Midwifes Role in Postnatal Contraceptive Care - Essay Example

Midwifes role in postnatal contraceptive care Introduction Pregnancy is considered by many as not less than a miracle. Midwifery is a special branch of medical profession which is mainly dominated by women. It is a profession that mainly deals with pregnancy and childbirth. In general, the roles of midwife are to look into pregnancy or childbirth, and of course the antenatal care during the pregnancy. A midwife is expected to look into aspects such as medical examinations, palpation, listening to the baby's heart and checking the wellbeing of both mother and baby, in preparation for the birth. There are also many cases where in midwives are involved in conducting free NHS antenatal classes. Additionally, they are also capable of offering pre-pregnancy advice on conception (soFeminine.co.uk, 2008). This paper discusses some of the major roles in providing postnatal contraceptive care. It argues how midwifes can be the best source of information for postnatal contraceptive care. The argument is, 'Is contraceptive advice the role of the midwife' This is an issue that has been asked by many and continues to be relevant even today. If we look at the past history it can be noted that midwifery is one of the few health care professions which is dominated by female practitioners. Right from the age of Agnodice in ancient Greece to the 18th century in Europe, the care of mothers and delivery of infants has been considered a female orientated profession. However, today there is a change in this attitude as men around the world are taking up this profession. Right from the early time when this profession came into existence it has been more-or-less a social role and was given due respect. It is only today with the development of modern day techniques of child birth, that midwifes are losing their demand. This becomes evident from the fact that in the 18th century, a separation among doctors and midwives arose, as medical men began to claim that their modern scientific practices were better for mothers and infants than the folk-medical midwives. Additionally, it was noted that during 18th century in England most of the pregnancy cases were taken up by a midwife, whereas by the onset of the 19th century the majority of babies were delivered by surgeons. Right from the beginning it was seen that midwives possess excellent knowledge and expertise in childbirth and were also knowledgeable about contraception and abortion. However, it was noted that this concept went against their role and they were discriminated and looked down because they wanted to depopulate society. As a result of this discrimination it was thought that it was important to give proper education to midwifes and improve their societal image. The first midwifery course was started in America, which has only improved over decades and now midwifery is a recognised and respected profession (Helenofellon, 2007). While the role of the midwife is very diverse, they are considered the best persons for providing information on the use of contraceptives to the young mothers. This is mainly because they in general have a long association with the pregnant women and their family and are also involved in supporting the mother and her family throughout the childbearing process. During this time they can develop good interpersonal relationship and help them adjust to their parental role by providing health and parenting education as well as help them plan for the future pregnancies. According to the recent NICE guidelines, contraceptive methods and advice about when to start them should be discussed with patients. Methods and timing of continuation of contraception need to be discussed within the first week of the birth (NICE, 2006). It is common that midwives work together with other health and social care services to meet the mother's needs including, teenage mothers; mothers who are socially excluded; disabled mothers and mothers from diverse ethnic backgrounds. Therefore, they have a greater access to these women who are in real need of help. Midwives are generally the first and main contact for the expectant mother during her pregnancy as they are considered as experts in normal pregnancy and birth and also in the postnatal care. In fact, it is estimated that in UK midwives are the lead professional at over 75% of births (Helenofellon, 2007). They assist the mothers make knowledgeable choices about the services and options available to them by providing as much information as possible and it is true in the case of contraceptives also. Midwives care for and support pregnant women, their partners and babies, before, during and after the birth. Today, in general it is expected that midwives need to give advice even before a baby is conceived. Some of the most common duties of midwives are monitoring the health of the mother and baby with physical examinations and ultrasound scanners; Counselling the expectant mother on various issues such as healthy eating, giving up smoking, giving up drinking, domestic abuse, exercise; Exploring the mother's options for the birth, for example natural childbirth, pain controlling drugs, hospital or home delivery; Looking after the mother and baby during labour and birth, and for around one month after the birth (Helenofellon, 2007). Today, it is expected that midwives also give advice on selecting the right contraceptive for planning the future pregnancies. It is important to note that contraceptive planning begins early in pregnancy, and continues throughout. Young women are encouraged by the attending midwives to make a contraceptive choice before delivery or very shortly afterwards since their next ovulation can start in next couple of weeks. Midwives can give practical support and also supply of contraceptives to the young mothers. However it is important that the midwives have additional family planning training or qualifications. The midwives need to find the most suitable contraception for each individual, by taking into account the needs of young woman. It is also important to look into the health of the child as any kind of hormone related contraceptives can have an impact on the child growth and development. Besides it is also essential to understand how women would feel about body image issues such as having no periods or slight weight gain. Midwives also need to have knowledge of previous contraception used (if any) and ensures that the young woman understands why the method may have failed. Midwives need to discuss future contraception, with a general account of all methods and, if the young woman has already made a choice, a detailed discussion of that method and how to access it locally. Midwives may also discuss STIs, demonstrates condom use and gives the young woman a supply of condoms (McLeish, N.D.). Today, teenage pregnancies have turn out to be a public health issue because of their negative effects on prenatal outcomes and long-term morbidity. It is important to prevent teenage pregnancy through proper education. And the role of midwifes is well recognised in this field. Coping with the demands of an infant is likely to be even more challenging and stressful for a teenager who is not mentally and physically prepared for when compared to an older woman. Pregnancy and the responsibilities that come with is not an easy task. A pregnancy at a very young age especially before the college days can have serious problems of health of both the mother and child. Besides, a pregnant teenager may face many of the obstetrics issues as women in their 20s and 30s but there are additional medical concerns for younger mothers, especially those under the age of 15 (Mayor 2004). The results of a UK based study conducted by Jarvis et al. (1997) among midwives working in the Maternity Unit of Billinge Hospital (UK) point out the following facts. The main purpose of the survey was to assess the postnatal family planning counselling provided by midwifes. It was found that all 67 respondents said that they discussed contraception with their clients before discharge from the hospital. It was found that seventy five per cent of midwifes directed their clients to family planning clinics, sixty four per cent referred them to their family practitioners, and thirty seven per cent provided leaflets listing family planning clinics in the area. Though there were several methods of contraception that was prescribed, 52% of midwives presented all contraceptive methods, 37% discussed only those methods with which they were familiar such as barrier methods, the pill, and Depo-Provera. Further, discussion with them pointed out that majority of them about ninety six per cent perceived themselves as the most suitable professional to provide such counselling because of to their long and reputable association with their clients. Additionally seventy nine per cent of them felt that the immediate postpartum period was the most appropriate time for this service (Jarvis et al. 1997). This study has aided very well to understand the effectiveness of the role of midwifes in postnatal contraceptive care. If we look into the reason of why midwives can be the best source of information for postnatal contraceptive care it can be said that it is because they have a close association with a woman's sexual and reproductive life. However it cannot be said that the midwives are not the sole persons to take this responsibility. It needs to be a team responsibility of all those concerned with family and community health and education. In fact it is a societal responsibility. From the perspective of a midwife, it seems that providing women especially the young mothers, with postnatal contraceptive care and guidance is the least of the likely influence that they could have on this issue. Today when teenage pregnancy itself is perceived by our society as a crime, and is placed alongside drug abuse and crime on Government initiative agendas (Mowlam, 2000; Gilham, 1997 cit. in Perry, 2002) this role of midwives is well recognised. The most undeniable point of the teenage pregnancy profile is that of social exclusion. Today it is well recognised that midwives with proper education can help to educate the teenagers in schools and colleges and can be of great help to the society. However, it is important to note that if the midwife is to play a valuable part in sexual health education, she must be familiar with these issues and need to be given all rights to handle such cases. According to a report of the fifth annual State of the World's Mothers, published by the international charity Save the Children it was found that 13 million births that accounts to a tenth of all births worldwide each year are to women aged under the age of 20, and they also reported that more than 90% of these births are in developing countries. These figures also showed that girls in this age group were two times as likely as older women to die from causes related to pregnancy and childbirth. Besides, the babies born to young mothers were 50% more likely to die than children born to women in their 20s. Studies have also found that the youngest mothers especially those aged 14 and less is faced with greatest risks. It was found that obstructed labour to be common in teenage girls, resulting in amplified risk of infant death and of maternal death. In the 10 highest risk countries, more than one in six teenage girls aged 15 to 19 gave birth each year and nearly one in seven babies born to these teenagers died before their first birthday. Studies also showed that young mothers and their babies were at greater risk of contracting HIV (Mayor 2004). In general, it is said that if a women is well educated, it is good for the family and children future. Schooling is important to a young woman's prospects throughout her life. This is because the amount of schooling a woman obtains affects her occupation, her income, her chances of marriage, her risk of poverty and welfare dependence and more over the quality of her own life and that of her children (Adler et al. 1994). Today in most parts of the world, the importance of schooling is well recognised especially for girls. Motherhood is and important and special event in a women's life, because childrearing consumes time and energy and mostly women bear the primary burden of child care. In case of young mothers caring for and rearing children consumes time and energy that could otherwise be spent on schooling, work and leisure-time activities. Midwives can play a significant role in educating teenagers in methods of avoiding pregnancy. Additionally it is recognised that issues such as poverty is of serious concern and the Department of Health's report on teenage pregnancy is associated with teenage pregnancy. In fact they suggest that the risk of becoming a teenage mother is ten times higher among young women from families dependent upon uneducated labour than those from professional families. Besides, children in foster care are more prone to become teenage mothers. Several researchers have worked on the issues related to teenage pregnancy and its impact on health and social life. They have found that teenage pregnancy is linked with low educational achievement, non-participation in education, training or employment, sexual abuse, mental health problems and crime (Social Exclusion Unit, 1999, cit. in Perry, 2002). Studies have pointed out that the main cause of many of these circumstances is associated to class disparity and the division of wealth. Nevertheless, there is no exclusive fundamental link between low education and teenage pregnancy rather it is part of a wide based socio-political web of issues (Social Exclusion Unit, 1999 cit. in Perry, 2002). Most of these studies say that it is possible to reduce the problems of teenage pregnancy with the involvement of midwives. The most important thing here is to make this knowledge available to the family planning arena. In fact many of them suggest that this knowledge should be the basis upon which midwives are educated to become sexual health educators. The factors which control teenage pregnancy rates surpass the facts of how to use a condom properly. Nevertheless, comparative studies show that the UK fares inadequately on this front. It is the details of these findings, around which the midwife is well suited to strap up her practical skills (Perry, 2002). Though not all teenagers experiment with sex at comparatively younger ages, but of those that are experimenting lack knowledge of contraception especially in UK. This rate is considerably higher than many European countries (Social Exclusion Unit, 1999 cit. in Perry, 2002). There is a reckonable link to dearth of information on contraception, and lack of access to contraception especially among the teenagers. Though the official role of the midwife includes giving contraceptive advice, the study by Jarvis et al. (1997) shows that it is not practiced effectively. However the Midwives Code of Conduct states that: "She has an important task in health counselling and education, not only for the women, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynaecology, family planning and childcare. She may practise in hospitals, clinics, health units, domiciliary conditions or in any other service (UKCC, 1998)". Studies have found that the National Teenage Pregnancy Midwifery Network, contributes effectively to preventing unplanned second pregnancies among young women by providing access to contraceptive advice (McLeish, N.D.). However in most of the places this role of midwives still needs improvement. Sex education plays an important role in bringing down the rate of teenage pregnancy. Researchers have suggested that midwives who are trained in contraceptive care can be of great help for accomplishing this goal. Studies point out that the accompanying low pregnancy rates indicate the helpfulness of this open ideology (MacKeith and Phillipson in Kargar and Hunt, 1997 cit. in Perry, 2002). Likewise, it was also found that places such as Finland has extremely low teenage pregnancy rates and is mainly attributed to the sex education. Finland provides a complete sexual education curriculum, which is taught to children age eight to nine and is led by a health care worker. Additionally, in Finnish schools, the emergency contraception pill can be administered. In fact these good examples should be taken as lessons for change in other countries where teenage pregnancy is high and needs immediate attention (Hudson, 1997 cit. in Perry, 2002). Even though the UK has had sex education in all secondary schools only since the Education Act (1993), there are yet no apparent guidelines on the issue of who should teach the subject (Dolby, 1998 cit. in Perry, 2002). As a result of this there are high teenage pregnancy rates. Perhaps the current system for sex education has several loopholes and is insufficient in several ways. Though parents play an important role in sex education, they have little knowledge on how to talk with their children about sex. As a result there is a considerable amount of misinformation and ignorance among youths about sex, and how to cope with puberty and adolescence (Social Exclusion Unit, 1999 cit. in Perry, 2002). This dearth of information among the teenagers can be filled by the help of health centres and midwives. The community health and education systems could partly cover these topics in schools and benefit the youth. In this aspect the midwives is well suited to speak about sexual health within the school curriculum as they is familiar with the reproductive anatomy and physiology. Additionally they also have modern information on sexually transmitted infections, prevention and treatment. Since they are always associated and well informed about the emotional aspects of pregnancy and child birth, they are also familiar with some of the psycho-social aspects of sexuality which can be of great support. A midwife is comfortable with the language to make students understand reproductive issues and is most probably responsive to the tact and insight necessary in discussing these issues. An advantage of utilising midwives fro sex education in schools is that they are not teachers in the school system cornered into teaching sex education with which they may not be comfortable. The fact that they would be seen as separate from the staff and faculty brings in confidence in students to come out with all their doubts on this issue without any fear (Social Exclusion Report 1999 cit. in Perry, 2002). In conclusion, it is important to note that the role of midwives has been of great support to the health care centres and hospitals. It is important to recognise the importance of their role and give them due respect in the medical field. Though their role is just restricted to taking care of pregnancy and childbirth, there are many fields in which they can support. Additionally, since they are mainly involved in pregnancy they are also recently involved in providing postnatal contraceptive care. Therefore, it is important to educate and train them in the field and provide complete support. This can not only bring down the rate of unwanted pregnancies but can also help in the improvement of women and child health. Besides, midwives can also be involved in educating the youth on the use of contraceptives. They are the best people who can give precise knowledge on these issues and can be of great support to the nation's wellbeing. References Adler N.E. et al., (1994) Socioeconomic status and health, American Psychologist, 49(1):15-24. Dolby L (1998). Is sex education in the Netherlands better organised than in Britain British Journal of Midwifery, vol 6, 96-99. Gilham, Bill (1997). The Facts About Teenage Pregnancy, Cassell, London. Hudson P (1997). Contraceptive advice for teenagers in Finland, Midwives, vol 110, 222-223. Helenofellon, (2007) So you want to be a midwife- A review by Helenofellon on Midwifery. [Online] Available from: [Accessed on 10 August 2008]. Jarvis, R., Lewis, P.A. and Blanchard, S. (1997) Postnatal contraceptive advice -- midwives' attitudes. British Journal of Family Planning, Jan;22(4):181-182. MacKeith P and Phillipson R (1997). Young mothers , In: Kargar I and Hunt S (Eds). Challenges in Midwifery Care, MacMillan Press, London. Mayor, S. (2004) Pregnancy and childbirth are leading causes of death in teenage girls in developing countries. BMJ(15May)2004;328:1152. McLeish, J. (N.D.) 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