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Practice comment

Direct entry now means no exit from the midwifery profession


Healthcare requires a flexible workforce – so direct entry midwives should not be denied opportunities to move to different areas of practice, says Stephanie Stevens

During the 1980s, direct entry midwifery was the subject of heated debate. On one side there was outrage that someone with no nursing background could be considered safe to practise as a midwife; others were eager to distance themselves from the medical model of childbirth.

Today, direct entry midwives are in the majority and rarely experience the prejudices that their predecessors faced. They also tend to stay in the job for much longer once qualified than their nurse midwife colleagues.

But why is this? If these midwives are remaining in a profession they love, that is good. However, if they are doing so because they are trapped with no career pathway outside midwifery, that is of no benefit to them, the profession and most importantly, the women they are caring for.

It would seem that midwifery distancing itself from the nursing profession has caused a problem. Midwives leave for many reasons – attrition is normal in any profession – and they have many skills that are of use in other areas of healthcare. But where can the direct entry midwife go?

Some have tried to move into other areas of the NHS such as health visiting and sexual health nursing but, to work in these roles, they must maintain full midwifery registration. For many, this is impossible, and they have to return to midwifery or leave the NHS.

This is now having a wider impact, particularly in the recruitment of health visitors as, historically, many midwives migrated to this profession. While the Midwifery 2020 project ( is looking at education and career progression, this appears to be restricted to careers within midwifery, giving no opportunity to move beyond.

In contrast, the Department of Health is spending a great deal of time and money in ensuring that there is a clear, transferable, career framework for nurses (DH, 2007; 2006).

It seems the debate around direct entry needs to start again – but with a new focus.

We have spent so much time arguing over whether midwifery needs a medical or social model – but do women really mind as long as they are provided with the care and support they want?

Nurses also work with healthy, well women, in many areas, such as fertility clinics and family planning. They do not insist on being separated from the nursing label. They recognise that being under the umbrella of a nursing registration enhances their career prospects and simplifies their registration. And there is an element of nursing in midwifery.

It is ridiculous that some nurse trained midwives have to lose this part of their registration because midwifery work cannot be classified as nursing, while other practitioners such as health visitors need to show no evidence of practical nursing skills to maintain theirs.

The direct entry course is popular and there needs to be a way of either incorporating this training with a basic nursing qualification or offering a validated conversion course to allow those midwives to pursue a career in other nursing roles. Most midwifery students embarking on the direct entry route are passionate about the profession but is it right that they should then be denied the career pathway and progression that nurses have?

In today’s healthcare, which requires a flexible workforce with a breadth of knowledge, is there any place for an education system that produces a practitioner who can never make a transition to a new field of practice?

STEPHANIE STEVENS is a health visitor and bank midwife in Sussex



Readers' comments (7)

  • Having read this, I have some comments. The diect route to midwifery qualification was inititated in its full on force by the commissioners who had a policy of recruit retain and so transfer across was made difficult for all areas of nursing and midiwfery. How easy is it to specialise in child nursing after completing a programme as an adult nurse? or similarly mental health? All areas had shortened course routes and these have largely been stopped. The facility is there in higher education to priovide flexible routes but the money and the political will is not there.
    Midwifery does not want to distance itself from nursing, the skills are inherent within each. Midwives face similar challenges against the medical model that primary health practitioners do. The medical model has its place but what the midwifery profession is saying is that is is not the only way. Unfortunately the maternity service is set up from a pathological basis not a health basis. This has been recognised in health care - PCTs can commission as needed and look at the fantastic health based care that has developed since.
    Lastly, the North West LSAMO and supervisors of midwives have been tremendous in enabling midwives to preserve their NMC status of registration and work in relevant areas without cutting standards. The yearly supervision process is very exacting for all midwives in the North West LSA area so we all know we are properly signing our intention to practise and fulfilling NMC requirements so we stay eligible to practise as a midwife for another year.
    If nursing was similarly rigorous, I think the debate and effects would be felt among enough nurses to properly raise the debate and encourage a move towards a more realistic adult view of professionalism. I am a nurse also and using my standards acquired through midiwfery I do keep a record of my hours and CPD to ensure I cover the 450.35 hours over 3 years but I've never needed to show them for nursing, yet every year I have to sit with my SoM and do a yearly tally the the NMC 3 yearly tally. I have colleagues who just tick the are on part 1 of the register and this is never chanllenged. Maybe Stephaine thats where some of the problem lies.
    But I totlally agree that educational provision would be valued, but paid for? It is almost - why should the workers be happy when we can just plunder other countires for their healthcare workforce when we run short.

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  • Nursing has been ill-served by the creation of divisions, primarily we should all be nurses, then continue with post graduate qualification in adults, paediatrics, public health, midwifery etc.

    The creation of silo groups and direct entry weakens the profession

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  • frustratedfairy

    Good lord is that woman rinsing that baby under the tap!

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  • lol!!! re. the pic!

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  • Direct entry to miwifery has opened up a can of worms over the years.
    If they have a patient with a medical condition that they have not got the clinical and theoretical knowledge to care for, ie, cardiac then a midwife with nursing experience has to undertake the patients care or the patient has to go to a general ward to be looked after.
    It seems they are returning to the 'old' way ie, taking on nurses to do midwifery training to eliminate the problems that have occurred with direct entry.
    Direct entry midwives are fabulous for the healthy term baby and healthy mother but when there is a problem....

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  • Direct entry midwives are fabulous for the healthy term baby and healthy mother but when there is a problem....

    A good midwife will refer to the appropropriate specialist and continue providing midwfery care.

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  • I fail to see how direct entry midwives could transfer across to health visiting as this profession still requires a nursing qualification.

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