By Caroline Flint

This suggestion, says Caroline Flint, is only slightly more absurd than asking midwives to train as nurses before they can train to be midwives. She argues that nurse training is not only unnecessary, it can be positively harmful

Just imagine that you want to be a solicitor. You go along to your local solicitors' practice and say, `I would like to become a solicitor', and the answer is, `You can't become a solicitor until you have first trained as a policeman.'

`A policeman? But I don't want to be a policeman. I want to be a solicitor.'

`It's very useful for you to be a policeman first - you learn about the criminal mind, you learn a lot of basics of the law, you learn about court procedure, you learn how law affects ordinary people. You need to have been a policeman first before you become a solicitor; you learn so many useful and basic things for your future role.'

Or perhaps you feel like becoming a dentist?

`I'm sorry but before you train to be a dentist you have to do a medical training first. You must first train to be a doctor - so much of what a doctor learns in his training is enormously useful to a dentist.

Or perhaps you want to be midwife?

`Well, before you train to be a midwife you have to train to be a nurse. It will be enormously useful to you. As a nurse you will learn to take care of bedsores and to prevent them, you will be able to scrub in theatre for amputations, you will be able to look after diabetics and you will understand the signs and problems of diabetes. You will learn about congestive cardiac failure, how to make a bed, the care of people with coronary
thrombosis, subarachnoid haemorrhage, concussion, how to give an injection, kidney dialysis, giving medicines - all thoroughly useful knowledge which no sane person could do without before becoming a midwife?'

Or is it?

Is it as nonsensical and wasteful as training a solicitor to be a policeman first? Or a dentist to be a doctor first? Would it be better if midwives trained to be chiropodists first? That would help them to learn how to communicate with patients, after all. Or perhaps we ought to train first as florists? We would have much prettier flower arrangements in the postnatal wards then.

But surely, you will say, it is really useful for a midwife to have a basic nurse training before she embarks on her midwifery training? It isn't as if she has to unlearn any of the things she has learned as a nurse, is it?

But, I would reply, what about her attitude to patients? Midwives don't have patients - they are with women as they go through a huge and life-changing experience. They are partners and colleagues. They work as a team, but a team of equal decision makers. The woman is not ill, she is going through a normal physiological process, like having your bowels open, or breathing, or making love.

Perhaps a midwife needs a different attitude to the women she is with from the nurse with her patients? When you are nursing patients, they are ill. Women going through childbirth are not ill.

What about the midwife's attitude to doctors? Does that need to be in any way different to the attitude of the nurse? Surely the doctor and midwife are there for the same thing? Working as a team of professionals. Well, yes and no. Not for nothing does the midwife call herself the `guardian of normal childbirth'. And as childbirth becomes increasingly technological, and more and more new tests and sophisticated diagnostic tools are used, a growing number of women have Caesarean sections or have their labour accelerated. It is the midwife who has the skill and knowledge to protect women from over medicalization. She can protect them from the over-enthusiastic use of tools which might help one woman enormously, but which might be inappropriate for another woman, and may indeed interfere with the normal physiological progress of labour.

What about the attitude of the nurse to illness? Might it not be very harmful to healthy women to be dealt with by people who had become conditioned to people being ill, who need `care' rather than just emotional support? Is this, perhaps, why the majority of women in this country who are in labour are actually lying neatly in a bed - the most physiologically undesirable position for them to be in? Why are they lying in bed? This is a position which engenders maternal hypotension, fetal hypoxia, less effective uterine contraction and the need for more analgesiaas well as failing to utilize the effect of gravity on the descending fetal head.

Is it perhaps because most midwives trained as nurses first?

In this country and in Europe it has always been possible to train as a midwife from the start of training and not to train as a nurse first. The training is longer than post RGN qualification - it is a period of three years in this country at the moment. But unfortunately there is only one midwifery school doing the direct entry training now, and there are about six applicants for every place.

We need to rethink our training of midwives. I'm glad to say that we are - both the Royal College of Midwives, the Association of Radical Midwives and the midwifery committees of the UKCC and the national boards. Are you thinking about it too? Isn't it time other midwifery training schools took the initiative and began training people who want to be midwives without training them to be nurses first? Or perhaps I'm wrong. What about being chiropodists first? It would be a useful sideline wouldn't it?

February 12,1986.