A job that delivers: Join the growing profession of midwifery

If you believe what you see on television hospital dramas, then being a midwife is all about high drama on the maternity ward or delivering babies in unusual places.

However, midwifery is about a lot more than that says Melanie Every, regional manager South at the Royal College of Midwives. "One of the things that is quite important to think about is that there isn't really a clear dividing line between hospital midwives and community midwives. They all work across the whole area so it's not necessarily about choosing between one or the other. Midwives provide total care sometimes even before the pregnancy begins by giving advice on giving up smoking or diet."

All midwifery training in the UK is undertaken in universities. There is a three-year degree course for midwives who are not already nurses and an 18 month course for nurses wishing to become midwives. "People thinking about this should be looking at what part of the country they would like to work in and do some research into which hospital the clinical experience element of the course takes part in," says Every. Tuition fees are usually paid in full and students may also receive a bursary for living costs.

"Training," says Natalie Doherty, who retrained as a midwife after 14 years as an actress (see case study, page 290), "was demanding so it shouldn't be something you take on lightly but it does give you a taste of what the job should be like."

As midwifery is already quite a specialised area of healthcare, it is quite difficult to specialise further. However, there are some opportunities for specialisation. Jan Mattis is a midwife who specialises in substance misuse. Based at Brighton and Sussex University Hospitals, Mattis goes out and works in the community.

"I'm part of a specialist multi-agency clinic for substance misuse and I work with people there and also with homeless people and people from the traveller community. I provide all of their antenatal care and as must postnatal care as I can. It's a demanding job and I have a very high caseload.

"I used to work in Birmingham and I was a manager on a big maternity outpatients department. I recognised that there was an increasing number of women who were drug dependent and I didn't know if I was giving them the right information, so I was funded to go on a substance misuse course. Then my current job as a specialist midwife for substance misuse, homeless and travellers came up so I moved here."

In the past few years there have been changes to the salary that midwives can expect to earn. NHS midwives' pay and working conditions are determined by the NHS pay system "Agenda for Change". A new midwife now earns about £19,000 excluding payment for on-call and unsocial hours. This can go up to £60,000 for midwives at the very top of their profession who become consultant midwives.

In the private sector, midwives can set their own rates, charging women as much as they like for their services though it is usually between £3,000-£4,000 for a pregnancy.

Viv Gray, 42, is an independent midwife working in London. "I worked in the NHS for six years and have been an independent midwife for nearly a year, working mostly in the community with women who are anything from six weeks to seven months pregnant. In terms of personal qualities you have to be interested in people, because it's a very important part of a person's life when they have a baby. You have to be fascinated by it and really interested by it otherwise people don't feel like they are being well cared for. You have to be able to learn technical tasks like taking blood and you also have to be really well organised as you have to plan your work and be able to prioritise. On a practical level you have to be able to drive a car. The work I do is mostly in the community and there's a lot of heavy equipment so I have to be able to attend births and get there on time."

Elke Heckel, 44, is also an independent midwife. "I left the NHS in 2000 after two years. I'm not very good at looking after more than one woman at a time - it got too stressful. What happens in my practice is you book a woman early on in their pregnancy and you form a relationship with them. You get to know their family, their partner and their needs. You need to be someone with good communication skills and someone who people feel safe with and who they can trust."

Another key personal quality potential midwives need is strength and confidence: "You've got to be able to be confident with someone in labour and support them and encourage them and help them to cope and be strong for them," says Doherty. "And, of course, you have to be a really nice person."

Nor is midwifery just a career option for women. "We've got male midwives and they are great," says Mattis. "Some women don't like this, but if they are the right person with the right attitude there is no reason why a man can't become a midwife."

'YOU'VE GOT TO BE PASSIONATE'

Verona Hall, 44, is an independent midwife with a practice in London

"From as young as I can remember, I said I wanted to be a nurse. I was a nurse for 11 years and then, in 1994, I decided I was ready to do my training as a midwife. Because I was already a nurse my training was 18 months. I enjoyed my training but at the time when I went into midwifery there were lots of changes in policy around choice and continuity of care, and although the hospital I was in was trying to do this it didn't feel right. For example, mums weren't getting the choice to have home births. I got a bit disillusioned but still had a passion for midwifery so I did an internet search for independent midwifery and got in touch with a practice who invited me for interview and gave me a job. After a while, I went back into an NHS hospital in London which developed my skills as a caseload midwife, but there were lots of 24 hour periods on call and I was looking after several mums in labour at once.

Even though I wanted to be independent, the thought of people having to pay didn't feel right for me. So I went to work in a private birthing unit in 2001 and from there I started setting up my practice which I started in 2002. The first year I probably had four or five clients and after that it just snowballed. I still work part time at the birth unit - just six shifts a month - to keep my skills up.

I think you've got to really be passionate about the job because if you're not really passionate about it then it can grind you down. But it's a fantastic job. There are highs and lows but if you stick with it you will love it. I love it."

'THERE IS ALWAYS JOY AND CELEBRATION AROUND BIRTH'

Natalie Doherty, 39, is a former actress who decided she wanted a change of direction. She works at the Albany Midwifery Practice, a self-managed partnership offering women care through pregnancy, birth and the postnatal weeks

"I'm quite a late career change midwife. I used to be an actress and as I got older I asked myself whether that was what I wanted to be doing in 10 years. I'd always been interested in biology but knew I knew I didn't want to be a doctor or a nurse and I didn't realise you can do direct entry midwifery rather than doing nursing first. My husband and I moved back to the UK after 14 years in Ireland [where you can't do direct entry] so I could do my training. I went to King's College London for a three year course and got a bursary.

This is my first job and I've been here for a year. I was really lucky to come straight into such an amazing practice. I knew that I wanted to work in the community in some respect as I like the continuity of care. You do some of that as a student and I always preferred that to high drama labour ward stuff.

What is difficult for midwives is the level of responsibility and the pressure because what you're doing matters and that's the same with any midwifery job. We're on call 24 hours a day, seven days a week when we're not on holiday. But the advantages are just huge. You really get to know women and their families. There is always joy and celebration around birth and it's such a privilege to be there especially if you've known them throughout their own pregnancy. It's hugely rewarding.

I have no regrets about re-training. My husband is still an actor and he often asks if I miss it and I'm not missing it at all. It was absolutely the right move - now I'm getting up every day and feeling like I'm doing something important."