Meg Taylor's Midwifery Writings


Recently, on their web site, the NMC illustrated an item about a boost to midwifery recruitment with a picture of a baby being bottle-fed. Various people protested that this image was inappropriate and the picture was replaced. But a representative of the NMC, an online journalist, said that the NMC was 'neutral' on the issue of breast versus bottlefeeding. I was in e-mail communication with this journalist and stated that I did not think that any health professional could maintain neutrality on this issue. Breast and bottlefeeding are not equivalent. There are serious inequalities in health between bottle and breast-fed babies, even in the affluent industrialised countries of the world. I know of no research which indicates that breast milk substitutes are a preferable choice on any criterion at all.

The response of the online journalist suggests a worrying level of ignorance about midwifery: its concerns and the subject of its expertise. I suggest that the time has come once again to consider a separate regulatory professional body for midwifery.

In the late seventies the Briggs bill proposed that the regulatory bodies for nursing, midwifery, and health visiting be amalgamated. I assumed that this was because at that time both the GNC and the CMB (I do not know about the body regulating health visitors) included representatives from the medical profession. If nursing and midwifery are to be autonomous professions their regulatory bodies ought not to include doctors: to do so is to imply that they are professions subordinate to, rather than complementary with, medicine. However I have now discovered that the UKCC also included representatives from the medical profession. I assume therefore that the amalgamation reflected an agenda of 'professionalisation'. It came at a time when many nurses wished their profession to reflect a more academic approach with higher qualified entrants. I now wonder whether there was a covert agenda to subsume midwifery within nursing in an attempt to increase the status of nurses: by conflating the two professions nurses could more easily assume responsibilities, such as prescribing and continuous professional development, previously unique to midwives. Certainly since the development of the UKCC, the Royal College of Nursing started to recruit midwife members.

There was much debate about the Briggs bill at the time in the Association of Radical Midwives (ARM). We suggested that the amalgamation implied an assumption that midwifery was a subsection of nursing. Our disagreement to this was based on an understanding of childbearing as a normal process which only rarely requires medical intervention. We strongly disputed the viewpoint that labour was normal only in retrospect; we prefer to see it as normal until proved otherwise. To see midwifery as a nursing speciality implies an ambiguous relationship with the medical profession. On the whole nurses deal with pathology and while they have their own sphere of expertise, it is the medical profession who has specific knowledge of pathology. Within the sphere of childbirth the pathological should affect only a small minority of mothers and babies. The vast majority, in theory, could be cared for by midwives who are the experts in normal birth without any reference to a doctor at all.

We asserted that midwifery should be autonomous and wished to retain a separate professional body, albeit one which was less authoritarian than the CMB. We were also concerned that the interests of midwifery would not be best served by a body in which midwives were at a considerable numerical disadvantage.

The Briggs bill was passed in1979 and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) was established. The UKCC was innovatory in that some members of the professional committees were elected by the registered practitioners of that profession. But while registered midwives therefore had the opportunity to elect their representatives on the midwifery committee, it still seemed the nursing paradigm was over-dominant.

In the nineties it was decided to revise the UKCC. As far as I understood one of the main reasons for this restructuring was the way in which the structure of the UKCC, by granting equal status to the four nations of the UK, was in effect discriminating against England which has a notably larger population than Wales, Scotland or Northern Ireland.

Those interested in the new proposed regulatory body were invited to participate in a process of consultation with an independent team of consultants. Again ARM was very active in this process, strongly advising that midwifery be regulated by an independent body because it had seemed to us that our fears about the UKCC had been amply fulfilled. In the event our recommendations were overlooked, and the NMC was formed.

I should like to suggest that the NMC is no better at representing midwives' professional interests than the UKCC was.

Since the late seventies, sections of the midwifery profession have been articulating a model of midwifery care which is primarily social rather than biomedical. .Having a baby is not pathological. Sometimes it may involve a medical emergency for both mother and child: the recent case of Sophie Wessex is an example which was promptly and appropriately responded to. But the vast majority of women are capable of giving birth of their own efforts without intervention. The fact that this is not widely accepted in this society is a reflection of the culture, not the physiology. And the culture has been shaped by the placing of birth within a medical framework. Midwifery, as a profession and a discourse, can place birth differently within a social, psychological and spiritual context. Midwives can respond to women on these levels without endangering their clients. In fact, to continue current practice uncritically is to place women at physical and psychological risk of iatrogenic disorder and to perpetuate a culture where childbirth is regarded fearfully and the socio-psychological needs of mother and child are undervalued, to the detriment of both.

But if midwifery is to be able to do this it must become a fully regulated, self determining, autonomous profession. Midwifery needs its own regulatory body.