title: Midwives and supervisors of midwives' perceptions of the statutory supervision of midwifery within the United Kingdom: a systematic review.
abstract: Within the United Kingdom, the statutory supervision of midwives has a central role in both the provision of safe, high-quality maternity services and in the regulation of midwifery practice. Despite its long history, little is currently known about how midwives and their supervisors perceive and experience the statutory supervisory process.
  
  
  OBJECTIVE
  to review and synthesise published research on midwives and supervisors of midwives' perceptions of the statutory supervision of midwives within the United Kingdom.
  
  
  METHODS
  a systematic review of published, empirical literature was undertaken. This comprised a systematic search of six electronic databases, supplemented by hand-searching and contact with five subject experts. Each of the 19 papers that met the inclusion criteria were critically appraised, thematic analysis was used to systematically extract key themes and a narrative approach to data synthesis was adopted, giving greatest weight to studies of higher methodological quality.
  
  
  RESULTS
  three studies were rated as high quality, 12 good quality and four poor quality. Four overarching themes were identified; within each theme a range of perspectives were reported. These encompassed very positive views at one end of the continuum to very negative views at the other. The four themes reported variable understanding of the statutory supervisory framework and engagement with supervisory processes; contradictory views regarding the value of supervision and inconsistent relationships were described across the literature. Supportive relationships and high quality leadership were described as being empowering and developmental while perceived power imbalances resulted in supervision being portrayed as punitive and destructive. Resourcing supervision, by way of protected time and recompense was recognised to be a challenge.
  
  
  CONCLUSIONS
  this review highlighted considerable variability in both midwives' and supervisor's understanding of the nature and purpose of supervision as part of the NMC statutory framework. In particular, the potential for supervision to enhance personal development and midwives' practice varied according to the nature of the relationship between midwife and supervisor. The importance of supervision being fit for purpose and supervisors possessing the requisite knowledge, skills and attitudes to execute their role and responsibilities effectively cannot be underestimated. More research is needed to examine ways in which statutory supervision contributes to patient safety and high quality care and what opportunities there may be for the statutory framework to develop and empower midwives to work within current, and future, contexts of maternity care.
  
  
  CONCLUSIONS
  as 13 of the 19 studies included within this review were conducted prior to publication of the current rules and standards underpinning the statutory framework for midwifery within the UK (NMC, 2004, 2006), it is plausible that the evidence base does not reflect contemporary midwifery and statutory supervisory practice. Notwithstanding, the research included within this review clearly suggests a need to increase both midwives and supervisors of midwives' knowledge and understanding of the statutory framework.
authors.affiliation: Academic Unit of Child, Family and Maternal Health, School of Healthcare, University of Leeds, Woodhouse Lane, Leeds LS2 9UT, United Kingdom. a.henshaw@leeds.ac.uk
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Henshaw
authors.forename: David
authors.initials: D
authors.lastname: Clarke
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Long
mesh_terms: D002983:Clinical Competence; D006801:Humans; D008427:Maternal Health Services / Q000379:methods / Q000592:standards; D009721:Nurse Midwives / Q000592:standards*; D009745:Nursing, Supervisory / Q000592:standards*; D010346:Patient Care Management / Q000458:organization & administration*; D061214:Patient Safety / Q000592:standards; D011787:Quality of Health Care; D012938:Social Perception; D006113:United Kingdom