“Centralisation, standardisation and market economics have been the dominant concepts in maternity care over recent years. Organisationally, NHS maternity care has been centralised into large units based on an industrial model where care is highly fragmented. Standardisation of services is seen as the way forward. The contradiction with the rhetoric of maternal choice is largely ignored. Indeed we have the ridiculous situation where, should women choose to decline some aspects of care, the midwife is likely to find that she cannot proceed to the next computer screen which records the consultation. NHS management thoughts seem to be focused on ever closer control of the workforce through prescriptive policies, guidelines, protocols etc, through wider management theory emphasises workers using their skills to the full and exercising the autonomy which links with job satisfaction. Ironically many midwives leave midwifery because they cannot practice as to the best of their ability and make full use of their professional judgement. At management level, there seems to be a fear of trusting midwives to do midwifery and to organised themselves in a professional manner. Yet, in other settings, this can work well with fewer managers and more clinical workers.”
– Mavis Kirkham
Kirkham M (2016). A much needed revolution. AIMS Journal 28(3):10-11.