Role of the Midwife in Care Interventions

Role of the Midwife in Care InterventionsTitle Discuss the following statement in relation to fork up. Midwifery expertise is as much about knowing when not to interfere in the physiological process of pregnancy and surrender as it is about recognising when and how to intervene in a way that go away facilitate and enhance the womans readiness to give carry.EssayWomen have been giving birth byout the ages. On the one hand this kindle be regarded as a normal physiological process which has evolved over the millennia to be a self-made method of perpetuating the species and like most evolutionary honed processes, is likely to work well most of the time. On the another(prenominal) hand, as any experienced clinician knows well, any physiological process has the ability to malfunction. A large relation of professional medical care in any handle of medicine is to be able to earn the normal variations and differentiate them from the abnormal. As a general rule it is only the abno rmal that requires treatment or intervention. ( hunt T 1994)Hippocrates is reputed to have said that it is the first rule for a physician that one should do no harm. (Carrick P 2000). In a modern context, this often means leave the normal unaccompanied 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 writings 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 impression of asepsis from his observations, we note 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 otherwise normal pregnancies.On a matter of more immediate concern we can consider the issues relating to accent mark incontinency as macrocosm an excellent illustrative example of how midwives can elect to intervene during pregnancy and the birth process in order to facilitate not only the birth process but the whole plain of potential difference morbidity surrounding maternity in general.Pregnancy itself is an independent variable risk factor for evince incontinence (Rortveit et al 2003). Although the midwife is not generally involved in the very early stages of pregnancy, on that suggest is good evidence that prenatal involvement in terms of preparation of the woman for the process of childbirth will reduce the incidence of stress incontinence post partum. (Reilly E T C et al. 2002). management in the practice of antenatal pelvic adorn 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 rescue the midwife can make a number of interventions which will help to reduce the eve ntual morbidity including having the knowledge that a large birth weight baby is more likely to produce pelvic floor damage and will therefrom be more likely to consider doing a prophylactic episiotomy to minimise 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 prevent malpresentations and the associated possibility of instrumentally assisted 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 take into accounts the ability not to intervene if the pregnancy and delivery are motion smoothly.Unnecessary intervention also has a more subtle downside in that it encourages dependence by the set about on the midwife. On an ethical dimension one can argue that this unnecessary dependence ero stilbesterol the patient divisions autonomy. (Coulter A. 2002). During pregnancy and birth, many women will find it all to easy 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 realistic. 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 ultimately 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 t o contract rather than immediately intervene to deliver the placenta. There is a delicate line to be drawn between actively delivering the placenta too soon and thereby increasing the risk of uterine hemorrhage 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 distinction 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 Ethics in the Ancient World. Georgetown University press 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 self-denial 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, Pedlar F. (2002) Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility a randomised controlled trial of antenatal pelvic floor e xercises. 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 August 2004pp 378 380Semmelweis IP. (1861) Die aetiologie, der begriff und die prophylaxis des kindbettfiebers. Pest, Wien und Leipzig CA Hartlebens Verlags-Expedition 1861.