Normal Midwifery Practice

Sam Chenery-Morris, Moira McLean

• Publisher: Learning Matters
• Year: 2012
• ISBN:
  9780857257581
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

For new students the language and concepts of midwifery care can at first be daunting. This book helps students to understand the expectations of midwifery training in relation to normal midwifery practice. It covers the basics of midwifery care including professional practice, frameworks informing midwifery care, key concepts and philosophies of care, communication and care skills, antenatal care, normal labour and birth, postnatal care, neonatal care and breastfeeding, as well as a brief introduction to medicines management in normal midwifery care. The book is designed to work alongside first taught modules in midwifery, and underpin training in subsequent years.

Chapter 1 Normal Midwifery Practice

Sam Chenery-Morris

NMC Standards for Pre-registration Midwifery Education

This chapter will address the following competencies:

Domain: Developing the Individual Midwife and others

Review, develop and enhance the midwife's own knowledge, skills and fitness to practise.

This will include:

• making effective use of the framework for statutory supervision of midwives;
• meeting the NMC's continuing professional development and practice standards;
• reflecting on the midwife's own practice.

Domain: Achieving Quality Care through Evaluation and Research

Apply relevant knowledge to the midwife's own practice in structured ways which are capable of evaluation. This will include:

• critical appraisal of the midwife's own practice;
• gaining feedback from women and their families and appropriately applying this to practice.

NMC Essential Skills Clusters

This chapter will address the following ESCs:

Cluster: Communication

Women can trust/expect a newly qualified midwife to:

• 1. be attentive and share information that is clear, accurate and meaningful at a level which women and their partners and family can understand;
• 5. treat women with dignity and respect them as individuals;
• 8. be confident in their own role within a multi-disciplinary/multi-agency team.

Chapter Aims

After reading this chapter you will be able to:

• understand the legal and statutory frameworks governing midwifery practice;
• understand the tenets of low-risk midwifery care;
• explore the idea of midwifery as both an art and science;
• define the ethical principles of midwifery practice, such as woman- and family-centred care;
• appreciate the concept of professionalism.

Introduction

The origin of the word midwife can be traced back to the 1300s and translated as with woman. Although the dictionary offers definitions of midwife as a verb as well as a noun (www.merriamwebster.com/dictionary/midwife), it is most often used as a noun, to describe the person. This chapter sets the foundations of the book, and the translation with woman is the underlying philosophy for this series of books. With woman can be seen as an antidote to the medicalisation of birth – it respects each pregnancy and birth as individual and unique. It encourages interaction between women, their partners and families and midwives, putting the woman at the centre of her care and the decision-making processes related to her care.

In the UK, 700,000 women will give birth each year, and the majority of these women will see a midwife for some or all of their care (Midwifery 2020, 2010). For women deemed to be at low risk, the midwife is likely to be the lead professional for their care. Women who are considered to have higher risks because of their own health and/or a previous or current pregnancy are seen by a consultant obstetrician in addition to or instead of a midwife. This model of care – differentiating women into low- and high-risk groups – has been criticised as reducing the choices open to women with higher risk pregnancies and as starting to offer a two-tier system of maternity care in the UK. The number of women whose pregnancies are categorised as high risk seems to be on the increase (Midwifery 2020, 2010).

Although this book is primarily aimed at normal midwifery practice and care, the underlying philosophy is that each woman and her pregnancy should be treated as unique, and that sharing of information and involvement in decision-making should be extended to all women, regardless of their pregnancy risk status. These concepts will be explored throughout this chapter as both the individual and the collective beliefs of midwives have an effect on pregnant women's experiences.

Defining Midwifery

The official definition of a midwife comes from the International Confederation of Midwives (ICM, 2011). Before you read this definition, Activity 1.1 encourages you to try to work out your own midwifery priorities.

Activity 1.1 Decision-making

Try to write your own definition of a midwife.

Now access this website to read the ICM's full definition of a midwife:

www.internationalmidwives.org/Portals/5/2011/Definition%20of%20the%20Midwife%20-%202011.pdf

How does this definition compare to yours? Probably you will have used many of the words in this internationally recognised document – for instance, competency responsibility accountable, partnership, normal.

See the suggested answer at the end of the chapter.

Now you have considered the definition of a midwife, what do you consider to be the most important aspects of this role? This chapter will set out the UK context of midwifery practice but take a moment to explore your own personal philosophy.

Activity 1.2 Reflection

What sort of a midwife do you want to become? Where have these ideas come from (if you know)? How will you remember this philosophy at the end of your training?

As this activity is based on your own reflection, there is no outline answer at the end of the chapter.

Just as the task above was personal to you, each woman's pregnancy and birth is personal and unique to her. But there are still standards and responsibilities that each midwife must achieve and uphold; these will be explored before we go on to consider other more complex concepts, such as normality and risk in midwifery practice.

In the UK the roles and responsibilities of a midwife are governed by the Nursing and Midwifery Council (NMC). Some of the most important documents that will shape your practice come from this source: for instance, the Midwives rules and standards (NMC, 2004a), The code (NMC 2008a) and the Standards for pre-registration midwifery education (NMC, 2009).

Activity 1.3 Communication

Take a look at the NMC website for midwifery-related content and documents:

www.nmc-uk.org/Nurses-and-midwives/Midwifery/Midwifery-Education-and-Practice

Discuss with a colleague on your course what you think of the content offered on this website. Consider the following: How easy is the site to navigate? Would you return to this site? If so, what for? What did you find particularly helpful?

There is no answer at the end of this chapter as each student will have their own views on the website.

It is worth accessing the NMC website a few times a year, as there are often consultations that are open to the public, students and qualified staff If you participate in these surveys, you are contributing to both the nursing and the midwifery professions.

Although the NMC governs both professions, midwifery is not a subset of nursing: the two professions are very different. Nurses are often caring for patients who are sick, whereas in midwifery the woman is generally well. Pregnancy is a normal physiological process; it is not pathological, as with a disease. In nursing there is only one patient to care for, although the family is important to recovery (especially when nursing children). In midwifery there is a pregnant woman, her developing yet unborn baby and usually a partner, too, so family-centred care, information-sharing with all parties and decision-making are heightened. You do not need to be a nurse to be a midwife, yet some midwives are also or have previously been nurses. Most midwives now enter the profession by direct-entry routes, with a three-year preparation programme. They qualify as midwives with eligibility to the NMC register and a degree, and they can work anywhere in the world. The number of nurses in the UK is huge – there are fewer midwives: in 2008, 660,000 nurses and midwives were on the NMC register, of which 35,000 were midwives registered as eligible to work in the UK (www.nmc-uk.org/Documents/Statistical%20analysis%20of%20the%20register/NMC-Statistical-analysis-of-the-register-2007-2008.pdf).

There are two publications/practices that set midwifery further apart from nursing, as nurses do not have either of these systems. One is the statutory/legal responsibility of midwives to have supervision (Standards for the supervised practice of midwives – NMC, 2007) and the other is the set of rules and standards that govern midwifery practice (Midwives rules and standards – NMC, 2004a).

Supervision

Just as midwives support pregnant women, supervisors of midwives support other midwives. Supervisors of midwives are experienced midwives who have undertaken extra training to support other practising midwives. The purpose of this supervision is to protect women and babies from poor practice but also to promote excellence in midwifery. Each midwife is supported by a named supervisor to ensure they are providing the right care to each woman, promoting normality and working in partnership with women; each midwife must meet their supervisor at least annually. Just as each midwife has a supervisor, each supervisor also has a supervisor above them, not as a system of hierarchy but as a system of continued collaboration to improve and maintain midwifery standards. The Local Supervising Authority (LSA) has a Midwifery Officer supervisor who reports directly to the NMC. As previously mentioned, the NMC is the professional regulator for the two professions and is currently the largest regulator in the UK. This framework aims to keep midwives safer and enhance their roles by providing support to improve and consolidate their practice in ever-changing contexts.

Midwives Rules and Standards

There are 16 rules in this publication, each detailing the responsibility of a midwife, with guidance to help each midwife understand the regulations. Rule 6 is the one that this chapter will focus on as it sets out the midwife's responsibility and sphere of practice (NMC, 2004a). Midwives rules and standards states that a midwife will provide midwifery care during the antenatal, intrapartum and postnatal periods and except in an emergency will not carry out any care they have not been trained for. The midwife is also responsible for recognising where there is a deviation from the norm (NMC, 2004a, p18). This means that a midwife must recognise what is normal and what is outside their sphere of practice. In order to undertake the following activity it might be useful to remind yourself of the Midwives rules and standards (which can be accessed at www.nmc-uk.org/Publications/Standards).

Activity 1.4 Decision-making

Consider whether the following are considered normal midwifery care.

• A woman is anxious about her pregnancy.
• A 32-week gestation pregnant woman's child has chickenpox.
• A woman requests an epidural in labour.
• A woman is 42 weeks and two days pregnant.

Discuss these with a fellow student and see if you come up with similar answers.

There are some sample answers at the end of this chapter.

This exercise might have highlighted to you how difficult it is to separate frequently occurring midwifery care with normal midwifery practice. It is also important to remember that the Midwives rules and standards govern our practice, but they do not say what we should do in each situation; this is something you have to learn through theory and practice, reading evidence and asking others – women and other midwives. There is not just one ‘right’ way in each aspect of midwifery, as each woman is unique and what matters to her might not matter to the next woman.

Normal Midwifery Care

We will first consider more broadly what care women can expect from a midwife. For most women, pregnancy and birth are normal physiological events. Pregnant women are usually healthy women in a perfectly natural state. Care of women durin...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Foreword
• Acknowledgements
• About the Authors
• Introduction
• Chapter 1 Normal Midwifery Practice
• Chapter 2 Communication and Interpersonal Skills in Normal Midwifery Practice
• Chapter 3 The Initial Antenatal Appointment and Care
• Chapter 4 Ongoing Antenatal Care
• Chapter 5 Midwifery Care in Normal Labour
• Chapter 6 The Role of the Midwife in Postnatal Care
• Chapter 7 Neonatal Care
• Chapter 8 Medicines Management in Normal Midwifery Care
• Glossary
• References
• Index