Midwifery and the 6Cs

As part of our Trusts ‘Celebrating Excellence in Nursing and Midwifery’ event recently our Director of Nursing emphasised to all participants the importance of delivering the values and behaviours of the 6 Cs as we go about our practicing our professions. The 6 Cs:





Courage, and


are the key components of the ‘Compassion in Practice’ policy document of the NHS Commissioning Board, and outlines the 3 year vision and strategy compiled by the Chief Nursing Officer and Director of Nursing at the DoH.

On examination of the implementation plans within the document my focus is of course drawn to the midwifery specific sections. There is of course the usual midwifery rhetoric one would expect to find in such a policy document…holistic responsive care, developing supportive relationships, advocacy, safe practice, providing positive experiences and such like. There are two areas however which I pondered on for some time. Firstly, as direction on delivering the ‘vision’ the document states that the contributions midwives make to public health will be mapped, based on the Midwifery 2020 paper of 2008. This would include such public health issues as improved breastfeeding rates, screening programmes and working with vulnerable families. For example as a direct result of the obvious health benefits to mother and baby from exclusive breastfeeding UNICEF have stated that the NHS could save up to £40 million each year if we only moderately increased breastfeeding rates in the UK. And in poorer nations exclusive breastfeeding is not just a health issue it s matter of life or death – where clean water is scarce and malnutrition is rife Save the Children have stated that just from early and exclusive breastfeeding 830,000 babies lives could be saved every year (see previous blog entries).

Secondly, action five in the ‘Compassion in Practice’ document emphasises the need for adequate and safe staffing, stating how crucial it is that “we have the right staff, with the right skills, in the right place” in order to deliver the ‘vision’. Recently the Royal College of Midwives have estimated that in the UK we need another 5000 midwives to cope with rising birth rates, and we’ve all felt this shortfall affecting the care we give our women and families. Imagine working in a nation with a health worker deficit of over 2.5 million staff. This is the reality my colleagues and I saw as we visited India in January as Health Worker Ambassadors for Save the Children (see previous blog entries). In the absence of qualified midwives and doctors we observed accredited social health activists (ASHAs) undertaking midwifery and health education responsibilities for less than minimum wage in order to improve the health and birth outcomes for the women and babies in their communities, the very model of ‘compassion’ and who were delivering the 6 Cs on a daily basis.  The State of the Worlds Mothers report from Save the Children has highlighted the need to invest in health workers as one if its major recommendations in the struggle to reduce maternal and child mortality worldwide. Health staff need to be recruited and trained, be well equipped and be incorporated into fully functioning health care systems to deliver the life saving care that so many are desperately in need of. 99% of all maternal deaths worldwide occur in developing nations, that’s 800 every day. 8000 babies pass away within one month of birth. It’s a lot to take on, but so much is at stake.

We all have our role to play in the implementation of Compassion in Practice, and in improving maternal and child health both in the UK and abroad. The health staff I have worked with in Asia and Africa have shown some of the greatest of the 6Cs I have ever witnessed as they have carried out their duties in the toughest of settings. But we can’t do this is isolation. Let’s hope that our world leaders don’t forget this as they meet at the G8 summit this month. As the State of the World’s Mothers report states, improving newborn, child and maternal health should not only be on the public health agenda, is also vital for global development.

 Useful links:

Compassion in Practice:


Midwifery 2020: Delivering Expectations


UNICEF & breastfeeding


Save the Children, Superfood for babies:


Save the Children ‘State of the World’s Mothers’ report: