Role of the Midwife in Care Interventions

Role of the Midwife in Care InterventionsTitle Discuss the following statement in simile to birth. Midwifery expertise is as much or so knowing when not to interfere in the physiological process of gestation and birth as it is about recognising when and how to intervene in a way that will facilitate and enhance the womans baron to give birth.EssayWomen have been giving birth throughout the ages. On the one hand this can be regarded as a normal physiological process which has evolved over the millennia to be a successful method of perpetuating the species and ilk most evolutionary honed processes, is likely to work well most of the time. On the other hand, as any experienced clinician knows well, any physiological process has the force to malfunction. A large proportion of professional medical care in any field of medicine is to be able to recognise the normal variations and spot them from the abnormal. As a general rule it is only the abnormal that requires treatment or interp osition. (Hunt T 1994)Hippocrates is reputed to have said that it is the first rule for a doctor that one should do no harm. (Carrick P 2000). In a modern context, this often means leave the normal alone as the ability to produce iatrogenic complications is well known. (Halpern S D 2005)If we restrict ourselves to the consideration of the field of accoucheusery, the preceding statement can be well illustrated in the literary works of Dr Ignaz Semmelweis who was horrified by the levels of puerperal fever that was killing nearly 40% of the pregnant women on his wards. (Semmelweis I P. 1861). Although he discovered the concept of asepsis from his observations, we pecker that on a simple level, the vast majority of the morbidity and mortality in this case was caused directly by the intervention of the healthcare professionals in what were other than normal pregnancies.On a matter of more immediate concern we can consider the issues relating to stress in temperance as being an excelle nt informatory example of how midwives can elect to intervene during pregnancy and the birth process in order to facilitate not only the birth process except the whole area of potential morbidity surrounding maternity in general.Pregnancy itself is an independent variable risk factor for stress incontinence (Rortveit et al 2003). Although the accoucheuse is not generally involved in the very early stages of pregnancy, there is good evidence that prenatal involvement in terms of homework of the woman for the process of childbirth will reduce the incidence of stress incontinence post partum. (Reilly E T C et al. 2002). Instruction in the example of antenatal pelvic floor exercises has been shown to reduce both the incidence and severity of pelvic floor damage during parturition (Salvesen et al. 2004)At the time of the delivery the midwife can make a number of interventions which will help to reduce the eventual morbidity including having the knowledge that a large birth weight bil k is more likely to produce pelvic floor damage and will therefore be more likely to consider doing a prophylactic episiotomy to background the potential for pelvic floor damage. Equally, in the time prior to the actual delivery, her intervention to establish the lie and orientation of the baby will help to stay fresh malpresentations and the associated possibility of instrumentally tendinged deliveries with the attendant possibility of resulting morbidity.(Norton C. 1996) Part of the acquisition of professional skill during training is to gain the knowledge which allows the ability not to intervene if the pregnancy and delivery are proceeding smoothly.Unnecessary intervention also has a more subtle downside in that it encourages dependence by the mother on the midwife. On an ethical dimension one can argue that this unnecessary dependence erodes the patients autonomy. (Coulter A. 2002). During pregnancy and birth, many women will find it all to prosperous to be subsumed by the medicalisation of the birth process. The professional midwife should be aware of this phenomenon and try to reduce its effect as far as possible. For many women, the midwife becomes the foremost trusted healthcare professional for the majority of her pregnancy and is the first point of contact with the medical establishment. The woman implicitly comes to trust the midwifes professional status and believes that the midwife will do what is necessary but not what is unnecessary. The midwifes professional status is therefore based in conclusion on this premise, and a sound professional judgement based on a firm evidence base, is central to her ability to produce benefit when she decides that intervention is necessary. (Paine L L et al. 1999).An area where non-intervention is actively practiced is during the third stage of labour where the experienced midwife will observe and allow the fundus to contract rather than immediately intervene to deliver the placenta. There is a delicate lin e to be drawn between actively delivering the placenta too soon and thereby increase the risk of uterine haemorrhage or uterine inversion, and not intervening at all and allowing the placenta to become entrapped in the contracting uterus with the implications of having to do a manual removal of the placenta possibly under a general anaesthetic. (Romero R et al. 1999).In conclusion we can consider that the role of the midwife is primarily to assist the pregnant woman through her pregnancy, her delivery and in the immediate post partum period. As we observed at the beginning of this essay, it is quite possible to intervene at virtually every stage of this process, but we would suggest that it is inherent within the role of the professional midwife that she should be able to draw a tone between those occasions where intervention is mandatory, those when intervention is prudent and those occasions where it is perfectly appropriate to do nothing.References Carrick P (2000) Medical Ethic s in the Ancient World. Georgetown University weigh 2000 ISBN 0878408495Coulter A. (2002) The autonomous patient. London The Nuffield Trust, 2002.Halpern S D (2005) Towards evidence based bioethics. BMJ, Oct 2005 331 901 903Hunt T (1994) Ethical issues in Nursing. London Routledge 1994Norton C. (1996) Commissioning comprehensive continence services, Guidance for purchasers. London Continence Foundation, 1996.Paine L L, J M Lang, D M Strobino, T R Johnson, J F DeJoseph, E R Declercq, D R Gagnon, A Scupholme and A Ross (1999) Characteristics of nurse-midwife patients and visits, American Journal of Public Health, Vol. 89, Issue 6 906 909,Reilly E T C, Freeman R M, Waterfield M R, Waterfield A E, Steggles P, pusher F. (2002) Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynaecol 2002 109 68 76.Romero R, Y C Hsu, A P Athanassiadis, Z Hagay, et al . (1999) Preterm delivery a risk factor for retained placenta. Am J Obstet Gynecol, 1999Rortveit G, Daltveit A K, Hannestad Y S, Hunskaar S. (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003 348 900 907.Ryan G L , Quinn T J ,. Syrop C H , Hansen W F, (2002) Placenta Accreta Postpartum Obstetrics Gynecology 2002 100 1069 1072Salvesen, Kjell, Mrkved, Siv (2004) Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ Volume 329 (7462)14 overbearing 2004pp 378 380Semmelweis IP. (1861) Die aetiologie, der begriff und die prophylaxis des kindbettfiebers. Pest, Wien und Leipzig CA Hartlebens Verlags-Expedition 1861.