The Heart- Hands and the Mind in Midwifery
The Art of Midwifery
Midwifery places the woman and the midwife at the centre of midwifery care. It is said that midwifery is an art that uses the heart, the hands and the mind. In relation to working with woman in childbearing this essay will discuss this statement. The essay will look at these three essential elements of midwifery, the heart, the hands and the mind, showing detail of how each are related and the importance of each element when working with women in childbearing. The ‘heart’ looks at the key values of compassion, respect for the women, the baby and oneself, and the importance of women centred care. The ‘hands’ focus on the skills, techniques and therapeutic touch of the midwife and the ‘mind’ highlights reflective and ethical practice, and the knowledge required to practice safely and competently.
At the heart of midwifery practice is the relationship between the midwife and the woman. This involves a relationship of trust. The women, relies on the midwife to give her confidence. The midwife is trusted by the woman to know what is best for herself and her body. The midwife benefits the childbearing woman with clinical knowledge, skills and recommendations, forming a relationship of mutual trust and respect (Alef Thorstenson, 2004). The mother and the baby are the central focus for the midwife.
Pelvin (2006) describes the midwife’s role as one of privilege. The intimate relationship between the midwife and the women exists, through a personal and momentous event in the life of a woman. The physiological procedure of birth and the post natal relationship between mother and baby is facilitated by the midwife however the midwife’s influence does not end there, the role attempts to assist the women to have a deeper understanding of herself and of her family relationships. A fundamental value of midwives as stated in the (Australian Nursing and Midwifery council [ANMC] Code of ethics, 2005) is the value of kindness and compassion to others and self, by respecting the fundamental rights and choices of the mother and ensuring that practice is ethically and culturally appropriate. Acts of kindness such as being gentle, considerate and caring should be a constant approach to midwifery care.
The art of midwifery involves achieving a balance between being competent and professional whilst showing heart by still demonstrating emotion. Hunter (as quoted in Jacob and Lavender, 2008, p. 78), says that “â€¦expressing emotion and sharing feelings with others is immensely valuable, both for enhancing relationships and also for developing a type of practice that is open-hearted and genuine.” This relationship is extremely valuable with pregnancy outcomes which may involve unexpected miscarriage, where supporting women and their families can be difficult.
The ‘hands’ in the art of midwifery looks at the benefit of therapeutic touch. Therapeutic touch can reassure the woman of her safety with the knowledge that her midwife is confident in her actions and sensitive to her needs. When situations do not allow words, the hands can convey reassurance and express confidence, compassion and care (Ernst, 2009). Touch can be used in many forms including close contact for physical support, helping the women to maintain her posture or just being there as a shoulder to lean on. Touch can provoke different responses by different women. While massage can be good for relieving pain for some, others find a simple light touch to the forehead is all that’s needed to reassure a woman she is not alone and that the midwife is there for her (Page & McCandish, 2007).
Another important ‘hands on’ skill for the Midwife is the ability to use palpitation and touch examination of the mother’s abdomen to assess and determine the baby’s growth, position, size and wellbeing (Grigg, C. 2006). Other skills utilizing the hands can include, teaching breastfeeding, blood pressure measurement, supporting the women through labour and birth, baby assessments and supporting the newborn infant and the use of interventions such as epidurals.
The (Australian Nursing and Midwifery council [ANMC], Code of Professional Conduct for Midwives in Australia, 2006) describes many other midwifery skills not only relating to the care of the woman but also her family and the community. It is the duty of the midwife to provide antenatal and parenthood education. The midwife is committed to working with the women, providing support and advice during her pregnancy/birth and through the postpartum period. The midwives responsibilities also extend to preventative care, detections of complications, promotion of normal birth and accessing the need for medical intervention and the carrying out of emergency procedures should an emergency occur.
Creating a positive atmosphere and environment for the birth is an important factor for many women. Most women have their babies in the unfamiliar and unwelcoming environment of the hospital, a positive attitude assists in reducing anxiety and stress, allays fears and allows the woman to feel secure in her surroundings. Page & McCandish (2007) suggest that simply by making more space and moving furniture in the room offers the woman more area to move and by providing different props such as benches, pillows, and cushions give the women more choices so as for example she can lean or rock when experiencing the intense pain of contractions. The skills of the midwife are many and varied and the hands are vital in conveying messages to the woman.
As the Australian College of Midwives, ACM Philosophy for Midwifery (2004) states midwifery is informed by scientific evidence, by intuition and by experiences. This involves the midwife using knowledge gained from research evidence, individual values and preferences, seeking out evidence to support decisions and discussions with the woman to decide on her individual birthing plan. Page & McCandish, (2007) describe evidence based clinical practice as “the judicious use of the best evidence available, so that the clinician and the patient arrive at the best decision, taking into account the needs and values of the individual patient.”(p.205)
Birth is a normal life event and not a disease process thus making health promotion the basis for midwifery care. Health promotion and education involves more than the provision of information to woman in antenatal classes lead by a midwife, where the midwife discusses topics the professional deems relevant. Education needs to move to a more client-led agenda (Beldon & Crozier, 2005).
When working with women it is important to always focus on women centred language and effective communication. Thinking and imagining how the woman is feeling assists in providing comfort and reassurance to the woman. Giving women information about the progress of the labour in positive terms that the woman will understand is most valuable. Knowing when to be quiet is also important. The midwife has to be mindful of her own facial expressions as these can have a huge impact on the woman’s feelings, a smile conveys reassurance that everything is ok and going well (Page & McCandish, 2007).
The midwife’s mind needs to be aware of the changes occurring in maternity care and know that the traditional medical model that once served the doctors and the hospital, is antiquated. As we move towards emerging midwifery models of care which favour continuity of mother and baby care by the same midwife throughout the women’s pregnancy, birth and beyond (Barlow, 2008). A midwife’s autonomy is increasing in maternity care. The Australian Nursing and Midwifery Council, Code of Ethics for Midwives in Australia (2005) also states midwifery care includes the promotion of ‘normal’ birth, prevention and detection of complications in the mother and baby, medical care access and the carrying out of emergency measures as important responsibilities of the midwife.
The heart, hands and the mind all play important roles in the midwifery model of care. Each area can be difficult to explain as separate components of midwifery as the three areas are intertwined and each just as valuable as the other in providing women with women centred care throughout the life changing experience of childbirth. It is evident from research into the art and science of midwifery that midwives are essential in providing care to the childbearing women that supports and guides women through healthy pregnancy, labour and the postpartum period. Midwifery care involves the promotion of ‘normal’ birth, prevention and detection of complications in the mother and baby, medical care access and the carrying out of emergency measures. Our role is to work in partnerships with women and their families by helping them to explore their options and make informed decisions.