By Caroline Flint

What will happen to the midwifery profession if assessment and training become generic?

At last years' Annual General Meeting of the Royal College of Midwives, Margaret Brain, President of the Royal College of Midwives said in her speech to RCM members: `As a profession we have the right to control and assess our own education and it is essential that we do so. In fact, if we lose control of our education we lose control of our profession.'

What did Margaret Brain know that the rest of us did not? What was causing her worries over midwives losing control over their education?

Throughout last year rumors rumbled that the midwifery education officers at the English National Board (and at the other Boards) are now to be `generic' and the Peat Marwick McLintock Report appears to take this aspect as having already happened.

What has happened for midwifery education officers is that they now can examine and approve mental handicap training schools or health visiting establishments.

What about midwifery education establishments? They are about to be visited and assessed by nurses who have never qualified let alone practised as midwives. Midwives' education will be assessed by nurses who are no doubt superb at assessment and evaluating district nursing, maybe psychiatric nursing or general nursing, but who will probably have no perception that the pregnant woman is a healthy individual who has no need to be in hospital and who has rights and needs which are totally different from all other members of a hospital's population who are always there because there is something `wrong 'with them. It is all very well to separate the education of nurses, midwives and health visitors and lump it under the name `education' and there may be good arguments in strengthening the educational input of professional officers, but to expect midwifery training schools to be assessed by people other than midwives means that indeed midwives have lost control of their profession. The next step is that midwifery itself will disappear and midwives will become post graduate nurses or obstetric nurses.

The precedent for this is all around us. It has happened in New Zealand, Australia, Japan, India, Scotland - in many states of America midwives are illegal, and in Canada midwives have just been having a tremendous fight to become legalized. Here in the United Kingdom we have had a wonderful legal framework for midwifery ever since 1902. Midwives felt that they were protected by the paragraph in the `Nurses, Midwives and Health Visitors Act' 1979 which states: `Each board shall consult its Midwifery Committee on all matters relating to midwifery and the Committee shall, on behalf of the Board, discharge such of the Board's functions as are assigned to them by the Board or by the Secretary of State by order' (7(3)). In law this means that the Board cannot disregard the consultation with the Midwifery Committee, but, as Board Midwife Mary Cronk pointed out at the Board Meeting on Tuesday 14th November, despite consultation the Board can totally ignore and ride roughshod over the expressed wishes of the Midwifery Committee.

The Midwifery Committee fought hard battles to prevent the `generalization' of the midwifery education officers. This is the same Midwifery Committee which only two years ago stated that midwifery education must ensure that midwifery remains `a separately identifiable profession'.

What about the paragraph in the Nurses, Midwives and Health Visitors Act (1979) which states `The Secretary of State shall not approve rules relating to midwifery practice unless satisfied that they are framed in accordance with recommendations of the Council's Midwifery Committee' (4(4))? Is the Midwifery Committee of the UKCC happy about this action? I can hardly believe it.

Midwifery education has always been different from even the most basic principles of nursing education, and now that nursing education is becoming more and more college based this divide is increasing. Midwife teachers have always had a high clinical input and links between service and education in midwifery have always been extremely close. Midwifery is almost an `apprentice' training, with the student midwife learning practically with an experienced midwife or midwife teacher. The reason that we have never seen a need for `Clinical Teachers' in midwifery is because we have always argued that all midwives are `Clinical Teachers' including midwife teachers. units the midwifery education department is within the service area. Although this often means that the Midwifery Education Department is cramped and stuck in a small space, it does ensure that the education of midwives happens in a practical setting, that theory is always based on practice and that midwifery teachers are always available to the service midwives and indeed frequently provide a welcome ear for disgruntled or worried midwives to act as a guide and supporter when difficult clinical problems are tackled.

Until now, experienced midwives have assessed midwifery training schools. They have been acutely aware of the clinical input that the students receive and the English National Board approval of training has been held up while a deficit in clinical practice has been rectified. This has given great help to the clinicians and managers who have been able to improve service despite financial cutbacks. Without this impetus the training school would not have been approved.

It is now time for the midwifery profession to look at the legal implications of this action by the English National Board. If the midwifery profession is being deprived of midwives assessing and approving its training then a profession is being destroyed. There has to be recourse to the law by way of judicial review. It is not in the interests of the women of the United Kingdom that the midwifery profession should disappear. It is up to the midwifery professional bodies to act on behalf of the profession to ensure that midwifery education is assessed by midwives.