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
1. Who referred you?
35
30
Number of women
25
20
15
10
5
0
Midwife
Obstetrician
GP
Person who sent the referral
Other
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
3. Was the appointment time suitable?
60
Number of women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
4. Was the length of appointment suitable?
60
Number of women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
5. Did you find the appointment useful/ valuable?
60
Number of Women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
6. Were your expectations met?
60
Number of Women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
7. Were all your questions answered?
60
Number of women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
8. Did you find the information helped you in your
decision making?
60
Number of Women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
9. Did you know about the role of the SOM prior to
appointment?
50
45
40
Number of Women
35
30
25
20
15
10
5
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
10. Would you contact a SOM again if needed?
60
Number of Women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
60
11. Would you recommend a SOM appointment to your
family and friends if they had any concerns regarding
their pregnancy?
Number of Women
50
40
30
20
10
0
Yes
No
Response
Evaluation of Supervisors’ Clinic
12. On a scale of 1-5 what is your overall evaluation?
35
Number of Women
30
25
20
15
10
5
0
Poor
Satisfactory
Good
Response
Very Good
Excellent
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 2012
 2 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
[email protected]
[email protected]