Psychosocial Aspects of Midwifery free essay sample

Psychosocial Aspects of Midwifery Care MW2222 Practicing midwives in our healthcare system today need to have an understanding of political and social factors of their practice in order to provide optimum service for the women and families in their care. The psychosocial needs of the individual should be considered, and midwives should contemplate external factors that may affect the woman’s health, pregnancy, outcome and their home lives. This is why the whole picture of a woman’s life should be respected in order to gain contextual knowledge. With the aid of a scenario true to real life practice, this essay will aim to: identify and analyse the psychosocial impact of the processes of childbirth upon women and their families; explore the social and political context of midwifery care; examine the changing role of women as a result of childbirth; discuss sociological explanations for inequalities in health and how these affect health and the provision of maternity care; discuss the impact of medicalising childbearing; explore psychological processes of those involved maternity care; explore social interaction between individuals, interpersonal skills in midwifery practice and the implications. The chosen scenario involves Mina (Mother-to-be), Carl (Mina’s Husband), Fay (Midwife) and Inez (Student Midwife). From the very beginning, it is obvious that Carl is a very supportive husband, which has a positive affect on Mina from what can be gathered by the writing of the scenario. On the other side, with Inez and Fay, there is a feeling of negativity; Fay is very dismissive of the birth plan, and Inez’s attempt to interact with the couple using their plan through discussion â€Å"Shall I go through [the birth plan] with them when we go back to the room? †Ã¢â‚¬ ¦ â€Å"Won’t need that, she’ll end up with a section. † Analysis of the scenario will begin with Carl, the supportive husband. According to FathersDirect. com (2007), fathers often feel marginalised from he pregnancy, birth experience, and many may feel unsure of their role in the new triad postpartum. Due to not experiencing any symptoms of pregnancy, men have a very indirect ex perience of this important time in the couple’s lives. Though there is the argument of couvade syndrome, where partners of the pregnant woman experience symptoms of pregnancy themselves, such as food cravings, bloated abdomen, fatigue and morning sickness (Brennan, 2008). Carl, however, seems to be very comfortable with his role in Mina’s period of childbearing. He has taken the role of supporter to the extent that he has adopted the title of â€Å"Team GB† for the couple. Signifying a bond between them that goes beyond husband and wife. It is now the social trend for the partner to be present and the birth; it has been shown in research that the partner’s presence in the preparatory classes and/or in the delivery room generally results in reduced maternal and fetal distress (Stapleton, 2012). This includes a reduced need for analgesia (Raphael-Leff, 2008). How men react to impending fatherhood is determined by how they view the concept of gender identity (Rodgers, 2011). Their reaction is also influenced by how their pregnant wife/partner encourages his bonding with the fetus for the duration of the pregnancy (Combs-Orne and Renkert, 2009. ). There is a model that suggests that there are categories that each parent can fall in to regarding how they accept and behave towards childbearing and childbirth. This research does take in to consideration that not all will fit strictly in to either one category or the other, and that there are those groups in between who do not quite fit the criteria. Focussing on the model of â€Å"Facilitators† and â€Å"Regulators† in this instance explores the Mina’s maternal orientation towards her pregnancy and motherhood (Raphael-Leff, 1986). The Facilitator adapts her life around her pregnancy/child, and responds to its needs as they arise. The Regulator however expects the opposite; she wants the baby to adapt to her life and routine. The latter establishes a strict routine that suits her needs, usually before her baby’s (Raphael-Leff, 1986). For example, some mothers may demand feed their baby, signifying they will adapt their time around the needs of their new born. In contrast, a Regulator will feed every 3-4 hours to establish a routine, even if the baby shows signs of being hungry before the times slot. The model that relates to fathers uses the categories â€Å"Participators†, â€Å"Renouncers† and â€Å"Reciprocators†. As mentioned above, the category that the male partner fits in is determined by his own concept of gender identity (Rodgers, 2011). The western culture has liberated women, and allowed men to essentially cross the traditional gender lines (Fischer, J, 2012) in terms of their roles socially. Men are now able to nurture without losing their masculinity; they have gained the freedom to choose their role in parenthood. This model that explains paternal orientations, written by the same professor as the Facilitators/Regulators model, explains Renouncers to be those who have a traditional view of mothers being the primary caregiver and the father as the breadwinner (Raphael-Leff, 2008). Participators explain the fathers to be the primary caregiver (Raphael-Leff, 2008), while it is still rare; it is becoming more frequent in our modern western culture. This is usually the case with â€Å"career women† who return to work rather soon after the birth of their baby, or those who suffer emotionally due to their birth or the pressures of motherhood. Then there are the Reciprocators, who employ behaviours from both extremes (Raphael-Leff, 2001. Pg 74); the partner is comfortable enough in his male identity to take on paternal and maternal aspects, and is the partner who is eager to be involved in the pregnancy as much as possible (Zeanah, 2009. Pg 28) – he is usually involved in antenatal classes and other preparatory activities with the woman. He sees the pregnancy in a very positive light. As a couple, taking these models in to account, Mina and Carl fall in to the categories of Facilitators, and Carl himself is a Reciprocator. They have both built their lives around their unborn child. They have organised and gained control of every aspect of their lives; down to the activities they would not have normally participated in if Mina were not pregnant, such as yoga, workshops and classes. As the environment surrounding someone changes, an individual can either attribute their successes and failures to things that they have control over, or to those external influences which are out of their control (Locus of Control, 2012). Mina and Carl approach the change in their life in the first manner; they have made the changes in their life in order to have control over what happens with the pregnancy and how they affect the labour and birth. Whichever approach a person takes on changes in the environment is known as â€Å"Locus of Control† (Locus of Control, 2012), which links back to a study performed in the 1960s by Julian Rotter. He aimed to investigate in to how behaviours and attitudes affected the outcomes of their lives. Those who have an internal locus of control believe that the outcomes are a result of their own behaviours and attitudes (Locus of Control, 2012). The opposite is when individuals believe that the outcomes are a result of influences that are out of their control, whether these influences be environmental factors or other individuals. (Locus of Control, 2012) Thus, individuals who have an internal locus of control believe that they are responsible for their own success (Locus of Control, 2012); this explains why Mina and Carl have taken it upon themselves to prepare as much as possible â€Å"We’ve done yoga, an antenatal course and birthing workshops†. They have also prepared for the labour and birth through the production of a birth plan. This could explain that they understand the limit of their control, and are guiding the health professionals involved in the care as to how they would control the labour and birth if they could. In addition to Mina being a Facilitator, she imagines her birth as an exhilarating event. Her main fear is that of being interfered with and thrown off course (the course being her devised birth plan). The Facilitator wants to let nature take its course, as she trusts her body and its ability to get through labour. Fay the midwife, however, has a lack of faith, which is a complete contrast. Mina wants a natural birth, and under the category of a facilitator, is anxious she will become over managed by rules and external decisions, hence the preparation for labour and birth, and the use of a birth plan. Mina greets pregnancy as a consolidation of her femininity and her identity as a woman. This is almost her way of consummating her womanhood; she sees labour as a private and intimate happening (Raphael-Leff, 2008). A caesarean section would be the complete opposite with the midwife, student, obstetrician and the rest of the surgical team present at the birth of her child. The birth of her baby would be more a like to a public viewing. If her fate, as Fay has decided it, were to be to have an emergency caesarean section, there will be more of a chance of Mina being psychologically disturbed by the event. Clinical guidelines by National Collaborating Centre for Women’s and Children’s Health, commissioned by NICE (2004) stated that a study has suggested a high level of intervention by an obstetric team (such as an emergency caesarean, but also includes forceps or ventouse delivery), is associated with the postnatal development of acute traumatic symptoms (Caesarean Section, 2004. Pg. 83), and the mother is more likely to suffer with postnatal depression. It has been suggested that hospitalisation and intervention during labour can have the effect of removing the locus of control from the woman and placing in in the hands of the medical staff. Thus, Mina is forced in to a passive dependent role to respond to the expectations and command of hospital staff rather than her own body (Raphael-Leff, 2008). By doing this, she loses control of her intimate moment, and Carl is also forced to abide by the obstetric team’s saying. Many women, along with Mina, want a midwife who will facilitate the birth experience she desires; though Fay doesn’t appear to show any interest in the birth plan Mina and Carl have taken time to compose. The International Confederation of Midwives (2011) defines a midwife as: â€Å"†¦a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. † Pregnancy, labour and the birth of a newborn are times of increased vulnerability. Fay has not identified to the couple or Inez, the student midwife, as to why she predicts a caesarean for Mina. Therefore, according to the ICM definition, she is not promoting normal birth or giving the necessary support, care or advice the couple deserves, and that she is required to give as a midwife. Healthcare professionals are given the role of guides in the transition to motherhood, yet a large number of women remembered labour as an unpleasant experience (Reed, 2012). The Commission survey in 2007 revealed that 37% of women felt they were ‘not always’ treated with respect and dignity, kindness and understanding. This statistic reflects the care that Mina is receiving from Fay with a lack of respect and understanding. In 2011 an article in the British Journal of Midwifery written by Nicholls et al explored the establishment of perceptions of a good midwife. Nicholls stated that a midwife is to provide individualised care and have good communication skills and instil trust in women. Fay has not expressed good communication skills by with holding information from Mina and Carl, and also by not explaining to Inez her reasons for predicting the outcome. She is very dismissive of the birth plan, which is usually utilised to fill a gap between the desires of the parents and the hospital procedures – it is not just for the benefit of the parents. This is why it is important for midwives to assess the parents’ wishes so that there is an understanding on both sides of the potential of the birth. The realities can be noted, and the possibility of not all wishes being able to be fulfilled explained by the midwife. This would demonstrate good communication skills, and being treated with respect, kindness and dignity. Failure to do so risks the trust of the woman and her family, resulting in a stressful labour, which could be psychologically damaging; leaving the woman feeling like a failure due to her birth not ‘going to plan’ as it were (Reed, 2011). Perhaps Mina is seen as demanding by Fay, as she sees Carl â€Å"struggling† with the â€Å"several† bags, one of which has been given the name of â€Å"blue labour bag†. Fay could perceive the couple as difficult clients; impatient and frustrated by the diligent planning they have done, which she could see as only making her job harder. Raynor and England (2010, page 84) suggested that clients perceived as ‘difficult’ tend to get less attention and can be denied of compassion or curiosity, and standardisation of treatment results in an impersonal experience and care as a whole (Deery 2010). Fay as a midwife is not making any attempt to acknowledge Mina as an individual. If midwives lose touch with their role, women become a production line or a succession of pregnant bodies (Dykes, 2006) and show little acknowledgement of the private nature of the birthing experience, its emotional significance and disturbing feelings it can provoke. The midwife must understand that the quality of the birth has a long lasting effect on the relationship of the mother and father to their baby and each other for years post delivery, and can affect how they are as parents. Perhaps as Mina is suggesting an active labour, Fay feels that this will make things more awkward for her; bending down to the pool to check Mina, auscultating the fetal heart rate with a sonic aid every 15 minutes, then every 5 minutes in the second stage of labour. Whereas a caesarean section involves technological aids such as fetal monitors, which replace direct contact with the woman during labour from the midwife’s view. Inequalities in health care are always present, though it is said in the Black Report (1980) that those who are educated are recipients of better health outcomes. However, we see here, that despite being well educated through antenatal classes and workshops, Mina and Carl are still at a disadvantage due to the midwife’s attitude to them as clients and her view of her practice. Due to the limited information about the couple, other suggestions regarding inequalities in maternity care cannot be made. However, the assumption of class could be made; Carl and Mina have been to yoga, workshops and antenatal classes, which could insinuate more middle class due to the cost and availability of classes. This would, however, be an assumption. Despite their possible higher than work class and education, they are still at risk of a poor outcome in terms of Mina’s health and experience. Now to turn to the issue in hand of student and mentor; in Midwives Magazine (2008), it was found that midwives do not use evidence-based practice enough to justify their practice, as student midwives are. Students in the study in the magazine found that this difference in practice, and the lack of use of evidence to support it created conflict between themselves and their mentors. Thus affecting the care that women received; it also resulted in subservient behaviour (Jones, 2008) from the students themselves. Fay does not just dismiss the birth plan; she dismisses Inez’s suggestion, disempowering the student. The implications of this are that Inez learns bad behaviour and practice – creating another midwife who does not respect her women as much as she should, and not giving her the freedom of choice and the opportunity for a normal, natural birth (Midwifery 2020, 2010). Pregnancy involves physiological, psychological and social changes, especially when having the first baby (Bjelica, 2004); it can be a very stressful event in a family’s life. Changes to a woman include physical appearance, moods, sexuality, while her role reaches a new quality. Around 50% of societies in the present day expect women to return to full duties within 2 weeks after delivery, whereas pre World War II, women were kept in hospital for up to the same amount of time after childbirth as routine (Raphael-Leff, 2008). In order for a woman to cope well with the stresses of her pregnancy and the impending birth, appropriate relationship of partners and support of the society are needed. Psychosocial support is needed; Carl provides physical and emotional support in the way of his presence antenatally and intrapartum, even as a physical leaning post for Mina through her contraction. She also needs empathy from the social environment she is in (Bjelica, 2004), which she would receive readily from Inez, if she, as a student, had not been disempowered by Fay. Overall, as a husband, Carl has provided the best support for Mina, and in return, he gets the satisfaction of making his wife happy; has a role in the labour process; and bonds with his unborn child. 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