Record keeping is a
vital part of any care we give as a midwife. It comes under the code of conduct
(NMC, 2015) that states we should “keep clear and accurate records relevant to
your practice”. As a midwife we have the role of recording everything we do on
either paper or electronic device, dependent on the trust, or sometimes both.
We also need to sign and record the date and time. We have the responsibility
to ensure this is kept up to date and confidential and not left open for people
who are not authorised to see. We should be able to explain why we have completed
an action and why at that certain time. We are then also accountable for
anything we do not write down and be able to explain why we did not think it
was necessary to record.
As a midwife we
must also always gain consent from our women before completing any action. This
links in with autonomy; women have the right to decide what we do and what we
don’t do to their bodies. We must explain any procedure we are going to do and
are responsible for ensuring they understand it and confirm it is OK to do so.
If we do not ask for permission to do something that our women are not OK with,
we are accountable for this and must explain why we did not confirm.
Keeping our women’s
information confidential also shows that we respect their rights to privacy. We
need to gain our women’s trust to create a strong repour and provide excellent
service. We should however not keep vital information to ourselves if it puts
our women or baby’s health or safety at risk e.g. domestic violence. We have a
responsibility to speak out where necessary and to ensure the women know that
we are required to pass important information on and refer if needed. If we are to disclose a patient’s
confidential information to someone else, we are accountable for it and must be
able to explain why we have done so. We are responsible for our actions as professionals.
a legal aspect of midwifery. Within the NHS code of practice, it states that
“it is essential, if the legal requirements are to be met and the trust of
patients is to be retained, that the NHS provides, and is seen to provide, a
confidential service”. We therefore have an obligation to follow these
guidelines as a professional.
accountability, it is being able to reason and answer for your own actions. As
a midwife we are accountable for the care we give. Any care that we give to our
women or babies, we should be able to say why we have done it. This guideline
can be found in the code of conduct where it states, “be accountable for our
decisions to delegate tasks and duties to other people” (NMC, 2015).
involves having control, whether it is shared or not. As a professional
midwife, we have the responsibility to provide care to our women. Under the
code of conduct it states we should “promote professionalism and trust”. By
following these guidelines, a midwife can display an important level of care
within his/her work.
A midwife’s role
regarding care is to provide a high-quality level to both our women and their
babies. Sometimes, we may also need to show care towards our women’s family in
challenging situations, for example, a still birth. Care can also include
supporting our women and encouraging them during both labor and pregnancy.
The model of
framework that is linked to Professional Midwifery Advocates is the Advocating
and Educating for Quality Improvement (A-EQUIP).
used to ensure good practice within midwifery is the use of Professional
Midwifery Advocates- previously known as Midwifery Supervisors. The removal of
supervisors and introduction of PMA’s began in March 2016 as the “previous
arrangements were not appropriate for public protection” (NMC 2016). The idea of having PMA’s is to create an
“improvement process that values midwives, enhances health and well-being,
builds their personal and professional resilience and contributes to the
provision of high quality of care and quality improvement” (NHS, 2018).
One way a midwife can keep her/his skills and
knowledge up to date is through revalidation. It was created in 2016 and is now
a legal requirement that must be completed every three years. It ensures
professionals are “practising safely and effectively inline with the code”
(NMC, 2018). There are eight requirements to successfully pass revalidation.
These include 450 practising hours and five practise-related feedback and
University defines justice as being “fairness in the way people are dealt with” (2018). In midwifery, justice would be
giving our women equal opportunities (as long as it is deemed safe), treating
them fair and in a way that does not discriminate anybody. Our women should be
able to feel confident and comfortable when raising and concerns or vocalising
their views and opinions. Being able to admit, apologies and explain why
something has gone wrong not only shows competence, but justice for our women
The third principle of ethics is
none-maleficence. This term is defined as being “non-harming
or inflicting the least harm possible to reach a beneficial outcome” (Medscape,
2013). This term is linked to preventing harm, pain suffering to our women as a
midwife. To do this, midwives must follow several of the six C’s. Being
competent and knowing how to do our job to a high standard allows us to prevent
mistakes from occurring that could potentially harm our women. We should also
have courage to arise any concerns or if we make a mistake that puts our women
at risk. To do this we must have good communication skills to pass on
Beneficence is acting in the best interest of
others. Relating it back to midwifery, it is important that the decisions we
make put our women’s health, safety and wellbeing before the fetus, as it does
not yet have any autonomy. This is known as person centered care. Our women
need to be able to trust us to put their health and safety first so that they
have a safe enjoyable pregnancy and labor. Beneficence is also included within
the code of conduct 2015 under the subheading “act in the best interest of
people at all times” (NMC, 2015). Although every action we take must benefit
the mother, we should however respect the right to refuse and ensure whatever
we do is explained and consented.
Autonomy is defined
as being “the right for an individual to make his or her
own choice” (BMC, 2012). When relating it to midwifery, it is vital that women
feel they are in control of their own body and the choices they make regarding
any care they are given. Putting this into practise, autonomy is a key word
when gaining informed consent from a woman. As a midwife we must always gain
consent by ensuring our patients understands both the benefits and risks to the
procedure being undertaken and has the mental capacity to make this decision.
Not only is this respectful and gives the women control over what happens to
her own body, it is also a legal act.
standards and legal framework will allow an individual to practice as a
registered Midwife, however being able to make a decision will require an individual
to identify what decision will have the best outcome. Within care, there are
four known principles of ethics. These are: autonomy, beneficence,
none-maleficence and justice. They were created and developed by Tom Beauchamp and James Childress in the ‘Principles of Biomedical Ethics’ book from 1985.
Referring to the book will give guidelines and support any health care
professional with making decisions. The code of conduct will also guide
Midwives with laying out what is correct and important to practice effectively
As well as the
legal framework and standards that are expected, there are also decisions
Midwives must make based on our ethics and morals. Cambridge Dictionary (2018)
define ethics as being “the study of what is morally right and what is
notthe study of what
is morally right and what is not”. Midwives must often make a decision quickly
and independently which may affect both mother and baby.
both Midwives and Nurses are also declaring that they have read, understood and
will uphold all expectations included within the NMC Code of Conduct. This is a
fundamental document that can be found on the NMC website that lists
twenty-five standards that the NMC, patients and the public have created to
form the best possible Midwives and Nurses. The most recent code that all
Nurses and Midwives should refer to was effective from March 2015. The previous
code to this was 2008. The code is updated when deemed necessary as we are
constantly adapting and improving our work to ensure our patients are given the
highest level of care. To give the best care, there are many various factors
that should be considered and that are deemed necessary by the NMC. These
include the following: priorities people, practice effectively, preserve safety
and promote professionalism and trust.
Profession is defined as being “any type of work that needs
special training or a particular skill, often one that is respected because it
involves a high level of education”. (Cambridge Dictionary, 2018). To become a
professional, we must first have our names put onto the registered midwife list
by the Nursing and Midwifery Council. To do so you must have had the education
and training necessary. The Nursing and Midwifery Council declared that the
idea behind having a register is to “set standards for education and practice,
and giving guidance to professionals” (NMC, 2015). There is a set international
definition of what qualities and training an individual should withhold to have
a profession in Midwifery; adopted by the “International Confederation of
Midwives (ICM), the International Federation of Gynaecology and Obstetrics
(FIGO) and the World Health Organization (WHO)” (NMC, 2015).
part of this essay I will begin by explaining what both the Nursing and
Midwifery register, and the code of conduct is and why they both exist. I will
then discuss the four principles of ethics (created by Tom Beauchamp and James Childress) and define each one, as well as relating
them back to midwifery. I will then discuss the revalidation system for all
midwives and the change from Midwifery Supervisors to Professional Midwifery
Advocates and the use of A-EQUIP in maintaining and updating midwife’s skills
and knowledge. Following this, I shall be defining the midwife’s role,
responsibility and accountability within care provided, confidentiality,
consent and record keeping. To back up what I have discussed I shall be
referencing to reliable and trusting websites, journals and books that allow be
to create a strong, well referenced piece of work that shows I have clearly
understood and met the criteria given. v