Association for Improvements in the Maternity Services. AIMS response to MBRRACE-UK report Oct 2018.. 2018. (accessed 6 November 2020)

Alaszewski A, Brown P. Making health policy: a critical introduction..Cambridge: Polity Press; 2012

Health, stress, and coping.. 1979. (accessed 6 November 2020)

Aveyard H, Sharp P. A beginner's guide to evidence-based practice in health and social care professions..Berkshire: Open University Press; 2013

Beck U. World at risk..Cambridge: Polity; 2009

Brocklehurst P, Hardy P, Hollowell J Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England National Prospective Cohort Study.. BMJ. 2011; 343:(4)

Carson D, Bain A. Professional risk and working with people: decision-making in health, social care and criminal justice..London: Jessica Kingsley Publishers; 2008

Care Quality Commission. 2019 Survey of women's experiences of maternity care.. 2020. (accessed 6 November 2020)

Cramer E, Hunter B. Relationships between working conditions and emotional wellbeing in midwives.. Women and Birth. 2019; 32:(6)

Dahlen HG. Working with the media: the power, the pitfalls, and the possibilities.. In: Luce A, Hundley V, van Teijlingen ER (eds). London: Palgrave Macmillan Ltd; 2017

Changing Childbirth, Part 1..London: HM Stationery Office; 1993

Edwards NP, Murphy-Lawless J. The instability of risk: women's perspectives on risk and safety in birth.. In: Symon Andrew (ed). London: Churchill Livingstone; 2006

Hadjigeorgiou E, Coxon K. In Cyprus, ‘Midwifery is dying…’. A qualitative exploration of midwives' perceptions of their role as advocates for normal childbirth.. Midwifery. 2014; 30:(9)

Healy S, Humphreys E, Kennedy C. Can maternity care move beyond risk? Implications for midwifery as a profession.. British Journal of Midwifery. 2016; 24:(3)203-209

Hollowell J, Rowe R, Townend J The Birthplace in England National Prospective Cohort Study: further analyses to enhance policy and service delivery decision-making for planned place of birth.. Health Services and Delivery Research. 2015; 3:(36)1-264

Hunter B, Warren L. Midwives' experiences of workplace resilience.. Midwifery. 2014; 30:(8)

Jefford E, Jomeen J, Martin CR. Determining the psychometric properties of the enhancing decision-making assessment in midwifery (EDAM) measure in a cross cultural context.. 2016;

Jenkinson B, Kruske S, Kildea S. The experiences of women, midwives and obstetricians when women decline recommended maternity care: a feminist thematic analysis.. Midwifery. 2017; 52:1-10

Jokhan S, Whitworth MK, Jones F, Saunders A, Heazell AEP. Evaluation of the quality of guidelines for the management of reduced fetal movements in UK maternity units.. BMC Pregnancy and Childbirth. 2015; 15:(1)

Saving lives, improving mothers' care maternal, newborn and infant clinical outcome review programme.. 2019. (accessed 10 November 2020)

Leachman A. How media promote fear around childbirth.. In: Luce A, Hundley V, van Teijlingen ER (eds). : Palgrave Macmillan Ltd; 2017

Leap N, Hunter B. The midwife's tale: an oral history from handywoman to professional midwife.Croydon: Pen and Sword Book Ltd; 2013

Lee S, Holden D, Webb R, Ayers S. Pregnancy related risk perception in pregnant women, midwives and doctors: a cross-sectional survey.. BMC Pregnancy and Childbirth. 2019; 19:(1)

Introduction.. In: Luce A, Hundley V, van Teijlingen ER (eds). : Palgrave Macmillan Ltd; 2017

Mander R, Reid L. Midwifery power.. In: Mander R, Fleming V (eds). London: Routledge; 2002

Mattison CA, Dion ML, Lavis JN, Hutton EK., Wilson MG. Midwifery and obstetrics: factors influencing mothers' satisfaction with the birth experience.. Birth. 2018; 45:(3)322-327

Miller S, Abalos E, Chamillard M Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.. The Lancet. 2016;

National Maternity Review. Better births improving outcomes of maternity services in England a five year forward view for maternity care national maternity review.. 2016. (accessed 10 November 2020)

Newnham E, McKellar L, Pincombe J. ‘It's your body, but…’ mixed messages in childbirth education: findings from a hospital ethnography.. Midwifery. 2017; 55

Newnham E, Kirkham M. Beyond autonomy: care ethics for midwifery and the humanization of birth.. Nursing Ethics. 2019; 26:(7–8)2147-2157

Nolan ML. Home Birth: The Politics of Difficult Choices..London: Taylor and Francis. Routledge; 2010

Numerato D, Salvatore D, Fattore G. The impact of management on medical professionalism: a review.. Sociology of Health and Illness. 2012; 34:(4)626-644

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates.. 2018. (accessed 6 November 2020)

Nursing and Midwifery Council. Future midwife: standards of proficiency for midwives.. 2019. (accessed 10 November 2020)

Office for National Statistics. Birth characteristics in England and Wales – Office for National Statistics.. 2017. (accessed 6 November 2020)

Home versus Hospital Birth.. 1998. (accessed 10 November 2020)

Overgaard C, Fenger-Grøn M, Sandall J. The impact of birthplace on women's birth experiences and perceptions of care.. Social Science & Medicine. 2012; 74:(7)973-81

Porter S, Crozier K, Sinclair M, Kernohan WG. New midwifery? A qualitative analysis of midwives' decision-making strategies.. Journal of Advanced Nursing. 2007; 60:(5)525-534

Possamai-Inesedy A. Confining risk: choice and responsibility in childbirth in a risk society.. Health Sociology Review. 2006; 15:(4)406-414

Power S. The imaginative professional.. In: Cunningham B (ed). : Institute of Education: University of London; 2008

Royal College of Obstetricians and Gynaecologists. Expert Advisory group report high quality women's health care: high quality women's health care: a proposal for change.. 2011. (accessed 30 July 2020)

Reiger K. Domination or mutual recognition? professional subjectivity in midwifery and obstetrics.. Social Theory and Health. 2008; 6:(2)132-147

Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Silva DRAD Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.”. The Lancet. 2014; 384:1129-1174

Rice H, Warland J. Bearing witness: midwives experiences of witnessing traumatic birth.. Midwifery. 2013; 29:(9)

Robertson JH, Thomson AM. An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study.. Midwifery. 2016; 33:55-63

Debunking lansley: on patient choice and the NHS reforms.. 2011. (accessed 6 November 2020)

Scamell M. Childbirth within the risk society.. Sociology Compass. 2014; 8:(7)917-928

Skinner J, Maude R. The Tensions of uncertainty: midwives managing risk in and of their practice.. Midwifery. 2015; 38:35-41

Spendlove Z. Risk and boundary work in contemporary maternity care: tensions and consequences.. Health, Risk and Society. 2018; 20:(1–2)63-80

Suominen S, Lindstrom B. Salutogenesis.. Scandinavian Journal of Public Health. 2008; 36:(4)337-339

Symon A. Risk and choice in maternity care: an international perspective..: Churchill Livingstone; 2006

Thomas P. A consumer view.. In: Mander R, Flemming V (eds). : Routledge; 2002a

Thomas P. The midwife you have called knows you are waiting… Failure to progress..London: Routledge; 2002b

Walsh D. Risk and normality in maternity care: revisioning risk for normal childbirth.. In: Symon A (ed). London: Elsevier; 2006

Witz A. Professions and patriarchy..: Routledge; 1992

Wong CYW, He HG, Shorey S, Koh SSL. An integrative literature review on midwives' perceptions on the facilitators and barriers of physiological birth.. International Journal of Nursing Practice. 2017; 23:(6)

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines. Potential benefits, limitations, and harms of clinical guidelines.. British Medical Journal. 1999; 318:(7182)527-30

World Health Organization International Confederation of Midwives White Ribbon Alliance. Midwives' voices midwives' realities findings from a global consultation on providing quality midwifery care.. 2016.;jsessionid=17CF9FC3420D80D56650F12EC7461153?sequence=1 (accessed 30 July 2020)

Wright MC. The sociological imagination., 40th edn. : Oxford University Press; 2000

Professional autonomy for midwives in the contemporary UK maternity system: part 1

02 December 2020
12 min read
Volume 28 · Issue 12


The history and professionalisation of midwifery has travelled through turbulent times to arrive at an opportunity for transformation in the contemporary UK maternity system. This professionalisation, the midwifery profession and professional autonomy are explored in this article from a sociological perspective, to answer the question of whether a midwife can achieve professional autonomy within the UK system. This is a two-part article. Part one has a strong focus on the historical context of midwifery, government policy and guidelines, risk, litigation and increasing managerialisation to frame the discussion in part two. The second part provides a discussion of autonomy, choice, managerialisation and reflexive practice, to create a conceptual framework utilising the concept New Professional Midwifery. This is to centralise a core belief in midwifery autonomy and women's choice facilitation. This paper is part one of two.

Midwifery in the UK is underpinned by the Nursing and Midwifery Council's (NMC, 2018) ‘The code: professional standards of practice and behaviour for nurses, midwives and nursing associates’. ‘The code’ presents the standards and behaviours expected of midwifery professionals (NMC, 2018). Autonomy and the ability to act on one's professional judgement are integral to midwifery education and professional practice (NMC, 2018; 2019). As educated, competent professionals, midwives are known to reduce global maternal and neonatal mortality, and improve quality of care (Renfrew et al, 2014); thus, demonstrating the value of the profession to society.

The professionalisation of midwifery has followed a complex, turbulent course of development, which forms the sociological basis for contemporary care in pregnancy and childbirth. An exploration of the historical context of midwifery, government policy, risk, managerialisation, litigation and social media help provide a fundamental basis for sociological imagination.

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