Edwina Thomas, BA, MM, RN, Clinical Nurse Specialist (Midwifery) Nepean Hospital, Sidney, NSW, Australia

The responsibility of caring for pregnant women and both their unborn and newly born babies falls directly and squarely upon the shoulders of midwives in whatever setting in which they work. In small peripheral hospitals midwives often fulfil much of the role played by registrars and residents in larger institutions. This certainly helps enable these midwives to provide holistic care, and truly function as midwives, but in doing so increases both the responsibility undertaken by, and the public's expectations of the midwife. Similarly, in all midwife-led antenatal clinics the responsibility of recognising deviations from normal and implementing timely, effective intervention is great. To protect ourselves we tend to engage in a lot of ritualistic practices that do little to ensure maternal and fetal well-being, but which serve to ‘prove’ we ‘did everything possible’ for a good outcome.