Arguably, the biggest challenge within maternity care is ‘meeting the health and social care needs of a rapidly changing population’ (Department of Health, 2010: 11). By providing evidence-based women-centred care, we, as midwives, hope to ensure the best possible outcomes for mothers, children and their families, and to reduce health inequalities. This ‘changing landscape of midwifery care’ and its challenges were addressed at the 13th National Conference on Current Issues in Midwifery organised by the British Journal of Midwifery, by a number of experienced and inspirational speakers on the 23–24 March 2015.
In 2013, Health Survey for England found that 57.2% of women and 67.1% of men were overweight or obese (Health and Social Care Information Centre, 2015), classified by the World Health Organization as a body mass index (BMI) of >25 kg/m2 (WHO, 2015). As Professor Siobhan Quenby (2015) described, this is clearly a public health issue with serious consequences. During pregnancy, obesity can affect maternal health, increasing the risk of gestational diabetes and pre-eclampsia, and can have serious and lifelong effects on the baby; increasing the risk of a plethora of diseases including diabetes, heart disease and hypertension and continuing to influence the health of future children. This must be communicated to women and their families—lifestyle and health choices have a direct impact on the health of future generations. Although this is not new information, statistics show that as health professionals, we are seemingly not carrying out our role as public health advocates as successfully as we should, and could, be. At the frontline of public health, we cannot allow raised BMI to become ‘normal’. As promoters of health we should be able to facilitate informed choices about health and lifestyle in order to reduce health inequalities.
The importance of communicating public health information in maternity is not limited to obesity, but is a multi-faceted art and science that should evolve with society with the aid of research, analysis and critical thinking. These skills are integral to our practice, as appraised by Dr Rebecca Smyth (2015) and Claire Singh (2015). In order to provide best care, research needs to be evaluated, although this in itself can lead to problems—deciding which evidence should be used in practice without being clouded by biases at publication and reporting levels, as well as our own biases.
However, as many of the speakers seemed to imply, what is the use of this evidence once we've found it, if we aren't applying it in practice? This was clear in Professor Christine Kettles' (2015) talk on perineal pain. Research has shown that women are affected by perineal trauma, both physical and psychological, long after the 6–8 week recommended recovery time. Despite this evidence, in practice we still seem to neglect conversations and examinations regarding perineal trauma, leaving women feeling ashamed and afraid to ask for advice. This omission is seen on a daily basis in practice; upon discharge perineal care is ‘skimmed over’ and postnatal community visits very rarely include an examination, potentially leading to ongoing and increasing health issues.
Similarly, Professor Julie Jomeen (2015) discussed the lack of specialist perinatal mental health teams across the country despite suicide being one of the highest causes of maternal mortality since 1997 (Centre for Maternal and Child Enquiries (CMACE), 2011).
Research has also shown that 69.7% of maternal deaths occur in the postnatal period (CMACE, 2011), but as Professor Debra Bick (2015) discussed, the postnatal care we are providing is not evolving to reflect the evidence and the change in maternal health profiles. In fact, Meisel and Karlawish (2011: 2023) believe that statistics alone are not effective in changing practice and recommend a parallel narrative to enable us to promote ‘understanding, uptake and use’ of guidelines. The struggle to improve postnatal care can be attributed to many factors including staffing levels and a reluctance to change practices; however, as Professor Cathy Warwick (2015) so powerfully stated, we should not allow ourselves to be over-occupied by the quantity of qualified midwives working in the UK, but realign some focus on to the quality of care that is being provided. Particularly after the report of the Morecambe Bay Investigation (Kirkup, 2015) was published, it is essential to re-evaluate our practice and ensure truly evidence-based care is provided, regardless of what our local or national guidelines recommend. This suggestion from Warwick is not intended to disregard guidelines entirely, but to challenge elements that may have become outdated with firm evidence. It is evident that this ideology does not carry through into practice, for example low-risk women being given a cannula and cardiotocograph monitoring on admission. Where is the evidence to support such practices? ‘We've always done it’ or ‘just in case’ appear to be good enough justifications. This is not a criticism as such, but a reflection on how human nature and the desire for familiarity and comfort shape decision-making. However, we should be challenging these statements and routine interventions and taking responsibility for our practices. A foundation of evidence should enable us to provide each woman with the level of holistic care that she requires, ensuring best possible outcomes. Although the Kirkup report may present initial challenges to our profession, as both Bick (2015) and Warwick (2015) expressed, perhaps this is the opportunity to really improve our services and have the courage to challenge practices and policies that may no longer be applicable to women. This will be reinforced by the revision of the Nursing and Midwifery Council's Code: Professional standards of practice and behaviour for nurses and midwives, introduced on the 31 March 2015 as discussed on BBC Radio 4 (Call You and Yours, 2015; NMC, 2015). Jackie Smith hopes that the new Code will ensure better patient safety by encouraging nurses and midwives to speak out about failings without fears of becoming a ‘whistleblower’.
In conclusion, conferences such as the 13th National Conference on Current Issues in Midwifery provide a vital space to challenge assumptions and encourage professionals to gather information in order to evaluate and assess objectively the narrative that runs throughout maternity care. In doing this, we have the opportunity to develop our practice and provide the best possible care for our women and their families. This, there is no doubt, will be reflected in the National Maternity Review that is due by the end of the year. The event was so educational and inspirational and I would encourage any maternity care professional, from health care assistants to consultants and, of course, midwives of all bands to attend. As I student midwife, I have gained a great deal of perspective on midwifery and it has reinforced my determination to be the best, well-informed midwife I can be in order to provide women with the care that they want and deserve.