Leadership Education – A Vital Component in the Future Development of the Midwifery Profession


to the benefits of suitably qualified practitioners across all health disciplines. After the war, improvements in diet and better understanding of nutrition, improvements in living conditions, access to free healthcare and the use of antibiotics led to an overall improvement in mortality and morbidity. There is a clear correlation between a healthy mother and positive outcomes for the neonate and infant, and those women who are healthy throughout childbirth will be fit to provide the best care for their infants. A number of reports following the war years identified that access to qualified practitioners produced the best outcomes and that investment in the health of women had long-term benefits;4


however,


misunderstanding of which interventions brought improvements for women led to an increase in the hospitalisation of women experiencing a normal physiological pregnancy and birth. This has clearly become the norm in the 21st century, with over 97 % of women giving birth in hospital, although the evidence to support hospital as the best place for low-risk women to give birth is constantly being questioned.5


Normal Physiological or Technological Birth? In the ongoing debate around pregnancy, place of birth and safety, and around whose domain childbirth is, the profession of the midwife continues to be undervalued and the role of the medical practitioner and technological intervention in birth seem to be increasingly extolled. Midwifery and midwives need to be critically evaluating their role and profession to ensure that women and their babies are receiving the best and most appropriate care. This clearly suggests that midwives need to be taking the lead in their profession.


The issue of leadership – often a lack of clear leadership – in maternity services is highlighted in a number of reports,6–8


all recognising the


importance of leadership within maternity services and recognising the role that midwives must play in their own professional leadership. In these reports, there is criticism of maternity services, a lack of leadership and the impact on the delivery of care.


The King’s Fund report6 identified the benefits of multidisciplinary


teams within maternity services, and midwives who contributed to the report agreed that team working is important for the delivery of care. However, further scrutiny of what the multidisciplinary team looks like and who is taking the lead on care demonstrated a lack of leadership structure that results in a blurring of accountability and a lack of professional direction. The Prime Minister’s report7


stated that


midwives should take responsibility for leading and managing their profession, clearly offering a mandate for the midwifery profession to regain its autonomy. It is essential to stress that midwives and midwifery are about the care and support of women with a normal physiological pregnancy and birth and that, when the care of women falls outside the norm, midwives need to work effectively with their medical colleagues to ensure that women receive the best care. Midwives need an understanding of their role and profession to add strength to their relationship with obstetricians in the care of women with more complex needs. A balance is needed between ensuring that all professional practitioners understand their roles and work together, avoiding the midwifery profession becoming subsumed once again by doctors. Both the King’s Fund report6 Maternal and Child Enquiries (CMACE) report8


and the Centre for clearly demonstrated


the need for the medical profession and the midwifery profession to retain their identities while working effectively together to support women and their babies.


EUROPEAN OBSTETRICS & GYNAECOLOGY SUPPLEMENT


It is unfair to suggest that midwifery lacks leadership as a result of the medicalisation of childbirth; leadership within the NHS has been subject to criticism for a number of years, with challenges to organisational structures and the lack of clarity and direction. In July 2011, the Health Secretary announced that an NHS Leadership Academy would be established to address leadership in healthcare, recognising that there needs to be consistency as well as flexibility in leadership education to meet the needs of healthcare professionals. It is anticipated that healthcare professionals’ leadership education and training will reflect the Clinical Leadership Framework.9 Leadership Academy will be formed in April 2012.


The NHS


Leadership Education – A Costly Pastime or Professional Necessity?


The criticism of midwifery leadership seems a fair, although damning, indictment of the profession. There are some excellent midwife leaders and, in the UK, pregnant women should feel confident in the care they receive. Nonetheless, there are changes that need to be made to ensure that women get the best care. Anecdotal evidence suggests that some midwives are not putting themselves forward for leadership roles; this is in part because of the changing face of the NHS and because becoming a leader can move the practitioner away from the direct care of women. However, there are also comments from midwives that senior roles are so wide and so little focused on midwifery that they find they lack the necessary skills to engage effectively with chief executives or professionals at board level.


A contributory factor is the lack of opportunity to develop leadership skills from the point of registration and beyond. Leadership education is not cheap and midwifery-specific leadership courses are few. In 2009, the Royal College of Midwives was the only organisation offering midwifery-specific leadership education and this was targeted largely at midwives who were already in senior positions.10 For midwifery to regain control of its future, there needs to be input and support for leadership education and training for all midwives, regardless of their level of experience. That means leadership needs to be introduced as part of midwifes’ training and that opportunities for professional development need to be available for midwives throughout their careers. Not every midwife wants to take on the challenge of ‘heading’ a midwifery service; however, there are other clear leader roles within the profession – for example, leading the care of women, leading a team in the community or hospital, and running a department. Midwife researchers and midwife teachers have a role in exploring the best way to deliver care and ensure that midwives are able to take on the role. The clinical midwife who sees her position as being ‘with woman’ needs to understand the profession as a whole and its leadership, in order to enable support for the leaders but also to ‘translate’ the care for women and demonstrate that the profession can work as a united team.


Ongoing education and professional development can be costly; there needs to be committed investment at all levels and that investment needs to be sustained. There is little value in providing education to senior midwives only: without adequate support behind them, they cannot be as effective and, without early intervention, the future leaders will not step forward. A failure to invest in leadership education and training is likely to be more costly; the midwifery profession will become lost in obstetrics, women will not be offered choice, childbirth will become increasing technological and women will lose confidence in their ability to give birth to their babies.


5


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40