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The skills and knowledge exclusive to midwives can mean the difference between a mechanized birth and a normal, natural delivery. Caroline Flint describes the unique contribution of midwives to success in pregnancy and labour You can't get a diploma by sitting and waiting patiently. You can't get a degree for talking someone through a stressful and painful experience in a supportive way. You can't get a doctorate for knowing in your bones that something isn't quite right. And so it is that one of the greatest problems for midwives is that their knowledge and skills are often indefinable, instinctive, and sometimes not easy to describe. Frequently, they don't realize that they've got knowledge at all and if they do they don't think of it as anything special. They do not even realize that it could make all the difference for a woman between having a normal, unmedicated birth, feeling incredibly clever and proud of herself or having a birth complicated by analgesics, possibly an instrumental delivery and feeling that she had no part in the birth of her baby. Because midwives are unaware of their value and worth neither is anyone else. Midwives recognize the special skills and knowledge of the obstetrician: the ability to deliver by forceps; the surgical skills involved in doing a Caesarean section; the ability to put up intravenous drips or to carry out fetal blood sampling and to interpret the results. Both obstetricians and midwives usually recognize the areas of skill in which both overlap: Midwives' ability to do vaginal examinations; to ascertain the position of the baby in utero ; to read fetal heart tracings; to suture perineums, resuscitate babies; to know about the progress of labour and deviations from the normal and similarly with pregnancy and the puerperium. In an interesting paper in the British Journal of Obstetrics and Gynaecology (1983, p.123) Michael Klein points out that women who were cared for in their own homes in early labour by community midwives enjoyed a number of advantages over a comparable group who did not have the benefit of a community midwife. Although they were generally in labour for longer, they spent comparatively less time in the labour ward, had fewer epidurals, received less pethidine, fewer forceps deliveries, had babies with higher Apgar scores and a higher number who needed no intubation.But equally important are the knowledge and skills that are exclusive to the midwife. For example, waiting is perhaps the most important skill for anyone involved in the often slow process of birth. It is the skill that has denigrated since the advent of active management of labour, but I suggest that there is a much needed place for it and that it is the midwives who are able to provide it. Women in the antenatal period really appreciate a health professional who shows real interest in her as a person. Midwives don't find this difficult and often their special skills ensure that their antenatal consultations are warm and caring and much appreciated by their clients. Again, by concentrating on the normality of childbirth when a woman is in highly suggestible state it wouldn't seem too far fetched to suggest that perhaps the midwife ensures normality of outcome. This was a point which was recognized by the midwives' boards before their demise in their excellent booklet, The Role of the Midwife' which suggested; ` Perhaps one of the main threats to the execution of the midwife's role is the practical application of the philosophy that childbirth is normal only in retrospect'.Despite the increased use of episiotomy over the past decade many midwives are still able to deliver with an intact perineum or minimal trauma and since the research conducted by midwife Jennifer Sleep (2) many midwives are re-learning this skill. Another skill exclusive to midwives is the hostess role. It is easy for the midwife to offer the newly-admitted labouring woman and her partner a cup of tea and for her to provide light refreshments throughout labour and after. This not only emphasizes the normality of labour but also helps to avoid ketosis.(3) Midwives also have the patience and the interest to wait patiently but all the time encouraging the woman, while she and her baby get breast feeding organized. An interest in and knowledge of pelvic floors and perineums again are the province of the midwife. The list is very long but these skills have something in common - they are all quiet skills, skills for which one can receive no paper qualification, skills which are unassuming, for which it would be difficult to get a prize. But nevertheless we mustn't underestimate them - for the women we care for, for the women we are with, these skills are of paramount importance. References 1. Central Midwives Board for Scotland, Northern Ireland Council for Nurses and Midwives, An Bord Altranais, Central Midwives Board. The role of the Midwife 2. Sleep, J. (1984). `Episiotomy in normal delivery'. Nursing Times 80:47; pp. 29-30; 48, ' 51-54. 3. Haire, D. (1972). The Cultural Warping of Childbirth London: International Childbirth Education Association. March 6 198 |
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