Chapter 16: Midwifery

Midwifery practice: Specific recommendations
Professional competence and accountability

The Nursing and Midwifery Council (NMC) should audit the content of undergraduate and ongoing postgraduate midwifery programmes to ensure all staff have up-to-date knowledge and recognition of the warning signs of immediate collapse as well as the signs and symptoms of serious medical conditions and to know when to refer women for medical opinion.

Providers of post registration education and training must ensure that all midwives have up-to-date knowledge and are able to recognise the warning signs of immediate collapse. In addition, that all staff can recognise the signs and symptoms of medical conditions and are able to provide basic management and refer women appropriately for medical opinion.


All midwives should read, and adopt, the Action checklist for midwifery practice which can be found at the end of this Chapter. In particular:

Raising standards through audit and review

The Strategic Health Authority (SHA) or equivalent has a responsibility to share good practice. Since it also has a responsibility for the performance management of all trusts, it should evaluate every trust’s response to the recommendations of the ‘Why Mothers Die’/’Saving Mothers' Lives Report. This could be linked to the response to serious untoward incidences (SUIs) and include the Local Supervising Authority Midwifery Officer and supervisor of midwives. This should include all Primary and Acute NHS Trusts or equivalents.


It should be mandatory for all Trusts to disseminate and audit the uptake of recommendations arising from all external or internal reviews, or root cause analysis of a maternal death, SUIs or ‘near misses’, for educational purposes for all staff.

Supervisors of Midwives should contribute to every internal review and should share the key points through the Trust’s Supervisors of Midwives forum.

Each Trust should have a clear, mandatory, induction process for all staff, including bank and agency staff. This should include clinical protocols, emergency procedures, how to summon medical aid, the location of resuscitation trolleys/equipment and the fire procedures. This should be subject to regular audit.


Maternity services must be commissioned as part of a locally managed maternity network, which has clear pathways of care, and standardised protocols and guidelines, including rapid and effective communication between specialities, units and health professionals.


Letters regarding a woman’s care should be copied to all clinicians involved in the woman’s care, including midwives.


Midwives should ensure that they have effective and clear communication routes with all other partners in a woman’s care.

Midwives offering midwifery led care must include the woman’s GP in all communications.