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Guidance aims to avoid staff ‘conflicts and tensions’ over women’s maternity care wishes

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With the right planning, NHS maternity services should be able to ensure pregnant women are cared for by the midwife they want at the birth of their child, according to new guidance.

The guidelines, published by the Royal College of Midwives, acknowledge units can find it a “challenge” when it comes to accommodating women’s wishes and it can be a source of conflict between midwives and managers.

“This has always been a challenge, particularly in recent years with many constraints”

Suzanne Tyler

“Inevitably, tensions sometimes arise when an individual midwife’s wish to respond to an individual woman seemingly clashes with the efficient running of a service,” stated the guidance – titled Facilitating women’s choice of midwife: Practical approaches to managing with flexibility.

“It’s easy for this to become a source of conflict between management/employer and practitioner unless arrangements are clear,” it noted.

However, the document said that, “with planning, good communication and flexibility”, services should be able to ensure women were supported at the birth by the midwife they wanted.

The guidance was put together after consultation with midwives and other midwifery experts, as well as the Clinical Negligence Scheme for Trusts.

It sets out a number of different scenarios and how these should be handled to give the best chance of fulfilling women’s wishes.


Examples include when a woman’s antenatal care is provided by a team of NHS midwives but she asks for one particular midwife to be present at the birth, and when a woman requests an NHS midwife from outside the team – either someone employed by the same trust or at a different trust.

The guidance said the woman’s wishes should be clearly set out in a care plan and discussed among the team at the earliest opportunity.

The midwife concerned should also discuss the request with relevant managers, supervising midwifes and heads of midwifery.

When a woman asks for a midwife from another NHS organisation to attend the birth – often a friend, relative or trusted midwife who delivered a previous child – a “formal honorary contract” would need to be drawn up.

The guidance also makes it clear what should happen if managers cannot guarantee a woman will get the midwife they want.

“Should a head of midwifery or midwife manager be unable to support flexible working and adjustments within the team to provide cover for this situation, this decision needs to be clearly communicated both to the woman and the midwife concerned,” stated the document.

“This may be because for genuine operational reasons it is not possible to give the guarantees,” it noted.

It warns that a midwife who goes against her employers wishes – such as attending a birth on her day off without permission – could face disciplinary action and the care she provides may not be insured if things go wrong.

“This is clearly a situation to be avoided and where management do feel unable to support staff working flexibly to meet women’s choices, we would recommend all steps are taken to find a solution as early as possible, perhaps involving an RCM representative,” said the guidance.

It also covers scenarios where a woman makes a private arrangement outside of the scope of NHS care and when a patient unexpectedly goes into labour and a midwife who happens to be nearby steps in to provide care.

Royal College of Midwives

Guidance to avoid ‘tensions’ over women’s choice of midwife

Suzanne Tyler

Suzanne Tyler, director for services to members at the RCM, said the guidance was developed as a direct response to members asking for advice on responding to the individual needs and wishes of women they care for.

“This has always been a challenge, particularly in recent years with many constraints of keeping maternity services running efficiently and effectively,” she said.

“Most often this occurs when a woman asks that a named, known individual midwife be present at her delivery,” said Ms Tyler.

“The RCM is anxious to avoid conflicts or tensions between managers and employers and individual practitioners, and so has developed some advice on how such requests can be facilitated,” she said.

She added: “We recognise that keeping a maternity service running and providing a service to all is complex and challenging, but hope that with planning, communication and flexibility the NHS should be able to accommodate women’s choices.”

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