By Caroline Flint

The UKCC is in the process of formulating a set of regulations that will govern the future practice of midwifery in this country. Caroline Flint suggests that the new rules will influence the pattern of childbearing for years to come

The UKCC is asking the midwives of Great Britain to help them to formulate rules which will last us (and the mothers and babies of our lands) well into the next century. What the midwives decide now will affect child bearing for decades to come. It is essential that we get it right.

Midwives are meeting throughout the country to discuss the proposed rules sent out for consultation. What will they decide? How can they get it right?

For many midwives, the words in the code of practice attached to the Central Midwives Board handbook, issued following the Midwives Act 1951, have been a constant inspiration : `The Midwives Act 1951 gives statutory recognition to the position of the midwife as a professional practitioner in her own right.'

Most midwives in 1984 are very deeply committed to the ideal of the midwife as a `professional practitioner' able to practise using her full skills for the benefit and support of the women, babies and families in her care.

But one problem is that the skills of the midwife are frequently intangible while the skills of the obstetrician are tangible.

So what do midwives need in their rules to enable them to practise as `professional practitioners'? What do women need defined in the midwives' rules to enable them to have a safe experience of childbirth? What do obstetricians need defined in our rules so that they can leave us to get on with the provinces that are ours?

1. There should be a fresh approach to the formulation of new rules.

2. The wording of the rules should be clear, concise and comprehensible.

3. In order to allow practical application throughout the United Kingdom the rules should be as broad as is consistent with legal requirements.

4. The rules should define the level of professional responsibility of the midwife.

5. While safeguarding standards of care the rules should permit professional development and not inhibit changes which would be desirable as knowledge increases and practice and attitudes change.

With these inspiring words ringing in my ears I am struck with delight when I read in the section on spheres of practice and levels of responsibility that the midwifery committee considers that a midwife should be required, at all times, to give care to women and babies on her own responsibility when there are no complications, and she should give this care in co-operation with registered medical practitioners where there are complications present. So far so good, but now my heart gives a little dive as the next two words are `or anticipated'.

The beginning of this proposed rule is exciting and enables me to practise fully as a midwife. The middle of it is necessary and reasonable, but what about complications which are anticipated.

Some people could anticipate complications in 95 per cent of the women we care for. I cannot feel that these words will be helpful either to midwives or to women.

The other specific section that worries me is section 5.9, `The duty of the midwife when engaged to attend a home confinement'. As a profession we need to acknowledge that it is the small group of determined women who have carried on insisting on having their babies at home, who have saved midwifery from extinction. So I am sad to read in the proposed rules that, `In view of the difficulties which. may occur for midwives when engaged to attend a home confinement and the increasing demand by women for this service, the midwifery committee considered that there could be merit in having a rule on this subject. Such a rule would require a midwife to:

1. Carry out the policy of the local supervising authorities (LSAs).

3. Continue the care of the woman and her baby(ies), unless otherwise instructed by the supervisor of midwives.'

What happens to the midwife if the woman she is caring for wants something that is contravened in the LSA policy? Her first duty as a professional is to her client, but what if she incurs disciplinary action by putting her client's interests first? LSA policies vary from authority to authority. This suggestion could put the midwife in a very delicate position.

A midwife as a professional has obligations. That obligation includes providing care to a woman who requests care at home, in the same way a lawyer is obliged to defend someone who is on trial even though he or she may not wish to, or may think that the defendant is guilty. A professional person has obligations which cannot be removed by anyone, including the supervisor of midwives.

August 15, 1984