Last year, the Nursing and Midwifery Council (NMC, 2015) issued a revised Code setting out the professional standards of practice and behaviour for midwives. The standards form the yardstick against which midwifery practice is measured, and those who fail to meet the standards can be called to account (Griffith, 2015).
It is essential, therefore, that midwives understand and apply the Code and its underpinning legal principles.
Treat people as individuals and uphold their dignity
The first standard against which the professional practice of midwives is measured is the requirement to treat people as individuals and uphold their dignity. To achieve this, midwives must (NMC, 2015):
Given the avoidable deaths and poor nursing care highlighted in the Francis Report (Francis, 2013) and Andrews Report (Andrews and Butler, 2014), it is no surprise that the NMC emphasises the need to promote dignity and the fundamentals of care in the first standard of the revised Code.
The Code defines the fundamentals of care as (NMC, 2015: 4)
‘including, but not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions. It includes making sure that those receiving care have adequate access to nutrition and hydration, and making sure that you provide help to those who are not able to feed themselves or drink fluid unaided.’
Maintaining the fundamentals of care and dignity underpins a midwife's duty of care to the women and babies in his or her care. They are essential to ensuring best practice in midwifery and lie at the heart of all that midwives do. Dignity concerns (Royal College of Nursing, 2008):
‘How people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals.’
The legal and professional basis for the concept of dignity has its roots in human rights law and is derived from the Universal Declaration of Human Rights, article 1, which proclaims (UN, 1948):
‘All human beings are born free and equal in dignity and rights.’
This fundamental right is reinforced by the Charter Of Fundamental Rights Of The European Union 2000 and the Council of Europe 1950, which consider dignity to be an inviolable right.
In practice, respect for dignity places a duty on midwives to treat women as individuals whose care and treatment is underpinned by understanding, empathy and compassion (Munby, 2012).
This duty is all the more important where that patient has an illness or disability that makes them vulnerable and at risk of having their dignity ignored (Hale, 2004). When caring for women who are vulnerable or incapable, midwives must show respect for the woman as a human being and a unique individual.
Ensuring that women receive fundamental care and promotion of dignity is essential to the role midwives undertake and, as the head of the Court of Protection has stressed, ‘your compassion is itself a vital aspect of our society's humanity and dignity’ (Munby, 2013).
Failing to ensure fundamental care and promote the dignity of women can result in a midwife's fitness to practise being called to account by the NMC. That accountability is not mutually exclusive, and further action might be taken through prosecution for ill treatment, wilful neglect or gross negligence manslaughter.
A midwife who failed to respect the dignity of a woman in her care was struck off by the NMC (The Telegraph, 2011). The woman gave birth to a son but he only survived for a few minutes after being born with his umbilical cord wrapped around his neck. An inquest held that the baby died of perinatal asphyxiation contributed to by the midwife's neglect. An NMC Fitness to Practise panel found the midwife guilty of professional misconduct for:
Conclusion
The first standard against which the professional practice of midwives is to be measured under the NMC's revised Code (2015) is the requirement to treat women and their babies as individuals and uphold their dignity. Maintaining the fundamentals of care and dignity underpins a midwife's duty of care to those women and is essential to good practice.
Failing to ensure fundamental care and promote the dignity of women and babies can result in a midwife's fitness to practise being called to account by the NMC. To ensure maximum protection of women and infants, a midwife who does not provide fundamental care or promote dignity can also face prosecution for ill treatment, wilful neglect or gross negligence manslaughter.