiritual aspects of pregnancy and birth are equally important. The midwife provides competent and safe physical care without sacrificing these other aspects.

The support the midwife offers is established by assessing the woman’s individual needs and by working in partnership with her and other healthcare workers. The midwife is usually the lead healthcare professional involved in caring for pregnant women. There will be occasions when you will need to work on your own as a midwife and times when you will be working as a member of the wider team. It is important that midwives work collaboratively with other healthcare professionals, including obstetricians, paediatricians, specialist community public health nurses and paramedics, in order to ensure a high quality of care for women and their families.

Medforth et al. (2011) note that the definition of a midwife was first officially formulated in 1972. This was after discussions and debates among various organisations and committees and is as follows:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

The midwife is the senior professional attending over 75% of births in the UK, providing total care to mother and baby from early pregnancy onwards, throughout childbirth and beyond. The role of the midwife is thus multifaceted.

The midwife’s role in public health

Another important aspect of that role is within the context of public health. Public health can be defined as improving the health of the population, as opposed to treating the diseases of individuals. This is particularly appropriate in midwifery as you will be caring for healthy individuals going through the physiological process of childbirth. Public health functions (DH 2004) include:

The Department of Health (2012a) defines public health as: ‘about helping people to stay healthy and avoid getting ill’. Within this definition specific areas are included such as nutrition, recreational substance use, sexual health, pregnancy, immunisation and children’s health. The key concerns of public health are dual: the health of populations and the health of individuals or groups within a population. The health needs of populations are embraced within overarching measures such as food and water safety, road safety and the provision of health services which are free at point of care.

A great deal of public health activity in the UK is derived from government; the drivers are political and economical, as the burden of disease is costly to a nation in which the state subsidises health and social care. Public Health England, introduced in April 2013, has been charged with protecting public health by delivering on the objectives of the Public Health Outcomes Framework (DH 2011, 2012b). The legislation responsible for this is the Health and Social Care Act 2012. At a national level in England, Public Health England will be the executive agency that delivers the wider agenda and at local level, the move of public health services into local authorities aims to create a multiprofessional approach to delivering local strategy and supporting better healthcare for the population.

Public health activities can take place with individuals, their families or communities, on a national or international level. The midwife is ideally placed to influence and enact public health policy when working with women and their families as well as being able to develop a population perspective within midwifery.

All the chapters in this text are concerned with midwifery practice, and as such are rooted in public health. Midwives make a substantial contribution to public health by promoting the long-term well-being of women, their babies and their families. They provide information and advice regarding screening and testing, sexual health, nutrition, exercise and healthy lifestyles. The midwife promotes breastfeeding, offering support and advice, as well as providing guidance to women and their families in relation to immunisation. Public health in midwifery is not new; midwives have always provided care that has a public health focus. Public health is at the heart of all aspects of midwifery practice.

Terminology

There are a variety of terms that can be used to describe women who use maternity services. ‘Patient’, ‘woman’, ‘person’ and ‘client’ are used throughout this text and refer to all groups and individuals who have direct or indirect contact with healthcare workers and in particular registered midwives, registered nurses and specialist community public health nurses.

‘Patient’ is the term commonly used within the NHS. It is acknowledged that not everyone approves of the passive concept associated with it or the way in which it can emphasise a medical focus. The term is used in this text in the knowledge that it is widely understood. The other two commonly used terms – ‘woman’ and ‘client’ – are also used to reflect changes in the way midwives and other care providers are considering their relationships with users of maternity services. The term ‘client’ emphasises the professional nature of the relationship that the midwife has with the women she cares for. The term ‘consumer’ is taken from the marketplace and highlights the concept of service users as consumers of products such as medications or care services. Client and consumer have their roots in healthcare provision during the 1980s and 1990s when, particularly in the health service, market forces and consumerism were in vogue. Another term used is ‘expert’. Experts are said to be on an equal footing with expert care providers (for example, midwives and obstetricians). They are often patients who live with long-term health conditions.

There are 35,305 midwives on the midwives’ part of the professional register (spring 2013) (see Table I.1). The majority of midwives in the UK are women and whilst it is acknowledged that the number of men entering the midwifery profession is increasing, for the sake of brevity this text uses the pronoun ‘she’.

Table I.1 Number of midwives on the midwives’ part of the professional register

	Number of midwives
Male	132
Female	35,169
Total	35,305 (four forms not filled)

The Nursing and Midwifery Council and Quality Assurance Agency (Education)

The primary aim of the Nursing and Midwifery Council (NMC), an organisation established by Parliament, is to protect the public by ensuring that midwives and nurses provide a high standard of care to their patients and clients.

The NMC is the regulatory body responsible for promoting best practice amongst the midwives and nurses registered with it. The key role of the NMC is to ensure that women receive the best possible care. It is the responsibility of the NMC to set and monitor standards in training (Nursing and Midwifery Order 2001). The NMC has produced a framework for quality assurance of education programmes which relates to all programmes that lead to registration or to the recording of a qualification on the professional register.

The programme you have embarked on, or are going to embark on, must meet certain standards. These include the standards set by your educational institution – for example, your university’s policies and procedures relating to quality assurance and external influences. The NMC and the Quality Assurance Agency (QAA) standards must be satisfied before a programme of study can be validated and deemed fit for purpose. Other external factors that must be given due consideration are the European Directives. Two European Directives – 77/453/EEC and 89/595/EEC.

The Nursing and Midwifery Order 2001 provides the NMC with powers in relation to quality assurance and, as a result of this, the production of a framework that education providers (for example, universities) that offer, or intend to offer, NMC-approved programmes leading to registration or recording on the register have to adhere to. There are many provisions in place in the UK that ensure the quality of education programmes.

The NMC has to be satisfied that its standards for granting a licence to practise are being met as required and in association with the law. It does so by setting standards to maintain public confidence, as well as to protect the public. By appointing representatives, it can be satisfied that it is represented during the quality assurance process in relation to the approval, reapproval and annual monitoring activities associated with programmes of study.

Each programme of study for pre-registration midwifery must demonstrate explicitly and robustly that it has included the rules and standards of the NMC so that those who complete a recognised programme of study are eligible for registration. The Standards for Pre-registration Midwifery Education (NMC 2009) are examples of standards that must be achieved prior to registration.

Midwives’ Rules and Standards

The Nursing and Midwifery Order 2001 demands that the NMC sets rules and standards for midwifery and local supervising authorities (LSAs) for the function of statutory supervision of midwives. The Midwives’ Rules and Standards (NMC 2012) replace those produced in 2004. The current Rules and Standards came into force on 1 January 2013 (see Table I.2).

The NMC’s Midwifery Committee undertook a full public consultation exercise when revising the Midwives’ Rules (NMC 2012). As this second edition of this text goes to press the new rules are included in the content. The rules are set to have the most far-reaching changes since the establishment of the NMC. The changes ensure that the rules are streamlined, clear and relevant, and the NMC will continue to maintain a statutory framework for the practice and supervision of midwives that aims to protect the well-being of mothers and babies.

The rules will continue to state the requirements for practice and the accompanying standards offer extra guidance on what standard would reasonably be expected from a practising midwife.

Rule	Description
1.	Citation and commencement
2.	Interpretation
3.	Notification of intention to practise
4.	Notification by local supervising authority
5.	Scope of practice
6.	Records
7.	The local supervising authority midwifery officer
8.	Supervisor of midwives
9.	Local supervising authority’s responsibilities for supervision of midwives
10.	Publication of local supervising authority procedures
11.	Visits and inspections
12.	Exercise by local supervising authority of its function
13.	Local supervising authority reports
14.	Suspension from practice by a local supervising authority
15.	Revocation

Becoming a competent midwife

Those who wish to study to become a midwife, and then go on to register with the NMC and afterwards practise as a midwife must undertake a 3-year (or equivalent) programme of study. The number of hours to be studied by student midwives can vary. Each programme must comprise 2300 practice hours as a minimum and the programme must be at least 50% practice based (the total theory and practice combined must be a minimum of 4600 hours). The NMC, for example, allows for programmes to comprise 60% practice and 40% theory. This flexibility must be NMC approved.

The title ‘registered midwife’ is protected in law. This means it can only be used by a person who is registered with the NMC and her name must appear on the national register. There are three parts to the professional register:

The student who wishes to undertake midwifery education must meet the NMC’s requirements as well as any specific requirements the higher education institution may have. How these requirements are set is the prerogative of the individual educational institution; however, the NMC must agree to and permit these requirements and there must also be evidence of literacy and numeracy. Those wishing to practise in Wales must also be able to demonstrate proficiency in the Welsh language where this is required. On entry, during and on completion of their programme, all applicants must demonstrate that they have good health and good character sufficient for safe and effective practice. It is the responsibility of educational institutions to have procedures to ensure assessment of health and character. Any convictions, cautions or bind-overs related to criminal offences must be declared. There are several ways in which this can be achieved – for example, self-disclosure and/or criminal record checks conducted by accredited organisations.

Completion of the programme and achievement of the standards mean that the student will graduate with both a professional qualification (registered midwife (RM)) and an academic qualification at degree level. The good character and good health declaration is made on an approved form provided by the NMC. This must be supported by the registered midwife whose name has been notified to the NMC, who is responsible for directing the educational programme at the university, or her designated registered midwife substitute. This midwife is known as the lead midwife for education (LME).

Standard	Summary
Standard 1	Appointment of the LME
Standard 2	Development, delivery and management of midwifery education programmes
Standard 3	Signing the supporting declaration of good health and good character
Standard 4	General requirements relating to selection for and continued participation in approved programmes, and entry to the register
Standard 5	Interruptions to pre-registration midwifery education programmes
Standard 6	Admission with advanced standing
Standard 7	Transfer between approved education institutions
Standard 8	Stepping off and stepping on to pre-registration midwifery education programmes
Standard 9	Academic standard of programme
Standard 10	Length of programme
Standard 11	Student support
Standard 12	Balance between clinical practice and theory
Standard 13	Scope of practice experience
Standard 14	Supernumerary status during clinical placements
Standard 15	Assessment strategy
Standard 16	Ongoing record of achievement

Once registered with the NMC, the midwife is accountable for her actions or omissions and is bound by the tenets enshrined in the Code of Professional Conduct (NMC 2008a). Legal requirements, such as participating in continuing professional development and maintaining a personal professional portfolio, must be addressed. This text provides you with insight into how to become a competent midwife.

There are 16 standards associated with pre-registration midwifery education. These range from the appointment of the LME to standards for the structure and nature of a pre-registration midwifery programme (see Table I.3). This text will address the standards for entry to the register for midwives. Currently, no other texts describe in the same detail the levels of education required to achieve the NMC standards for pre-registration midwifery education proficiency.

Case notes and activities

Most of the chapters provide the reader with case notes to consider and activities to carry out. They are included to encourage and motivate you, as well as for you to assess your learning and progress. It is also anticipated that they will enable you to link theoretical concepts with what is occurring in the clinical setting. There are a variety of review questions provided for you to attempt so you can test your understanding and learning. You are encouraged to delve deeper and seek other sources – both human and material – to help with your responses.

In most chapters you will find useful snippets of midwifery knowledge, gathered and honed as a result of many years of midwifery practice, called midwifery wisdom.

The aim of this text is to encourage, inspire and stimulate you, as well as instilling in you the desire, confidence and competence to become a registered midwife. What is required from you is an interest in women and their families through all stages of pregnancy. Becoming a member of the midwifery profession places many demands on you, the key demand being the desire to care with compassion and understanding for the women and families you will have the privilege to work with.

References

Department of Health (DH) (2004) Standards for Better Health. London: Department of Health.

Department of Health (DH) (2011) Public Health England’s Operating Model. Available at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131892.pdf (accessed May 2013).

Department of Health (DH) (2012a) Public Health, Adult Social Care and the NHS. Available at: www.dh.gov.uk/health/category/policy-areas/public-health/ (accessed May 2013).

Department of Health (DH) (2012b) Structure of Public Health England. Available at: www.wp.dh.gov.uk/healthandcare/files/2012/07/PHE-structure.pdf (accessed October 2012).

Medforth J, Battersby S, Evans M et al. (2011) Oxford Handbook of Midwifery, 2nd edn. Oxford: Oxford University Press.

Nursing and Midwifery Council (NMC) (2008a) The Code: standards, conduct, performance and ethics for nurses and midwives. London: Nursing and Midwifery Council.

Nursing and Midwifery Council (NMC) (2008b) Statistical Analysis of the Register: 1 April 2007 to 31 March 2008. London: Nursing and Midwifery Council.

Nursing and Midwifery Council (NMC) (2009) The Standards for Pre-registration Midwifery Education. London: Nursing and Midwifery Council.

Nursing and Midwifery Council (NMC) (2012) The Midwives’ Rules and Standards. Available at: www.nmc-uk.org/Documents/NMC-Publications/Midwives%20Rules%20and%20Standards%202012.pdf (accessed May 2013).

Page L, McCandlish R (eds) (2006) The New Midwifery: sensitivity in practice, 2nd edn. Edinburgh: Churchill Livingstone.

Aim

This chapter aims to relate and understand how the development of communication from infancy can influence and inform our skills as adults in order to enhance your work-based experience to meet the needs of clients in your care.

Learning outcomes

By the end of this chapter you will be able to:

1. appreciate that development of interpersonal skills is co-dependent on key concepts from parent–infant interaction

2. analyse the needs of infants which parallel the needs of adults to enhance the care of mothers and babies

3. enhance communication skills to overcome common barriers to communication and building relationships in practice

4. develop strategies in practice that meet essential skills clusters for pre-registration midwifery education.

Introduction

This chapter will highlight the unique abilities of babies to communicate from birth, and how their optimal development relies on contingent responses, which are part of the parent–infant attachment process. These qualities in interpersonal skills are fundamental to building relationships, and the lessons from infancy influence our adult ability to communicate. Thus, by enhancing early relationships between parents and babies, midwives can reapply these principles in everyday communication. The common errors that inhibit midwifery communication will be outlined and skills of listening and empathy will be analysed.

Midwives are in a unique position to observe how humans learn to communicate. When time is taken to observe infants, it can be noticed that babies are ‘pre-programmed’ to interact with adults (Stern 1998). This is due to their preference for the sound, sight and movement of adults to other comparable stimuli and they are especially attracted to their mother. This interaction is probably a biological instinct, as humans depend on mother and other adults to care for them to ensure survival.

The work of MacFarlane (1977) clearly highlighted the ability of babies, and dispelled many myths around infants, such as the idea that babies cannot see. Not only can they see (and focus well at about 30 cm) but they like to look at contrast and contours found in the human face. They turn to sound, particularly the mother’s voice; they will turn to the smell of their own mother’s breast pad in preference to another. So they develop recognition of their mother very quickly through their senses, and communicate their needs through behaviours (RCM 1999). As adults, we also communicate through voice and behaviours.

The behaviours of a human baby are social and communicative; they mimic adults, most noticeably by facial changes. So if you smile, open your mouth wide or stick out your tongue, the baby will watch carefully and then copy (Murray & Andrews 2010), which is quite remarkable when you consider how they know that they even have a mouth. Indeed, this mimicking can be observed in the first hour after birth. This response to adults demonstrates babies turn taking in their non-verbal responses and vocalisations, provided the adult is sensitive to them (Brazelton et al. 1974).

Being sensitive to interaction in this dance of communication requires that the other is responding to that baby (or indeed an adult) and does not ignore or overwhelm with intrusive responses. The critical aspects of building relationships is engagement but its absence gives the message of indifference, which indicates lack of importance, and possibly feeling unwanted by the other or even a feeling of non-existence (McFarlane 2012). This indifference can readily be recognised when a mother is suffering with postnatal depression (RCM 2012). ‘Insensitive mothers’ may be overintrusive in communicating with their baby, and base their responses on their own needs and wishes, or general ideas about infants’ needs. The same dynamic is easily replicated by midwives when they have an agenda which differs from the client’s needs, for example during a booking history.

Midwifery wisdom

You cannot feel indifferent towards clients in your care. If you find yourself feeling this way, then think ‘how can I love this person?’. And ‘who can help me feel cared for?’.

Care taking and our sensitivity to infants are normally based on how we were cared for as infants. If we formed a good enough attachment to our parents and they were in tune with our needs, if they were ‘baby centred’, then we become secure adults (Steele 2002) and naturally become ‘woman centred’ in midwifery care. Sensitivity also comes from our attitudes and behaviours. Thus, every time babies are changed in a loving way or sympathetically responded to when lonely, tired, hungry or frightened, they take in the experience of being loved in the quality of care received. For a baby, physical discomfort is the same as mental discomfort and vice versa (Stern 1998).

The key aspects of early parenting and building a sensitive relationship are described clearly in the RCM’s Maternal Emotional Wellbeing and Infant Development (RCM 2012). It is the parental attunement to the needs of the infant (which midwives have a role in fostering) that leads to loved individuals who do not become antisocial adults. Through our early relationships and communication from conception to 3 years of life, Sinclair (2007) suggests that we develop our emotional brain and our capacity for forming relationships. Fundamentally, human beings at any age respond and feel understood when an attuned warm, positive and sensitive other interacts with them. As a professional responding as a sensitive mother would, you too can communicate in this way with clients in your care, which can enhance how you build relationships and improve communication.

Contributors

Preface to the Second Edition

References

Acknowledgements

Introduction

The unique role and function of the midwife

The midwife’s role in public health

Terminology

The Nursing and Midwifery Council and Quality Assurance Agency (Education)

Midwives’ Rules and Standards

Becoming a competent midwife

Case notes and activities

References

1

Effective Communication

Introduction