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PARISH HALL, ST MARY MAGDELENE CHURCH, RIBBLETON, PRESTON
SATURDAY 20TH MARCH 1999
The meeting was well attended; almost 40 people came from all corners of UK. Again we welcomed a fair number of student midwives coming to their first National Meeting, most of whom decided to join ARM. The fact that the registration fee is now £6 for all midwifery students regardless of whether they are ARM members or not, indicates that the decision to join is not a financial one!
The Parish Hall was a congenial venue, with the atmosphere of similar older halls, wood floor and panelling, large windows, etc., very sympathetic to the topics presented by the workshop leaders - eco-friendly maternity and child-care. We were especially grateful for the helpful presence of the caretaker, checking that we had all the facilities we needed.
The (very small) Preston group had prepared a really interesting day for us, and the local branches of Baby Milk Action, La Leche League and Real Nappies set out their stalls, gave short talks about their work, and gave workshops later in the day. Unfortunately, Fiona Dykes; who was to have spoken about "Perceptions of Failed Lactation" was unable to attend due to personal circumstances. However, the amended programme gave us more time to debate the pressing topical issue - proposed changes in midwifery legislation.
The meeting began as usual with brief introductions all round the room. Then Ishbel gave a brief outline of ARM - beginnings, development, etc. for the benefit of newcomers. Some announcements were then made:
Sara Birch-Dowd had resigned from the group, having given up her midwifery course due to pressures of work interfering with family commitments. The Constitution provides for a mid-term vacancy to be filled, on a temporary basis, with the proviso that the new member acts as full member of the Steering Group until the next AGM, and will then be eligible for nomination and election for a full term. We were pleased to welcome Vicky McGuigan who offered to fill the vacancy until the AGM in September. Ishbel will send her the usual introduction papers.
There was only one response to the announcement of this vacancy (in the Winter 1998 issue of MM). Sally Herbert has therefore taken on this job, and will be working with Ishbel, gradually developing a sale-of-goods system which will yield greater profit and lower expenses. To this end, after discussions over the previous months within the Steering Group and between Ishbel and Deborah (Treasurer), sales of ARM items will henceforth be on a mail-order basis. All ARM items held by regional stall-holders are being recalled, and will in future be held in Ormskirk as Central Stock.
Under the new system members are still encouraged to represent ARM at local study days and conferences. Since most activity takes place during the breaks in the programme, it is usually possible to attend the speaker sessions, for personal professional development. ARM tables at these local events will carry only samples for display, together with a supply of leaflets for immediate distribution. Purchases will be made via mail-order form, which will be sent with payment to Sally, who will then despatch the order with one week. We hope this system will be less onerous for local members, as they will not need to deal with large parcels of goods, nor concern themselves with sales and monies. For details on how to apply to attend such events on behalf of ARM please see "ARM stands at Local Events" in the Notices section)
ARM will continue to have a stand at the major midwifery conferences, i.e. RCM AGM/Annual Conference (4 days) and Student Midwives Conference (1 day), MIDIRS Hot Topics study days (2 days twice a year), MIDWIFERY TODAY UK Conferences (5 days), etc. Supplies for sale from the stand will be taken from Central stock for these events, as well as a supply of mail-order forms. Volunteers to help Sally at these events will still be needed, as the ARM stand can become quite busy during the breaks in the programme. These helpers will usually be able to sit in on the sessions and take part in workshops, etc.
The concept of a Higher Level of Practice (HLP) was mooted by UKCC in 1994, and at that time the UKCC Midwifery Committee did not endorse it as applicable to midwives. It is seen as elitist, and not relevant to mothers and babies. However, the issue is still being addressed, and the UKCC recently sent out a questionnaire purporting to establish the views of nurses, midwives and health visitors on HLP. This document appeared to take for granted that HLP would be implemented, and the main thrust of the questionnaire was to ascertain whether and how the HLP should be recorded.
We debated the whole issue of levels of practice and there appeared to be a consensus that HLP is not the equivalent of Specialist practice. We accepted that many midwives develop special expertise in a particular field of practice, (e.g. lactation, maternity care of drug abusers, etc.). The same may be said of nurses and health visitors, though we did not presume to speak for these colleagues. We agreed that HLP might be appropriate for nursing, which is a very broadly based profession, quite different from midwifery which is very specific in its sphere of care and responsibilities.
The UKCC has announced the results of the questionnaires, and states that there is a majority in favour of HLP. However, it appears that adverse comments from consumer and other groups (ARM, IMA, AIMS, etc.) have been given equal value with comments from single individuals, without acknowledging that such group responses represent the views of a large number of members.
An extract from Brenda van der Kooy's letter to the Chair of UKCC Midwifery Committee on behalf of IMA gives the issues in a nutshell:
"This must not proceed for midwives until the principle has been fully debated by the profession as to whether such a division is necessary or appropriate. We strongly believe that, as a profession, we must strive for the development of an education system that ensures a high level of practice as standard for registration for all midwives, with ongoing development throughout their careers. Introducing a second tier of midwife will have profound effects for childbearing women and midwives. The system would rapidly develop into midwives and obstetric nurses, if only by different names. Which women would then be cared for by the lower tier and what will be their reaction to this?"
A petition was drawn up echoing the above. It is hoped that we will collect sufficient signatures to prove that midwives' approval of HLP cannot be taken for granted.
The UKCC has announced a series of meetings through April and May, "to which members of the midwifery committees are being invited. The invitation lists have been drawn up in liaison with the National Boards, RCM, Unison and the RCN." Two of these will be in England, (London and Bristol), and one each in Scotland (Edinburgh), Wales (Cardiff) and Northern Ireland (Belfast). We agreed that ARM should try to have at least one member attending each of the meetings, and some members expressed the intention to attend. Others will confirm when they know they will be free on the days mentioned. (It is hoped we will receive reports of some of the earlier meetings in time for the Summer issue of MM).
Mary Cronk outlined some recent (non-confidential) cases which illustrated the importance of professional accountability. Events leading up to the PC cases demonstrate that midwives often believe that they are no longer accountable if they have called a doctor, and if they proceed to practice under the orders of the doctor. The unhappy results of some of the cases dealt with show that if a midwife believes that treatment ordered by a doctor is inappropriate to that woman's care, then the doctor must be challenged, or a more senior medical practitioner be consulted. If the doctor insists on this particular course of action, then the midwife should refuse to comply, suggesting that the doctor take full responsibility for carrying out the treatment personally.
Some of the cases have highlighted the midwife's meticulous record-keeping of the situation, and it was shown that keeping good records of poor quality care does not absolve the midwife from responsibility for carrying out such care. It's no use saying "I called the doctor, and he signed the trace, so I'm covered". Examples cited included setting up and increasing the rate of Syntocinon IV administration on junior doctor's orders, in spite of evidence of fetal compromise,
This session produced a hightened awareness of the totality of midwives' accountability for their actions, under whatever circumstances they practice.
The Report was submitted to the Government in the Autumn of 1998. From the time the Review was completed (around June), ARM and others who had submitted evident made periodic enquiries to JMC as to the likely publication date of the report. We were all told that any decision to publish would depend on the Government after they had seen the Report. Suddenly, on 9th February 1999 the Report was published, and almost simultaneously the Government published their response.
The JMC Report contained several items which gave us hope that our submissions had been taken seriously. For instance it agreed that midwifery is a distinctly different profession from nursing, and that there should be equal representation of the two professions on any new regulatory body so that one profession could not over-rule the other. However, this principle was effectively quashed by the Government in their response, which retained health visiting as one of three professions to be regulated under the new legislation.
A drastically smaller council and generic committees give no reassurance that most of the work will have to be done by unaccountable officers. The most worrying aspect however, is that the changes are to be brought in as part of the Health Bill, which is currently nearing the end of its course through the House of Lords. The current Act will be repealed by Order of the Secretary of State, and the new legislation incorporated in the Health Bill, rather than a separate Bill.
ARM, IMA, AIMS, etc. lobbied RCM for a joint meeting to discuss the issues, and to frame a response with the weight of all UK midwifery and consumer organisations. This meeting was held at RCM HQ on 9th March. The groups represented were ARM, AIMS, IMA, MLG, ASM, NCT, RCN (Midwifery Society), Unison (Midwives Forum), RCM National Boards, RCM HQ. Jean Donnison was also present at our suggestion, because of her deep knowledge of the history of midwifery legislation.
The RCM had already tabled amendments to the Health Bill, which enabled the more pressing issues to be debated and recorded in Hansard. Following the joint meeting RCM produced a draft response to the Government, which was circulated for consultation to the groups' representatives. It was a good paper, and we have submitted our amendments, as have the other groups.
At the Spring 1999 National Meeting we formed a plan of action which included writing to our individual MPs telling them of our position, and alerting them to the momentous changes which are being planned with little opportunity for debate in the House of Commons. It was also agree that contacts with Peers should also be used in the same way. Jean Donnison sent us a copy of a letter she had sent to her MP, and told us we could use it in any way we found appropriate. We agreed that it is an excellent letter, and it was offered to members to use in writing to their own MPs.
Concern was expressed that so much time has been lost by lack of publicity and information going out to all midwives in UK, from the time the JMC Review began, in 1997, through the consultation period early in 1998, and following the completion of the review. ARM was alerted at the start, as usual, to the implications of the review, and we did what we could to get information to our members, but more could have been done by RCM, given that there is regular correspondence with branches and individual members.
There was unanimous agreement that RCM should be seen to be leading the profession in response and submissions towards new legislation which preserves the best of the current Act, and institutes changes which are beneficial both to the public and to the professions which serve them. We agreed to write to Karlene Davies with our support and encouragement, offering our help in any way useful.
Jackie Stopyra from La Leche League then led a discussion. We had already kept her busy at her stall during the break. She told us about the growing worldwide support network for breastfeeding contacts. They organise group discussions, and produce leaflets, books, etc. They offer telephone counselling, and occasional visits. There is a growing amount of LLL information on the Internet. Leaders are mothers who have breastfed, and have been specially trained.
Alison Watts from Baby Milk Action then told us about their long-standing campaign to increase public awareness of the way manufacturers of breastmilk substitutes market their products worldwide. Nestlé are the major culprits in this field, though the others are not blameless. The WHO code is very specific in the way such milks ought to be marketed, and some countries have adopted the code more or less successfully. However, the manufacturers are very powerful politically, and have managed to get many loopholes in the UK Law relating to breastmilk substitutes, and this has the effect of watering down the WHO code. Baby Milk Action have set up a working party specifically to challenge the UK Law, and are continuing their campaign of boycott against Nestlé.
Carol Baird from the Manchester branch of the Real Nappy Association, told us that 8 - 9 million nappies are disposed of every day in Britain. One child uses approximately 5000 disposable nappies until potty trained. These nappies stay in the landfill sites indefinitely - and viruses may remain active within the nappies for 2 weeks, (e.g. polio). Some nappy gels contain chemicals which were banned from sanitary tampons as they were implicated in Toxic Shock Syndrome. These chemicals are added to make the nappies "super-absorbent". The RLA has a nappy library of various types of alternatives to disposable nappies, and there are several nappy washing services around UK for families choosing to use non-disposable nappies.
Mary Cronk - enlarged on her earlier short report on the work of the Professional Conduct Committee. It was most enlightening to learn how the members are selected, hear of the long process of deliberations, consultations, hearings, etc. leading up to the decision-making which the accused practitioner is facing with mixed feelings of hope and dread.
Peter Jones - demonstrated baby massage on a very co-operative baby who had accompanied his mother to the meeting. The baby appeared to have totally enjoyed the session!
Olga Parker - once again hosted the Caring and Sharing session which was open to anyone at the meeting. Caring and Sharing is an opportunity for anyone to talk about the ups and downs of midwifery practice, student course work, etc. The group can be as small as 2 people, but sometimes is much larger. Unlike the other workshops there is no need to "sign-up" on a workshop list. Problems are aired in a totally supportive environment, and good things are also shared.
What a lunch! Peter and his colleagues had really pushed the boat out, and served a delicious homemade vegetable soup, followed by a variety of savoury dishes and salads. Then to top it all he served up locally made ice cream with his own homemade stewed apple! We are concerned that future volunteers to host National meetings might be put off by the thought of having to reach such a high standard of catering!
The meeting ended with a short get-together to exchange views on the day - expectations realised or exceeded. Most were enthusiastic about the informal yet professionally valuable sessions held throughout the meeting, and many commented on the appreciation of greater awareness of the issues concerning midwifery and maternity care. There was some despondency about the lack of recognition by Government and management of the value of a high quality midwifery service, which will only come when problems of pay and conditions are adequately addressed.
There was a vote of thanks to Peter Jones and his Preston colleagues for a very successful meeting, and a special vote of thanks to the caretaker for his vigilance and assistance
IK Modified 14th June1999