Supervisors Embrace the Challenge Beverley Walsh, Lorraine Perry Supervisors of Midwives East Cheshire NHS Trust

The Supervisors of Midwives at East Cheshire NHS Trust are a cohesive group who work proactively to support the highest standards of midwifery practice and care for mothers and babies

Background A group of 8 Supervisors Ratio of 1:15 Participation in the 24hr on call rota East Cheshire NHS Trust has around 2,500 bookings per year with a delivery rate of around 2000 Maternal age range Large geographical area in “leafy” Cheshire Low prevalence of Teenage Pregnancies and ethnic minorities

Supervision is…. A statutory responsibility which provides support & guidance to every midwife practising in the UK (NMC, 2008) A means of promoting excellence in midwifery care, supporting midwives to practise with confidence, therefore preventing poor practice (NMC, 2008) A duty to protect women and babies by actively promoting a safe standard of midwifery practice (NMC, 2008)

Supervision also…. Has a duty to promote childbirth as a normal physiological event (DH, 2004, 2007, 2010) Ensures advocacy for women to make informed choices, providing advice and individualised plans of care Demonstrates how women influence the development of maternity services and how midwifery care is responsive to local needs

Linked Objectives LSA Standards for Supervisors of Midwives CNST Maternity Standards Chief Nursing Officers 10 High Impact Actions East Cheshire NHS Trust Board Objectives aligned with Qipp Quality Agenda

Successes in 2011… Demonstrated a commitment to woman centred care Provided a source of professional knowledge and expertise ensuring evidence based care within all areas of midwifery Helped midwives identify and meet personal & professional development requirements Liaised with clinicians, management & education

Successes in 2011… Reflected on clinical incidents and maintaining records of all supervisory activities in an articulate manner Investigated incidents and supported midwives through supervised practice through a fair & equitable process Provided leadership and guidance to midwives Remained motivated and proactive, acting as a catalyst for change

Demonstrated by…. Representation at: Labour Ward Forum Clinical Governance Maternity Service Liaison Committee Perinatal and Obstetric Audit Band 7 meetings Unit meetings CNST Risk management Safe guarding

Promotion of normality with involvement in the development of a care pathway for VBAC An action plan following our annual LSA supervisory audit Supervisory investigations of clinical incidents and complaints The monitoring of all supervisory events to assess recurrent themes Proactive in advertising the role of Supervision within East Cheshire

Participating in the development of guidelines The implementation of Midwifery Led Care including the development of guidelines and pathway for normality Monitoring of K2 compliance demonstrating awareness of current vulnerabilities following clinical incidents

Presentation on CNST standards Presentation on the national health service litigation authority Presentation on the role of midwives at the local nurses and midwifery day in May Presentation on social networking to maternity unit

Involvement in monthly audits including:- Multidisciplinary Record keeping Third and fourth degree tears Caesarean section rate Breastfeeding (BFI) Audits in line with CNST standards

Other Achievements Presentation of a case study at an LSA forum (referral of Midwife to NMC) Published articles on accountability, infection control initiatives and instigating changes in practice (BJM)(RCM) Won the “Excellence in midwifery BJM award” Nominated for RCM award One supervisor won “midwife/nurse of the year” for the trust

Weekly Supervisory Clinic 3 x 1hr appointments each week Referral pathway Antenatal /Intrapartum /Debrief VBAC

Weekly Supervisory Clinic 3 x 1hr appointments each week Referral pathway Antenatal /Intrapartum /Debrief VBAC

Supervisor of Midwives Clinic A Total of 87 referrals in 12 month period 54 women contacted (61%) 33 women unable to contact 1 woman contacted but declined to be interviewed

Supervisor of Midwives Clinic

Supervisor of Midwives’ Clinic Reasons for referral Previous emergency LSCS to discuss VBAC = 43% (23) Previous traumatic delivery = 5.3% (10)

Supervisor of Midwives’ Clinic Primigravida anxious re labour and delivery = 3 Previous emergency LSCS requesting waterbirth this pregnancy = 3 Multiple pregnancy birth planning = 2 (1x twins, 1 x triplets)

Supervisor of Midwives’ Clinic Requesting elective LSCS = 6 Post natal debriefs = 2 Other reasons included:- gestational diabetes, previous baby had congenital abnormality, previous pre term delivery.

Evaluation of Supervisors’ Clinic

Looking forward to 2012… Audit of on call events To continue to promote supervision through the use of the Trust website and the introduction of a DVD As supervisors at Macclesfield we will continue to be an advocate for the women and their families and a support for midwives in all areas of practice

Looking forward to 2012… We will continue to be involved in monitoring the quality, safety and performance of our maternity unit Continue to evaluate the supervisors clinic Facilitate a presentation on interviewing techniques in collaboration with GMP for the supervisory away day.

Challenges for midwives on supervised practice Maintaining confidentiality in a small unit during and after the process Maintaining staff morale and keeping a positive view of supervision Facing difficult decisions and supervisory dilemmas Maintaining professional boundaries in relation to the role of manager /supervisor

Challenges for 2012 Finding dedicated time to undertake supervisory activities As part of midwives one to one promote a topic for discussion Continue to promote the role of supervision to the general public

Challenges for 2012 Ensuring multi-disciplinary compliance with good record keeping standards Maintain the momentum and drive to move forward

Don’t just take our word for it! LSA Comments: The team of Supervisors are highly motivated and represent a rich mix of skills, expertise and leadership Supervisors have a strong commitment to the service. They are functioning as leaders of the profession and providing a positive role model for the midwives and beyond

Don’t just take our word for it! Peer review/ Midwives: Everyone interviewed was very positive about their experience at this hospital. Small effective friendly team, where you would be well looked after. The midwives felt the normality agenda was driven by the Supervisor of Midwives There is a tangible enthusiasm from the midwives for the service Midwives readily recognise the leadership, support and overall contribution that supervision of midwifery makes to the unit

References Department of Health. (2004). National Service Framework for Children, Young People and Maternity service. London: HMSO. Department of Health. (2007). Maternity Matters: Choice, Access and Continuity of Care in a Safe Service. London: DH. Department of Health. (2010). Equality and Excellence: Liberating the NHS. London: DH

THANK YOU ANY QUESTIONS Beverley Walsh, Lorraine Perry Supervisors of Midwives