Although many lay claim to being the ‘oldest profession in the world’, midwifery, in one form or another, has undoubtedly been an integral part of society for as long as we have been giving birth. The word 'midwife' comes from the old English 'mid' meaning with, and 'wife' meaning woman. Traditionally, this was the role of the local ‘handywoman’ - a woman who despite a lack of formal training, was experienced at assisting birthing women and often had several children herself.
All this changed in 1902, when Parliament passed the Midwives’ Act. This established a formal qualification which it was necessary for midwives to achieve before they were allowed to practise, effectively transforming midwifery into the profession it is today. Nowadays, the route into midwifery is strictly controlled by the Nursing and Midwifery Council (NMC) who regulate the training that must be undertaken and provide a code of professional conduct to which midwives must adhere.
The most common misconception about midwives is that they just ‘deliver babies’. In fact, for many midwives, this is only a small proportion of their work. Who is there to provide the antenatal care, advice and support that women need as they prepare to become mothers? If complications arise at any point in the pregnancy, who is there to recognise it and ensure the appropriate referral is made? After the birth, who is there to support women with establishing feeding, learning about and bonding with their babies, checking the woman’s body is returning to its pre-pregnancy state and discussing contraceptive choices? The midwives!
In addition to this, many midwives also become involved in issues which impact on, but are not directly related to, a woman’s pregnancy. For example, if a pregnant woman finds herself homeless, a victim of domestic violence, seeking asylum or becoming depressed, it is often the midwife who is best placed to recognise this and to find the right support for her. Some midwives work exclusively with the most vulnerable groups in society, such as teenagers, women with disabilities, drug misusers, bereaved couples or mothers with HIV, using specialist knowledge to try to improve outcomes. Not to mention midwifery managers, supervisors of midwives, practice development midwives and even consultant midwives, who have a vital role to play in improving the care midwives are able to provide to women, as well as the working lives of midwives themselves.
Officially, midwives are responsible for women from the time that they book into a particular service, until 28 days after the birth of the child. Nonetheless, this, like so many aspects of midwifery, is subject to some degree of flexibility. For example, some midwives choose to become involved in family planning and the provision of pre-pregnancy advice, and more and more midwives are providing care until six weeks - or even in some cases three months - after the birth.
Midwives are the bastions of normal pregnancy and birth and, if all is going well, there is no need for a woman to see any other health care professional during her pregnancy. However, if some aspect of the woman’s pregnancy appears to fall outside the realm of ‘normal’, the midwife is duty bound to refer her to an appropriate colleague, such as an obstetrician or a physiotherapist. Thankfully, the majority of women require midwifery care only. After the birth, the midwife will eventually hand over care to a health visitor, who will help women to negotiate all aspects of early childhood, such as decisions surrounding immunisations and how to wean their child onto solids.
Whilst the NHS is undoubtedly the biggest employer as far as midwifery is concerned, it is certainly not the only option. In fact, a myriad of ways to work as a midwife exist, both within and outside of the NHS. Most hospitals will have an antenatal clinic, an antenatal and postnatal ward, as well as a labour ward and midwives may work in just one of those areas, or rotate from one area to another. Depending on the size of the hospital, there may be other departments too, such as a Centre for Fetal Care, where couples whose baby may have been identified as having a problem antenatally will go to obtain specialist care, or a Day Assessment Unit, where women can have potential problems closely monitored without having to be admitted to the ward.
Hospitals usually have community midwives who provide antenatal and postnatal care for women in their own homes, as well as attending home births. Some hospitals offer team midwifery, which usually involves midwives working both in the community and the hospital. This means midwifery care will be provided by a team of midwives, giving the mother-to-be an the opportunity to get to know them during her pregnancy. A small number of hospitals provide a similar scheme called caseload or one-to-one midwifery, which, instead of a team, provides women with one, named, midwife to provide her care with whom she can build a trusting relationship. Some midwives work within birth centres, midwifery-led units which may be found within a hospital or as a stand-alone centre. These offer women the option of giving birth in a less medical, home-from-home environment, which is known to improve the rate of "normal" births without compromising the safety of the mother and baby.
In terms of working patterns, midwifery can be incredibly flexible. Shiftwork is the norm for those working within a ward setting but this can be on a full-time or part-time basis, and may be worked out around the hours most convenient for the individual, such as working nights only. Clinics or specialist areas are often open from nine to five, and although community, team and caseload midwifery usually involve being on-call, this drawback may be countered because it provides a very flexible and satisfying way to work.
Should a midwife choose not to work within the NHS, there are many private hospitals to choose from, although an emphasis on the care provided by consultant obstetricians means the role of the midwife may be much more limited within this setting. Another option, and one which almost certainly gives midwives the greatest autonomy, is that of independent midwifery. This involves being hired privately by women to provide their midwifery care and attend their births, which are usually - but not exclusively - at home. Although it means being on-call all the time for their mothers, the midwife is able to take on as much or as little work as she chooses. Independent midwives tend to have excellent normal birth rates and high rates of satisfaction amongst the women they provide care for; many midwives find this a very enjoyable way to work.
Despite popular opinion, it is not actually necessary to train as a nurse prior to becoming a midwife, although it is true that many of the midwives currently practising were nurses first. If you are currently a nurse, or are planning to train as one, you must undertake a further 18-month midwifery training following your three-year nurse training programme. Direct entry programmes, which train midwives from scratch, are generally three years in length, although some four-year courses exist which incorporate the same number of hours as the three-year course but over a longer period of time. These may be particularly suitable for those with young children.
Direct entry courses are increasingly popular and are seen by many as the future of midwifery, as those trained in this way tend to be more likely to remain in the profession long-term. Whichever route you choose to take, you will need either an Advanced Diploma of Higher Education in Midwifery or a BSc (Hons) in Midwifery in order to qualify. The only real difference between these two options is an increased emphasis on the academic side of things on the degree course, although the practical requirements are the same whichever course you take. For example, you are expected to be the lead midwife at 40 births before you are able to qualify.