The Code
In the Code there are four pillars; prioritise people, practise effectively, preserve safety and promote professionalism and trust).
Prioritise people - You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.
Practise effectively - You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay, to the best of your abilities, on the basis of best available evidence. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice.
Preserve safety - You make sure that patient and public safety is not affected. You work within the limits of your competence, exercising your professional ‘duty of candour’and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.
Promote professionalism and trust - You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the professions from patients, people receiving care, other health and care professionals and the public.
Which standards within the four pillars are most relevant to this case scenario?
Standards of proficiency for midwives
In the Standards of proficiency for midwives there are six domains:
- Being an accountable, autonomous, professional midwife
- Safe and effective midwifery care: promoting and providing continuity of care and carer
- The midwife’s role in public health, health promotion and health protection
- The midwife’s role in assessment, screening and care planning
- The midwife’s role in optimising normal physiological processes and working to promote positive outcomes and prevent complications
- The midwife’s role in first line assessment and management of complications and additional care needs
- The midwife’s role in caring for and supporting women and newborn infants requiring medical, obstetric, neonatal, mental health, social care, and other services
- Working with others: the midwife as colleague
- Developing knowledge, positive role modelling and leadership: the midwife as scholar and leader
- The standards say that midwives are fully accountable as the lead professional for the care and support of women and newborn infants, and partners and families. They provide care based on the best available evidence and keep up to date with current knowledge and skills, thereby helping to ensure that their care is responsive to emerging evidence and future developments. They work in partnership with women, enabling their views, preferences, and decisions, and helping to strengthen their capabilities. Midwives work in partnership with women to promote positive outcomes and to anticipate and prevent complications. Midwives make a vital contribution to the quality and safety of maternity care, combining clinical knowledge, understanding, and skills with interpersonal and cultural competence.
Which domain(s) had most relevance for this case scenario about additional care needs, complication and multidisciplinary working?
Standards for pre-registration midwifery programmes
Approved education institutions, together with practice learning partners, must provide practice learning opportunities that enable students to develop and meet the NMC Standards of proficiency for midwives. This includes:
3.3 provide students with learning opportunities to enable them to achieve the proficiencies related to interdisciplinary and multiagency team working
3.4 provide students with learning opportunities to enable them to achieve the proficiencies related to continuity of midwifery carer across the whole continuum of care for all women and newborn infants
3.5 provide learning opportunities, across the whole continuum of care
3.5.5 develop the required knowledge, skills and behaviours needed to support and care for no less than 40 women who have additional care needs or develop complications including those related to physical, psychological, social, cultural and spiritual factors.
Reflect on your learning from this case scenario. What will you take back to practice?
- Consider as part of your reflection - are there other standards not given above?
Bibliography
IHRD (2018). Report of the Inquiry into Hyponatraemia Related Deaths; Chairman Sir John O’Hara. Website: www.ihrdni.org. Report: https://www.ihrdni.org/inquiry-report.htm. (Accessed 21/01/2026).
Moen V, Brudin L, Rundgren M, Irestedt L. Hyponatraemia complicating labour-rare or unrecognised? A prospective observational study. BJOG. 2009 116:552-56. https://pubmed.ncbi.nlm.nih.gov/19175600/ (accessed 21/01/2026)
National Institute for Health and Care Excellence Guidance (2025), NG229 Fetal monitoring in labour https://www.nice.org.uk/guidance/ng229/chapter/Recommendations. Published December 2022; updated Nov 2025. (Accessed 21/01/2026)
National Institute for Health and Care Excellence (2025). NG235 - Intrapartum care [P] Supporting document for the recommendations on fluid balance and peripartum hyponatraemia. https://www.nice.org.uk/guidance/ng235/evidence/p-supporting-document-for-the-recommendations-on-fluid-balance-and-peripartum-hyponatraemia-pdf-474720226460. June 2025. (Accessed 21/01/26)
NHS Resolution (2023). Recognising and avoiding significant maternal and neonatal hyponatraemia https://resolution.nhs.uk/resources/recognising-and-avoiding-significant-maternal-and-neonatal-hypoatraemia/ (Accessed 21/01/2026).