By Caroline Flint

More home births, more community group practices, continuity of care at all times and elected supervisors of midwives. These are just some of the elements in the Association of Radical Midwives' vision of the profession's future. Caroline Flint explains

All through October packages were flying round the country and thudding on midwives' doormats. They had titles like: `Why I am a midwife', `What I want to be doing as a midwife in six years' time', `How I want to see midwifery functioning in ten years' time', `How can we manage midwifery in a creative way?T 'How much should we be paid?T 'What should a midwifery pressure group do to achieve change?T 'What are the most powerful forces/influences in midwifery today?' Every time I opened one of the envelopes, I was overwhelmed by the caring and the commitment to mothers and the midwifery profession that the documents represented. They also represented the painstaking preparation for a weekend organized by the Association of Radical Midwives to plan the future of our profession: where we wanted to go and what we wanted to achieve.

What came out of that weekend was a document called Draft proposal for the future of the maternity services, which is now out for consultation.

The document is mind-blowing. It begins: `We have set out in ARM to propose a new vision for the maternity services in ten years' time. Though we recognize and applaud the strides our profession has made over the previous ten years, we feel the crisis is far from over. Many midwives feel frustrated with the present segmented pattern of maternity care and find themselves far from feeling like "practitioners in their own right".'

The new proposals are based on the following basic principles:

• The parturient woman is the central person in the process of care.
• All women should have continuity of care, whether they are at low or high risk.
• Care should be community-based.
• Women should have choice in childbirth
• Services should be accountable to the consumer.

The Association of Radical Midwives sees midwives of the future working in community group practices of between two and five midwives, and taking responsibility for the 80 per cent of women at low obstetric risk. These group practices would work from a variety of places including shops, consulting rooms, health centres, houses, community centres or local hospitals. Each group practice would take on no more than 50 women per midwife per year. These women would be cared for in the community during the antenatal period, and at home or occasionally in hospital during labour and postnatally. The midwives would be paid by the NHS, but they would be self-employed like general practitioners.

Forty per cent of midwives would work in hospital in teams of about seven attached to a consultant, caring for women at high obstetric risk. Together they would do all antenatal, intra partum and postnatal care, mainly within the hospital, but would be able to go out into the community whenever needed. They would be looking after 20 per cent of expectant mothers.

The midwives would elect their supervisor of midwives, who would be their spokesperson. She would initiate regular, frequent meetings with a representative from each group practice and each consultant based team. She would provide information and opportunities for further education, study days, refresher courses and regular annual weekend study events. She would investigate any complaints and would organise any disciplinary hearings.

Hospital consultant obstetricians would work closely with their trusted team of midwives. They would remain, as now, the expert on the abnormal. Together with their registrar, they would have regular meetings with their midwives. The senior house officer would be seen and would see himself as a learner, and he, together with medical students and midwifery students, would be taught about midwifery matters by midwives. The student midwife would do a three-year direct entrant training course. For two years she would receive a grant as a student, and for the third year she would receive a salary.

All women would expect and receive continuity of care - there would be no place for one health professional to provide just one part of the continuum. So a GP could not pro vide only antenatal care, but he could decide to look after women all the way through and provide all antenatal, delivery and postnatal care in the same way as the group practice midwives do. Alternatively, he might want to branch out into pre-pregnancy care, counselling and follow-up family planning.

The Radical Midwives' document also addresses itself to the issues of a midwives' trade union, the statutory bodies, practice managers, sabbaticals, international links, independent midwives, evaluation tools and so on. Here are the thoughts, dreams and aspirations of a group of committed midwives. They are determined to make it happen. If they do, midwifery will never be the same, and having a baby will be a much more pleasant experience for the majority of women in this country.