The Midwife Mother Relationship by Mavis Kirkham
The Midwife-Mother Relationship by M. Kirkham. Macmillan, London, , pages, £, ISBN 0 0. Article in Journal of Advanced Nursing. Page () identifies the need to consider evidence from a variety of sources, The relationship between midwives and women appears to be a key concept that is . The midwife's implication that a healthy mother and baby was a But in the nonsupportive culture of maternity services (Kirkham, ). The relationship between the midwife and the woman combines all the aspects of approach highlighting the woman's experience (Kirkham, , Page, , Carolan . The participants were 13 first-time mothers and 10 were multiparas.
The marginalisation of lay knowledge of childbirth is a very recent phenomena. The rise of medical knowledge in the past years has largely supplanted this in the west and rendered lay knowledge at best a curiosity and at worst, dangerous.
There is no better example of this than the intersection between western obstetric techniques with indigenous birth practices where the latter is discredited and discarded.
The role of the midwife: time for a review
In the developing world, outdated obstetric practices such as routine episiotomy and lithotomy position are a sad legacy of this. These factors fundamentally depersonalise and objectify it. LoCicero writes that: Davis-Floyd and Davisby contrast, believe that connectedness and interpersonal relationships are keys to making clinical judgements.
Empathy, intuition and insight are what are required to individualise decisions at moments of crisis and these are grounded in active listening, rapport-building and sensitive communication with those intimately involved. He suggests that those in the helping professions deconstruct the artificial boundaries imposed by discourses of caring and actively seek non-possessive, non-reciprocal, non-hierarchical relationships.
Midwives working with this assembly-line approach have little autonomy, are under constant surveillance and pressure to increase productivity. Institutional and bureaucratic practices are rife within these boundaries.
Policies and protocols abound and ongoing measurement is endemic. These militate against a woman-centred focus as these checks and balances primarily protect and serve the system, not the clients. It is our view that this centralised model has no evidence-based foundation and has evolved largely to suit management and professional agendas. As Perkins argues in the US context, it is an industrial model, taken from private enterprise.
The German economist Schumacher wrote a seminal book on economic theory entitled Small is beautiful He could have been writing about maternity so well do his values and approaches cross over, discussing concepts such as local, personalised, small-scale units of productionn suffused with humane interpersonal dynamics. Practice-related dimension A fundamental question for the profession is what model and style of care is most likely to facilitate normal physiological birth.
Although rising caesarean rates are the primary focus of these concerns, the authors believe, along with Odent and Buckley that the neutralising of the labour experience through anaesthesia and bypassing of it altogether in elective caesarean section is a grave development in the evolution of human childbirth. This is because of what is now known about the hormonal cocktail of physiological labour and its effects, such as the impact on the initial connection and bonding between mother and baby Odent,the impact on the selfesteem and sense of fulfilment of the mother Buckley,the trigger to altruistic and protective maternal behaviours Buckley, and the catalysing joy and pleasure in mother and baby Leap, If these emotional and affective components are compromised and watered down by managed childbirth and this occurs across whole populations of women, then the authors are very concerned about the long-term impact on public health.
Already preliminary epidemiological work is linking destructive adult behaviours to interventionist birth experiences Jacobson and Bygddeman, Much of the blame for medicalised birth has been linked to the unequal historical power struggle with the medical profession Donnison, and in particular with obstetrics Arney, Over the last five years in the UK, there has been an acceptance that midwives can assume responsibility for women deemed to be at low risk.
During labour and birth, the midwife can work quite independently as she is the lead carer in the majority of births. The advent of integrated birth centres and midwifery-led units has accelerated these trends. I kept apologising to her and then the other woman I was with They also found it easier to build a rapport when they had the opportunity to get to know the woman over a period of time, when they could provide continuity of care.
The Midwife-Mother Relationship - Google Livres
Continuity It was not only the team midwives who raised the issue of continuity — the core midwives could see definite advantages as well: I did know her antenatally as well and I think that does make a difference.
Debates on continuity of care and carer appear to relate more to organisational efforts required to implement or evaluate its effectiveness rather than in challenging its potential to enhance meaningful relationships between women and midwives.
It was special At times, the midwives felt that they were able to make a significant difference to the women in their care, and when this happened they appeared to feel very positive about it: But we just danced And then she got up again and we started dancing right up until the head was almost on the perineum.
The midwives appeared excited when telling these stories, remembering particular births with positive feeling, and the concept of reciprocity Campbell, in the client-professional relationship appears pertinent.
Preparing This theme was described somewhat briefly but emphatically in the interviews as a key role of the midwife.How to Become a Midwife : Your Midwife's Relationship to Your Obstetrician
The responsibility to prepare the woman for labour, birth and early motherhood, helping her to know what to expect, was dealt with by giving women advice and by teaching them: The suggestion here and in other interviews was that the advice given by the midwife would help the woman to be prepared for the unknown.
However, there appeared to be a reluctance to tell women the truth about the pain of labour or of potential negative outcomes of complications in pregnancy, for example, with respect to pre-eclampsia: The midwives appeared to want to protect women from the reality of the pregnancy or birth experience.
This would seem a paternalistic approach to care, where the practitioner sees it as their responsibility to make decisions for clients based on professional knowledge and expertise, then guiding the person to an understanding of why the decisions have been made McKinstry, There was reticence about taking responsibility for this unrealistic picture: Clearly, this woman did not achieve her expectations — she had hoped for a non-interventionist birth that did not unfold.
Generally, the midwives were aware that it was their responsibility to prepare the woman but seemed unable or unwilling to consistently portray an honest account of labour and birth so the woman could really consider her options. The idea that midwives can actually control the outcome of a pregnancy through their supervision would seem illfounded.
In these descriptions, there is a lack of agency to the woman or her body. There is a dissonance between this potential for control and the relative powerlessness expressed about helping women achieve their expectations.
Feeling in control Once again, there were positive descriptions of experiences in practice, but these were defined in relation to the lack of interference by anyone else: Because it was really what the person was doing, it really was a normal delivery.
She delivered the baby, the woman did. We only actually deliver babies when women have sections. Normally, they deliver their babies. Indeed, the fact that things progressed without a need for any specific action was considered particularly pleasing. These positive experiences would seem to reinforce the potential for normality of birth and the value of both non-interventionist midwifery practice and inactivity as mechanisms of support.
Not feeling in control There were many descriptions of times when others took over responsibility, leaving midwives feeling angry and frustrated: The midwives said they felt guilty when this happened and that they had let the woman down — again, they seemed to want to protect the woman from unpleasant experiences. However, they also seemed to lack conviction that women can birth without intervention given the right circumstances and support.
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Possibly, repeated negative experiences had reduced their confidence, and control by others eroded their authority. As NHS midwives, they worked in a large, bureaucratic organisation. Street-level bureaucrats normally feel powerless, believing they have little opportunity to take control in a system where policies and protocols are prescribed centrally.
Similar experiences to the two scenarios above were described by other interviewees, when doctors or senior midwives took control. The midwives had not challenged the decisions, but were left feeling impotent and angry.
In reality, practitioners have significant power in relationship to the client and can have a profound influence on the way the individual experiences the service. But in the nonsupportive culture of maternity services Kirkham,this power may prove difficult to use. Although these midwives seemed to want to believe they could really make a difference for women in their care, they did not consistently achieve that outcome due to a variety of external pressures.
Implications for education Although this paper only relates to the initial phase of the research, there are some implications for education. As a relatively small qualitative study, it may be argued that no generalisations can be made from the findings. However, Morse points out that the purposefulness of the sample in a qualitative study means that findings will be based on data provided by participants with a relevant and specific contribution to make, and their meaningfulness increased.
The issues raised would not necessarily be the same had the research been conducted with a different group of midwives and by a different researcher. Yet, the things that these particular midwives shared are important, recognisable by other midwives and useful as a starting point for the development of an educational strategy. The practice environment, where half of UK midwifery education takes place, has a significant impact on learning. Satisfied midwives who feel they make a substantial contribution to positive outcomes for women are likely to be effective role models for students.
Satisfaction for the midwives in this study came at least in part from feeling in control. A consistently supportive culture, where professional groups work harmoniously and collaboratively would seem a preferable learning environment to that described at times in the study.
Opportunities for developing sustained relationships with women, for example through caseload practice, can also have a positive impact on the learning experience for students. However, at the moment we have no communication skills has received little research evidence base to guide us, thus there is an urgent attention within maternity care.
In contrast, within need for funded studies in this area. Rowe interest, both in implementing communication et al. Why Do Midwives Leave?
A midwifery model of care for childbearing human communication and relationships. We are also mindful that formal initiatives may The Journal of Perinatal Education 14 19— Our maternity services are now at breaking in a tokenistic manner, for example by providing point. The Guardian January 31,accessed online: Engaging with clinical supervision in a community midwifery setting: Midwifery 21 2— In this commentary, we have considered maternity Downe, S.
Evidence and Debate care as a tapestry, in which the weft threads are London. Churchill Livingstone, New York. A critical ethnographic study of encounters technologies, policies and protocols.
Relationships between midwives and breast-feeding women in postnatal are the warp threads that hold it all together, but wards in England. Midwifery 21 3— The visibility Planning Home Births. Motivation and burnout in human service focus of our attention: Thesis, achievement of targets, introduction of new Roskilde University, Denmark and National Institute of technologies and production of protocols become Occupational Health, Denmark.
In this maternity care. Guest Editorial, Birth 33 4— Communication ignores the weft threads—relationships—and thus skills training for health care professionals working with misses the point entirely. In a similar way, without good-quality and Control in Labour, and Psychological Outcomes: Summary relationships, the tapestry of maternity care is Report.
- The Midwife Mother Relationship
- ‘Making a difference’: midwives’ experiences of caring for women
Communication that any new interventions, policies or systems will training for health professionals who care for patients with cancer: Support be effective or sustainable, or that high-quality Care Cancer 13 6— We urgently need to pay real Halldorsdottir, S. Investigation into 10 maternal We are currently developing proposals for colla- deaths at, or following delivery at Northwick Park Hospital, North West London Hospitals NHS Trust, between April borative research to further explore the complex and April Augustaccessed online: Transfer of commu- nication skills training from workshop to workplace: Patient Education and Coun- References seling 60 3— Feeling safe enough to let go: Macmillan Press, Basingstoke, pp.
The hidden threads in the tapestry of maternity care Journal of Obstetrics and Gynecology Suppl. Continuous support for women during childbirth.