As we are all now aware, statutory supervision in midwifery has been revoked and the 2012 Rules and Standards are no longer functional. Unprecedented changes within the profession are ongoing, leaving midwives in somewhat of a quandary. Of course, The Code (Nursing and Midwifery Council, 2015) can still help to determine the standards of practice required, but midwives are familiar with having dedicated reference documents that specifically take into account the needs of women and families.
Statutory supervision has been replaced by the voluntary, employer-led role of the Professional Midwifery Advocate (PMA). Although it is voluntary, the role is written into the NHS contract and will be one of the key lines of enquiry in Care Quality Commission (CQC) inspections. It is too early to identify if there is likely to be any national standardisation, which might leave midwives somewhat confused. So how are PMAs trained and what might their role look like?
My colleagues and I have successfully facilitated three courses to develop the skills of former supervisors of midwives, enabling them to become PMAs. Based on the A-EQUIP (Advocating for Education and QUality ImProvement) model (NHS England, 2017), it keeps women and babies as the central focus and suggests four main functions: clinical supervision, personal action for quality improvement, education and development, and monitoring and evaluation.
I wanted to focus on clinical supervision in this article as it will be offered to all midwives and is relatively new to midwifery.
So what is clinical supervision? A slightly dated but still relevant definition is: ‘A formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety in complex clinic situations’ (Department of Health, 1993).
The important part of this definition is that midwives will be offered facilitated discussions to talk through aspects of their practice. There is no agenda set by the PMA and the sessions are completely voluntary; however, it is hoped that midwives will have annual contact at least. PMAs will be available to midwives to have one-to-one or group sessions and, once trained, should identify themselves and use embedded communication routes to promote their services. You might be ‘allocated’ a PMA, but should be able to change if you feel more comfortable meeting with someone else.
A midwife may ask for a meeting and discuss whatever is important to them at that time. No records will be kept by the PMA, so the discussion is confidential. Do expect that a ‘contract’ will be established at the beginning of the meeting to define how long the meeting will last, the boundaries of the relationship and to anticipate that either person might want to end the meeting should vulnerabilities arise. One example is a midwife who wanted to talk about a recent bereavement and the effect it was having on her. The PMA had had a similar loss and identified during the meeting that it was affecting her ability to support the midwife. This was discussed and a meeting arranged with another PMA.
The basis of the relationship is that PMAs work with midwives to facilitate learning and reflection, so you might meet to discuss complex care planning, problems with professional relationships or workload. Don't expect to be given answers and solutions. PMAs will be trained to coach midwives to identify the skills, knowledge and resources needed to solve the problem. This will take longer initially, but will equip you with the confidence to make sound, ethical decisions.
You may also be offered optional group meetings. These sessions will be based on trust, honesty and respect, and participants will be asked to give the meeting their full attention and reflect on their feelings at the time, to facilitate a group community and an insight into any distractions, such as family illness, insomnia or stress. A topic might be identified, such as an increased number of third degree perineal tears that month, and anyone can contribute and have their views respected. Alternatively, there may be no agenda and discussions might be led by those present. You do not have to bring anything to the meeting, but you may wish to take notes. Your PMA will not keep any records.
Why is this timely? The NHS has complex and rapidly changing systems that require a shift from autocratic leadership to facilitation and coaching. As well as encouraging empowerment and increasing confidence, it can help reduce sickness and and improve morale.
This is a culture change for midwives who are constantly reminded to record what they are doing and why. It's about listening and being ‘with that’ person rather than directing. This is certainly a new role for midwives, but hopefully a timely and well received intervention.