By Caroline Flint

The Central Midwives Board

From 1902 until 1979 midwives in the United Kingdom had their own Statutory Body - for midwives in England and Wales it was the Central Midwives Board which was housed in the impressive Iolanthe House which had been the home of W.S Gilbert of the composing duet - Gilbert and Sullivan. The Scottish midwives had the Central Midwives Board for Scotland the Northern Ireland Council for Nurses and Midwives looked after midwifery in Northern Ireland.

The Central Midwives Board was made up of 14 members:

four appointed by the Minister of Health four were doctors - one appointed by the Royal College of Physicians, one by the Royal College of Surgeons, one by the Royal College of Midwives and one by the Society of Apothecaries; two were certified midwives appointed by the Royal College of Midwives;

four were appointed by (one each) the Queens Institute of District Nursing, the County Councils Association, the Association of Municipal Corporations and the Society of Medical Officers of Health.

For the whole of the Board's life midwives were always outnumbered, and it wasn't until 1965 that the Board was chaired by a midwife. The Central Midwives Board carried out several functions laid down in statute:

• The maintenance of a Roll of Certified Midwives.
• The removal from the Roll of Midwives who had been guilty of professional conduct.
• Approving courses of training for people wishing to become midwives.
• The disciplining of midwives who had a case of misconduct brought against them.
• Setting the standards for, and approving courses for Midwives' Refresher Courses. o Setting standards of practice for midwives - which they did in two publications - the Midwives Rules and Guidance on the Midwives Code of Practice.

In 1979, despite misgivings from several midwifery organizations the Central Midwives Board was replaced when the Nurses, Midwives and Health Visitors Act was passed and the National Boards for Nursing, Midwifery and Health Visiting were set up in the four countries of the United Kingdom. Heading this was the United Kingdom Central Council for Nursing, Midwifery and Health Visiting.

Doughty midwife campaigners had ensured the protection of the specific interests and needs of Midwifery by the inclusion of Statutory Midwifery Committees - both at Board and Council level. The Midwifery Committees were seen as the successors to the Central Midwives Board, the Council was responsible for maintaining the professional

The Midwives' Roll had been the envy of the other professions because their Roll was the only one which was `living'. The nurses roll contained everyone who had ever qualified as a nurse or health visitor and only those who had taken the trouble to inform the relevant body were removed at death or cessation of practice.

The other duty of the Central Council was to establish standards of professional conduct for all the professions - as the Central Midwives Board had done since 1902 and to hold the Professional Conduct Committee which would be responsible for removing the names of miscreants from the Register. The Council was also to make statutory rules governing the entry to training and criteria for registration - their remit was also to improve the standards of training of all three professions.

The Central Council was to be made up of 45 members-of that number was to be one midwife from each National Board.

The four National Boards were to approve institutions which provided training/ education courses for nurses, midwives and health visitors and control the examination system. The Boards also held the Investigating Committee to investigate charges of misconduct against a nurse, midwife or health visitor and refer to the Professional Conduct Committee at the United Kingdom Central Committee any serious cases.

The National Boards also held 45 members - five of those members were elected midwives. The midwives at both Board and Council level became members of the Midwifery Committees of either Board or Council, they were joined by some midwives who were appointed by the Secretary of State and by the representatives of the medical, nursing and health visiting professions. For the first time ever, midwives formed the majority on their own governing body.

Despite the clause in the Nurses, Midwives and Health Visiting Act (7.3) `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', the Midwifery Committee at Board level began to realize that even when they had agreed a matter which was in the interests of midwifery, the matter would be brought to the open Board and unless it was worded in such a way as to be acceptable to all the other members of the Board - could be outvoted.

The Act had not safeguarded the work of the Midwifery Committee at Board level in the way it had done to the Midwifery Committee at Council level in two clauses - 4.4 `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 Council' and 4.5 `Any matter which is assigned to the Midwifery Committee otherwise than under Subsection 3 shall be finally dealt with by the Committee on behalf of the Council, so far as the Council expressly authorize the Committee to deal finally with it, and the Committee shall make a report to the Council as to the way in which they have dealt with the matter.'

Cracks in the system began to show up at the English National Board - despite the rule about `consultation' with the Midwifery Committee, midwife members were becoming concerned that matters which they felt were relevant to their profession were being labelled `management ' or 'administration' matters and by-passed the

A head-on clash came in 1989 when, against the expressed opposition of the Midwifery Committee, the Board decided that approval of midwifery, nursing and health visiting schools was to be performed by Education Officers who were `generic'- i.e. that any education officer could approve any training school. That a Midwife Education Officer could approve a training school for nurses, or psychiatrically trained nurses and likewise an Education Officer who had a qualification in Mental Handicap nursing, or general nursing could approve a training school for midwives because all that they were `approving 'was the educational component.

At a stroke this destroyed the concept that in midwifery, education and practice are joined together - that midwifery is a practical skill and needs to be taught at the bedside as much as in the classroom. Midwifery Tutors had always expected to practise clinically in order to extend their students knowledge and skills, and likewise, all midwives saw themselves as teachers of those less experienced than themselves. It also lost midwives control over their own education.

Throughout Europe, midwifery and nursing have always been two separate and different professions - with their own individual training. In England, Direct Entry into midwifery has always been a way of entering the midwifery profession. The loss of

Is this just the bleating of a small profession which doesn't want to be overwhelmed by a larger, amorphous profession? It may just be that. On the other hand midwives are saying that if they disappear and become just another branch of nursing, women will be the ultimate losers. Midwives and nurses have fundamentally differing philosophies. Nurses are caring for the sick, and inevitably (except for a few practitioner nurses) that includes working with, and following the instructions of, doctors.

Midwives, on the other hand, are dealing with healthy women. They see part of their role as protecting women against the over enthusiastic ministrations of a medical profession who can find pathology around every corner - the rivalry between obstetricians and midwives is healthy and has a protective function for women. Midwives can take on a healthy woman who is pregnant and can provide full care for her throughout her pregnancy, labour and the puerperium. She can prescribe a limited range of drugs - such as pethidine, local anaesthetic, syntometrine and ergometrine, she can arrange ultrasound scans and blood tests. Unless the woman exhibits any deviations from normality, the midwife is not obliged to refer to a doctor at all - although most work in liaison with doctors.

The fact that few midwives take on the full range of midwifery practice is to be regretted, but that midwives should be seen, and see themselves as a separate and identi-

A group of midwives, together with mothers and members of the consumer groups have got together and with the help of a lawyer have drafted a new Bill for Midwives. This would set up a separate statutory body for midwives - called the Central Midwives Council and would ensure that midwives would be a strong and identifiable profession, that midwives would be judged in professional misconduct issues by midwives - not by nurses, and that midwives' education would be planned and approved by midwives.

Many obstetricians regret the passing of the strong midwife - she may have been a rather bolshy individual, but she knew exactly what she was doing and she certainly saw her loyalty as lying with the women in her care. Midwives and Obstetricians have always worked together in a sometimes uneasy liaison, there are vested interests trying to destroy midwifery as a separate profession and midwives need the support of Obstetricians - it is they who can invariably see the strength of the midwives' argument.

Spring 1991