Once again midwifery is in crisis. This time the very real threat is to the Albany Midwifery Practice which offers individual caseholding midwifery care to 216 women a year in Peckham. The practice’s statistics are well nigh impeccable – a perinatal mortality rate of 4.9 per thousand achieved in an area 14th from the bottom of the deprivation scale against a local rate of 11.4 per thousand and a national rate of 7.7 per thousand. The caesarean section rates also reflect the high standard of care offered to these women – over the last 12 years the CS rate has been consistently 8-10 percentage points lower than the institution to which it contracts its services.
Starting up in 1994 as the South East London Midwifery Group Practice, the Albany has long been regarded as the midwifery model to which many midwives aspire. Student midwives from all over the country clamour to do an elective placement there and come back inspired by what they have seen and experienced.
There are other caseloading teams attached to King’s College Hospital. What makes the Albany so different from the others and why are they under such pressure now? Until six weeks ago when I learnt of the troubles they are having, I would have said that they had the best of both worlds – self management but contracted-in to the NHS, a group of midwives fulfilling to all intents and purposes the NHS Community Midwifery Model. I feel sure that their results are owed in no small part to being in a position to act as true advocates to the women they serve. They had no line managers to micro-manage their time, they had control over their working time, they worked with collegues as friends. I presume they must also have had sympathetic supervisors and support in high places. But all that has changed.
A year ago they were all summoned to a meeting and informed that they had an unusually high number of term babies admitted for hypoxic ischaemic encephalopathy and were to be put under special measures. Various “HIE’ cases were to be referred to CEMACH (the list changed from meeting to meeting) and it would take up to a year to investigate. Then, at the end of September this year there was an early neonatal death following a home birth, the home birth and early labour assessment services were suspended. By the time you read this the CEMACH report should have been completed (now CMACE – the confidential enquiries into maternal and child death have now been privatised, another story).
You can guess as well as I what pressures the Albany midwives have had to endure during the last year and by now I hope that there is evidence of widespread support for them, not only from the mothers they serve but from their colleagues inside the NHS and outside. This sad tale has all the hallmarks of a classic witch hunt on the model used against Wendy Savage in the late 1980s, that is: trawl the data to find the worst cases and ignore all that is good. We are hoping that the Albany midwives will receive as much support as Wendy Savage did but I find myself wondering whether midwives will feel able to stand up and be counted or whether the climate of fear, exacerbated by the credit crunch and fear of cutbacks, is now so bad that they will keep their heads down, offering up only a silent prayer that the Albany midwives will be exonerated.
And what of radical midwives? For once, I feel lucky not to be a midwife. I’m out of reach of the NMC because I have no registration to lose. It’s easy for me to be radical and sometimes I feel I have to rant and rave on behalf of midwives who are constrained by fear of loss of their livelihood.
Apart from articles predating the crisis, this whole issue has been prepared with the Albany in mind. I feel strongly that if the Albany goes down there is little hope for woman-centred midwifery as opposed to CNST-led control of women, both mothers and midwives. This is why I have dared to include an article criticising the NMC, its processes and its judgements. Midwives giving true woman-centred care are being hauled over the coals and midwives working in hospitals are increasingly thinly spread, subjected to closer and closer scrutiny, and if they step out of line they run the same risk referral to the NMC as those working outside hospital.
Midwifery is a feminist issue. This predominantly female profession is in danger of losing its very identity through NHS control of the ways midwives are allowed to work and NMC rulings on midwives who work in different ways. It is a feminist issue because midwifery respects and honours the power of the female body to do what it was designed to do, to give birth. Nowhere is women’s power more evident than in the act of giving birth; it can feel like climbing Everest, and we get it handed to us on a plate – but without support it can feel like being thrown to the lions. I believe that our patriarchal society is afraid of women’s power. Men have admitted women into the higher echelons of the professions, but largely on male terms and women have paid a high price for admission – now they must do it all if they are to have it all. It has been said that as more women have been admitted to these traditionally male professions: medicine, the church, law; the professions have lost status. But midwives are in danger of losing their profession altogether and becoming cogs in the NHS machine. Giving birth can be one of the most empowering things in a woman’s life – or it can be profoundly disempowering.
All over the country midwives are striving to empower women but when they themselves are so disempowered what hope is there?
I hope that the Albany midwives will be able to weather this storm and continue to inspire the rest of the NHS, managers and midwives alike. To do that they need our united support. With enough backing, Save the Albany could mark the rebirth of the midwifery profession, not its demise.
This article was originally published in Midwifery Matters issue 123, Winter 2009