Midwifery care of the birthing woman


Midwifery care embraces the ‘heart, hands and mind’. Discuss each of these elements
with regard to the midwife’s role and responsibility in the provision of safe and culturally
competent care during birth.




Midwifery care recognizes the women's unique needs, right to self-determination, individual needs expectation and midwifery care place the woman and her infant at the center of care. Midwifery is both an art and a science that use the heart, the hands and the mind. This essay will discuss these three fundamental midwifery elements heart, hands, and mind and how each of these elements relates to midwifery roles, responsibilities and influence of philosophical, physiological, psychosocial, spiritual, cultural and environmental factors on birth. The ‘heart’ highlights key values of midwife-woman partnership; midwife provides compassionate care when providing care to the woman during labourz and childbirth. The ‘hands’ are the midwifery therapeutic touch during the birthing environment and its effect on the woman during childbirth. The mind looks at midwifery knowledge, necessary to provide competent and safe care.

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The Heart

Developing a trusting relationship between the woman and the midwife is at the heart of midwifery practice and this involves a relationship trust. A good quality professional relationship is a key feature of midwifery practice. DahlbergAune (2013) found the good alliance between familiar midwife and the woman built on respect and trust for one another enables the woman to feel more empowered, feeling of control, increase confidence and satisfaction for the woman throughout pregnancy, birth and postnatal care. Karlström, Nystedt, and Hildingsson (2015), found that a positive interaction between the woman and the woman is vital for the woman to experience a positive childbirth and the woman benefits from a positive midlife-woman partnership bond which reflects on a reduction of pain intensity during labour and childbirth and promotes normal physiologic childbirth. The Code of Ethics for Midwives (2018) states that midwife works with the woman during childbearing age and parenting time in partnership, foster a healthy experience for the woman and her infant, to decrease and prevent possible injury. Working with partnership allows midwives and women to create trusting relationships which increase positive labour and childbirth experience. 

At the heart of midwifery are compassion, empathy, and kindness. Pregnancy and childbirth bring in woman’s life significant changes, feeling of vulnerability, fear of childbirth and the labor pain Moloney and Gair (2015) found compassionate midwifery professional care builds an affiliative bond, soothing feeling, and combination of kindness and continuous midwifery companion presence results in a positive birth experience promoting confidence in parenthood. Midwife empathizing with the birthing woman means truly being with the woman during childbirth, feeling for and with the woman as the woman goes through the strong feelings and emotions of labor and childbirth while providing childbirth care, kindness, and compassion. Moloney and Gair (2015). Compassion and kindness characters are key values of midwifery care and essential components of the midwifery professional requirements. (The Nursing and Midwifery Board of Australia [NMDA, 2018]) require midwives to deliver kindness, compassion and safe midwifery care such a care is a fundamental preservation of the dignity and protection of vulnerable child birthing women. Kindness, empathy, and compassion are essential components of professional midwifery care and these key roles have strong influences on positive child birthing experience for women. 


The Hands

In the art of midwifery, hands are represented by therapeutic touch.Through the use of their hand's midwives have traditionally taken a non-intervention approach to labor and childbirth.  Therapeutic touch like massage allows the midwife to support the woman during childbirth such a care increases woman’s feeling of support, comfort, caring and brings a compassionate approach to midwifery care delivery. Ringdahl (2013). Bolbol-Haghighi, Masoumi&Kazemi (2016) identified the benefits of therapeutic use in childbirth can decreased labor pain, anxiety, decrease significantly intervention, and increase women childbirth satisfaction. Incorporating touch therapy during labor and childbirth reduce pain and anxiety and provides comfort to birthing women. 

Midwives use their hands to create a positive birth environment that supports normal physiological birth. By simply moving furniture around, moving the bed on the side of the room, therefore, the woman can move freely across the room, draw curtains, close door to ensure privacy to create ambient, calm home feel environment. Hodnett, Downe, Walsh (2012) found women birthing in alternative hospital birth settings are associated with lower-rated medical intervening and higher women's satisfaction during labour and childbirth. Freedom of movement encourages the women to adopt upright positions also allow gravity to promote the downward movement of the baby to support physiological labour and childbirth progression.Lawrence, Lewis, Hofmeyr  (2013) found that women who adopted walking and upright positions during labor reduced labour duration, lower the need for caesarean birth and need for epidural. The Midwife use her hands to create ambient, safe, private and calm birth environment these are associated with lower medical interventions, better clinical outcomes and supports normal physiologic process.

The Nursing and Midwifery Board of Australia outlines professional standards, knowledge, and skills for midwives. Midwives roles are to work in partnership, provide care and support not only the woman but also the woman’s family, infant and the community(The Nursing and Midwifery Board of Australia [NMDA, 2018]). The midwife’s responsibilities are to take preventative care, recognise any complications in mother and child, access the need for medical intervention, promotion of normal birth and perform emergency procedures in emergency(The Nursing and Midwifery Board of Australia [NMDA, 2018]) The midwife is committed to giving support, care and advice antenatal, promote and protect normal childbirth, provide care to woman's newborn and parenthood education.


The Mind

Midwifery practice is holistic, based on scientific evidence, by collaboration, by individual knowledge, and individual experiences. Researching scientific evidence is one approach that enables midwives to manage the explosion of new literature and technology. Midwives actively interpreting evidence information, uses research to provide knowledgeable midwifery informed care and recognize when evidence is less than sufficient to provide complete inform midwifery care National competency standards for the midwifery (2010). Skaggs, Daniels, Hodge, and DeCamp (2018) found by applying evidence-based information into patient’s care have positively impacted patient’s health outcomes and increased patient's satisfaction (National competency standards for the midwifery, 2010). Evidence-based midwifery practice is conscientious of use current best scientific evidence and research in making decisions about the woman and infant care. 

Good verbal, non-verbal communication, understanding vocal clues and touch clues communication are crucial to delivering safety midwifery care, provide appropriate midwifery support, to empower woman and allow the woman to self-express. Heatley, Watson, Gallois, and Miller (2015) found that positive woman-centred communication improved psychological care is closely linked to improved health outcomes, increase midwifery care satisfaction. Positive interaction and woman-centred communications during childbirth have the significant effect on the woman's experience, these feeling positively affects the woman's mental, physical health and relationship with her baby postnatal. Bohren, Hofmeyr, Sakala, Fukuzawa, and Cuthbert(2017).The Code of the Conduct (2018) for midwives states effective communication is the necessary part of midwifery profession and communication must be respectful, kind, compassionate and honest. Woman-centred communication and partnership, midwife giving a lot of emotional support during labour and birth deliver the positive outcome for the woman and her infant.

In midwifery collaboration with other health professionals is an essential practice that ensures women who cross a low-risk pregnancy to high-risk pregnancy receive appropriate care to protect maternal and foetal well-being. Watkins, Nagle, Kent, and Hutchinson (2017) found the successful collaboration between midwives and other health professional is increasingly seen as necessary to deliver effective, safe healthcare to childbearing women. Good knowledge of midwifery Guidelines for Consultation and Referral allows midwives to integrate evidence with experience and assist midwives to appropriate refer woman between health care providers and health care settings Australian College of Midwives (2018). Collaboration between midwives and other healthcare professions improves the midwifery quality care and safety for childbearing and foetal/infant. 
Australia has become one of the most ethnically diverse societies. Midwives acknowledge and value the spiritual and cultural elements of labour and childbirth for women. Abdollahpour and Khosravi (2018) found that spiritual beliefs provide the woman a mechanism how to cope with the labour and childbirth pain and help the woman define the meaning of childbirth. The Code of Conduct for Midwives (2018) states midwives recognize that Australia is curtly divers nation, midwives acknowledge and understand woman's cultural background and midwives place women in central to midwifery practice in delivering cultural safety safe care to birthing Aboriginal women. Midwifery care respects the diversity of woman's need and the variety of personal, spiritual and cultural meaning which woman; families bring to the pregnancy, birth and early parenting.

The way the midwifery care is delivered dependents on the midwifery education,  on individual midwife believes delivery of maternity services and the midwifery philosophy. In Yanut, Ckaranuta, Manukau, Gjunu (2015) found midwifery philosophy education build on woman-centred care, holistic care, collaborative care, and evidence-based care are fundamental to midwifery practice. In this study authors stated educating midwives in clinical practice deepen understanding of the midwifery philosophy and enhance overall health for the woman and improved quality of midwifery careYanut, Ckaranuta, Manukau, Gjunu (2015). 

The art of midwifery consists of sensitivity to the needs of women and families and being able to meet these needs in the most appropriate way. It involves knowing when and how to intervene to promote safety if it becomes necessary and is grounded in scientific knowledge. The science of midwifery overlaps with evidence-based knowledge. The core of the art and science of midwifery lies in the knowledge of and devotion to keeping birth, and other related processes normal as possible.


Reference list

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