Health and Social Care - Literature review Example

Running Head: Health and Social Care Health and Social Care Name Institute Date Midwifery is a health care system in which health care personnel provide prenatal, antenatal and postnatal care services to the expecting mother. Midwifery healthcare system is divided into three categories, the primary, secondary and tertiary healthcare (Australian College of Midwives (2006b:5). Primary health care involve providing primary medical care to expectant mothers and this care is provided mostly by midwives. It is the indispensable and incorporated care founded on practical, scientifically sound and socially acceptable procedure and technology. Primary health care services are made accessible to all expectant mothers as close as possible to where they reside through their complete involvement in the spirit of autonomy. It is the first level of contact of with expectant mothers at the individuals; family and community level (Roberts 2000:140). Primary health care include broad services which stress on health promotion and preventive care rather than curative services. Primary health care recognizes the role played by health determinant factors such as social, emotional and physical factors. It is based on provision of health care services to all people regardless of their class, race, gender or ethnicity (NSW Health 2006). It also adapts an interdisciplinary approach to healthcare, which also include the community in the management of their own care, to health care. Primary health care identify preventive measures which can be implemented to prevent the onset of a disability at the prepathogenesis stages. Primary healthcare practice centers on the detecting possible risk factors for illness in expectant mothers and aims at factors which can be changed. Other services offered by midwives in this area include counseling and education and reproductive health care (Australian College of Midwives 2007:12). Secondary health care is an intermediate level of health care. Secondary healthcare provide specific technical, therapeutic and diagnostic services. Secondary healthcare is usually acute care, such as emergency care, offered by clinical specialists in a hospital setting. Expectant mothers who experience complicate pregnancy, labor and birth are often referred hospital-based obstetrician from the primary healthcare professional. Secondary health care provide health care services to a wider group of expectant mothers from a broad geographical location than those served by primary health care. Secondary health care is aimed at coming up with measures which can be helpful in detecting underlying diseases when explicit medical signs are not evident. When a disease is detected at the early age it becomes easier to treat it (Straton 2006:23) Tertiary healthcare refers to specialized and highly technical healthcare services, such as diagnosis and treatment of disease and disability, which are offered mostly by the private clinical profession. Examples of such services include specialized neonatal intensive care units, advanced diagnostic support services and highly specialized obstetric care. Tertiary health care come up with measures to be implemented to treat a disease after it becomes indicative. It therefore centers on restoring and maintaining maximum function, while preventing the occurrence of other diseases (Australian College of Midwives 2006b:7). Midwifery services in Australia The strengths, weaknesses, threats and opportunities of midwifery services in Australia can be identified by looking into the four areas of maternity care: pregnancy care, childbirth, post-birth and pre-conception care. One of the strengths of the antenatal clinics is that they provide continuity of care to expectant mothers. Midwives are responsible for normal maternity care services. Studies have shown that women do not experience difficulties during labor when placed under the care of care givers who are familiar to them (Working Party on GP Obstetric 2005:87). Midwives have adapted a collaborative and interdisciplinary approach to maternity care within the health care system. This has provided women with low risk pregnancies with various alternatives outside the secondary and tertiary health care setting (Department of Health for Children, Families and Maternity 2007:45) Midwives have come up with home visiting programs in order to provide quality pregnancy, birth and post-birth care (Straton 2006:10). These home visiting programs are meant to provide care to women at their residence. These have saved the women from traveling long distances for maternity care services. They have thus formed antenatal groups which provide a forum for education and training for expectant mothers. In these groups, they visits expectant mothers in their home setting where they advise and train then on how to adapt a health lifestyles to avoid pregnant complications. They have also come up with pregnancy and parenting classes. (Department of Health WA, 2006a:57). These classes are meant to provide expectant mothers with information as regards care choices during the pregnancy, delivery and post-birth period. For example, they teach then on importance of proper dietary, alcohol and cigarettes absenteeism and the regular exercise. Studies have shown that adapting a health lifestyle has helped in reducing complication cases reported during pregnancy. However, the high prices charged for these antenatal classes has prevented many women to attend such classes and therefore do not benefit from such education (Ponton 2005:371). Antenatal clinics also give postnatal care services. Midwives in Australia continue to visit mothers and babies for at least the first 10 days, especially those in the rural and remote areas, in their homes to advise them on proper after-birth care. During this time, they offer them breastfeeding lessons where they teach them the importance of the mother’s milk and exclusive breastfeeding for the first six months to the baby’s health (Roberts 2000). Exclusively breastfeeding the baby for the first six months have resulted to decrease in cases of children illness at both the early and later life. They also help them to build a positive relationship and inform then of the available support services near them. By doing this, the midwives can identify those families that are at risk or who may need extra services and advice them accordingly or refer them to tertiary health care institutions (Straton 2006:53). Midwifery-led continuity care has not led to improved patients’ outcomes. Midwifery care interventions have led to decrease in rates of virginal birth, inductions and epidurals where as immunization and breastfeeding rates remain high even after six months. Furthermore, midwifery-led care has also led to decrease in prenatal mortality, sexual transmitted diseases during pregnancy, antenatal admission for women with serious complications and finally but not least decrease in admission of sickly babies to neonatal intensive care (Working Party on GP Obstetric 2005:87). Rates of premature birth and teenage pregnancies have also reduced. Studies have shown that children born in midwifery-led care services are less likely to require resuscitation and only a few are admitted to hospital after birth. Midwifery care services have widely helped women in the lower socio-economic group who cannot access secondary maternity health care. However, it is important to note that midwifery-led care has not led to increase in caesarean delivery rates experienced throughout Australia (Ponton 2005:370). There are a number of weaknesses in he midwifery services in Australia which include lack of choice, lack of capacity. There are limited alternatives and availability of maternity care services offered to pregnant women (Midwives Focus Group 2006:28). Due to the scarcity of obstetric services, pregnant women are forced to travel long distances looking for these services. These have led to increase in expenses and the separation of women from their families and friends when they need them most (Working Party on GP Obstetric 2005:87). Most women are not aware of the available options and networks they can link into (Midwives Focus group 2006:56). Workforce shortage in Australian maternity care system has led to poor delivery of maternity care. There are few midwives, obstetricians, neonatologists and allied health professional trained in Australia. This has greatly limited the ability of the available workforce to deliver quality maternity care. Hospitals in Australia are forced to recruit health professionals from abroad (Metropolitan Clinical Services group 2006:86). The maternity care in Australia is not adequately addressing the needs of women who are at high risk, including the socio-economically disadvantaged women and women with mental illness. Recommendations Education and training programs: It is important to design educational and awareness programs focused educating and informing women of the available maternity care options and support network services. It is important to provide women with adequate information or guidance as regards available maternity care options so that they can be able to make informed decisions about their care. Midwives should develop care pathways and give women a copy to help then tap into other services if need be (Metropolitan Clinical Services Group 2006: 58). It is believed that increasing women’s access to midwifery-led care services will result to low rates of complications during birth. Women should have access to low risk delivery facilities. Midwifes should also be trained to perform certain low risk births procedures as this would result to less complicate births rates (Cohen 2003:45). Maternity care health professionals need to be more flexible in helping expectant women to make choices (Metropolitan Clinical Services Working Group 2006:78). More Aboriginal health professionals should be trained to take care of Aboriginal women needs (Straton 2006:68). Recruiting and developing qualified health professionals is vital to future midwifery services (Health Reform Implementation Taskforce 2006b:97). Community-based care: Maternity care services should be community based. It is imperative to change the current support for GP obstetrician model of care which is highly medicalised and develop a community-based care model. This will help solve the problem of lack of capacity in addressing the needs of expectant women, especially in the rural and remote areas in Australia (Working Party on GP Obstetrics 2005). This community-based care model should adapt a multidisciplinary approach and developed within the community not the hospital setting (Australian College of Midwifes 2006:67). Community based maternity model recognizes the role played by midwives in maternity care. Such a model will lead to continuity of care whereby the midwives take care of normal maternity services where as the obstetricians take care of emergences (Department of Health South Australia 2006:19). Midwifes should be allowed to practice all their competences within the scope of the midwifery practice. This means that they should provide a complete range of antenatal, labor, birth and postnatal services on their own without being supervised by a physician (Community Midwifery WA 2006:78). A collaborative and multidisciplinary maternity care approach: The midwives should be let to operate independently while collaborating with other disciplines within the health care system (Brown and Bruinsma 2006:63).Midwives should consult general practitioners, general practitioners obstetricians, pediatricians, anesthetists, child health nurses, allied health professionals and other health professionals when necessary and should always refer cases of emergency or special cases to secondary or tertiary maternity health care (Queensland Health Department 2005:38). A collaborative approach also means involving local communities to participate in formulating health care policies and priorities as concerns pregnancy and birth. For example, a midwife should ensure a coordinated, devoted and comprehensive approach to care and encourages open lines of communication between all disciplines in cases when the patients/families are struggling with end-of-live decisions. Midwifes should also encourage and empower communities to take care of their patients (Health Policy and Clinical Reform 2006:45). To support this, they should assess the needs for community’s care giving roles and teach them how to take care of their patients. An important element of coordination of care is the facilitation of patients and families in the course of care to guarantee “faultless” provision of maternity care (Hodnett 2005:67). The midwifery practice should implement a woman-centered care initiative in order to deliver quality maternity care. A woman-centered care focus on the woman as an individual, her unique needs, expectations and aspiration as opposed to the needs of the profession involved. In the midwifery care, women should be allowed to participate in the management of their own care (Fry 2003:320). Women should be included in decision-making in all matter affecting their health. A woman-centered care initiative will result to higher customers’ satisfaction. Midwives should also promote a family-centered care and services to bring about cooperation between the patient/family and team members. It is believed that developing a woman-centered care will permit midwives to completely use their skill base. Such a move will also draw non-practicing midwives back into the labor force and even encourage others to take up this profession. This will solve the problem of shortage of midwives and lead to increase in number of maternity clinics (O'Cathain 2002:644). Family birth centers: It is important to come up with family birth centers, especially in the rural and remote areas, so that maternity care services can be offered close to women’s home as possible. However, these centers need to maintain link with other hospitals so that they can get easily get support services if needed. Such a move would encourage more families to participate in planning and experience pregnancy and childbirth in a secure, relaxed and personalized setting (AHMAC 2006). In conclusion, developing an effective midwifery services in Australia lies at the heart of developing appropriate educational and training programs, family birth centers, community-based care model and a woman-centered care model. If all the measures are implemented, the maternity services system in Australia will experience a midwife service that is intensive, evidence based which focuses on outside hospital low-risk births and respects the rights of women and their families. References AHMAC. (2006). National cooperation on maternity services guiding principle briefing paper. Canberra, Australia, AHMAC. Australian College of Midwives (2007). Position declaration: evolution of care between midwives and child and family health nurses. Canberra, Australia. Australian College of Midwives. (2006) Information on maternity care services. Australian college of Midwives. Australian College of Midwives. (2006b). Midwifery continuity of care. Canberra, Australia. Brown S. and Bruinsma F. (2006). Prospect for Victoria’s community maternity services: “is this what women would like”? Australian Health Review, 30: 56-64. Cohen H. (2003). Western Australian nationwide obstetric services evaluation: Report of the project working group. Perth, Australia. Community Midwifery Western Australia. (2006). Community Midwifery Western Australia- pregnancy and Childbirth Centers. Department of Health for Children, Families and Maternity. (2007). Maternity issues: Option, access and stability of care in a secure service. London, DH Publications Orderline. Department of Health South Australia. (2006). New Birthing Choice for women in the South. Adelaide, South Australia. Health Policy and Clinical Reform. (2006). Future directions in maternity care. Canberra. Australia. Health Reform Implementation Taskforce. (2006b). Health Workforce Strategic framework 2006-2016. Perth, Australia. Fry MJ. et al. (2003). Preterm delivery a long distance from home and its considerable social and financial pressure. Aust.N.Z.J.Obstet.Gynaecol, 43:317-21. Hodnett ED. et al. (2004). Continuous support for women during childbirth. Cochrane Database System Review. Metropolitan Clinical Services Working Group. (2006). Discussions on the Future direction of maternity care. Perth, Western Australia. Midwives Focus Group. (2006). Discussions on the future directions of maternity care. Perth, Western Australia. NSW Health. (2006). Models of maternity service provision across NSW. Sydney, Australia. O'Cathain A. et al. (2002). Use of evidence based brochures to support informed option to maternity care: randomized controlled trial in daily practice. BMJ, 324:643-6. Ponton K. et al. (2005). Modern model of maternity care behind helpless rural population. Australian Journal of Rural Health, 13: 368-72. Queensland Health Department (2005). Re-Birthing: Report of the Review of Maternity Services in Queensland. Brisbane. Roberts C. (2000). Rates for obstetric intervention among private and public patients in Australia: Population based descriptive study. BMJ, 321, 137-141. Straton J. (2006). Pregnancy and Post-birth care. Perth, Australia. Working Party on GP Obstetric. (2005). GP Obstetrics: Submission. Perth, Australia. Read More