PURPOSE:
At the Nursing and Midwifery Council (NMC )we were getting a lot of inquiries from senior midwives about two areas of concern. Firstly, what a midwife should do when a woman requests care which does not align with local guidance or declines care from a midwife, indicating they wish to freebirth. Secondly, that care in labour and birth was potentially being given by people who are not registered with us and could be in breech of Article 45 which specifies the Protected Function of the Midwife in the UK. We formed a group of a range of key stakeholders The issues were complex and it took time to work through the issues as well as considering the language used; crucially, we were committed to women’s fundamental birthrights. Three subject Task and finish groups met on two occasions to discuss a line of enquiry in relation to principles for women, midwives and the Trusts/Health Boards. We discussed the issues from the perspectives of women, midwives and NHS Trusts/Health Boards.

DISCUSSION:
A collaboratively-developed principles document endorsed by national stakeholders which has been circulated to all Trusts and Health Boards. A review of NMC processes when a concern is made about a unregulated person so that appropriate and proportionate action is taken.

EVIDENCE WHERE RELEVANT:
The number of inquiries received.

KEY MESSAGE:
Midwives need support from a range of stakeholders where they are facing tensions between a woman’s right to make autonomous decisions and the support they receive to provide midwifery care. Within a complex maternity landscape, this work demonstrates the importance of working together to problem-solve tricky issues where a number of stakeholders are involved but are all facing the same issue. Next steps: A communication campaign with Doula UK to highlight the roles of the midwife and a doula in providing personalised care. Policy - professionalism