Obstetric anaesthetists are part of the delivery suite team. This involves working closely with midwives, who are often the lead professionals caring for the pregnant woman. It is therefore important to understand the training that midwives have received, and for senior anaesthetists to take responsibility for teaching obstetric analgesia and anaesthesia and the management of critically ill obstetric patients to midwives.
Training and regulation of midwives was formally established following passage of the Midwives Act in 1902, with the establishment of the Central Midwives Board (CMB). In 1983, the CMB was replaced by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), whose functions were taken over by the Nursing and Midwifery Council (NMC) in 2002. The NMC register currently has ~618,000 nurses, ~33,000 midwives and ~8000 dual-qualified nurse-midwives.
Special considerations
Midwives working in the NHS have completed either a degree course in midwifery (usually 3 years) or a midwifery short programme (at least a year and a half) if they already have a nursing qualification. The structure of the courses varies considerably, as does the obstetric anaesthetic involvement.
Midwifery training usually requires the following topics to be covered:
• Biological sciences, applied sociology and psychology, and aspects of professional practice
• Pain in labour, the pain pathways involved, and pain relief (including both non- pharmacological and pharmacological methods)
• Anaesthesia, including both regional and general anaesthesia in pregnancy
These modules do not have to be taught by obstetric anaesthetists, although in most training schools there is a good relationship between the midwifery tutors and obstetric anaesthetists, who may as a result be involved in many hours of teaching. This relationship has led to increasing awareness that anaesthetists are involved with the sick maternity patient and that they should be involved in teaching both high-dependency care and the recognition of clinical risk factors. Teaching of these skills is particularly important for direct-entry midwives and has led to the following topics often being taught by obstetric anaesthetists:
• Postoperative and recovery skills, including basic airway management manoeuvres and monitoring of recovery from neuraxial blockade
• Risk factors associated with women who have medical problems
• Care of the critically ill woman, e.g. high-dependency care for women who have preeclampsia, sepsis or haemorrhage
This extension of the teaching role of the obstetric anaesthetist may require around 18 hours of teaching to be given to each group of students. The students who have general nursing qualifications will require less time than the direct-entry students.
In order to practise, midwives must be registered with the NMC. To remain registered, they must maintain a professional portfolio as evidence of their keeping up to date, and notify the NMC annually of their intention to practise. Part of midwives’ continuing professional development and training will include the practical management of epidural analgesia. The ability to administer epidural top-ups requires additional in-service teaching, which is usually done on the delivery suite. A certificate is issued to the midwife on completing the training satisfactorily. The exact requirements of the training differ depending on local practice and may require an update of resuscitation skills.
Anaesthetists are often involved in other areas of professional development, for example intravenous cannulation, resuscitation (adult and neonatal) and specific high-dependency and simulation training.
Key points
• It is important that obstetric anaesthetists are involved in midwifery training.
• Midwives require instruction during their midwifery training, as well as continuous education and maintenance of skills once qualified.