How Normality Can Be Facilitated and Maintained During Childbirth - Essay Example

? "The ancient Jews called her the wise woman, just as she is known in France as the sage-femme, and in Germany, the weise frau and also Hebamme or mother's adviser, helper, or friend. The English 'midwife' is derived from midwife, or with-woman"(J.H. Aveling). The Latin term cum-mater and the Spanish and Portuguese term comadre, have the same meaning: with woman (Coalition for improving maternity services, n.d). Midwives have been part of the human experience as long as we know. In earlier times, a midwife didn’t receive formal education to assist birth. It was a mystery how they gained the knowledge and skills in these areas. In modern times, they are not only responsible for attending women in labour and birth but also help her family especially the birth partner in dealing with the situation. In this paper we shall discuss how normality can be achieved during childbirth by the midwives. There are various factors that a midwife has to consider and take care of while preparing a woman to give birth. A midwife never works all alone; she is connected to many different individuals like her colleagues, supervisors, other health professionals and their families. It is very important for a midwife to satisfy the needs and aspirations of the women and her family she is dealing with. A midwife should treat each woman as a distinct individual and respects her values and beliefs regarding pregnancy. It should be remembered that the experiences during pregnancy, birth and postpartum period affects women, babies, fathers and their families in a huge way and have a long lasting impact on society too. The midwives should ensure that every woman had a joyful and healthy birth experience ( Levisley, 2011). Good communication skills A midwife should have the ability to communicate well and at the same time the power to listen patiently to a woman through her various stages of pregnancy. A small action or gesture by us can make a huge difference to the care and treatment of the patients, their infants and partners. A midwife should always keep in mind that although she deals with matters of births everyday but a new mother may not know about the process of pregnancy. Certain special behaviors like being compassionate, pleasant, providing continuous support, unbiased information, consistently reassuring the to-be mothers are expected from a midwife (Nasak, 2005). There are some actions which will go a long way in enhancing the admission, birth, postnatal and discharge stages of pregnancy –having patience, providing continuous support and praise to the patient. The midwife should be able to provide the information regarding the various aspects of pregnancy and birth, for example the effects of different forms of pain relief, without being prejudiced. Some other ways which might help the mother is by providing them written information in booklets or notice boards. A midwife is responsible for making accurate medical notes which is passed onto the health visitor. In case of mothers with second babies, it has been observed that the midwives are less inclined to inform and support them but it is very important to remember that the mothers still needed their advice as each birth and child is different. It is the duty of a midwife to handle every patient equally regardless of her age, profession or previous experience (Nasak, 2005). Environment Every woman should be given the opportunity to choose a place where she feels secured, relaxed and cared for giving birth. Her personal preferences, emotional wellbeing and privacy should be respected and taken care of. A mother’s ability and confidence to give birth is enhanced or diminished by the ability of the midwife and the environment where she gives birth. The midwife should encourage the woman to opt for home birth because this is the place she will feel most relaxed. The choice of time and place where the pregnant woman would like to take antenatal and postnatal classes should be adjusted according to her convenience. Nowadays, places other than the hospital and clinics might be convenient for the pregnant women to learn about pregnancy. They should be provided the choice of these places for example children’s centers, drop in clinics, and their home. Midwives should be flexible with the time when the patient is comfortable to take the classes whether its morning, evening or night. They should also adjust themselves to individual needs (Livesley, 2010). Active birth classes should be provided by the midwives to implement the Maternity Matters recommendations and reduce the rate of a caesarean birth. The midwifery team should not only provide birth classes for women but also for their birth partners. We can also have trial based birth classes on the birth unit which includes the use of active birth materials, that is, Birthing Balls, chairs, water pools etc. during the classes the midwife should discuss all the birthing options and help her in charting out a Birth Plan. Services should be introduced whereby a woman should be able to contact a midwife directly through a dedicated phone line which will not only enable her to contact her named midwife in early pregnancy but also make prior booking arrangements. (Coalition for Improving Maternity Service, n.d). Responsibility during Labour A midwife should take the following steps during the time of labour. She should first check the pregnant woman’s blood pressure, pulse rate and temperature. The patient’ urine should be checked and her bladder should be kept empty. Perform an abdominal checkup to see the position and the movement of the baby. Moreover, the midwife should constantly check the baby’s heartbeat as well as conduct an internal examination. She should then share the information of the tests and their accuracy with the woman and thereby help in choosing the most appropriate management for the mother and her baby. She should ask the mother to eat well, take proper nourishment and rest. She should encourage her to stay active. A woman would like to change various positions during labour , a midwife should direct her the correct positions like either standing ,or on all fours unless restricted and also discourage the use of lithotomy (flat on back with legs elevated) position. When the labour is in progress the midwives should work with the mother and her family and when the birth approaches be there to guide and steady her. (King Edward Memorial Hospital, n.d). A midwifery perspective during pain in labour The skill of a midwife when with a women in pain completely rests in believing the women when they are not able to believe in themselves. The only way to soothe a woman during her labour is through continuously supporting her with compassionate words, making her believe in herself. A midwife should be able to educate and councel the women regarding the various choices available to her for pain relief during labour. A midwife should stand by her throughout her labour and provide comfort and relaxation when she is in pain. Being by the woman’s side, suggesting the positions, the use of cushions, bed and chairs and water goes a long way in relieving her of pain. There are many therapies like the epidural therapy and the water therapy should be suggested by the midwives. Medication should be the last of the priorities for relieving pain. Also if a midwife has some problem with a particular labour she should take the advice from the supervisor of midwives and take appropriate actions (Midwives, n.d). Midwives need to encourage physical positioning during labor such as walking around, standing, rocking, or leaning on birthing balls. She should let the woman relax in her own way whether she prefers to take a shower, bath or sleep on a bean bag. Midwives also usually allow women to eat and drink during labor. It is our duty to ensure that minimum interventions like electronic fetal monitoring, labor-inducing drugs, pain medications, epidurals, and episiotomies are being used during pregnancy. Through a midwife’s support, a woman can tap into enormous reserves of strength during the birth process and learn that she is capable of much more than she realized (Midwives, n.d). Midwifery with teenage mothers A midwife should provide education experience to each woman she handles especially teenage mothers. It is very important that a pregnant teenager’s family is included during health promotion activities particularly when breastfeeding targets are to be achieved. A United health policy needs to be formed where teenage mothers comes into contact with the midwives “before they are pregnant, before attitudes to breastfeeding are established and before the concept of pre-conceptional care is lost.” This will help in educating the children and teenagers about the benefits of pre-conceptional care and breastfeeding. Midwives should be sensitive to the negative effect it might have on a woman’s health for example, we teach that breastfeeding is good for the health of a woman and her infant but she might become depressed and burdened if it is not achieved (Beldon, 2011). Ante-natal care Ante-natal care includes medical examinations, palpation, listening to the baby’s heart, and check the wellbeing of the mother and her baby on a regular basis. She should educate the woman regarding the benefits of natural birth process, for example, inform her that this way of giving birth is with minimum interventions and reduced labour pain. A woman should be allowed to choose her companion during labour which might include her husband, family, children or friends. The traditional procedures of shaving , enemas, intravenous drips, withholding nourishment and electronic fetal monitoring should be avoided at any cost.She should bring together all the resources, do trial run, check and recheck the entire process before the arrival of the baby. She should always maintain a good relation with the mother and her family (Nageswaran, 2007: 197-199). Post natal care The midwives are just only responsible for the pregnancy period and birthing process but their duty continues even after that. Immediately after birth she should assess the health of both the mother and her child for example, seeing that her blood pressure has come back to normal, check how much blood loss has taken place, checking urine passes and assisting in feeding the baby. The hospital midwife should continuously monitor the health of the woman and when she is assured everything is fine, she can release the patient and the child. Furthermore, the midwives are responsible for taking care of both mother and child for 28 days after the birth. She should pay regular home visits for checkups which include monitoring the healing and help the mother deal with a new born. One of the most important tasks during this period is to encourage the mother to breast feed the child and assist her in learning the technique of breastfeeding (Hirsch, 2005). At this point of time, a new mother has many question as she finds herself in a completely unknown situation, she has the fear that whether she will be able to handle the child properly or not. It is the responsibility of the midwife to calm her down, relax her and encourage her by praising her, communicating with her frequently and answering all her queries. It is the duty of the midwife to teach the new mother that breastfeeding provides the best nutrient for the newborn and the infant. She should encourage the starting of breastfeeding within half an hour of the birth of the baby. They should encourage the mother and her family, especially of premature newborn or infants with congenital problems, to touch, hold, breastfeed and care for the baby to the limit it suits the baby. The midwife teaches the mother how to breastfeed and how to maintain lactation even when separated from the baby. Communication with the father is also required to enable him to adjust to the new situation and give equal attention to the mother and the baby (Coalition for Improving Maternity Service, n.d). Interprofessional relationship A midwife should be able to detect any problems in a pregnancy and trained enough for emergency situations. However if anything goes wrong a midwife should immediately consult the supervisor of midwifery or a gynecologist before taking any step. They should work in collaboration with their medical colleagues and seek their advice if anything abnormal is detected. In other to avoid such situations, midwives should review and evaluate the effectiveness, risks and rates of her procedures on a periodic basis. Also they are not certified to perform any caesarian operations (Nasak, 2005). For working in an interprofessional relationship it is necessary that each person involved should show respect for each other and value differences. Midwives should give and take feedback from other members regarding the health of the women and her child. As a team member a midwife should value other member’s roles and responsibilities and interact with them with sensitivity and kindness. It is very essential in a team that each member revises his own work and keep on discussing issues with other members to enhance learning (Googledocs, n.d) A midwife should always work in collaboration with family physicians, nurses and obstetricians to support normal birth. There are various advantages of working in an interprofessional collaborative care. First and foremost, it results in better and improved outcomes for health care and childbirth. Also, it leads to better utilization of staff and a satisfactory work environmental. Although it is found that there are lot of hurdles in IPC difference in the views and working style of the team members and inequality due to status and salary. Also poor collaboration and lack of defined roles and responsibilities adversely affects the quality of safety and care of the women and her family (Basso, 2011). Physiological changes during pregnancy The most important physical change that takes place during pregnancy is the growth of the abdomen of the mother from the fourth month of pregnancy. The growth of the fetus in the abdomen creates other changes in the interiors of the body as well. As the fetus increases in size it starts occupying more place in the body because of which the other organs in the body have to adjust into a smaller place. This results in various changes in the system of the woman’s body like frequent need for urination, low appetite, decreased lung capacity and lower back pain when the load of the baby is increased on the back. During this period various hormonal changes within the body as well as an increase in the blood production of the woman to support the baby. It is the duty of the midwives to make sure that the woman and the baby are progressing positively. A midwife should offer a pregnancy massage to the woman as it will relieve the woman of her pain and anxiety (babymed.com). Psychological changes during pregnancy The emotional changes that take place in the woman’s body are due to the hormonal changes taking place inside her body. She becomes anxious and fears that nothing wrong happens. She is frightened whether she will be able to survive labour, will she make a good mother and handle the baby with love and care (Nageswaran, 2007:131-133). Also other than these changes, something else affects a woman psychologically. When a woman is pregnant unlimited love and attention is bestowed on the mother and the baby. Some women become attached to the attention they get during pregnancy. Although once the baby is born all the attention shifts to the baby and the mother is considered secondary. This leads many women into depression as they are unable to bear the changes that take place after the baby is born. So it is very important for a midwife to continuously communicate with the woman after pregnancy and pacify her. In fact, pregnancy classes should be held by the midwives to talk about the various emotional changes that take place prior to the birth and after the birth with both the parents (babymed.com). The communication regarding the psychological changes should be done both with the father and mother as both are equally involved in the process of the birth of their child. Also, there are various other emotional ups and downs after the baby comes home, like feeling uncomfortable with having a baby, feeling anxious about caring for the new baby and even negative emotions about the baby from time to time as sleep deprivation takes its toll on the new mother and father. A midwife needs to prepare both the parents for these changes. It is essential that whoever is caring for or advising women in relation to their pregnancy, birth or postnatal care has the appropriate skills and knowledge to understand, interpret and manage as appropriate, the complex physiological, psychological and social changes a woman or baby may experience (Livesley, 2010). Conclusion A good midwife is one who has gained all the knowledge and skills required for the safe and effective practice. She should take part in appropriate learning and practice activities that maintain and develop their competence and performance. Midwives also have to stay up to date in order to keep their registration .She should respect and believe in mother’s values and beliefs. A midwife must be able to care for women throughout pregnancy, birth, and during the postnatal period too, as well as care for newborn babies. . References Nageshwaran, Ramya and Sanyal, Smita Barooah (2007). Pregnancy care. New Delhi: The Lotus Collection. Print. 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