25 March 2022
We the undersigned seek the resignation of the RCM board and the CEO, with processes to elect a new board and CEO to be commenced as soon as possible; we await your early response.
Since the publication of the Kirkup Report and more recently the Interim Ockenden Report there has been a concerted attempt to undermine and smear midwives, the midwifery profession, and to deny the legitimate experiences and wishes of childbearing women who wish to retain autonomy over their own bodies and births. These attempts have been led by powerful actors in government and media. They have been biased and misogynistic in tone, given the reality of female physiology, and the sex of the vast majority of midwives and birth workers. Nevertheless there exists the irony that intervention levels in pregnancy and labour have never been higher in the UK, some hospital trusts have induction rates of nearly 50% and Caesarean Section rates of near 40%. The cases which are attributed to “normal birth ideology” are failures to escalate or refer appropriately, and do not offer proof that there is fundamental, wholesale failure in the physiology of birth.
Despite the overwhelming evidence, demonstrated most recently by the Lancet series of reports, that optimal outcomes of physical, psychological and emotional health are consequent on physiological labour and birth with minimal intervention, recent published comment, interviews and blogs from the RCM suggest this evidence has been ignored. The majority of professional midwifery associations in the world continue to see their role as promoting and supporting the physiology of birth as reflected in our NMC Standards of Proficiency for Midwives. This view is supported by the World Health Organisation, FIGO, and the International Confederation of Midwives, and is associated with a promotion and strengthening of professional midwifery in countries where it is not present or robust.
The UK was among the first countries in the world to develop a strong midwifery profession and was historically regarded as having a maternity service to aspire to. The RCM has undermined and misrepresented the evidence regarding physiological birth and has allowed itself to indulge in the demonisation of the profession it was formerly presumed to represent. The failures noted by the recent reports in maternity services are complex, institutional and systemic and should not be laid upon individuals and professional groups. There is no evidence that wholesale increases in levels of medical intervention in labour and birth will reduce rates of stillbirth and intrauterine death, since countries which have better outcomes than the UK, also have lower intervention rates. In the UK, NHS trusts have varying rates of stillbirth and intrauterine death, higher medical intervention rates in labour do not correlate with improved outcomes in these trusts.
All midwives are aware of the desperate shortages of staff in many places of work, and poor staff retention rates, as many find the reality of their work prevents them from offering the standard care they aspire to. We are convinced that the recent messages received loud and clear from our professional body, suggest that our primary role in supporting physiological childbearing is a mistake which should be rectified, and that our attempts to give compassionate continuity of care are not appreciated. This radically undermines morale for many midwives who hear these reports. They negatively impact the confidence of the population in physiological processes and the midwifery profession. We may take from these messages the assumption that autonomous professional midwifery is no longer required in the UK, even by our own professional body, the RCM. We repeat our request that the board of the RCM resign and a new board be elected and that the CEO is reappointed to reinstate the RCM as a professional body which supports its members.
Response from the Royal College of Midwives
19 April 2022
Thank you for your letter which the board discussed at our meeting in March 2022.
The letter came before the Ockenden Report was published, which was a devasting read for all of us working in maternity services. What is clear from the report is that the situation at Shrewsbury & Telford Hospital Trust occurred not because of individuals or because of midwives. Rather, there are long standing complex systematic issues that we need to understand and work through collectively. The 15 Immediate and Essential Actions which apply across the NHS in England have now been accepted by the Secretary of State for Health & Social Care. The RCM needs to see how best we can support them, which of course supports our members and all those working in maternity services.
The board has sought legal advice and following that can find no reason for us to offer our resignation or ask the CEO to do the same.
The RCM is fully committed to and supports the role of the midwife as defined by the Nursing and Midwifery Council Future Midwife standards and proficiencies, which describe the role of the midwife as an autonomous practitioner working within the multidisciplinary team to care for all women. In that role, midwives support physiological pregnancy, labour, birth and postnatal care. Evidence-based midwifery practice is absolutely key to safe and sustainable maternity care. The RCM states clearly that the role of the midwife is essential in supporting women in making evidence-based and informed decisions during their maternity journey and being their advocate.
There have been difficult conversations around the term ‘normal birth’ since the Kirkup report. It has been seen by some as divisive and linked to an approach that appears to only value a normal birth above all other possible types of birth or outcomes.
The RCM is leading and working across the maternity community, including midwives, obstetricians and women, to develop, a new shared positive narrative around birth through the Re:Birth project which collectively enables us to come together to discuss these issues.
It is clear to me that all of those involved in providing and supporting maternity care – midwives, maternity support workers, obstetricians and the wider team need to continue creating an environment where women are well supported by well-resourced teams who have the time to provide the right care and advice at the right time. The midwife is a key member of this team, with a responsibility to provide care for all women. Therefore, the RCM continues to campaign for more midwives, and for better pay and conditions, as we truly understand the pressures that our maternity teams are experiencing on a daily basis.
We are keen as an organisation to work collaboratively with partners in midwifery and across maternity and neonatal care. I know that our CEO Gill Walton has spoken regularly with you to discuss current issues and that we presented at your recent conference. We would like for this collaboration to continue and I know that Gill would be very happy to meet with you to discuss this further.
In such challenging times for maternity services, it is important for all us – Royal Colleges, midwifery associations, policy-makers, maternity staff and, of course, the women and families in their care – to listen to each other to create a shared vision for safe, high quality, personalised maternity care in the UK.
Chair of RCM Board
ARM Response to the Royal College of Midwives’ Reply
International Day of the Midwife – 5th May 2022
The board of the RCM responded to our open letter on April 19th. The steering group of ARM and other members have spent some time considering RCM’s response and do not accept that the roots of our original concerns have been addressed. RCM claims to hold a position which wasn’t expressed clearly in some of the interviews and public statements made by RCM and Gill Walton in the light of the Ockenden report. It is a standard and impersonal response and as such has an arrogant and dismissive tone. There is no expression of regret or any candid admission that some RCM messaging was very harmful and detrimental to the reputation of the midwifery profession, and likewise harmful to the many women and birthing people who would prefer their midwives to support them in a physiological process.
While we are not surprised that the board and CEO have declined to resign, we would have expected a more serious attempt to redress the damage done and speak to the strength of feeling reflected by the number of signatories to the letter. These signatures were gained in a very short time and without great effort to advertise; implying that there are grave concerns among midwives and those interested in maternity care. This is despite the overwhelming pressures on maternity services and on midwives’ attention at present.
We would also like your assurance that ARM members are not one of the groups mentioned by RCM as being “influential and causing problems”, if we are included in that group we would naturally pause before considering requests to work together to improve midwifery and maternity care.
To rectify the enormous damage done, we believe it is vital that the RCM makes a clear public statement about the role of the midwife as defined by the NMC standards for practice and the international definition of the midwife. What does the RCM really think a midwife is, or should be? We request that this be done immediately to counteract the impression that the RCM gave which suggested that midwives should no longer consider themselves autonomous practitioners whose area of expertise lies within physiological pregnancy, birth and the puerperium. It should also be made clear that midwives’ support of normal physiology does not imply that they would cease to care for women whose pregnancies and births become more complex. Midwives will also continue to care and provide support for women who find themselves in need of medical intervention in collaboration with medical practitioners, who would take the lead on the optimal medical interventions recommended for higher risk cases.
We would also like further insight into the position of RCM on the role of maternity assistants, nurses and other clinical staff who may be used in various aspects of maternity care. There should be clarity on this development and undertaking, that they will not be instrumental in fragmenting the midwives’ role or continuity of midwifery care.
We believe that RCM should be seeking to work with the members of Association of Radical Midwives in embedding “Better Births” into NHS maternity services (2016). Our own New Vision for Maternity Care (2013) suggested ways of humanising childbirth. The RCM could be using the very clear evidence from the Lancet series (2014) and the Birthplace study (2011) supporting continuity of carer and physiological labour, and reflecting on the resulting improvement in outcomes for women and babies. Many midwives who have been striving to implement effective continuity of care and caseload midwifery have seen their work undermined, and though we realise that there are many maternity services and midwives who are under enormous pressure, this work is essential in providing further evidence of the effectiveness of good relational care. You will have been aware of the recent statement of Jacqueline Dunkley-Bent confirming that work to implement caseload midwifery will not be reversed.
We also draw your attention to Professor Mary Renfrew’s heartfelt article, ‘Midwifery the Joy and the Struggle’ (2022 ) written to support students and NQM who are undoubtedly wondering what they are to make of the apparent reversal of all they have been taught and led to expect of their new profession and must be discouraged in belonging to a profession whose largest representative body seem to be undermining them.
The Association of Radical Midwives’ membership and those who signed the open letter wish to propose that the Royal College of Midwives undertake to work with us in equal partnership to support and implement the best maternity care and the most effective and confident midwifery profession possible. We believe our major professional body has allowed itself to become a complacent and compliant part of the establishment. The RCM should, on the contrary, be a dynamic and proactive body supporting excellence in midwifery and maternity care.
Response from the Royal College of Midwives
1 June 2022
Thank you for your letter dated 5 May 2022, received on 25 May. We have noted the contents and substantive questions, to which we responded in our previous letter dated 19 April 2022.
We continue to work hard in the best interests of our members, who are facing unprecedented pressures, from the impact of the cost-of-living crisis to concerns about their ability to provide safe care with diminishing staff numbers. Representing them, whether directly in the workplace or indirectly through our influencing work with policy-makers, continues to be our primary focus.
Gill Walton, CEO RCM
Giuseppe Labriola, Chair of RCM Board