The chief medical officer's (CMO's) latest Annual Report, published in December, focused on women's health (Davies, 2015). Media coverage of the report has focused on the key message that obesity is the greatest threat to the health of women in the UK. This is, of course, a crucial point—and one that is all too familiar to most midwives. Maternal obesity is linked to a range of adverse outcomes including: increased risk of miscarriage or stillbirth; a variety of pregnancy complications such as gestational diabetes; a higher risk of developmental abnormalities; and ongoing poor outcomes for the child including a greater likelihood of obesity, diabetes and hypertension in later life. However, the relevance of the CMO's report to midwifery practice extends far beyond the issue of obesity.
Among the recommendations in the report, two that may be of particular interest to midwives are concerned with data and research. The CMO has recommended that the Royal Colleges of Midwives (RCM), Obstetricians and Gynaecologists (RCOG), and Paediatrics and Child Health (RCPCH) work with the Department of Health to ‘determine the optimal data items, assessment tools and linkage to child outcomes to capture information about women's mental and physical health before, during and… after pregnancy’ (Davies, 2015: 13). A further recommendation is that the UK Clinical Research Collaboration works with research funders to review the need for and spending on research in pregnancy, particularly concerning three key areas: ‘preconception interventions to improve maternal and child mental and physical health; screening tests, prevention and treatment for pre-eclampsia, fetal growth restriction and preterm birth; [and] optimum models for antenatal and postnatal care’ (Davies, 2015: 14). This call for research is linked to figures showing the costs of responding to complications such as pre-eclampsia and preterm birth, which could potentially be averted if screening were in place; however, there is currently insufficient evidence to support such screening because of a lack of underpinning research. Midwives are aware of the importance of a robust evidence base—whether that evidence comes from research studies or routine data collection—and the CMO's report highlights the need to broaden and strengthen the evidence base.
The report is critical of missed opportunities for health promotion during the reproductive years. The CMO points out that pregnancy is a time when women engage with health services and are more likely to be motivated to make positive changes to their health and wellbeing. The RCM has welcomed the report but stated that, in order to deliver the CMO's recommendations, ‘the health promoting role of midwives must be recognised and resourced and systems must change in order for us to achieve this’ (RCM, 2015). The RCOG's response to the report echoed this sentiment, stating that the NHS must be structured to provide services in a range of settings to enable better continuity of care and integration across primary and secondary care, and across health and social care.
It is clear, given that the ‘reproductive years’ account for such a significant portion of a woman's life, that midwives have a fundamental role in promoting and improving women's health. We must ensure that we continue to build the evidence base and make the case for midwife-led maternity services to provide the best possible care to women during this crucial period in their lives.