The international definition of a midwife, according to the United Kingdom Central Council for Nursing Midwifery and Health Visiting, is a community-based practitioner who ‘must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant’.

All midwives undergo the same specialised three-year training, but many have reached the most experienced (‘G’) grade before they go out and work in the community. They are generally attached to hospitals and fall under the control of the Director of Midwifery, although they may also run clinics in GP surgeries and health centres. It is possible for your local team of community midwives to carry out all your antenatal and post-natal care, as well as delivering your baby, either at home or in hospital.  However, there is no standard pattern of maternity services in the UK and choices vary from one locality to another.

Every mother is entitled to a 28-day period of post-natal visits by a community midwife, irrespective of where she has had her baby. The midwife will generally come from the closest maternity unit within your local authority. There is a standard procedure for activating these visits. The 1995 Patient’s Charter sets out very clear guidelines about advanced notification and timing of visits.

The chief concern of a community midwife is to ensure that the mother and baby are progressing well. Her responsibilities include checking the state of the baby’s cord and the mother’s uterus and perineum, helping to get breastfeeding established, weighing the baby and offering advice and support where necessary. Unless you are still in hospital, your community midw ife will carry out the Guthrie blood test (a pinprick on your baby’s heel) on day six to screen for a rare but correctable metabolic disorder called PKU and possible thyroid deficiency.

It is up to you to adjust the length and frequency of your midwife’s visits according to your needs. If you have a very strong objection to the midwife who has been assigned to you, it is possible to request a change. You are not obliged to receive a community midwife in your home, although your refusal will be documented. The important thing to know is that there is someone to turn to for guidance during the first month of your baby’s life if you should need it. At the end of that period your local health visitor will assume responsibility for your family’s combined well-being.

It is widely acknowledged that there is a shortage of midwives working in the UK – 93,000 registered and only 33,000 practising. This makes it harder for the government to deliver its promise of continuity of care in labour, a mother’s right to a named midwife, the provision of a home birth service and flexible post-natal support.

Resources

The best way of making contact with your community midwives is through your health centre, GP surgery or hospital antenatal clinic. These are also good places to find out about their pre-conception and antenatal classes. If you are considering having a home birth you should inform your local midwives between weeks 34-36 of your pregnancy and arrange to go along and meet them.

Contact NHS Direct ) for information about the services that are available in your area or write to the Directory of Midwifery at the local maternity unit to find out how they organise their community midwifery services. The government’s 1994 Maternity Services Charter will give you an idea of your rights and the standards you can expect.

The following list of NHS maternity hospitals in the London area may be a useful starting point.

Association for Improvements in Maternity Services (AIMS) is a useful source of information and support about childbirth choices. Call them on .

Association of Radical Midwives is an organisation committed to providing personalised, sympathetic maternity care to women.

Independent midwives work outside the NHS and therefore charge private rates. The Independent Midwives Association can put you in touch with an approved local independent midwifery practice.