Leadership and Education
Leadership Education – A Vital Component in the Future Development of the Midwifery Profession
Gail Johnson Education and Professional Development Advisor, Royal College of Midwives, London
Abstract
This article briefly explores the evolution of the role of the midwife, the midwife’s social standing and the medical model of practice, as well as the rise of the midwife as a professional and a leader of the profession within the historical context and the modern National Health Service in the UK. Midwifery leadership education appears to be undervalued and it is vital that professionals regain control of leadership if their profession is to flourish.
Keywords Midwife, medical model of practice, feminism, professional, leader, leadership education
Disclosure: Gail Johnson runs the Royal College of Midwives leadership programmes as part of continuous professional development for midwives. Received: 16 December 2011 Accepted: 17 February 2012 Citation: European Obstetrics & Gynaecology, 2012;7(Suppl. 1):4–6 Correspondence: Gail Johnson, Education and Professional Development Advisor, Royal College of Midwives, Learning, Research and Practice Development, 15 Mansfield Street, London, W1G 9NH, UK. E:
gail.johnson@
rcm.org.uk
Women have been caring for and supporting women through childbirth long before any records documented their position. Midwifes’ knowledge, skills and empathy are provided to minimise risk and improve outcomes for women and babies. The evolution of the midwife and the midwife’s role is dynamic and fluid, and the image of the midwife has changed dramatically from references in the Bible and the poorly educated, gin-drinking midwives of the 1700s. While the role and image of the midwife have changed, the need for child-bearing women to have a knowledgeable and caring supporter remains. Women experiencing childbirth in the 21st century are better informed, have access to healthcare and have higher expectations of a positive outcome. Whilst it is plain to see why some of the changes in the midwife’s role and in women’s knowledge and expectations have occured – for example, a greater understanding of the physiology of birth and the importance of good health and nutrition on pregnancy outcomes – what is less clear is why the role of the midwife seems to be losing its autonomy and leadership seems to be moving further away from the profession.
It is worth exploring how the midwifery profession has evolved in the UK, what has influenced its role and its impact on care and on women’s outcomes, and what the future holds for it, as well as to consider whether midwives should be taking the lead in their profession and how this might be best achieved.
Male Domination Challenging the Profession By the beginning of the 18th century, the role of the midwife started to decline alongside the growing ascendancy of men in the childbirth arena.1
labour and, in some cases, reduce perinatal morbidity and mortality. The perceived success of the forceps elevated the role of the male practitioner above that of the midwife, even when there was no evidence that the intervention was appropriate or valuable. However, even with the increasing numbers of ’man-midwifes’, midwifery was still viewed as a lower occupation than that of surgeon or physician, and the unregulated state of midwifery meant that there remained a lack of clarity as to whether midwifery sat as a profession in its own right or was part of the surgeon’s role.
Re-emergence of Midwifery Leadership In 1902, the Midwives Act was passed; its purpose was ‘to secure the better training of midwives and to regulate their practice’. A woman could not call herself, nor practise as, a midwife unless she was certified under the Act.2
The Act was a first step in raising the profile
of the midwife and firmly established the role as important in the care and protection of child-bearing women.
The majority of maternity care was provided in the community by certified midwives with support from general practitioners, and this approach meant that the midwife’s role once again became important and placed the midwife as a professional who provided care to those women experiencing a normal physiological pregnancy and birth.
Increasingly, male practitioners were called in to attend women in normal labour, which brought with it the increased use of technology to speed up and control the birth process. The 1720s saw the invention of the forceps, an intervention that aimed to shorten
4
The National Health Service and Midwifery The NHS brought a revolution in the provision of healthcare: care that was free at the point of delivery, so that everyone could have access
© TOUCH BRIEFINGS 2012
Prior to the establishment of the National Health Service (NHS), patients were required to pay for any care or treatment. In the 1930s, a certified midwife could expect a fee of around 10 shillings (50p), whereas a doctor would charge £2 or £3 and a hospital birth would cost up to £123.3
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