Protecting the Public: The Current Regulation of Midwifery

Throughout the 20th century, the regulatory frameworks that govern midwifery in the UK have grown, such that the current practice of midwifery and the provision of maternity care are now influenced by a myriad of regulation. Despite these controls there is little empirical data, especially in relation to the practice of midwives, which demonstrates the effectiveness of these systems and strategies. Whilst maternal mortality rates are at an all-time low, patient safety incidents still occur and claims of clinical negligence have continued to climb over the past thirty years. This raises the question of whether the regulatory mechanisms which are designed to ensure the health and wellbeing of the pregnant woman undermine or promote quality care and, whether the current statutory aim of ‘protecting the public’ is being realised. Whilst this is too ambitious a question to resolve fully in a doctoral thesis, I aim to make a contribution to answering it by giving voice to one specific group who are particularly well placed to comment but to whose voices are rarely heard, namely midwives.

The study offers a socio-legal exploration of midwifery governance through an examination of the understanding and experience of a group of midwifery practitioners. The study gathered both quantitative and qualitative data from a cohort of midwives practising in the South East of England between the period of May 2012 and March 2013. This data was analysed in order to establish the views and opinions of the midwives in relation to the regulatory frameworks. As a result, a complex picture of regulation emerged, with a particular focus on the importance of clinical governance, the Nursing and Midwifery Council and statutory supervision of midwives. The themes that emerged included: the impact of regulation on the provision of care, the role of regulation in facilitating woman centred care, and the unease about mechanisms used to address issues of poor practice. Whilst good practice was evident, concerns and challenges also arose in terms of the regulatory framework, which, to the study participants, at times did not appear to support the provision of safe quality care.