Social and cultural issues in midwifery

Introduction

Midwifery is a specialized branch of nursing which is dynamic with respect to social and cultural changes prevalent in society. It involves offering professional care to women as well as childbearing families. Clients are the central concern for this profession making the state of well being the main focal point for midwives. As a cultural and social practice, midwifery is dynamic with respect to the day to day encounters experienced (Kinnane, 2008). As such midwifery nurses share a common purpose and moral obligation to ensure quality care is accorded with fidelity and trust to the clients regardless of their position in society. Midwifes are thus tasked with seeking to ensure that women n the best possible birth experiences and more so accord a smooth transition towards parenthood and more so family formation. This paper seeks to offer identify and discuss social and cultural issues in an effort to accord Megan, a client with challenges after her first and second pregnancies.

Megan enjoys good family relations and support but after a traumatic first pregnancy and the second pregnancy which involved birth by caesarian section she suffers from symphysis pubis dysfunction. This condition is now commonly referred to as Pelvic Girdle Pain (PGP) (Muennich, 2009). It is not uncommon for midwifes to encounter such conditions when according care to clients. In this condition, the client’s pelvic joints tend to lose the required degree of stability during pregnancy resulting in mild or severe discomfort.

As much as the role of the midwife is clearly defined in professional guidelines handbooks, the real life experiences they witness are at times much more complicated. Each child birth experience is different and unique and midwifes have to respond as the situation demands in the appropriate manner, sensitive of the client and it the right time (Kinnane, 2008). This inadvertently requires the input of fellow midwives working together as well as those who have been with the client in previous child birth times (NHMRC 2010). Midwifes who have accorded the client care in the course of the pregnancy all work together to ensure the client is afforded the best care possible.

Midwifes are the client’s friend

Given the nature of this nursing practice, it is difficult to set a distinct line separating personal life and the professional life (Kinnane, 2008). Regardless of the personal situations a midwife may have, it is necessary for them to ensure that they accord clients care with a professional touch. According to (Seaton, 2010), development of relationships with mutual trust between the client and the midwife allows for openness and personal disclosure critical to according professional care. Friendship between the client and the midwife is very beneficial to the professional dispensation of care.

In the past, it was common to find midwifes and nurses being taught not to be socially attached to clients above what professional practice entails (Hastie, 2006). This was essentially to ensure the faith in the profession such that the midwife remains in total control of the experience with the trustworthiness and capabilities consistent of a professional midwife (NHMRC 2010). This however resulted in outcomes viewed by clients as uncaring, detached from the situation and unapproachable.

In Megan’s case, this would provide a situation where she would find it difficult in opening up to the midwife for objective advice regarding her conditions and previous experiences (Seaton, 2010). However, there is also a risk of situational dependence arising from protective paternalism. All in all, what the professional is obligated to offer the client is a supportive role offering advocacy for any issues arising from child birth situations.

For women, child birth is a life moment in which they are highly vulnerable. The fact that midwifes are obligated with offering clients what is needed at the time of vulnerability tends to make clients attached to midwifes (Hastie, 2006). This is of great importance as this allows for professional integration of clients’ cultural needs and preferences thus ensuring clients attain desired experiences (NHMRC 2010). This also allows for greater capacity for enhancing overall quality of service resulting in positive outcomes, healthcare gains and patient satisfaction.

Caring for clients while reintegrating with their families

Megan’s condition presents complex family interactions which may result from her ex experiences with her previous experience (Hastie, 2006). The fact that she suffers from PGP only compounds the unease she may have relating with other family members. As such, it is common for midwifes with whom Megan have a bond to feel the need to follow up on her progress as a family member. This unique bond is essential in enabling to rehabilitate Megan to full physical, emotional and mental health (NHMRC 2010). Post birth support and cases of extended follow up are not facilitated in most health care systems. From an ethical perspective, offering such care is obligatory upon the midwife on a moral standpoint.

At times, a woman may after childbirth experience an emotional state that is overly complex such that natural occurrences seem to go out of hand. It is only natural that in such a situation the paternal father experiences emotional distress (Seaton, 2010). The family perspective should thus be followed up by the midwife as described by the Australian healthcare system.

The Australian maternity healthcare system has three levels, the primary, secondary and tertiary levels. Primary maternity healthcare is accorded to clients experiencing zero complications from the pregnancy stage to the post natal care stage.  Collaborative social and cultural environment play a significant role in enabling clients are accorded professional care.  Midwives as such have to have a reasonable degree of cultural competence allowing for a healthy understanding of client cultural values and beliefs and how to respond to them (Seaton, 2010). This implies that midwives have to be flexible to social and cultural values so as to exercise an ideal degree of control over the child birth experience. More so, midwifes should be in a position to accommodate the values of different cultures bearing in mind boundaries defined by profession’s value system.

Conclusion

Dealing with diverse situations in the workplace can present numerous challenges in a socially and culturally diverse setting such as Australia. Megan’s case is simply one of many cases and as such may not be as complex as many situations may present. However, it is important for midwifes to understand the level of control they accord to each situation (NHMRC 2010). They should therefore exercise great care in incorporating flexibility in controlling specific situations. Personal values should be regulated by professional conduct and ethical considerations in such settings. As members of a social practice, according care to other members of the society is in essence a gift of both fidelity and trust. Offering professional care to clients in a socially and culturally diverse environment such as Australia should therefore be defined by professional conduct and ethical responsibility.

References

Hastie, C. (2006). Midwifery: Women, History and Politics. Birth Issues, 15 (1), 11-17.

Kinnane, J. H. (2008). Everyday Encounters of Everyday Midwives:Tribulation and Triumph for Ethical Practitioners. Thesis, degree of Doctor of Philosophy. Queensland University of Technology.

Muennich, M. (2009). What is Symphysis Pubis Dysfunction (SPD)? Retrieved from http://www.thinkbaby.co.uk/pregnancy-illness-and-complications/what-is-symphysis-pubis-dysfunction-spd/1346.html

National Health and Medical Research Council. (2010). National Guidance on Collaborative Maternity Care. Canberra: NHMRC.

Seaton, L. P. (2010). Cultural Care in Nursing: A Critical Analysis. Thesis, degree of Doctor of Philosophy. University of Technology, Sydney.