A leading midwife who was employed by the Nursing and Midwifery Council to advise on midwifery education claims she was “silenced” when she tried to talk about the everyday challenges of maternity care and that midwives are basically seen as “a nuisance” by the regulator.
In an explosive resignation letter, Dr Helen Shallow, a consultant midwife and former head of midwifery, also accused the NMC of “paying lip service” to a consultation on education standards for midwives.
“Very soon into post I realised that midwives were considered a nuisance – a difficult group”
Dr Shallow, who has been a midwife for more than 30 years and is a well-known advocate for the profession, joined the NMC in July last year in the role of midwifery education and policy advisor.
However, she told Nursing Times she resigned five months later in December due to the working culture she said she experienced there and what seemed liked ingrained prejudice against midwifery.
In her 11-page resignation document – shared with Nursing Times – she said she could no longer continue working for the NMC, because she felt her professional opinion was not being listened to and she had been “in effect silenced”.
“Ethically I couldn’t continue – my job was untenable. I felt very bad after leaving”
According to the letter dated 4 January, some colleagues at the regulator made “derogatory comments” about midwifery and midwives “that appeared to be standard banter”.
The letter also alleged that the consultation on new standards for midwifery was viewed by some at the NMC as just an exercise to make it “look good” and midwives’ views would have little or no impact on the outcome.
In an interview with Nursing Times, Dr Shallow said she was originally keen to take the high profile job because she felt she could make a “significant contribution” to the project on the standards, called Future Midwife, thanks to her wide-ranging clinical experience and academic credentials.
For her PhD, she researched problems in maternity care and made recommendations about midwifery education.
She also hoped she could “build bridges” between the regulator and her profession, highlighting concerns about “the deteriorating relationship between the NMC and midwifery registrants”.
However, she claimed it soon became clear that her midwifery expertise and views on midwifery education and care were not welcome and that the organisation had “little or no concept of midwifery, its values and traditions and what midwives are trying to achieve”.
She told Nursing Times that, as the only midwife in her directorate, she often felt obliged to “correct NMC staff about midwives and what we do”.
“Very soon into post I realised that midwives were considered a nuisance – a difficult group who thought of themselves as somehow ‘special’,” she said, adding that some at the regulator “openly challenged” why midwives needed to have a separate midwifery panel.
Dr Shallow also said she felt registrants were seen virtually as “the enemy” by the NMC, and “were somehow inherently not to be trusted or a potential adversary who must be kept in check at all times”.
She said: “This was insulting, particularly as midwives deal with the safety of mothers and babies every day of their working lives and generally care very deeply and provide an excellent service in very difficult and challenging circumstances.”
- Call for NMC to apologise to midwives over Morecambe Bay cases
- NMC must ‘take account of registrant views’ in FtP cases, says chief
Meanwhile, when it came to the new midwifery education standards, she claimed she was “reprimanded” by managers when she tried to talk about the difficulties of midwifery practise amid staffing shortages and closures of maternity units.
In her letter, she accused the regulator of failing to take into account “the realities of service provision at this time” and “the very real safety issues facing nurses and midwives every day of their working lives”.
“I have learned that despite recent NMC ‘transformation’, I work in a tightly controlled organisational culture that is powerful and constraining, leaving no room for innovation,” the letter stated.
“Whenever my passion and commitment for midwifery comes through, cold water is poured on my ideas and thoughts. I have learned that I am not allowed an opinion.”
“It felt like I had failed but I am confident I did not fail – it was the failure of the organisation”
She told Nursing Times that all communication around the Future Midwife project was “highly scripted”. “I felt that the NMC’s over-riding priority, which is what it came across to me, was not public safety but more safeguarding their reputational risk,” she said.
“As a result, all communication was highly scripted – for example when we held webinars for members of the public and midwives to engage in the Future Midwife project,” she said.
In addition, Dr shallow said she feared the consultation process on the standards was nothing more than “smoke and mirrors”.
In her letter, she claimed a senior colleague told her that “engagement made the public feel involved, made the NMC look good” but would “probably not” make a difference to the result.
Speaking to Nursing Times, she said: “To me, it seemed like we had an end point even though we were going through this lengthy and hugely expensive process.
She said: “The amount of travelling, hotels, overnight stays here, there and everywhere in the name of consultation can be justified if you believe it is genuine, but I would cast a question mark over that.”
Dr Shallow also described decision-making processes at the NMC as “really convoluted and opaque” and said team structures were “bewildering, chaotic and confusing”.
Her experiences went some way to explaining why the regulator has a high turnover rate, with around a quarter of new starters leaving within six months just like her, she noted.
She said she was upset and disappointed that she was unable to continue in the role and had decided to share her resignation letter because of her deep-seated concerns about the future of midwifery and midwifery regulation.
“I didn’t go for the job lightly and I got paid extremely well, so I gave up a considerable salary because ethically I couldn’t continue – my job was untenable. I felt very bad after leaving. I felt particularly that I had let my colleagues down,” she told Nursing Times.
“I had so much national support for taking this role from very senior midwives around the country and to resign after six months was not good,” she said. “It felt like I had failed but I am confident I did not fail – it was the failure of the organisation.”
She ended her resignation letter, saying: “The job is undoable for myself as a midwife with strong midwifery values centred on relationship, effective communication and mutual respect and regard.”
“We are taking steps to learn from Helen’s experience for the benefit of future employees”
In response, the NMC told Nursing Times that it acknowledged some of the issues Dr Shallow raised and was keen to learn lessons from her experience.
“Dr Helen Shallow resigned voluntarily from her position as midwifery education and policy advisor at the NMC,” said Dr Geraldine Walters, director of education and standards.
“It is always sad when an employee leaves, for both the individual and the organisation. Her letter of resignation was shared with HR and copies were made available for council members,” she said.
“We acknowledge some of the issues that Helen raises in her letter and are taking steps to learn from Helen’s experience for the benefit of future employees,” said Dr Walters.
The NMC told Nursing Times it had now appointed an interim senior midwifery education adviser and was currently advertising the substantive post.
Geraldine Walters Jan09 3
Dr Walters stressed that the regulator did value midwives and genuinely wanted to work with them on developing the new midwifery standards.
“We recognise the enormous contribution that midwives make to our healthcare service and they are greatly valued,” she said.
“As we continue to develop our new midwifery standards we’re committed to working closely with midwives in a range of forums including practising midwives, midwife educators and managers, the Royal College of Midwifery and our own midwifery panel,” she added.