The Role of The Midwife in The Healthcare

In 1946 the World Health Organisation (WHO) defined health as a ‘state of complete physical, mental and social well-being. This definition integrates the main concepts of health and identifies that health can be viewed differently by individuals and groups (Bowden, 2006). Health and well-being are a combination of physical, social, intellect and emotional factors (Dunkley,2000). The concept of health promotion has emerged with the increasing realization that our health is one of our most valuable personal assets. The health promotion agency (2008) describes health promotion as a process enabling people to exert control over the determinants of health and thereby improve their health. Similarly, the WHO identifies that health promotion involves equipping people to have more power, enabling them to make choices regarding improving their wellbeing (WHO,).

Ewles and Simnett(2003) determine from this that the fundamental elements of health promotion are improving health, empowerment, and education. Health promotion is not an extended role of the midwife but a core competency. In its code of professional conduct (2008), the Nursing and Midwifery Council (NMC) outlines the role of the midwife to include supporting women in caring for themselves to improve and maintain their health. Davis (2002) points out that every interaction with a woman is an opportunity to improve long-term health as midwives are trusted as authoritative figures in the delivery of health promotion. The royal college of midwives ‘Vision 2000’ describes the midwife as a public health practitioner, and relevant models and approaches can enhance the way that midwives deliver care. A health promotion approach can be described as the vehicle used to achieve the desired aim (Dunkley-Bent, 2004). This essay will focus on applying Beatties (1991) model of health promotion to breastfeeding; analyses the challenges midwives may encounter when promoting breastfeeding and health promotion in general and evaluates the effectiveness of the midwife in promoting breastfeeding. The word ‘midwife’ simply means ‘with women’ (Alberta Association of Midwives 2012). According to the International Confederation of Midwives Council (2005), the midwife is a conscientious and accountable trained specialist in ‘normal’ pregnancy and birth. They work in ’partnership’ with the woman, her partner and family to offer the vital care, support and advice required during the antenatal, intrapartum and postpartum period to independently guide the women through the pregnancy and birthing process and provide care for both and the newborn.

The scope of the midwife includes the support and encouragement of normal birth, identifying complications with the pregnancy and performing emergency procedures. Midwives play a significant and critical role in the delivery of health counseling and education which should include antenatal education not only with the women but with the family and network and wider community. It is the midwives’ role to promote health and wellbeing to women and their babies (NMC, 2008). Health promotion, as described by Scriven (2010), is said to be ‘improving, advancing, supporting, encouraging and placing health higher on personal and public agenda’s’. Midwives use health promotion models and approaches to enable a common value to be made clear; allowing all team members to work towards the same goal. As a result, effective communication between midwives is more likely, and therefore the quality of health promotion given to women is improved (Bowden 2006).

Commonly, Tannahill’s model of health promotion, developed by Downie et al (1996), lends itself well to midwifery practice. The model mainly focuses on health education, health protection and preventing ill-health. These three main topics overlap; in which health-promoting activities may fall. Child vaccination programmes implemented by the NHS is an example of health protection overlapping with ill-health prevention that occurs in practice (Bowden 2006). This example emphasizes the positive feature of the model; being able to carry out both objectives of improving health and preventing disease (Sykes 2007). The educational approach is often used in this model whereby the midwife gives facts and information to the women who may then choose to act on the information given, or not (Bowden 2006). Similarly, the behavior change approach is commonly used in midwifery when encouraging women to change her attitudes or beliefs to adopt a healthier lifestyle (Bowden 2006). There are many health promotions approaches and models.

However, no specific model is relevant to every woman. Each woman will have individual needs and therefore requires an individual assessment in relation to health promotion. Health promotion is an essential part of a midwives’ responsibility; “the nature of health promotion work in midwifery is geared toward promoting the health of the mother and ensuring an optimum environment for mother and baby” (Dunkley,2000). Breastfeeding can be a controversial topic; it can bring about mixed opinions and responses from mothers and midwives. The reason for the promotion regarding breastfeeding is that apart from being economically friendly, it also holds many benefits for the baby and for the mother (Dunkley,2000). Health promotion is predominately a proactive process. It is a process that is done with people not at people, either on an individual basis or within groups, Participation and partnership are key components of the process. Beattie’s model is appropriate as it provides a structured framework to guide, map and contextualize health promotion intervention related to breastfeeding (Seedhouse,2003). Beattie’s (1991) has two dimensions; “mode of intervention” and “focus of intervention”. The “mode of intervention ranges from authoritative which is top-down and expert-led: to negotiate, which is bottom-up and values individual’s autonomy. The “focus of intervention” ranges from a focus on the individual to a focus on the collective.

The model uses these dimensions to generate four strategies for health promotion – health persuasion, legislative action, personal counseling and community development (Tonnes and Tilford, 2001). The health persuasion technique utilizes the medical and educational approaches to inform women of the research-based health benefits of breastfeeding. This intervention is top-down, directed at individual women and led by midwives as health experts (Perkins,1999). It relies on persuasive tactics to ensure compliance. Being medical-based, it aims to reduce mortality and is conceptualized around the absence of disease. As midwives do not regard pregnancy and childbirth as states of ill-health, its validity in midwifery care must be questioned (Dunkley,2000). The benefits of breastfeeding are well-documented; however, difficulties arise in making this information relevant and personal to each woman’s ‘information’. According to Condliffe (2005) midwives’ reported a lack of confidence within midwifery practice but Mezey and Laazenbatt (2009) said that it was due to concerns with lack of experience on the relevant subject area and discussion. (……1). It would appear that the challenge for midwives is having the time and resources readily available. Positive messages about breastfeeding should be evident in the midwives practice room (Ewles and Simnett,2003). Literature and posters that promote breastfeeding can be prominently displayed. All magazines and literature in the waiting room can be examined to ensure that there are no unwanted advertisements or promotions of formula.

Health persuasion assumes that women make rational, conscious decisions about how to feed in response to factual health-related information (Crater,2002). Personal attitudes will affect the woman’s decision more than anything; and changing beliefs, values, and attitudes is difficult and requires more time, resources and dedication than most midwives have, due to an overload of work. According to Crossland (2015), he stated that breastfeeding is cost-free and other health incentives could be spent on other poor health choices but Whelan (2014) stated that breastfeeding needed all the support it could get so midwives could encourage it within their practice. It is important in the midwifery profession that a Continuity Model of Care is adopted as this encourages a close professional relationship to develop between both the midwife and the woman throughout the birth process.

Continuity of Care allows the midwife to provide personal care that is tailored specifically to the woman and her family’s needs with the ability to address any further complications or issues that may arise, improving both the quality of her care and her birthing experience. Continuity of Care is advantageous as it can be provided in a wide variety of settings, both formal and informal environments, in order to set the woman at ease, making her feel more comfortable. (Pairman, et al 2010) The midwife must be aware of all relevant aspects with respect to the culture of the woman they are providing care for. A barrier that may exist within the Midwife-Woman partnership may be age. Another observation that may have to be observed regarding cultural sensitivity includes ethnicity. This should be permitted unless there is a clinical reason which prohibits it. (Health Care Providers Handbook, 2010).Birth is universal to all women; however, the experience differs in many cultures as births are considered sacred events in many countries (Robinson & Thomson2009,p142). There are dangers in the midwife being unaware of or misunderstanding a culture, the most serious is stereotyping people when it is assumed that a culture makes all members of the cultural groupthink, feel, and behave in a certain way. (Bowden and Manning 2006). The relationship between the Midwife – Woman partnership differs within our own culture as our upbringing, education, experiences, location and our general way of life impacts on us all differently. The role and responsibility of the midwife are to work with evidence-based practice “with evidence-based practice” with effective communication to provide advice, support, encouragement, and education to facilitate the woman’s ability to breastfeed (Johnson and Taylor,2006).

Support throughout pregnancy can have a long-lasting effect no matter the scale the task may be. A good example of this is the midwives’ role in health promotion and in supporting women in feeding their babies(Crafter,1997). When a woman needs more general sources of advice and social support than those provided through the maternity services, midwives still play a key role in providing relevant information and advice and referring her to other professionals and organizations for support. (Cooper & Fraser 2003). If the chosen method of feeding an infant is breastfeeding, a mother should expect midwives to assist them in the latching on of the baby and in the correct way so it is not painful or uncomfortable for the mother. Woman-centered care is the overarching framework for the National Competency Standards for the Midwife (2006). Woman-centred care is a concept that implies that midwifery care, is focused on the woman’s individual, unique needs, expectations and aspirations, rather than the needs of institutions or professions recognises the woman’s right to self-determination in terms of choice, control, and continuity of care encompasses the needs of the baby, the woman’s family, significant others and community, as identified and negotiated by the woman herself follows the woman between institutions and the community, through all phases of pregnancy, birth and the postnatal period is ‘holistic’ addresses the woman’s social-emotional, physical, psychological, spiritual and cultural needs and expectations (ANMC, 2006). By adhering to the rules, standards, and guidelines the midwife can ensure that the care provided is of the highest standard.

Midwives understand that each woman is an individual and her needs are assessed on an individual basis, with a non-judgmental, caring nature. Ewles and Simnett (1999) list the following activities that could be seen as health promotion practices; Mass media advertising, campaigns on health issues, patient education, self-help groups environmental safety measures, public policy issues, health education about physical health, preventative medical procedures, codes of practice on health issues, health-enhancing facilities in local communities, workplace health policies and health and social education for young people in schools. Ewles and Simnett (2003) also identify approaches to health promotion. These all flow from a set of aims which hope to be achieved. They emphasize that no one aim or approach to health promotion is right but that it is important for us, as healthcare workers to consider which is appropriate for us, and relevant to our work. However, one of the most important factors is educating people, to allow them to make informed, healthy choices according to …

In conclusion, the RCM Vision 2000 describes the midwife as a public health practitioner. Midwives have always enhanced, facilitated and supported factors, which promote physical health, psychological, social and spiritual wellbeing for the woman and her immediate family. Some of the key points that should be considered for the future of midwifery health promotion practice, is that it needs to be clearly defined, ‘national and political recognition of the midwife’s contribution to public health should be improved and midwives should promote health within the socio-cultural and economic context of how individuals live their everyday lives’. Providing antenatal care to woman and fetus demonstrates a unique opportunity to enhance holistic health through advice, guidance, support and social networks where the woman can be offered further specialized care if needed. This assignment has discussed the concept of health and health promotion. Beattie’s and healthcare model was used to show the importance that a supportive environment is created in which people can challenge ideas and question beliefs. Beattie’s model is adaptable and could be applied to many scenarios; the model shows knowledge of awareness of adult education by provoking a deep understanding of processes and problem solving, and therefore the quality of teaching and the learning process. There are many ethical issues involved in parent education. Participants need to be listened to carefully and their questions answered truthfully, which gives a positive effect on the woman and leads to the skills and confidence to take more control over their health.

The Midwife woman partnership is a complex relationship that balances on understanding and acceptance factoring in the beliefs, rituals, lifestyle, ethnic values and the risks associated of the woman or mother to be in order to achieve both a positive and empowering labor, as well as a favorable and healthy outcome for all involved. This understanding makes it essential for Midwives to be aware of all the cultural differences apparent and possess knowledge pertaining to the cultural expectations and lifestyles of all cultural groups. It is important for Midwives to continually undertake further training and education, to maintain their professional development, as well as broadening their existing knowledge and skills. Good health is not just the physical well-being of an individual, but the social, emotional, cultural wellbeing of the whole community in which everyone is able to achieve their full potential as a human being thereby bringing about the total wellbeing of their community.

Works Cited

1. Alberta Association of Midwives. (2012). Midwives in Alberta: Practice Guidelines Handbook.
2. Beattie, A. (1991). Health promotion models and values. Oxford University Press.
3. Bowden, S. (2006). Midwifery and the promotion of normality. Elsevier Health Sciences.
4. Davis, D. (2002). Continuing professional development for midwives: Challenges, opportunities, and strategies. Midwifery, 18(1), 4-8.
5. Dunkley, C. (2000). Health promotion in midwifery practice: A resource for health professionals. Elsevier Health Sciences.
6. Ewles, L., & Simnett, I. (2003). Promoting health: A practical guide. Elsevier Health Sciences.
7. Health Care Providers Handbook. (2010). Cultural sensitivity.
8. Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance, and ethics for nurses and midwives.
9. Royal College of Midwives. (2000). Vision 2000: A blueprint for the future of midwifery.