Royal College of Midwives
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The Royal College of Midwives is a British midwives organisation which has existed under its present name since 1947, and is UK’s only trade union, professional organisation led by midwives for midwives and those that support them.
The forerunner of the Royal College of Midwives, the Matron's Aid or Trained Midwives Registration Society, was founded in 1881. Zepherina Veitch, a midwife who had worked with the poor in London, together with a number of her colleagues established the Society and aimed to "raise the efficiency and improve the status of midwives and to petition parliament for their recognition."
Childbirth in the late 19th Century was both difficult and dangerous. Maternal mortality stood at around 500 per 100,000 births compared with approximately 12 per 100,000 today. Few women had access to trained attendants in childbirth and many of the poor had to depend on local untrained midwives.
Shortly after its founding, the Society changed its name to The Midwives' Institute and started a 20 year-long campaign to petition parliament for the regulation of midwives and midwifery. In this campaign they faced growing opposition from doctors who saw their livelihood being threatened by the wider availability of well-trained and affordable midwives. In 1902, the Institute's efforts were successful with the passing of the first Midwives' Act for England and Wales. This established the Central Midwives' Board, which governed the training and practice of midwives and made it illegal for any unqualified person to act as a midwife. It also established Supervision of Midwives, a process, which continues to this day with the aim of ensuring the highest possible quality of midwifery care and ensuring public protection. Legislation to regulate midwifery in Scotland was enacted in 1915 and 1922 in Northern Ireland.
The ethos of promoting education for midwives has been a key objective of the RCM since Dame Rosalind Paget, one of the founding members, joined the Trained Midwives Society in 1886 and organised the first series of lectures. She also established a Library at the same time and was instrumental in founding the precursor of today's RCM Midwives Journal, the Nursing Notes. Today, the RCM educational remit involves the provision of Continuing Professional Development in all its forms to midwives, and offering advice and support to individuals entering midwifery or returning to practice.
The Institute continued to seek to influence legislation in order to improve standards of midwifery and to protect the interests of midwives. In 1911 they were successful in achieving an amendment to the National Insurance Act, which enabled married women to have a choice between having a midwife or a doctor as their attendant in childbirth.
The Institute recognised that many midwives struggled financially as the fees they charged were low and many of the women for whom they cared could not afford to pay even these small amounts. In recognition of this, in 1901 the Institute established an insurance scheme to cover loss of earnings during quarantine periods, (after a midwife had attended a women with puerperal fever), to pay their legal defence when they had to attend inquests and also to pay the doctor where a midwife needed to summon medical aid. It was not until 1919, that the Institute was successful in ensuring that local authorities should bear the responsibility of paying a doctor's fee and reclaiming this from the family rather than putting the burden upon the midwife.
In its early days the Midwives' Institute maintained an employment register, which was used to facilitate members' search for work, which could be consulted by the public who were looking for recommended and trained care.
The Institute continued to provide lectures and continuing education opportunities for midwives. In the 1920s it devised its own advanced course for teachers and awarded a diploma to those who passed the voluntary examination. The provision of this programme was formalised in the 1936 Midwives' Act, which established the midwife teachers diploma and in addition made provision for 5-yearly refresher courses and established regulations regarding return to practice after a period away from midwifery. In all these achievements, the Institute had been an active campaigner.
The 1936 Midwives' Act also recognised the uncertainty of income for midwives in independent practice. Following a campaign by the Institute, a salaried midwifery service was established under the control of the local authority and midwives were given the opportunity to join this scheme or to remain in private practice.
In 1931 for the Institute's Jubilee, Queen Mary visited the Institute and praised the great value of the daily work of midwives. However, maternal mortality remained high and the Institute took part in a major study to look at ways of reducing deaths that occurred during pregnancy and childbirth. In 1941 the Midwives' Institute changed its name to become the College of Midwives and in 1947 it received a Royal Charter. Educational developments continued with the RCM being the main provider of the five-yearly residential statutory refresher courses for midwives. They later developed the Advanced Diploma in Midwifery which provided the additional knowledge for those wishing to progress into teaching or management. Later the College developed teaching and assessing courses for midwives in clinical practice to allow them to support students as they develop into tomorrow's midwives. Many of these innovations have since been introduced into nursing.
By the 1950s, College membership and its services had grown and there was a need for larger accommodation. The library, education programmes and other work to meet the needs of members demanded a much larger building. Following a nationwide appeal, which raised £150,000 in 2 years, the Queen Mother, as RCM Patron, laid the foundation stone of the Mansfield Street headquarters in 1956. This building was refurbished in 1999.
Throughout the 1960s and 1970s there were major changes in the administration of health care and also in the organisation and provision of maternity services. The greatest change was the move from birth at home to birth in hospital and the increased use of medical intervention. Throughout these changes, the RCM campaigned for an integrated service, which would provide every mother and baby with the highest possible standard of care. Following the introduction of the Industrial Relations Act, members of the College voted in 1976 to become a trade union, and the College was formally divided into the Royal College of Midwives Limited and the Royal College of Midwives Trust (an educational charity).
The structure of the College has changed with the needs of its members over the years. In 1946 The Scottish Midwives Association voted to join the College and established the RCM Scottish Council, now the RCM UK Board for Scotland. The RCM now has a Board in each of the four United Kingdom countries.
The College's work in providing professional leadership, lobbying for effective legislation, ensuring the best possible terms for the employment of midwives and advancing midwifery knowledge has continued to the present day. The College has continued to influence updating of midwifery legislation to ensure that, whilst protection of the public is at the forefront, the distinctness of the profession remains clear. The College continues to be active with Government ministers, the Parliaments in Westminster and Edinburgh and the new Assemblies in Belfast, London and Cardiff in influencing decision makers as to the pattern for the future provision of maternity care. On behalf of its members, the College lobbies for improved salaries and conditions of employment, and to ensure that midwives are able to fulfil the role for which they have been prepared.
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