This post continues the discussion of Sharon's Story.. the previous two posts described the birth and postnatal transfer. Now I want to look at the Supervision angle.
Virginia, in the story you say that you consulted with your supervisor before transferring Sharon to hospital. What is the relationship between a Supervisor and an independent midwife? When do you consult her, normally?
Midwifery is the most regulated profession under the health umbrella. We are more regulated than nurses and doctors. We are obliged to keep updated and can be called upon at any time by our regulatorybody, The Nursing and Midwifery Council (NMC), to prove we are keeping updated. Midwives keep portfolios as proof of updating.
We have a system of promoting excellence in midwifery care and that system is known as Supervision. It is not supervision as most people understand the word, where the midwife is policed or told how to practice. Rather, it is a support system to enable midwives to practice with confidence, therefore preventing poor practice. Each Midwife will have her own personal named Supervisor of Midwives (SOM). If a midwife has a practice issue, she can talk to her SOM in confidence for guidance and support. The Supervisor has a duty to help the midwife in order to ensure good practice, but also to fundamentally protect mothers and babies. A SOM has a duty to promote normal childbirth and to support women’s informed choice.
You can read more about the supervision system on the Nursing and Midwifery Council website, under the Midwives' Rules and Standards.
If carried out to its full potential and aim, Supervision is an amazing support system. It is not an hierarchical system. A supervisor of midwives could be a head of midwifery, but she will also have a named SOM herself. If any accusation of bad practice is made about a midwife, supervision is used to address the issue and determine if it has foundation or not. There are correct procedures to follow.
As in all walks of life, sometimes ideals and intentions are not met and the same can be said of supervision. Midwives may, perhaps due to previous bad experience, see supervision as a punitive system. That is not how it should be. My career and experience has shown me both sides - but not equally so, I am pleased to say. Luckily (!) I experienced poor Supervision early on in my career many years ago, and so my learning curve about it was very steep. Now, and since becoming an independent practitioner, supervision has been excellent for me. It comes from the top down and the Local Supervising Officer, Helen Odell, follows the guidelines for supervision as they should be followed and actively supports all midwives in her geographical area.
My own named Supervisor of Midwives is a constant support and sounding block for me and I am often on the telephone to her discussing issues of practice. It is not easy for her as she needs to approach our relationship a little differently as I work differently to the other midwives she supervises. I will always call her in the event of a dilemma, difficult situation and even when an unusual yet fantastic situation occurs.
I am very passionate about my profession. This passion has not gone away since the day I started. In fact it gets stronger as my knowledge grows. Yes, my knowledge continues to grow, as no matter how or what your professional status is, there is room to learn more and improve. Someone could be in a profession for 30 years but if they continually repeat practice over and over it does not necessarily make them experienced. Experience can be measured in type, not quantity of time. If the passion and commitment ever goes then that is the time I will get out. If ever I am bored with it, I will not be giving women a good service.
Did you have any further discussions about this case with your Supervisor? Did she review the case? Were any issues raised about your practice?
As I put this story on my website and it was unusual, it was drawn to the attention of my supervisor and the LSO, Helen Odell, and quite rightly procedure was followed whereby the case notes were reviewed. The case notes demonstrated a much fuller picture than the brief story which was originally put online. I was commended for the care I gave.
You wrote the original article in a very candid and open way. Can you explain to us the difference between a midwifery reflection and a case study? It sounds to me like a midwifery reflection is opening your heart, and a case study is covering your back!!!
Midwives reflect, midwives question. We reflect on ourselves on what we did what we could have done better and what we may do again should the same situation arise. Unless you can see where you go wrong how can you strive to improve. When we reflect we are critical about ourselves, we admit to failings, we even admit to others failing or how we felt towards others. However, if we write a case study then it is fact and will include everything but not the feelings or thoughts of the person writing it. A case study is a detailed analysis of a person, a collection and presentation of the facts. A story, however, is a bit of both, but aimed at a certain audience and written in a way to make something interesting.
Weren't you a bit naive, putting what was, really, a simplistic summary of a complex case online in that format? Surely it would leave you open to criticism from those who did not know the full facts of the case. If you don't mention all of the factors you considered, some people may, also naively, assume that you did not actually know about them!
Yes, I was naive. I was trying to write a representative, descriptive story that emphasised my commitment to woman-centred midwifery. It was aimed at women looking for a midwife. Women who may have had similar bad experiences, or who were going through some of the issues now. Women who may have no or limited knowledge on the subjects concerned. I wrote it in an attempt to empower women. If I had been writing for a professional audience, the emphasis and level of detail would have been quite different.
Well, I'm glad you published the story, as it has raised plenty of issues for discussion. Thank you very much, Virginia; I'm looking forward to dissecting some other unusual stories at a later date!