View from the ground, by Sue Hope
If you were asked to recite a list of primary care team (PCT) members, the list might go something like this: GP, practice nurse, district nurse, health visitor, pharmacist. I cannot help but wonder how many would actually include community midwives in this group? Not many, I suspect. Hopefully after reading on, this may change and the midwife can become a more integral part of your PCT.
Honestly, if I’d constructed a list of PCT members a few years ago, I probably wouldn’t have included a community midwife either. I have a very acute background; I’ve spent 20 years working in various hospitals, 10 of those coordinating a busy labour ward. It wasn’t until I had to change my working pattern, due to the arrival of my children, that I saw the other side of midwifery. It’s almost like a completely different occupation.
I have been a community midwife for approximately 5 years now and consider myself extremely lucky that we, unlike many other trusts, remain based in primary care. I hate to ramble about communication, but as we all know from numerous serious case reviews, national mortality reports, and learning from incidents, good communication is key to safe and excellent practice. So why wouldn’t community midwives be part of the PCT?
I have been inspired to write this article by the care and good practice in some of the surgeries I have had the pleasure to work with. Note that I say ‘work with’; this is exactly how I feel. It’s very much teamwork—something I have not always experienced in other PCTs.
It’s always daunting when you are moved to another surgery as a community midwife. In some surgeries you are seen as a visitor or contractor. In others, you’re welcomed as part of the team. I cannot tell you how wonderful it is to feel part of the current team that I am in. I’m not just talking about GPs. It is also about support from receptionists, practice managers, secretaries, nursing staff, everyone; and feeling like a respected practitioner. I really wanted to highlight this element of good practice. All members of my current surgery work together to provide the best care. We ask each other for advice and help each other out. Everyone is respected for the role they fulfil in patient care. The most important point here is, again, that we communicate.
Communication is so important in all aspects of health care including for example, looking after our patients with social or mental health issues. When I see a pregnant patient for the first time, I have no idea if they have had any social care involvement or if there are other undiscovered issues. They may choose to tell me, but they also may not. Since we still use GP systems, this information flags up when opening a patient record. This is invaluable. Midwives have an important role in being with patients and are lucky enough to form a very special relationship. Community midwives have a responsibility to ensure the patient is safe and are required to ask if they are safe numerous times throughout the pregnancy in the form of a routine enquiry. As a PCT, we should ask about personal safety at every opportunity. After all, good communication between patients and PCTs is essential in these situations. The midwife is able to use their relationship with the patient to communicate and share any issues with the GP and other relevant PCT members.
Years ago, in another trust, I looked after a lady whose husband had severe mental health problems. He was an asylum seeker who had been treated terribly in his own country. It wasn’t until he murdered his wife 6 weeks after their baby was born that I was aware of his history and his diagnosis. I will never know if we could have protected her, but at least we could have tried. Not to mention that I was in their house alone doing postnatal visits! This was some years ago but it’s very sad to think that better communication between the surgery and other professionals might have changed the outcome.
In summary, I would just like to say ‘don’t forget the midwife’; we all know the importance of communication and information sharing and we all want to provide the best care and safeguarding that we can. The role of the community midwife is not just to provide physical antenatal care, it is to support the patients throughout all aspects of their pregnancy including emotionally and mentally. Use the knowledge gained from your midwife. How many other health professionals get patient contact up to 10 times in 7 months? If you’re lucky enough to have a midwife as part of your surgery, share your knowledge and experience as they will share theirs. Most importantly? Communicate.
Community midwife, Buckinghamshire