Throughout this essay I will be discussing the legal and professional frameworks in which govern and guide the profession of midwifery. This discussion will encompass the ethical principles of care in relation to midwifery practice along with developing personal strategies and skills required for lifelong learning. I will also be demonstrating my knowledge on the role, responsibility and accountability of a midwife regarding various aspects of care for instance confidentiality, consent and record keeping.
There are many different legal and professional frameworks in which guide the profession in order for mother and baby to receive the best care possible, these include: The Nursing Midwifery Council (NMC), The Royal College Of Midwives (RCM), NICE guidelines along with Human Rights Act 1998, Mental Capacity Act 2005, confidentiality, consent, data protection, and Professional Midwifery Advocates (PMA).
The Nursing Midwifery Council was founded is 2002 and has many different roles however their main role and mission in relation to midwifery is supporting better and safer care for mother and baby and ensuring that all health care professionals are on their register to deliver the highest standards of care and ensuring all staff meet their requirements in order to become a practicing midwife, its required that all staff value people, fairness and transparency along with having the skills they need to care for people safely, with integrity, expertise, respect and compassion (NMC, 2015).
The NMC has policies that regulate the work of midwives, in order for them to demonstrate best and safe practice. The code sets out standards for professional practice and is then underpinned by law- it’s essential that all midwives follow the policies and procedures set by the NMC.
The NMC was a legal framework and the code was made to regulate the work of midwives. The code concentrates on extremely important aspects of care such as ensuring that a women’s confidentially is not at breach, it regulates the practice and work of midwives to ensure that they are providing the best care possible for the woman and her family. Another framework is the NICE guidelines; NICE guidelines are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings. There are many different benefits of the NICE guidelines as they help health and social care professionals to prevent ill health, promote and protect good health, improve the quality of care and services and adapt and provide health and social care services. (NICE, 2017). NICE guidelines don’t regulate the way in which midwives work nor do they tell them what they can and can’t do, they are simply there as a guide for best practice as well as guidance on how to act in the best interest of the mother and baby. The guidelines of each hospital are based on their policies and how the NICE guidelines have influenced each individual trust so each trust has their own set of guidelines that they follow by, therefore not every hospital will have the same principals of care. Midwives work on the basis of best evidence on how they perform day to days tasks for example communication. Another framework which governs and guides the profession is the RCM, the RCM is ‘the only professional organization and trade union dedicated to serving midwifery and the whole midwifery team. They provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources’ (RCM, 2014). The RCM supports the accountability of registered nurses and midwives- as a registered midwife, they are legally and professionally accountable for their actions, irrespective of whether they are following the instructions of others or acting upon their own initiative ( Griffith, Tengnah and Patel,2010, Page 6). The midwives are taking responsibility for their actions and ensuring that they are always putting the woman and baby’s interests first. The midwives are accountable for the overall care given to mom and baby and responsible for demonstrating safe and professional care at all times- if anything goes wrong she will be responsible for her own actions. The midwife should always ensure that she is asking for consent before she carries out anything to do with the mother or baby, for example, she should ask the women for consent to carry out a vaginal examination or for baby to have the Vitamin K injection. Its also extremely important that midwives don’t breach a women’s confidentiality, for example, speaking in the corridors to other midwife or an anesthetist about the woman, this also involves leaving the mothers or baby’s notes left on the side for anyone to read or leaving a computer with badger net open unsupervised. Its essential for all midwives to follow the data protection act in order to keep mother and baby’s documents safe and secure. The Data Protection Act 2018 controls how personal information is used and everyone responsible for using personal data has to follow strict rules called ‘data protection principles’. They must make sure the information is: used fairly, lawfully and transparently, so only midwives who need to see the information should be able to access it, it should only be used for specified, explicit purposes, it should only be used in a way that is adequate, relevant and limited to only what is necessarily accurate and, where necessary, it should be kept up to date and no longer than is necessary along with being handled in a way that ensures appropriate security, including protection against unlawful or unauthorized processing, access, loss, destruction or damage. If a midwife does not follow the data protection principals then she is breaching the women’s confidentiality which can also be breaching the Human Rights Act 1998. (The Data Protection Act, 2018).
Within the midwifery profession, there are many different ethical issues with practice. A midwife may come across an issue when deciding what they would believe to be the ‘right’ decision and ‘best’ course of action in a situation. An example of this is a midwife may believe that telling the woman the truth is the right decision along with it being her duty, this decision could also be based up the fact of the feelings and emotions of the women if she finds out she had not been told, it can also be based on many differences such as upbringing, culture, previous experience or religion. Many different types of issues may arise if the decision was made to tell the mother the truth or not put the overview of this is each time a midwife makes a decision she must apply some of the key ethical principles to this moral conundrum which includes rights, duty, veracity, consequence, beneficence and non- maleficence. A midwife has the role of making the right decision based of ethical principles of the woman who in which she is caring for at the time, some decisions could be made wrong due to the midwife having different ethical beliefs to the woman or other individuals caring for her. Morals refer to what a person believes is right or wrong based on their cultural experience, upbringing, and education, (Griffith, Tengnah and Patel,2010, Page 26-28 ).
The development of personal strategies and skills are essential in midwifery practice as it allows them to continue with proving best practice. Reflective practice is put into place in order for midwives to improve their services and the way in which they choose to do things. It’s extremely beneficial as they are able to learn new and improved strategies along with identifying their strongest and weakest points of practice leading them to reflect on this and improve on what doesn’t always go well. In order to improve the development of personal strategies and skills revalidation is essential. The RCM state that ‘Reflection is known to be of benefit in experiential learning, developing critical thinking and enabling integration of theory and practice. As part of a larger study, the aim here was to ascertain midwives’ and students’ perceptions of how critical reflection was facilitated in education and practice contexts. The role of reflection in enhancing learning is widely debated’ (RCM, 2009). This shows that there are many different benefits of reflective practice not just for practicing midwives but also student midwives, it shows that reflective practice is put in place as a learning tool for both midwives and student midwives to learn and improve from. Revalidation is also a strategy of development and it is the process that allows a midwife to maintain her registration with the NMC, it demonstrates midwives continued ability to practice safely and effectively and is also a continuous process that they will engage with throughout your career. This is an extremely important document that all midwives should process through with as it will continue to aid them into continuing to be the best midwife they could be by showing safe and effective practice (NMC, 2015). Reflective practice allows midwives to see what needs to be improved and what needs to be demonstrated more within practice and it allows them to develop their personal strategies and skills.
There are many different important aspects of a midwife and their role which include: preserve safety, promote health, act in an emergency, referral, confirm normality/ an expert in normality and monitor wellbeing. A midwife has a responsibility of preparing women for the delivery of new life and being present during all stages of pregnancy, labour and the early postnatal period (NHS, England, ND). A midwife is a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period; conduct births on the midwife’s own responsibility; provides care for the newborn and the infant, including preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance, and the carrying out of emergency measures (RCM 2014). Midwives are responsible for their practice as they decide what way they practice and what interventions they believe are in the best interest of the woman and in the midwives care. They do not have they control or authority over who holds them to account or what they are accountable for- they are required to work within the law and in accordance with the NMC code (2008a) and the Midwives rules and standards (NMC, 2004B) (Griffith, Tengnah and Patel,2010, Page 36). The NMC (2008a) argues that the purpose of the code is to inform nurses and midwives of the standards of professional conduct required of them in the exercise of their professional accountability. Exercising accountability required the practitioner to have control over what they are accountable for. The purpose of accountability is to ensure that mothers and babies are not harmed by the midwives acts and omissions and to provide redress to those who have been harmed. To be able to achieve this, accountability has functions which include: A protective function, a deterrent function, a regulatory function and an educative function (Griffith, Tengnah and Patel,2010, Page 37-38 ).
Midwives have a huge responsibility of caring for women and their babies and they have to ensure they do so with safety and best practice as they are both responsible and accountable for anything that goes on within the care they are giving. It’s extremely important that all midwives promote confidentially and ensure they are demonstrating this within their practice; they need to ensure that only authorized individuals know information about the mother and baby, along with ensuring that no documentation is in view of an unauthorized individual. It’s also essential that midwives keep records the purpose of this is to have an account of care and treatment given to the women or baby. This allows progress to be monitored and clinical history to be developed. The NMC emphasizes that record keeping is not an optional extra but an integral part of the care that is extremely important as the direct care provided to women and their babies. (Griffith, Tengnah and Patel,2010, Page 26 ).
It’s extremely important that midwives demonstrate within their practice and promote privacy for not only the women but also her family along with ensuring there are no safeguarding issues that could arise and if so what can be put in place to prevent them. Within midwifery care, there are three spheres of duty of confidence which includes: duty under the law, duty under the NMC code and duty under the NHS employment contract. (NMC, 2015)
In conclusion, I have been able to discuss the legal and professional frameworks in which govern and guide the profession of midwifery which included the RCM, the NMC and the NICE guideless, I was able to discuss the ethical principles of care in relation to midwifery practice along with developing personal strategies and skills required for lifelong learning. I was able to demonstrate my knowledge on the role, responsibility and accountability of a midwife regarding various aspects of care for instance confidentiality, consent and record keeping.
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