The Outcome of Midwife-Mother Relationship in Delivery Room: A Qualitative Content Analysis
Key words: Midwifery, woman-centred practice, grounded theory, The relationship between midwives and women appears to be a key. Results 1 - 10 of Evidence-based information on importance of relationship between midwife and woman in labour from hundreds of trustworthy sources for. The relationship between the midwife and the woman is essential for a positive experience for woman during childbearing period, i.e. pregnancy, childbirth and.
Are there other health concerns or issues eg. What a woman needs to know to consent to a routine vaginal examination during labour as per a hospital guideline rather than in response to a situation: It is particularly important to provide clear information when a woman is making decisions outside of recommendations or the norm. In order to do this she needs to have adequate information. For example, if a woman is choosing to birth at home she needs information about the benefits, risks and other options.
She needs know the difference between home and hospital, including how the setting might alter the management of any complications. Information sharing needs to be documented. Like any aspect of care there needs to be evidence that it happened. Some hospitals are using consent forms for common interventions eg.
VE and ARM with a list of risks for the midwife to read out and get the woman to sign. If you give the woman any information resources — write down what you gave her.
‘Making a difference’: midwives’ experiences of caring for women | RCM
This involves being honest with women about your experience and ability to meet her needs. Safety is in the eye of the beholder — it is up to the woman whether she thinks a 1: Which brings us to the issue of bias. Information sharing needs to be unbiased, and this is extremely difficult because we are all biased and have our own beliefs and opinions. However, there are some strategies to avoid transmitting your bias whilst giving information: Present both sides of the coin see above ie.
Ensure that the woman knows you are not invested in her decision, and that you do not want to influence her either way — say this to her. Avoid telling her what you did with your own pregnancy, birth, baby — again, this is not relevant to her.
Not only can this influence her decision, but it can also make things problematic if a transfer to that hospital is needed. A good way to assess whether you are providing un-biased information is to look at what women in your care choose to do.
If all of the women you care for choose the same option — you need to consider if you are influencing them. Women are individuals and there should be a range of decisions being made. For example, if a woman declines the offer of a vaginal examination — you simply document her decision and carry on. You may need to let colleagues know what her decision is and ensure that they respect it. In some settings you may be question or pressured about her decision — but ultimately you are fulfilling your legal responsibilities regarding consent.
This trumps any institutional cultural norms or expectations. Midwifery care is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological and physical experiences of women and based upon the best available evidence. For example, competent management of an emergency situation will be different in a home setting compared to a hospital setting. However, if midwives meet their responsibilities abovethen women become accountable for their decisions and the outcome of their decisions.
Midwives in Sheffield and London recommended women to book their hospital bed for birth within the first few weeks of pregnancy. Similarly in Nottingham and Derby the local health authority fought a rear guard action to remind women of the advantages of home birth over hospital birth, to little avail McIntosh The NCT formed in as the Natural Childbirth Trust had been originally organised in order to help women to work with the system; in particular early NCT classes advocated relaxation and controlled breathing as superior to appearing out of control and in need of analgesia.
The original aims of the Trust were clearly based round hospital care, and included the requirement that husbands should be present if desired, that analgesia should not be forced upon women and that they should be humanely treated. AIMs, set up inhad at its beginnings in more polemical and strident fashion, when its founder Sally Willington wrote a letter to the Guardian newspaper saying: No mention of midwives or of doctors; she offered a view that was not only stark but that reflected a particular agenda.
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A woman would expect to get information herself, not rely on professionals; both AIMs and NCT developed the concept of women not as patients but as consumers of the maternity services.
It boasted as members school teacher and welfare workers as well as consultants, surgeons and psychologists, and was granted an audience at the House of Commons just a year after coming into being The Times Similarly, the NCT was good at making and using its contacts. As Sheila Kitzinger — another childbirth campaigner and wife of an Oxford Don — remarked in interview, it was the relationships with Doctors that meant things got done interview with the author.
She commented very favourably on relations between herself and the obstetricians at the John Radcliffe Hospital in Oxford. Jean Robinson, who campaigned against unnecessary inductions of labour in the s through AIMs, also spoke of her contacts; consultants in both London and Oxford.
Clearly socially these women were on the same level as the doctors and politicians they dealt with and contacts could be informal and non-threatening. This gave them influence and power in developing and selling their view of childbirth. One of the primary functions of the NCT was to run ante-natal classes in relaxation and childbirth preparation for women and their partners.
As Betty Parsons commented, many of the lessons she gave were private one-to-one lessons; even the group sessions cost money. Nearly twenty years later Janet Balaskas, who had started off as an NCT teacher but now ran her own Active Birth movement in North London agreed that the women she dealt with belonged to a privileged group interview with the author.
This clearly was out of the reach of many women. The same commentator explained, rather scathingly, that although some classes were beginning to be offered on the NHS, a couple of sessions were not going to replicate the intensity needed to achieve success. Women were only allowed to attend NCT classes if they had the permission of their doctor. The career of Janet Balaskas in many ways sums up some of these issues.
She was radicalised by her own experiences of pregnancy and birth; shocked by what she felt was the medicalization of the English system she was in a position to return to her native South Africa to deliver. Even there, she asked permission of the doctor to have a natural birth.
On her return, she trained as an NCT teacher, but was disillusioned with their continued acceptance that women should passive in labour and lie on their backs to deliver. In interview she talked about organising a rally in to protest at the refusal of the Royal Free Hospital in north London to allow women to have active births. She estimated that about people attended Kitzinger suggested about ; including the wife of a member of Pink Floyd who donated stage and speakers, and the newsreader Anna Ford.
At this point only two hospitals, both in well-heeled west London, and independent midwives offered active birth. Balaskas talked about change being incremental and word of mouth which only works in a tight geographical area; her classes still run in the same area of North London. Although safety was always central to the rhetoric of the maternity services, and was particularly used to promote hospital birth and the use of technology, certain groups of women began to use different criteria to inform their experience of pregnancy and birth.
This was partly based on personal experiences of technologically mediated birth. The language of feminism seems also to have been significant to many women in terms of the rights and control that they demanded over their own bodies. Equally important was the drive by some women for birth to be seen a psychological event as much as a physical one.
Kitzinger described the process of engagement with policy; radicalisation of women through demonstrations was one thing, real progress came through the media and through Government. These were all particular class and social skills, and Kitzinger and others argued that the work they did made a difference to all women.Why Midwifery Care is So Important
As Balaskas commented, birthing pools and space to practice active birth are now encouraged in NHS facilities and supported by midwives; this could be seen as the positive impact of the work of an elite.
However, it could also be seen as at best an irrelevance; women from low income backgrounds and ethnic minorities continued to have the highest rates of perinatal and maternal morbidity and mortality; birthing balls and pools made little impact on their needs for responsive care Confidential Enquiry Reports. The impact of the consumer voice on relations with health professionals Relationships between midwives, doctors and women were complex, and the stories told about maternity care from each perspective do not always tally.
To women, midwives and doctors could be cold and bossy, or deeply warm and caring. To the midwife, women could be unnecessarily demanding or laughably ignorant. Both groups used shorthand and concepts of heroic attitudes or behaviour to describe characteristics of the other, in a way that made sense and made a complex and symbiotic relationship more manageable.
‘Making a difference’: midwives’ experiences of caring for women
Certainly there were groups of midwives who were instrumental in developing a radical language and in working alongside women, in particular the Association of Radical Midwives which was formed in by a group of student midwives, who themselves felt oppressed by the system under which they worked.
In terms of change, however, their efforts were dismissed by some of the consumer campaigners; Kitzinger argued that they were not a major influence on changes in maternity care, although Balaskas said that she would always support the right kind of midwife; one not driven by fear or policy. However, midwives were often seen by women as being part of a discredited system, and this impacted on the relationship between mother and midwife.
This seems to have been particularly true of hospital midwives. For Kitzinger, however, it was more about a state of mind: Well many midwives were very authoritarian and thought that it was a sort of games mistress approach almost, that you had to behave yourself as if you were on a hockey field and obeyed the rules, otherwise everything would go to pot.
This included not just lack of staff and equipment, but lack of respect by doctors, particularly in the large teaching hospitals, for the work that midwives did. Littleford felt midwives were regarded as pliable handmaidens both by doctors and increasingly by some women; and that their demands could be incompatible.
Within the rhetoric of urban consumer groups and radical midwives there was no attempt to include the voices or needs of non-middle class members of the community such as women from low income families, refugees, teenage mothers or single mothers.