Midwifery as a self-regulating profession?

There is some debate about private midwifery, in particular the desirability - or even the need for - insurance and regulation. It is an interesting debate to follow. One side argues for no Medicare funding - we never had it anyway, no insurance - we haven't had that for a few years, and no regulation. I would ask - if there was no regulation - are we indeed a profession? Does it matter? A friend sent me an article recently that has fascinated me: "Why is UK medicine no longer a self-regulating profession? The role of scandals involving "bad apple" doctors."

It was a very interesting article to read. The article identifies the role played by a series of medical scandals in the UK that basically ended the model of self-regulation of the medical profession that had been in place for 150 years. The original motive for professional self-regulation was "to resolve the principal-agent problem inherent in the doctor-patient relationship. The profession, in return for its self-regulating privileges, undertook to act as a reliable guarantor for the competence and conduct of each of its members".

This is perhaps what is lacking in midwifery, and perhaps why we are seeing a huge amount of regulation at the moment. Midwifery has never really had a process of self-regulation. Midwives have not held each other to account for preventable outcomes. The collegial model adopted by the medical profession "left it fatally vulnerable to the problem of "bad apples": those unwilling, incapable or indifferent to delivering on their professional commitments and who betrayed the trust of both patients and peers". I wonder if this is what we are seeing in midwifery?

In the UK, it was the convergence of social and political conditions and public anger and shifts in social attitudes that presented an opportunity for imposing standards for accountability. Private midwifery has, until recently, been untouched. I remember leaving hospital employment to move to private practice and being amazed by the lack of processes, accountability, systems, structure ... hospitals are full of these things but they were lacking in private practice. If I did these things, it was up to me. If not, it was no problem. I set up many processes and systems and dedicated a lot of resources to ensure that these were robust, practical and worthwhile. I have found he process of eligibility and meeting the requirements of the Quality and Safety Framework to be relatively ok because I already had much of this in place.

However, to those who argue against the need for increased accountability, insurance, regulation - professionalism - that is thrust upon us, I would venture to say that those attitudes are the precise reason why we have been thrust into the position of such intense regulation and accountability. If we did not have these, would we be members of the profession that is midwifery? For those who could care less about professionalism, I would ask why they completed their degree and applied for registration. Anyone can be with a woman in pregnancy and birth, but the title and practice of midwifery is one that we should hold dear and be proud of: it is one that is made stronger by regulation and accountability and one that gives the public an assurance of a certain standard of care.

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