Role of the Midwife in Contemporary Maternity Care - Essay Example

The Philosophical Foundations and Role of the Midwife in Contemporary Maternity Care: The term “midwife” has its origin from a combination of two Anglo-Saxon words “mid” and “wif” which means “with” and “woman” respectively. In English definition, a midwife is one who provides care to a mother and baby in the entire pregnancy period, at birth and after birth. Midwifery is a practise premised on the notion that pregnancy, labour and giving birth are natural life processes and generates a heavy experience upon which a woman, her family and the wider community attaches great meaning. Through creation of a shared connection and continued care, midwifery helps enhance these principles of health and well being, (Wickham, 2009). This paper will explore the philosophical foundations and the role of midwives in contemporary maternity care. But first, it briefly considers history of midwifery. It is interesting to know that midwifery has been with humanity since time immemorial. The midwife was referred to as “the wise woman” by the ancient Jews. In the Bible, the midwife is mentioned in Genesis 35.17: where Rachel was in labour and the midwife encouraged her not to be afraid as she was going to have another son. In Exodus 1:20, reference is drawn to how well God handled midwives and as a result “people multiplied and waxed very mighty.” Since society in the ancient times was primitive in nature, the midwife was at times suspected to draw her mysterious knowledge and skill from supernatural powers. Some midwives were therefore feared while others were associated with evil powers and were pursued, cornered and killed. Midwives in UK did not go through intensive formal training and were not required to have any licenses to practice until 1902. Adapting the UK mode of midwifery, America’s midwives started to practice without any specialized training or control until early 20th century (Medforth et al, 2006). The most significant development was the emergence of literature associated with the scientific validation for the midwifery model of care which derived from an substantial evaluation of 7000 clinical research studies also known as “the Cochrane database”. In America, today, it is recognized and widely accepted that safe and effective care for women at childbirth is provided by the midwife whose outcomes are undoubtedly reassuring as well (Lesley et al, 2006). In New Zealand, Midwifery developed wide recognition in the 1990s when amendment of the Nurses Act separated nursing and midwifery making them individual professions. Today in New Zealand, many women choose midwifes as their maternity care service providers. In New Zealand, scope of midwifery covers normal pregnancy and birth, and is provided throughout pregnancy and up to 6 weeks postpartum. In the event that the pregnancy deviates from Normal, the midwife is under duty to consult or refer the woman for specialized care. The government finances all midwifery care expenses, and birth may take place in hospital, primary birth department or in the home (New Zealand Health Information Service, 2003). In Australia, maternity care has been experiencing hiccups for sometime. This has been largely due to fast growing health care costs and systems inefficiencies. Because of this, the government is trying to provide facilities for improving service delivery (NSW Department of Health, 1989; Health Department of Victoria, 1990; South Australian Health Commission, 1995, NHMRC 1996; 1998). Australia has heeded the Cochrane Collaboration Database and World Health Organization reports which point to increased acceptance of fact that woman centered models of care need be applied in health care service provision in contemporary maternity care (Hodnett, 1997, WHO, 1996). To achieve this, those involved in service provision must learn to give first priority to the needs of the consumer. Service providers must embrace teamwork and need to get closer to community while implementing variety, control, and sustainability as the basic principles of practice (Department of Health UK, 1993). The first universally applied definition of a midwife was crafted in 1972 following lengthy deliberations between different institutions and groups and was thus put forward to mean: A person who has been admitted in the right procedure to a programme of midwifery education, that is well known and recognized in the particular nation of establishment and has fulfilled requirements of the prescribe course successfully to duly qualify for registration or licence for midwife practice within law confines (Medforth et al, 2006). Unlike the biomedical model, the philosophical foundation of midwifery advocates for the protection, support, and sustainability of normal birth process. Biomedical framework relates to disease diagnosis and treatment hence concerns itself with the pathological malformations associated with childbirth. Unlike hospital based practice, community based midwifery avails a range of opportunities of working in more of “with woman” ways and this is an ideologically congruent approach (Lesley et al, 2006). Midwifery is a mutually respectful partnership between a woman, her family and the midwife. Traditionally, midwifery is a complete practice comprising of the understanding of the physical, expressive, socio-cultural, psychosomatic and sacred elements of the reproductive experience of a woman. Midwifery provides the woman with important information to facilitate independent and well informed decision making regarding self-care. This is because each woman is unique and has her own strengths. Women need be encouraged and supported to actively follow their instincts and participate in self-care decisions because they need to be “active givers of birth instead of being passive receivers of birth technology” (Wickham, 2009). The importance of midwifery can be attributed to a number of factors: Midwives role can be described as the “birthing of the woman” which in its own way, initiates a woman into a profound mysticism. Midwives act as custodians (guardians) of natural childbirth and well women. They help promote mother and baby well being through optimal healthcare frameworks. Midwifes makes the childbirth experience a more profound experience by recognizing a woman’s dignity and integrity while partnering with her family and community in the crucial rite of passage process (Hamilton et al, 2008). Healthcare reform talks have flared up in today’s society. Bound between the need to minimize costs and safe delivery, pregnant women are aware that their decisions and choices significantly determine their own wellbeing, the well being of their babies and what they finally get to incur as maternity care costs. In contemporary society, being a midwife must be backed with adequate clinical skills together with wider mastery of the social and emotional experiences involved in a woman’s childbirth process. The midwife today need be professionally equipped to apply “woman-centred” principle to practice alongside provision of education, counselling, specialist care, and support to a woman and baby from pregnancy, through childbirth, to postpartum period (NCT, 2000). Midwives recognize fact that pregnancy and childbirth experiences are a special occurrence in a woman’s life and these experiences are unique for each birth. Adapting woman-cantered approaches to practice demonstrates empowerment of the woman to be responsible for her bodily and motherhood decisions. This empowerment has the effect to bring about enhanced socio-economic, political, and well being of both the mother and her family and helps boost their confidence. According to Davis Floyd, "The core values and beliefs of both individual women and the wider society in which they live condense into visible, focused form in childbirth, where their perpetuation is either assured or denied. It is both my belief and my hope that in the end—or the beginning—the salvation of the society which seeks to deny women their power as birth-givers will arise from the women who, nevertheless, give that society birth" (Floyd, 2003, p. 307). When women belonging to a given community are empowered, held in high esteem and allowed opportunity to participate actively in decisions which involve their well being, they develop better mental capabilities and confidence necessary for a healthy society free from insecurity fears. Midwifes need to apply therapeutic communication founded on a “genuine attitude, empathy, simplicity and respect. Being genuine demonstrates that the midwife loves and accepts the whole relationship as it is. Being empathetic describes showing through own emotions and feelings that you can understand and feel the situation. Simplicity means being clear and easy to be understood. Finally respect means showing honest regard for the situation. These elements help develop a connection between the partners and strengthen midwife-client relationship (Brennan, 2006). Society has grown to be a globalized unit. This means that contemporary midwives must be flexible enough to manage complexity and diversity which come with globalization. Of special importance to this paper is cultural diversity. Past researches indicate that cultural diversity has had influence to the level of motivation of midwifes in responding to and embracing the women (clients) they deal with. Every person in society regardless of his/her cultural inclination must be offered the opportunity to achieve his/her health potential (Lesley et al, 2006). Nurse-midwifes must therefore develop vital cultural competencies in their work so that their delivery of care service is not hampered by the lack of knowledge about the clients. This will help midwives positively manage the dynamic change process in contemporary society. The cultural competencies describe a basket of manners, approaches, and guiding principles or the skills that are necessary to convert values and orientations into desired course of action. Put simply, midwives must have the ability to respect these culturally diverse beliefs and values of both the clients and core-staff in the community while reconciling them with own cultural inclinations (Hamilton et al, 2008). The broad disparity in healthcare needs arises from the diversity of women. To fulfill their primary care demands, midwives need to see to it that women from exposed backgrounds are provided with duly responsive care. Moving forward, healthcare systems may find it appropriate to rely on midwives to spearhead the process of designing and execution of health enhancement strategies to incorporate needs of women of color and the culturally diverse groups. In the respect grounded partnership of midwife and client, the midwifes must endeavor to sustain language and communication obstacles and there provide an enabling environment that will all open (heart to heart) sharing of issues of concern with the clients with regard to cultural beliefs and values inline with reproductive health. Midwives should actively take part in training programs for cultural competence (Hamilton et al, 2008). According to Duffy (2001), there is need to establish a transformative cultural education in group members interaction forms the basis of the learning process which then emphasizes the notion of shared power across cultures. In so doing, every individual develops an understanding of how personal values and beliefs impact on the outside world. For the midwife, this reflection will draw his conscience toward how his personal assumptions affect client care. It therefore becomes important that contemporary midwives should endeavor to avoid contradictions and misunderstandings. Midwives must be able to identify and acknowledge cultural connections and avoid generalizations. Sutherland (2002) argued that the socialization process has made some people to regard their ways of being to be relatively superior. Midwives should disengage themselves from this kind of ethnocentrism which may tend toward patient alienation and unfair practice. Midwives must demonstrate universally acceptable service provision and must remain proactive enough as to foster cultural competence in service delivery. In the previous sections, this paper mentioned the importance of women-centered service. In the context of cultural diversity therefore, if midwives fail to consider the magnitude of marginalization of individuals and groups in society and the related limit this puts to individuals or group choices, it will not be easy to deliver the necessary patient-focused care as envisaged. On the contrary, midwives might end up giving irrelevant and difficult to apply advice to the clients. As a result, the supposed to be partners will treat one another with suspicion due to judgmental attitudes that arise from wrong advice (Lesley et al, 2006). In order to achieve effective implementation of woman-centred care in contemporary society, all leaders, professionals and stakeholders must be committed to developing sustainable service delivery models. According to (Ladipo et al, 1999), it is not easy to achieve notable improvements if midwifery continues to be limited by staff and other resources. There has to be a recognition of the positive contribution made by midwives need for enhancing conditions and terms of service so as to create an enabling environment for enhanced care and support to women and babies in society. The midwife’s leadership role should be encouraged and supported. Midwives are now being seen as autonomous practitioners. It is therefore imperative that they provide their services and care professionally. Indeed, they are expected to give women the necessary support, care and advice during pregnancy, labour and the post-partum period up to six weeks alongside facilitating births and providing care to the newborn In summary the role of a midwife in contemporary maternity care is working in partnership in a holistic manner with the childbearing woman, guiding and empowering her by giving her the confidence and strength to trust in her own instincts and believing in her own choices while appreciating and sustaining the cultural differences in values and beliefs of her clients. References Brennan, M.(2006). Therapeutic Communication Skills, Retrieved 8/4/ 2011 from http://www.youtube.com/watch?v=xpFkrD02t1A Davis-Floyd, R. (2003). Birth as an American Right of Passage. Berkeley, CA: University of California Press. Department of Health NSW. (1989). Maternity Services in New South Wales. Final Report of the Ministerial Taskforce on Obstetric Services in New South Wales. Sydney: Department of Health Publication No: (HSU) 89-007. Duffy M. (2001). A critique of cultural education in nursing. Journal of advanced nursing 36(4): 487-495 Hamilton C, & Peate I.(2008). Becoming a Midwife in the 21st Century, West Sussex: John Wiley and Sons.p.283-298. Health Department of Victoria. (1990). Having a baby in Victoria. Final report of the Ministerial Review of Birthing Services in Victoria. Melbourne: Health Department of Victoria. Ladipo D, Reed H, Wilkinson F (1999) Changing Midwifery: working conditions and the quality of care. ESRC Centre for Business Research, University of Cambridge: Cambridge Lesley A. et al, (2006). The new midwifery: science and sensitivity in practice, Philadelphia: Elsevier Health Sciences. . Medforth, J., Battersby, S., Evans, M. et al. (2006). Oxford handbook of Midwifery. Oxford: Oxford University Press. National Childbirth Trust (1998) Ten Point Plan for Maternity Care. NCT: London New Zealand Health Information Service: "Report on Maternity - Maternal and Newborn Information 2003. NHMRC (1996) National Health & Medical Research Council Options for Effective Care in Childbirth Australian Government Printing Service, Canberra NHMRC (1998) National Health & Medical Research Council Review of Services Offered by Midwives Australian Government Printing Service, Canberra Page L ed. (2000) The New Midwifery: science and sensitivity in practice. Churchill Livingstone: London Sutherland L. (2002). Ethnocentrism in a pluralistic society: a concept analysis. Journal of transcultural nursing 13(4):272-281 WHO (1996) Care in Normal Birth: A Practical Guide. Family and Reproductive Health, WHO, Geneva. Wickham S. (2009). Midwifery: Best Practice, Volume 5, Philadelphia: Elsevier Health Sciences, 2009. Read More