Professional dominance and subversion in maternity services

Abstract

Recently Safe Birth: Everybody's Business (Kings Fund, 2008) recommended the need for greater teamwork to improve safety in maternity services. The report states that there is little understanding of the differing philosophies between midwifery and obstetrics. These professional tensions often arise at the interface of clinical care, where each finds themselves struggling to understand each other, and sometimes jousting for position. Such dysfunctional behaviour compromises safety. This was tragically illustrated by the high profile midwifery case before the Nursing and Midwifery Council (NMC). The main charge was that the midwives failed to monitor Mrs A (a woman having a vaginal birth after caesarean section (VBAC)) correctly during labour, disregarding the consultant obstetrician's instructions for continuous electronic fetal monitoring. Mrs A's baby sadly died. The NMC (NMC, 2008) has dealt with the facts concerning the midwives’ behaviour during the care of Mrs A. However the underlying organizational cultural origins, contributing to dysfunctional behaviour between doctors and midwives, are complex, widespread, and still need to be addressed (Kings Fund, 2008).