The role of quality assurance in future midwifery practice

Recent recommendations have been made which would give midwives a more central role in maternity care and a greater degree of independence than they currently enjoy. This paper argues that midwives' current attitudes to quality assurance are incompatible with this enhanced role. Research conducted in three health districts is described, which explored the perceptions of nurses, midwives and managers towards quality assurance. The findings indicate that quality assurance (in whatever form that concept is operationalized) is a demonstration of accountability. For managers this accountability is primarily for the service as a whole, whilst nurses and midwives view their accountability as being owed to patients/clients. The main methodology which the study identified as being used for monitoring nursing care was the development and auditing of explicit standards. This approach has been actively promoted by the Royal College of Nursing, enabling nurses to regain control of the purely professional aspects of the nursing profession. Midwives in the study districts showed a marked reluctance to adopt such a strategy, taking the view that as independent practitioners consensus standards would be unacceptable. It is argued that this attitude is inconsistent with the basic principle that professionals are accountable for both demonstrating and developing the quality of professional practice. It is further suggested that midwives currently have an opportunity to regain professional control of midwifery practice, which will be lost unless they are prepared to take responsibility for evaluating the standards for which they are accountable.