Exploration of Roles in the Maternity Care Team and the Role of a Midwife


The National Health Service (NHS) gives a wide range of services, support, intervention and screening which can optimize the health and wellbeing of the public. The ability to offer maternity support workers including midwives allows many women to get the help that then need for their wellbeing. There are services which offer support to women through the pregnancy (prenatal period) including afterbirth which focuses on the support of infant feeding, infant care and the transition to parenthood.

Throughout the medical system there are professions which work together to for the Maternity Care Team. This team usually consists of a wide range of professionals such as a midwife, paediatrician, dietician, obstetrician, anaesthetist, sonographer, obstetric physiotherapist and a health visitor. Each of these professions have a role within the team in providing adequate care and needs to the pregnant patients.

A maternity support worker is not the only profession who is able to support mothers during and after pregnancy, but also a midwife. A midwife is a profession who enables care and has a responsibility for providing care and supporting women allowing the ability to make informed choices about their care (rcm.org.uk). Usually a midwife gives support during the antenatal period all the way to the point of twenty-eight days after birth, sometimes more.

Becoming a midwife takes effort from individuals. Typically, a degree is taken to get qualified as a Midwife and registered with the Royal College of Midwives. However, reports from the Royal College of Midwives (RCM, 2016) indicate that Midwifery is an ageing profession where, in England, there has been an increase of Midwifes by one thousand five hundred since 2010, however, the problem arises when the age profile is taken into account. The age for under 50 fell resulting in 1 in 3 midwives are in their fifties or sixties. Even though a higher age may be a great asset since there will be a lot of life experience from the older generations, they will be closer to the retirement age. Therefore Midwifery, as a profession, needs to be promoted more towards the younger generation so there are more younger students to take the retired midwives places. Or we may face a point where there is a decrease in Midwives as we will not have trained them fast enough to replace the older generation of midwives resulting into supply issues.

The aim of this essay is to identify and explore the roles that are within the maternity care team. Also, I will identify my role, define its purpose, role and boundaries, and explore the range of different professionals and occupations that I may encounter during my work. To this end, I will explore the professional role definition, regulation and responsibilities of one of these professions discussing the skills required to work effectively with them as a maternity support worker including the role as a Midwife. There are many roles within the maternity care team such as a midwife, dietician, health visitor, maternity support worker and many more. We will discuss these roles with in-depth information.


Throughout a woman’s pregnancy there are various professions which she will meet. Not only will she meet these, but the pregnant woman’s maternity support workers such as a midwife. Firstly, it would be the best choice to investigate the role of a maternity support worker (MSW) and what the profession includes. The role of a maternity support worker was introduced from a team in the NHS confederation called the National Large-Scale Workforce Change. This team reached out to fifty-five NHS trusts throughout the United Kingdom to implement a new role called the maternity support worker (MSW). The team specified that by having this role it could allow the reduction of midwife time on non-clinical tasks along with the addressing of the retention of midwives and other staff including the recruitment issues that are being faced (Jenny Edwins, 2008). A maternity support worker is a type of healthcare assistant who works with direct contact with a midwife. However, the Royal College of Midwives states that there is no distinct definition of a maternity support worker, only that it is uses to describe someone who is and unregistered employee working in a maternity team (RCM, 2016). However, they are responsible for the assistance of providing adequate assistance for the care of the woman during their antenatal and post-natal periods. The role is not only limited to helping the mother, but also to provide care to the babies once delivered (Plotr.co.uk, 2016). For a multitude of reasons, the maternity support worker role cannot be a substitution for a midwife or a doctor as these professions are trained to a better standard and have more knowledge on the profession. Therefore, there has to be boundaries on what a maternity support worker is unable to do. Some examples are listed with the Royal College of Midwives (RCM, 2016) including the inability to discharge women and babies; monitor progress of pregnancies; assess postnatal or postoperative recovery; initial examination of the newborn and a vast amount of exclusions. They are allowed to do the following: Clean and make beds; report signs of illness to the midwife; inform patients of breastfeeding and its benefits. This list is not exhaustive and it clearly shows some of the complex aspects this profession must attain showing the high level of standard of clinical and practical skills to support other midwives and other doctors in the maternity care team. The RCM is supportive of maternity support workers giving assistance to midwives. It is views that a home birth should be assisted by two qualified midwives. However, the Royal College of Midwives believe and supports that it is sufficient and will not be compromised if there is one midwife and one maternity support worker if the maternity support worker is educated to a higher knowledge (RCM, 2016).

Through the pregnancy, a woman is under constant care of a midwife. This is where they are graded as either a low risk or high risk. This categorization allows health care professionals to give the correct care for the woman including the unborn child. Firstly, the midwife will deal with almost all low risk pregnancies (RCM, 2014). But if a woman were to be considered a high risk then the midwife would be able to deal with the women where obstetric input is essential. Obstetrics is a medical field in which obstetrician are concerned with the care of the pregnant woman including the fetus and the detection including management of diseases before, during and after birth (NHS.UK). Usually an obstetrician is involved in a birth when it is deemed a high risk which is a case of a complex pregnancy from a result of distress during labor or a caesarian birth (NHS.UK). After the birth of a child which has medical conditions, there is a profession known as a paediatrician who assesses the baby. If there is a complication then the paediatrician will be there during birth (NHS, 2017). A paediatrician is a doctor who is highly skilled and has the ability to care for babies and children up to the age of eighteen. Paediatricians manage the medical problems that may rise from infants, young children and young people (Health Careers NHS). There are four types of paediatricians. Firstly, there are general paediatricians which focus on children up to 16 years of age and offer general support to them. Secondly, there are neonatology paediatritions which specializes in the care of newly born babies. More specifically, in the intensive care unit (ICU) where they care for the babies who were born early (prematurely) or with problems. Thirdly, there are community paediatrics where these types of doctors are situated within the community allowing them to look after children that have mental and physical disabilities, and social behavioral problems. Lastly, paediatric cardiologists help with children who have problems with their cardiology system (NHS.UK). If a woman needs advice or help to maintain a defined diet then she can visit the dietician who will be available to give advice on the optimal foods to eat and the optimal drinks to consume. They usually work with people who have digestive problems; who want to lose weight; who has allergies; who have an eating disorder (Health Careers NHS). Another member in the maternity care team is the anaesthetist. This profession is concerned with the practice of providing anaesthesia to patients including the administration of pain relief (Oxford University Hospital, 2015). If an epidural is selected for the required relief from pain, the anaesthetist will be the person that administers the epidural ensuring that the patient is pain-free throughout the process of labor. The anaesthetist can administer the corresponding anaesthesis if a caesarean or instrumental delivery is elected by the doctor (http://www.ouh.nhs.uk/services/departments/anaesthetics/anaesthetist.aspx). The sonographer is a professional in which almost all pregnant women visit to see the wellbeing of the child in uternine. Sonographers perform dating scans which are usuallt carried out at about twelve weeks and then a nuchal translucency scan (which checks the thickness of the skin behind the neck for signs of down syndrome) around 11 to 13 weeks (usually at the same time as the dating scan). Later on about twenty weeks, the sonographer typically carried out an anomaly scan which checks the fetus if there are any abnormalities (http://www.nhs.uk/conditions/pregnancy-and-baby/pages/antenatal-team-midwife-obstetrician-pregnant.aspx) which the obstetrician may need to look in to for referral to specific specialists, or even the paediatric may need to look during the post-natal period. Another profession which a woman might meet is the Health Visitor which is a nurse with specialized training and who focuses on the support and advice to families with children up to the age of five (NHS, 2017). The extensive information detailing the position and roles in the maternity care team is necessary for the promotion of the wellbeing for women and babies. Forward from this point is where I will detail one role within the maternity care team introducing specific roles and the current setting in the health care field. The role will be a midwife. I will list the positives and disadvantages of this role, explore the role itself and how a maternity support worker will interact with a midwife and how the midwife role is able to integrate itself into the maternity care team.

Until the Midwives Act of 1902, there were no certifications or any need to become qualified to be called a midwife and to deliver babies so any woman could call themselves a midwife (RCM, 2008). When the Midwives Act of 1902 came into force in two thousand and five, it allowed midwifery to become regulated so that a woman could not be called a midwife unless she were certified under the act. If the woman were to practice midwifery, uncertified, and she was caught, then she would face charges from local courts to pay a fine of five pounds which in 2010 was increased to ten pounds (RCM, 2008). In the modern days, and currently, there is no national minimum academic entry requirements and no minimum or maximum age to enter midwifery profession. Usually a university degree is studied which, in some universities, come with an opportunity to register as a registered nurse or registered midwife, however, there are conditions imposed such as attaining minimum qualifications of grade C or above in five General Certificate of (Secondary) Education (GCSE/GCE) including English and Mathematics. The basic definition of a midwife is a profession who assists in the process of childbirth. The International Confederation of Midwives (ICM) (internationalmidwives.org) defines a midwife as:

“A midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.”

This shows that midwives are highly educated and recognized as high standing professionals and are part of a profession which is highly regulated. This high regulated profession can be complex with the need of midwives to continuously adapt to changes to improve health care to women and babies. The International Confederation of Midwives (ICM) (internationalmidwives.org) also states that the role of a midwife is to work with women giving the support that they need along with the care and advice throughout the antenatal period, labor and after birth. However, this is not the only inclusion, there is also the promotion of optimal wellbeing and the education and health counselling which the midwife must discuss not only to the woman but the family as a whole.

In a study reported by The Guardian, around a half of the female population on which have been pregnant had an experience where they could not gain access to a midwife on a timely manner (The Guardian, 2017). This is blamed on a shortage of midwives. As previously stated, there are currently shortages in midwifery which affects many pregnant women but also puts further stress on current midwives in achieving their goal to promote wellbeing and support women during and after pregnancy (The Guardian, 2017). The shortage is caused by the unequal amount of midwifes, at an older age, retiring and new qualifying midwifes taking up a job in the profession. In a study conducted by the RCM (rcm.org.uk) it is believed that there needs to be an increase of midwives. Currently, in England, the is a commissioning of training for over two thousand and five hundred new positions for midwifery, however, due to the aging (retiring) populations of midwives it only allows a net gain of one midwife per twenty five entering for midwifery training per year (rcm.org.uk). Unfortunately, this increases the issues of the inability to provide a optimal care experience for women during pregnancy. There have also been issues where maternity care units have to turn away patients as they are full or being over worked. Since midwives work in a team there are required skills which must be met such as team work. The Nursing and Midwifery Council (NMC) set out standards, (Liverpool John Moores University, 2012) which give a multitude of detail and the rules to govern midwifery as a practice which all midwives must follow. Some standards which is not an inclusive list are: • The ability to provide a safe and effective practice. • Provide woman centered care. • Meet certain ethical and legal requirements. • Respect individuals and communities.

A midwife role has not only got the curtesy of caring for people who are considered as problem free, but is also able to care for women who have problems. Some problems might be obesity which typically affects 2 in 5 pregnant women. But this type of obesity can stem from gestational diabetes. This is when the knowledge of the midwife would come to an advantage as the midwife can explain the condition and provide the relative help or even diet plans to reduce this type of illness. There are other illnesses that the midwife can help with but this shows that the midwife needs to build a specialist knowledge base to provide information to help for the appropriate care for women. More specifically there are mental health midwives which assist in pregnancies with women who have mental health complications. The RCM (rcm.org.uk) indicates that 1 in 10 women will eventually be affected by a mental illness either during pregnancy or during the post partum period. The Royal College of Midwives also state that about twenty three percent had not received any education to do with mental illnesses during pregnancy thus creating evidence that many midwives are not confident to support a woman with a mental health condition (rcm.org.uk). It is essential that all women including women who have mental health issues get adequate help during pregnancy and the introduction of mental health midwives will increase the reach that a woman is entitled to. Since mental health during pregnancy is a serious illness, it demands attention. This means that midwives need to be educated and given specialist training so that women and their families are not left on their own. During pregnancy, if a patients health was getting worst and had to be admitted into hospital or got professional help, then mental health midwives could be able to take the stress off the normal midwives on the ward so the midwives could give the care needed to all mums and babies.

During the post-natal period, the role of the midwife is to give the correct support and educate the mother about infant care and infant feeding. This could be an opportunity where breast feeding is promoted as the promotion and support for breastfeeding is an integral part of being a midwife. Or if breastfeeding has already been elected as a way to feed the infant, then the midwife could support this decision and give extra information about the process as they have a better understanding on how breastfeeding works. However, a dilemma could arise as some midwives may have experiences themselves about breast feeding which give them a negative impact which can result to inappropriate care being given to breastfeeding mothers (Susan Battersby, 2014). A study carried out by the Royal College of Midwives (RCM, 2014) showed that eighty percent of mothers wanted to breastfeed where twelve percent stated they did not want to breastfeed, with eight percent had not decided yet. But it also states that only fifty seven percent of the women in the survey were given enough information on breastfeeding where the rest, forty three percent were not given enough information. Another aspect the same study revealed is the time and resource management. Just over a quarter of both maternity support workers and midwives agreed that there is not enough time or support available for new mothers to gain enough knowledge for some of the important aspects of breastfeeding such as latching-on and the correct positioning. It is believed that this is a problem in the maternity care system itself where professionals don’t have the time and resources to administer this education to women. To improve the education to mothers about the benefits of breast feeding, it should be taught early in the midwife’s career so they themselves get a full understanding on what the process is. This is a fundamental aspect in which all professions in the maternity care team, especially the midwives who have one on one contact with the patient. It is essential that a mother is taught on how to either breastfeed or bottle feed during the postnatal care. And it must be considered that when a woman chooses not to breastfeed that it is a decision which needs to be respected. The aspect of increasing awareness of breastfeeding is dwindling due to the low rate of midwives. The NHS figures show that the NHS in England is short of up to four thousand and five hundred midwives which introduces a limiting factor. If this were to increase then the situation would get better. Women should be treated equally regardless of what way they have chosen to feed their infant new born (RCM, 2014).


As stated in the essay, the maternity support worker interacts with the midwife and creates an aspect of relief for midwives by reducing their workload which is non-clinic related, such as the paper work and promotion of breastfeeding, and many more roles. We have explored the role of a maternity support worker along with the other roles within the maternity care team and stated who they are and what they do and how they may interact with each other at the antenatal, intrapartum and postpartum periods of the pregnancy. It is also stated that there are role boundaries which a MSW must abide to such as the inability to deliver the baby as its outside of their profession. It is clear that the role of a maternity support worker is a key role in society and within communities and will further allow the advancement of the support and advice that is given to pregnant women and families.

We can conclude that becoming a midwife takes years of dedication and education to get to a standard which is acceptable in the maternity care team. The skills required reach a “high bar” and is not a job for the feint hearted due to the complexity of the profession. The role of a midwife has been detailed giving relevant on goings with some issues that society faces today along with the roles and the complexity of this role. Midwives have a vast knowledge of the maternity sector with the care of women during the antenatal, intrapartum and postpartum periods along with the promotion of an optimal wellbeing. The role of a midwife is complex with a multitude of roles which is part of the midwife role. Midwives are an influence on women as women tend to look up to them for assistance throughout the pregnancy. We have even investigated the facts that there are not enough midwives in the workforce due to the older aged midwives retiring faster than the introduction of newer midwives creating a system which becomes stressed leading into maternity units to become closed which is a massive issue in providing optimal care to women. However, even though midwives are the only profession which is directed at maternity care, the only other profession which can deliver a baby is a doctor. And the positive affect is that the doctor does not need further training to deliver a baby. A midwife has a set of guidelines which must be followed which is given by the Nursing and Midwifery Council regarding certain legalities and ethics of what needs to be considered in a medical practice. Another role we looked at which related to midwifery is the mental health midwife which is essential to women who suffer from a perinatal illness. Even though this is an emerging profession, it will be better in the long term to have this profession as 1 in 10 women suffer from some sort of mental illness either during the pregnancy or during the postpartum phase. Midwives are essential to providing adequate care to women throughout the pregnancy by offering professional sound advice, giving pain-relief, maintaining the standard practice of midwifery, maintaining the bond of the mother and child, and expressing the optimal choices that a woman should consider throughout the pregnancy.


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