Midwifery

Midwife, howdie, ban chuideachaidh are some of the names given in Scotland to the person whose main occupation is to care for women before, during and after the birth of their babies.

The coming of the NHS in July 1948 with its three administrative layers brought changes to midwives’ practice. It fragmented maternity services, encouraged hospitalisation and medicalisation of childbirth; and diminished the midwifery role for a time.

Home births were declining by 1952 and some midwives were feeling very worried about their future.

The Salmon Committee Report in 1966 made things worse. It re-organised the administration of hospital midwifery and finished up with a divisive, inflexible and standardised hierarchy.

The original NHS structure was overhauled by the NHS (Scotland) Act, which got rid of the three layers of administration. Integration of maternity services in Scotland after 1974 aimed for more continuity of maternity care and professional team working.

However, the 1973 Tennent Report recommended 100 per cent hospital births with increasing medicalisation, birth being regarded as only normal in retrospect, and midwives were expected to toe this line.

Sheelagh Bramley in 1977 and Mary Turner in 1978 were the first midwives to be elected chair of the Central Midwives Board for Scotland (CMB). However, amid some controversy, the Briggs Committee Report had heralded the end of the CMB in 1983, the start of the United Kingdom Central Council and, subsequently the Nursing and Midwifery Council.

Later decades have seen a return of optimism. In 1993 the Provision of Maternity Services in Scotland: a Policy Review signposted a move away from over-medicalisation of childbirth and towards woman-centred care. Women became more vocal. Informed choice became the buzz-words, along with a new sense of partnership.

Midwifery education also changed. In 1992 a new three year programme for midwifery students began across Scotland. From September 2008 all student midwives will study to degree level.

Now, in Scotland there is increased intra-professional partnership working with emphasis on normal childbirth. There are twenty-two Community Maternity Units. Some larger units include a midwife-led unit. Home births are a reasonable option for some women.

The Scottish Multi-professional Maternity Development Programme resulted from the Expert Group on Acute Maternity Services (EGAMS) Report and has worked since 2004 to promote team-working, professional development and normality in childbirth.

Keeping Childbirth Natural and Dynamic (KCND), a new Scottish programme, aims to maximise opportunities for women to have as natural a birth experience as possible. To date the majority of NHS Boards have appointed a Consultant Midwife with the aim of implementing this.

With the anticipation of normality in childbirth wherever possible, a woman is most likely to encounter the midwife at an early stage and discussion her options for birth. In the 60 years of the NHS in Scotland midwives have come a long way. They will continue to have the best interests of childbearing women and their babies at their heart – whatever the changes the future might bring.

Dr Lindsay Reid
Midwife writer

• Further information
• SMMDG website