Changing childbirth—the midwifery managers’ tale

Abstract

This paper concerns Maternity Services. It begins by describing the development of the current policy in Britain which culminated in the report Changing Childbirth. It proceeds to describe a qualitative investigation in which a group of Heads of Midwifery Service in one health region were interviewed concerning their views about the basic recommendations of the report and their experiences concerning the feasibility of its implementation by 1998. On the basis of its evidence, the study concludes the policy is failing to be fully realized due to both a lack of earmarked resources and confused objectives which are not fully accepted by professionals and are not understood by service users. The findings demonstrate that the Heads of Midwifery believe that what was proposed as a bold and innovative policy has become no more than lukewarm advice. The conduct of the study is described in detail to illustrate how operational managers can research the ways in which policies are influencing service delivery in their field of practice.

Identifying problems with data collection at a local level: survey of NHS maternity units in England

“…There may be justifiable reasons for not collecting data for the “indicators of success” listed in Changing Childbirth ,16 but the lack of these data makes it difficult to assess the policy's overall impact. This information may be collected on a sample or ad hoc basis for health authorities, but our survey of health authorities found that only 58% monitored the implementation of the policy 14…”

Women׳s views on partnership working with midwives during pregnancy and childbirth

“…An example of this is the indicator that every woman should have a named midwife, which was based on the views of only 190 women. This is seen as a significant weakness in a document heralded as an agenda for change (Bradshaw et al, 1997).…”

II. Trust the Experts? A Commentary on Choice and Control in Childbirth

“…There is general agreement that the promise of Changing Childbirth (Department of Health, 1993) to more fully involve women in their maternity care has not, so to speak, been delivered (Bosanquet et al, 2005;Bradshaw and Bradshaw, 1997). One reason cited for this failure accords well with Crossley's own feeling that women's increased participation is too idealistic and impractical.…”