The role of the midwife: how has it changed over time?

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The NHS has now been operating for 70 years and since its introduction, healthcare across the country has improved enormously.

England is the only country in the world that provides free healthcare from ‘cradle to grave’ and this means that most people will have first-hand experience with the NHS - it touches the lives of everybody.

Today, 1.7 million people are employed by the NHS. When it was first formed, the majority of its employees were nurses. Over time, the need for more complex care has grown and as a result, doctors are now the majority. Day-to-day care has become the remit of healthcare assistants and nurses are now more highly trained, requiring degree-level education to provide the specialist care that patients need.

Before the creation of the NHS, women typically gave birth at home, usually without the help of a qualified professional. This meant a higher rate of mortality for both mothers and infants. With the advent of the NHS, women were encouraged to have their babies in hospitals and they would often stay for a week or more, supported by midwives throughout their stay.

Is it like One Born Every Minute?

Midwives may say that TV documentaries like One Born Every Minute are a more realistic portrayal of giving birth than a soap opera, but that they don’t always show the real hard work that midwives carry out 24 hours a day. As a midwife, no two days are the same and it’s unlikely that they will work a typical 9-5 day, often working beyond their hours to see a mother give birth to her baby. It’s clear that midwifery is a demanding yet incredibly rewarding career, taking real dedication, determination and a desire to achieve.

Women who have their babies in hospital now spend less time on the ward and are often released soon after they have given birth. Birthing units are becoming more popular and give parents and birthing partners the opportunity to be more independent but with professional support on hand. Midwives therefore have less time to develop a bond with parents, so need to be excellent communicators - especially considering the wide variety of people that they are in contact with. They must show a passion to care for people and an ability to react professionally in all situations.

As knowledge about pregnancy and childbirth has grown, the role of midwives has expanded, often now beginning to work with mothers from the moment that they are trying to conceive, throughout their pregnancy and often well into the postnatal (after birth) period. Their skills have had to develop alongside this and they are now expected to know about different areas such as congenital abnormalities and premature births.

I remember my 3 months on the maternity ward as a student nurse with great fondness, but as an 18 year old I don’t think I appreciated what the mothers were going through. It was a loud and frightening experience, as women are completely reliant on you having the skills and knowledge to be able to reassure them at an extremely vulnerable time in their lives. You learn very quickly that mothers just want to know that everything is going to be fine and that the midwives can follow the birthing plan or give them the medication that they need. It was a more than rewarding element to my nurses training and I will always remember the babies I saw being born during my 3 months.

The future of midwifery

As with other areas of the NHS, there are ever-changing and ever-growing demands on midwives. For example, the profile of the mothers that they treat is changing - it could be looking after a woman who is a refugee and speaks no English, or an older mother having her first child.

The average age of a first time mother is 30.5 years and the average percentage of first-time mothers aged over 30 has risen by 7% since 2007, now sitting at 55%. This trend suggests that more and more women are waiting to have children later in life, which presents different concerns and considerations for midwives to take into account when they are caring for their patients.

The number of live births per year is also decreasing, but this does not mean that midwives will soon be out of a job. Thanks to the advancement of technology, women might choose to give birth somewhere other than the hospital - and complicated pregnancies don’t necessarily mean that a baby will not survive. Midwives could potentially be attending home births and births in new birthing units as well as hospital births.

Fathers are also beginning to have a bigger role to play and desire greater involvement in the birthing process - a midwife’s role may extend to the fathers too, especially if they are the mother’s selected birthing partner. Midwives are not just delivering babies, but are highly skilled members of the healthcare team. In the future it could be that midwives need to be even more flexible and have more knowledge about community care and working in a diverse environment.

(Statistics from: Birth characteristics in England and Wales: 2017, Office for National Statistics).  

How to become a midwife

In order to become a midwife, students will need to be degree-educated. This can either be through a midwife degree, or through general nursing and then completing an 18 month course to become a midwife. The best way into midwifery is to progress to higher education from a Level 3 qualification such as BTEC Nationals, A-Levels or a combination of both. A BTEC National in Health and Social Care gives students a broad introduction to the subject and various optional units, which gives students a good base for furthering their knowledge at university. By completing work experience, a student develops work skills and can attend placements that develop communication and empathy skills. Having a vocational qualification allows students to explore other areas of healthcare and have valuable experience in working in a placement.

Midwifery students typically spend around half of their degree on supervised practice placements in community and hospital settings, as well as learning about the physical, emotional, social, political and cultural aspects of maternity care in the UK.

All these things make for a challenging, yet incredibly rewarding and fascinating career choice.

Esther Trehearn is the Subject Advisor for Health and Social Care and Childcare at Pearson. She has been working at Pearson for nearly two years. Before Pearson, Esther worked in Further Education teaching Health and Social Care to 16+ students at a large FE college. Prior to this she worked as a nurse in the NHS and several different roles in Social Care settings.

The views, thoughts, and opinions expressed in these blogs belong solely to their authors, and are not necessarily those of Pearson.

Esther Trehearn