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The Role of a Midwife8th December 2015 Clinical Negligence
Midwives perform an incredibly important, often stressful and uniquely rewarding job. This is an occupation that demands so much and offers perhaps the most satisfying outcome of all - the introduction of a healthy new life to the world.
But are midwives given everything they need to perform their duties to the best of their ability? Do they have the time, support and guidance to not only do everything expected of them, but also all they want to do for both mother and child? Are they under too much pressure, and does this impact their work? Is the profession understaffed? To help us answer these questions, we look at the various roles a midwife has to undertake.
Different roles - many and varied
The definition of a midwife, as presented by the International Confederation of Midwives and agreed upon by the World Health Organisation and the International Federation of Gynaecology and Obstetrics, reads:
"A midwife is a person who, having been regularly admitted to a midwifery educational programme that is duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery."
What this definition doesn't explain, however, are the numerous roles a midwife has to perform as part of their overall job specification. To put this in general terms, it is the responsibility of the midwife to provide women with the necessary support, advice and care they need during the three stages of pregnancy, labour and the postnatal period.
Provided everything is normal during pregnancy - and referral to a doctor because of complications is not required - midwives often provide all of the antenatal care a woman needs, and provide care for both the mother and infant following the birth for a period of up to 28 days, although this can be extended if necessary.
One of the most important roles a midwife performs is providing support to women in labour. This can obviously be a very difficult and worrying time for a woman, with up to nine months or more of pregnancy leading up to this point. Complications may arise during childbirth, and with the health of both the baby and mother of the utmost concern, the midwife has a huge part to play by helping with the delivery, providing care to the mother and offering reassurances when necessary. Midwives play a crucial role in observing the mother and carrying out checks to determine fetal well-being during labour and identifying early signs of fetal distress that may warrant medical intervention.
In some circumstances, the midwife may be required to stay with the pregnant woman for a significant length of time, sometimes throughout the duration of the labour. This can be extremely difficult and tiring, especially given the constant care required over a long period, coupled with the heightened emotions of such a time. Midwives will also be required to assist with the various forms of birth available when appropriate, including water births. If a birth becomes more complicated, requiring intervention from an obstetrician, midwives play a crucial role in assisting the obstetrician in preparing for the delivery
There are two types of midwife who work in the NHS in the UK - hospital midwives and community midwives. As the name suggests, the former are found in hospitals and staff antenatal clinics, as well as labour and postnatal wards, and have their base in various locations including hospital obstetrics, birth centres and consultant units.
The latter, however, provide care to women at their homes or in a clinic. They tend to work in teams and are available to assist with home births and will often visit mother and child at their home for up to ten days after the birth, making sure everything is okay and progressing as would be expected.
Providing the right care
To simply state that midwives provide care for women during and after pregnancy would be to perhaps oversimplify the variety in their workload. This is because the care they provide comes in many different forms and requires an array of skills. Their various roles include:
Detecting any complications, with regard both mother and child
Making sure emergency measures are carried out when necessary
Promoting natural birth, where applicable
Accessing further assistance, if appropriate - such as contacting a doctor in special circumstances
We are already getting a clearer picture of not only the range of roles a midwife must undertake, but also the importance and great responsibility of each and every task. Having a child is one of the defining moments of a person's life, and while bringing a new human being into the world evokes immeasurable joy, there is always a degree of anxiety about whether everything will go to plan and the baby and mother will be healthy. It is part of a midwife's job to provide the care and reassurance needed at such difficult times.
If this was not enough, there are a great number of other roles a midwife can take up to ensure others - and not only the mother and child - are provided with all of the support they need. For example, education and counselling forms an important part of a midwife's role, and this can involve teaching other family members, and even the wider community, about different aspects of pregnancy, childbirth and caring for an infant.
A midwife might therefore be expected to:
- Provide antenatal education for parents-to-be
- Help to prepare would-be parents for the changes they can expect
- Provide education about sexual health
- Teach would-be mothers about women's health
Is too much expected of midwives?
With so many hugely important roles to perform, midwives could be forgiven for expecting they would be afforded adequate time to spend with each patient, and expectant mothers might anticipate a continuity of care that sees them consult the same midwife throughout. However, there have been suggestions that understaffing has had a marked impact on the ability of midwives to perform all of their duties to the best of their ability, and to therefore provide the very best care for families going through such an important, yet difficult experience.
Indeed, the government has stated that an additional 2,300 full-time midwives are needed to keep up with the birth rate as it currently stands, and the Royal College of Midwives has suggested this figure could be anywhere between 2,600 and 3,000. If there are not enough midwives to keep pace with the birth rate, it poses a number of questions. Not least, we have to question whether midwives are able to provide the appropriate care to each and every expectant mother and, if not, can this exacerbate the threat of clinical negligence? After all, if midwives are too overworked, how can they be expected to ensure every detail, no matter how small it may seem, is covered?