Fundamentals of Midwifery: A Textbook for Students (8 page)

The statutory supervision of midwives
Supervision of midwives was introduced over 110 years ago as a purely inspectorial function tolower maternal mortality rates and to protect mothers and babies from unsafe midwifery prac- tice. It is enshrined in law and has evolved to support the protection of mothers and babies by promoting excellence in midwifery care, through the leadership roles of Supervisors of Mid- wives. This is achieved by every midwife in the UK having a named Supervisor of Midwives, whether they practise clinically, or in education, or in a research post or whether they practise in the NHS, or are privately employed. Supervisors of Midwives work within a framework of supervision outlined by their Local Supervising Authority (LSA) Midwifery Officer who appoints them to practise within that LSA area. They have a caseload of midwife ‘supervisees’ and have a responsibility to ensure their supervisees’ eligibility to practise by undertaking an annual supervisory review to identify and discuss how best to address any developmental needs. On the basis of that review and on any other relevant information, the supervisor then submits the midwife’s annual Intention to Practise (ITP) to the NMC which is displayed to the public on the NMC register.
Clinical consideration 13‌
Intrapartum stillbirths are a central indicator of patient safety and quality of care, but despite this stillbirth rates have changed little in the English National Health Service over the past two decades. Increasing evidence indicates that fetal growth restriction is currently missed in most pregnancies in the NHS, and that better antenatal detection needs to become a cornerstone and key indicator of safety and effectiveness in maternity care. This has, therefore, been an LSA priority over recent years with the LSA and supervisors disseminating best practice evidence to midwives within local confer- ences, presentations, newsletters and during annual supervisory reviews. Preventing poor practice has occurred by the LSA producing a best practice competency assessment tool for fundal height measure- ment, which supervisors have worked through with midwives to ensure that midwives consistently and competently measure and respond to fetal growth in the same way. Intervening in unacceptable practice has occurred by LSA reviews where clusters of stillbirths have been noted. Reviews have led
to some changes to generic practice within Trusts, e.g. the implementation of customised growth
charts. Other reviews have led to additional supervisory input to aid the development of individual
midwives’ practice where required. All maternity services are required to ensure the availability of 24-hour access to support and advice from a Supervisor of Midwives for midwives and service users. Supervisors practise in a team within maternity services; hold regular supervisors’ meetings to determine their local work priorities; are involved in the maternity services’ clinical governance systems, for example, audit meetings and risk management meetings; and ensure that their supervisory framework encom- passes involvement with their local universities in the recruitment to and progress of student midwives through their midwifery education programmes. Evidence from the diaries of newly qualified midwives (MINT research commissioned by the NMC 2010) indicates that where the role of a Supervisor of Midwives for student midwives occurs it enhances students’ understanding of supervision.The example in Box 1.6 demonstrates how supervisors work to promote excellence in mid- wifery care, prevent poor midwifery practice and intervene in unacceptable practice.A Supervisor of Midwives is now commonly assigned to every student midwife undergoing a pre-registration midwifery programme. The student midwife can contact the Supervisor of Midwives, in confidence, at any time to voice concerns or to debrief following an upsetting or difficult situation in the clinical area.