Midwifery at a Glance

Eleanor Forrest

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781118874455
• eBook ISBN: 9781118873601
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Midwifery at a Glance offers an easy-to-read yet comprehensive overview of everything a midwifery student needs to know, from conception to care of the newborn.

This practical guide provides coverage of normal pregnancy, maternal and foetal physiology, and pre-existing medical conditions and how these affect pregnancy and birth. It also features vital information on the role of the midwife, evidence-based practice, health promotion education, and perinatal mental health, as well as neonatal care and an overview of emergency situations.

Midwifery at a Glance:

• Contains superb full colour illustrations throughout
• Is written specifically for midwifery students and includes all the concepts found on the midwifery curriculum
• Demonstrates links with other relevant multidisciplinary healthcare professionals

Midwifery at a Glance is the ideal guide, offering educational support for midwifery students in the application of midwifery knowledge into clinical practice.

Part 1
Introduction

Chapters

1. 1 Historical overview of midwifery
2. 2 NHS values
3. 3 Ethics
4. 4 Role of the midwife
5. 5 Drug exemptions
6. 6 Women’s choice and care options

1
Historical overview of midwifery

Midwifery is one of the oldest occupations in the world, if considered simply as the presence of a woman accompanying another woman during her childbearing event, with knowledge passed from one generation to another. The term midwife is understood to mean ‘with woman' but older terms have existed such as ‘howdie' in Scotland. Midwives' status in the community rose and fell over the centuries, influenced by medical men and concern over their mysterious powers. Soranus of Ephesus (2nd century AD) is credited with writing the first textbook on midwifery, which described desirable characteristics of a good midwife to be ‘literate, with her wits about her, good memory, loving work, respectable, not unduly handicapped as regards her senses, sound of limb, robust, long slim fingers and short nails, soft hands, free from superstition and of sympathetic disposition.' The contemporary concept of a ‘good midwife' is related to the complementary areas of theoretical knowledge and skilled competence underpinned by lifelong learning, communication skills, and personal qualities including emotional intelligence, with a midwife's professionalism being central to women's empowerment during childbirth. However, often women became midwives by default of attending a birth with a midwife and then being asked to attend others.

The first school to train midwives was founded in Edinburgh in 1726, followed by Glasgow in 1739, with others following in England. However, training was mainly under the auspices of the Faculty of Physicians and Surgeons. The 18th century also saw the rise of male midwives among controversy regarding their role in attending women. Smellie (c. 1750) provided anatomical knowledge that contributed to understanding the mechanism of normal labour, while Chamberlen (c. 1733) used forceps to aid delivery of a live baby rather than just to extract the often dead fetus. During the 19th century, educated middle class women tried to improve the status of midwifery as a profession through the eradication of caricatures such as the uneducated, drunken Sarah Gamp portrayed by Charles Dickens. The Ladies Obstetrical College (1846) was formed by these educated women, offering theoretical and practical training, but was disbanded due to puerperal fever. The London Obstetrical Society Examining Board (1872) required candidates for midwifery to be aged between 21 and 30 years and have proof of attending a minimum of 25 cases; however only six took the exam.

Rosalind Paget and Zepherina Veitch were influential women in the establishment of the Midwives Institute (1881; to become the Royal College of Midwives (RCM)), which campaigned for the registration of midwives, culminating in the Midwives Act 1902 (England and Wales) which specified the education and training, registration and certification, supervision and control of midwifery practice. Therefore it was not until the 20th century that legislation existed to regulate midwifery practice. The roll of qualified midwives maintained by the Central Midwives Board (CMB), included women who already possessed a recognised qualification in midwifery and women of good character who had already practiced as a midwife for at least 1 year (bona fide midwives). Legislation laid down several aspects of midwifery practice and rules concerning equipment, clothing and standards of hygiene that were considered essential, which continued until the 1970s.

Improvements in midwifery practice focused on strategies to reduce maternal and perinatal mortality rates, aided by social and environmental and technological advances, combined with changes in working practices and education and training for midwives. Pressure groups such as the Association of Radical Midwives (ARM) and the National Childbirth Trust (NCT), together with the RCM as a professional and trade union-affiliated organisation, through various reports and campaigns, have influenced both the provision of care and status of the midwife as professionals (Table 1.1).

Changes in the regulatory body (CMB to UK Central Council (UKCC) to Nursing Midwifery Council (NMC)) over the years have seen modifications to the Midwives Rules and Standards (NMC, 2012) and The Code (NMC, 2015) to less specified activity with greater use of professional knowledge and competence. Supervision of midwives increased after 1996, with their role and function being prescribed within the Midwives Rules and Standards; however recent investigations into the practice of midwifery supervision (such as Morecombe Bay and Guernsey) have led to the demise of this within the regulatory function of the NMC (Chapter 5).

In 1986, Project 2000 recommended a 3-year curriculum, with midwifery being seen as a branch of nursing. This was fiercely rejected by the profession and a year later the RCM advocated a 3-year curriculum for midwifery in the UK with direct entrant midwifery, which was supported by the English National Board in 1988. Whilst two hospitals continued some direct entrant training (Edgware and Derby), in 1989 seven ‘midwifery schools' commenced 3-year direct entrant midwifery training, and by 1994 there were 35 three-year pre-registration programmes, at both degree and diploma level, linked to higher education institutions. The formation of the UKCC in 1989 had led to removal of the requirements for specified hours of medical practitioner input into the midwifery curriculum and examination. By 2009, the NMC, within their standards for pre-registration midwifery education, stipulated that midwifery should became an all degree profession.

Midwifery remains an important occupation and is highly valued by women. However, constant tension between personal qualities, as aligned to the NHS values and the six ‘C's of Care (Chapter 2), and professional competencies of midwives and other occupations have all had an impact on the status of midwifery and the autonomy and control of midwives. Changes in relation to the skill mix in maternity services and in midwifery supervision and the future of the Midwives Rules and Standards have set the scene for the potential of professional control remaining an important issue in the future of midwifery practice.

2
NHS values

The NHS was founded in 1947 to improve health and wellbeing within a common set of principles. The NHS Constitution was first published in 2009 by the Department of Health as part of a 10-year plan to provide the highest quality of care and service for patients in England. Updated in 2015, it explicitly states the principles (Box 2.1), values and pledges that patients, the public and staff can expect from the NHS and what the NHS expects from them in return.

NHS Scotland has published the 10 Essential Shared Capabilities supporting person-centred approaches to care (Box 2.2) that has themes comparable to the NHS Constitution. Following the failings at the Mid Staffordshire NHS Foundation Trust, it is vital that everyone involved in the NHS learns from the findings of the subsequent Francis Inquiry and Keogh and Berwick Reviews (Box 2.3). The NHS values describe how everyone using or working within the NHS should be treated and the updated constitution reflects that the NHS's most important value is for patients to be at the heart of everything the NHS does.

Six values

The six NHS values are respect and dignity; compassion; working together for patients; improving lives; everyone counts; and commitment to quality of care. These apply to all recipients and providers of care and describe the aspiration to facilitate co-operative working at all levels of the NHS.

Applied to midwifery practice these values can be considered as:

1. Respect and dignity – every person is valued as an individual and respect is given to their aspirations and commitments in life, and their priorities, needs, abilities and limits should be understood, irrespective of whether they are a mother/baby, family member or staff. Care should be provided with honesty and integrity and listening to the views of others, for example when formulating a birth plan, to enhance provision of safe and effective care.
2. Compassion – midwives should respond with humanity and kindness to each mother's need, pain or distress and find things that will provide comfort and relieve suffering to mothers and their families but also their colleagues, for example during labour and in times of bereavement.
3. Working together for patients – mothers, babies and their family come first in everything a midwife does. Collaboration with the multidisciplinary team and networking plus seeking the views of service users will contribute to effective care delivery.
4. Improving lives – the public health role of the midwife and health promotion can affect the mother's health. Midwives can innovate and improve care to improve health and wellbeing plus the mother's experience of the NHS, for example establishing teams to support vulnerable women.
5. Everyone counts – midwives should maximise resources for the benefit of the whole community of mothers, babies and their families, whatever their social or educational background, their race, religion or culture; for example all women should have equal access to antenatal classes.
6. Commitment to quality of care – midwives must provide safe and effective care. The right care, in the right way at the right time is dependent upon midwives' knowledge and skills, com...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• About the companion website
• Part 1 Introduction
• Part 2 Anatomy and physiology
• Part 3 Preconception
• Part 4 Antenatal
• Part 5 Intrapartum
• Part 6 Postnatal care
• Part 7 Common medical disorders
• Part 8 Obstetric complications
• Part 9 Fetus and baby
• Part 10 Psychological dimensions
• Part 11 Midwifery skills
• References and further reading
• Index
• End User License Agreement