Changing Midwifery: Working Conditions and the Quality of Care

Maternity units have been expected to achieve, within constrained resources, significant improvements in the quality and continuity of care as required by government policy. While significant advances have been made, these have been achieved by drawing upon the professionalism and vocational commitment of midwives, and at the expense of their working conditions and sense of wellbeing. While this approach has, in the short term, served the purpose of increasing midwifery output within existing resource constraints, the quality of care has suffered. The increasing problems of recruitment, retention, and falling morale within the profession suggest that it is not sustainable. In the longer term, if the improvements in care achieved thus far are to be sustained, there is a need to reform midwives' working conditions and working environment. This is not to imply that the answer to the ongoing dilemmas facing the maternity services lies solely in improvements in the pay levels or pay structure for midwives. The solution is also dependent on the extent to which midwives are afforded the enhanced status and autonomy recognised as necessary for the improvement of maternity services. Furthermore, strong representation of midwives, alongside improvements in management structures and systems of communication in NHS trusts, are necessary if midwives are to be enabled to participate in decision-making and thereby effectively contribute to improvements in the quality of care.