Midwifery in the Millenium: the

Role of the Advanced Midwifery

Practitioner in the promotion of
normality.
Sue Briggs, Angela Chapman, Michelle
Barford
On behalf of the team at Diana, Princess of
Wales Hospital, Grimsby
Northern Lincolnshire and Goole NHS
Foundation Trust

Advanced Midwifery Practitioner

The role was developed in order to continue to provide a

comprehensive quality service following :

An acute service review and Trust merger

Implementation of WTD reducing junior doctors hours
Role reconfiguration for junior doctors
Plans at that time to relocate maternity services at Grimsby
First cohort commenced training in 2001

Evolvement of the Role

The Political climate continues to influence the scope of

midwifery practice and boundaries of care are constantly
evolving.
The NHS modernisation programme: NHS Plan (DoH,
2000)
Making a difference (DoH 1999)
Ideology that encourages exploration of new midwifery
roles Vision 2000 (RCM 2000)
Maternity Matters (DoH 2007)
Safe births, everybodys business (Kings Fund 2007)
High quality care for all (Darzi 2008)
Standards for maternity care (RCOG 2008)

Evolvement of the Role

It was envisaged that the Advanced Practitioner would:

Build on and enhance the service
Develop practice according to service needs
Have a dynamic and constantly evolving role
Strengthen relationships with medical colleagues by
having enhanced clinical, diagnostic and decision making
skills
Be empowered to increase their knowledge and expertise
in managing birth and focusing on women centred care

Who is the Advanced Midwifery

Practitioner (AMP)?
The

AMP is a midwifery clinician who can advance

and develop clinical knowledge and skills to promote
excellence in maternity care. She is an experienced
Labour Co-ordinator

While

being trained to an advanced level and able to

undertake activities and procedures traditionally
practiced by Medical staff the AMP still has a large role
to play in the promotion of normality within the
maternity services.

Training

Academic training through local University

Initially input into A33 now Autonomous practitioner

programme at degree level

Clinical training with input from Clinical supervisor lead

Consultant for Labour

Competency booklet developed locally

Support from rest of senior medical team and AMPs

What extra does the role encompass?

Input

into medical rota 10 sessions/40 hours

per week
Carry 2nd on call bleep instead of SHO
Response to emergencies
1st assistant in theatre
Ventouse practitioner
Ordering of investigations/initiation of
treatment/care planning

Role Development
The

role extended beyond the Labour Ward into

antenatal, postnatal and neonatal care e.g. maternal
admission and discharge; patients reviews e.g. 1st
day following operative/ instrumental delivery,
examination of newborn
Seamless service, enhanced continuity of care.
Guardian of promotion of normality whilst
acknowledging and responding appropriately when
deviations from normal occur
Understanding clinical challenges and supporting
all colleagues

Promotes midwifery
skills rooted in
normality

Supporter and
enabler of staff

Contributes to EB
guidelines that support
practice and promote
normality

Leads developments in
professional practice

Promotes research
awareness

Educates and
facilitates

Role of AMP
in Promoting
Normality

Encourages the A/N

education of women
Is an advocate for
mothers and
midwives
Acts as a catalyst
for change

Challenges the biomedical care model

A Team player working in

partnership with midwives,
nurses & medical colleagues

Promote midwifery
values and a women
centred service

Promotes staff
development

Refrains from undertaking

interventions unless clinically
indicated and evidence based.

Personal Considerations
The Advance Midwife Practitioners
Promote a culture of care viewing pregnancy & birth as normal
physiological processes.

Are guardians of normality of childbirth, whilst acknowledging

& responding appropriately when deviations from normal occur.

Through professional collaboration challenge an overly medical

model of care.

Remember their midwifery roots/ be an advocate for mothers

& midwives.

Collaborate with Midwives & Medics to develop EB guidelines

supporting practice that promotes normality.

Working with mothers

The AMPs support midwives to:
Identify

low risk women & where appropriate promote

home birth & MLC.

Help

women to view vaginal birth more positively &

have confidence in their ability to give birth, breastfeed
& be a happy parent.

Provide

informal Antenatal education that promotes

normality & realistic expectations. e.g. VBAC

Inform

women of alternatives to unnecessary medical

interventions / work with them to make evidence
based informed decisions about their care.

Creating a conducive Environment

The AMPs: Promote

a relaxed atmosphere conducive to

normality.

Encourage

a low tech approach to reinforce

concept of minimal intervention.

Maintain

a culture of normality even when

intervention is required, e.g. promote skin-skin
following uncomplicated ventouse delivery.

Clinical Practice
The AMPs promote normality by:
Encouraging
Support

& supporting less intervention.

1-1 labour care & continuity of care and carer.

Encouraging

non supine positions in labour &

mobilisation.
Discouraging

inappropriate use of EFM Encouraging &

supporting IA via Pinnards / doppler. (NICE, 2001)

Encouraging

midwives to get back to basics by

advocating good pressure area, bladder & perineal
care.

 Encouraging

& supporting use of non-pharmacological

methods of pain relief and coping mechanisms relaxation, Tens, birthing ball, use of water / birthing pool.

Encouraging

appropriate hydration / nutrition.

Supporting

physiological management of 3rd stage of

labour for low risk women.

Encouraging

support

early skin - skin contact & breastfeeding

Encouraging

midwives to get mothers not in established

labour / pre- lab ROM home

Encourage

planned early discharge for low risk mothers

(possibly facilitated by AMP/midwife discharge exam of
newborn).

Educationalists
The AMPs

Utilise
Are

opportunities for informal teaching.

proactive towards multidisciplinary

education.
Educate staff about the AMP role (not just for the
abnormal)
Promote mothers/ midwives educational
resources that focus on normality
Facilitate the acquisition of skills/ knowledge in
the care of normal low risk mothers.
Remind midwives that 1 intervention leads to
another!

Educationalists cont
The AMPs

are actively involved in the inhouse training programme which is

multidisciplinary

CTG
Neonatal

resus
Obstetric emergencies including drills
HCA training

Staff Development
The AMPs:-

Lead

& support the developing role of midwives in line

with unit philosophy e.g. LDRP & Midwifery led care.

Empower

Midwives to have confidence in their ability to

manage normal birth using a low tech approach.

Promote

women.

discussion around low intervention for low risk

Encourage

practice.

Support

Midwives to think critically & reflect on

staff to question & change practice.

Research and Audit

The AMPs promote normality by:-

Keeping

up to date with contemporary issues that

focus on normality.

Critically

appraising the evidence base for midwifery

knowledge & practice.

Considering

other National / International

perspectives of care / practice.

Encouraging
Auditing

research awareness

, reviewing & reflecting on practice.

On going Training for AMPs

Regular
ALSO
NLS

update in ventouse delivery

refresher

training

Perineal

repair training

An overview of the AMP role in promoting normality

normality

Communication
Maintain a good relationship with
multidisciplinary team & network.
Be an advocate for mothers and
midwives.

Lead

Help

Clinical &Professional
Be a visible, credible, role model
Support

practice that promotes

new initiatives to support

normality.
Promote

birth as normal life event.

develop supportive EB guidelines.

Facilitate

mothers to make informed

choice.

Education
Undertake formal/ informal teaching.

Research & Audit

Critically appraise research evidence

Act

Encourage

as a resource for staff

Facilitate

the acquisition of skills/

knowledge in care of low risk mothers.

Keep

Remind midwives One intervention

leads to another

Audit

research awareness.

up to date with contemporary

issues.
practice & review & reflect.

The effects are clear to see

Reduced

CS rates 17.1% 2009 (16.3% 2008)

SVD rate 71.2% 2009 (70% 2008)
Birthrate plus in 2009 - 45.9% of all births in the
unit within the I and II category which is stated in
the report as being significantly higher than
found in many units in England.
Excellent working relationships with senior
medical staff . True Team approach

The Effects cont

Support

for junior doctors

Seamless

approach to doctors rotation

Challenge

practice e.g. induction of labour

Only

undertake necessary investigations

Keep

a record of cases

Acknowledgements

Special thanks to Sara Butcher for giving us the presentation and

allowing us to adapt and add to it
The rest of the AMP team at DPOW Sara Butcher, Jeanette Rowe and
Brenda Waite
The other Co-ordinators Tracy Martin and Carol Horsley
The Consultants; Werner Mueller, Ian Stuart, Arabinda Saha, Ibrahim
Bolaji, Silas Gimba and Mahadeeva Manohar
Staff Grades; Shanka Gangophady and Nasser Mohammed
Sheila Youssef Acting HoM, PSM Obs, Gynae & Sexual Health
The Midwives at DPOW, NLAG