Midwifery care through labor and delivery lowers complication rates and reduces the likelihood of unnecessary cesarean sections.
The issue of the role of midwifery care in the reduction of delivery and labor complications is interesting form both a medical and historical perspective. The assertion that midwifery is helpful with delivery problems and the reduction of cesarean section needs to be understood against the background of the acceptance of the nurse — midwife.
It should be borne in mind that midwifery was established as a procedure for assisting the mother during birth long before modern scientific medicine and institutional nursing (Seaton, 2006). The history of the modern nursing-midwifery began with the establishment of the first certified American nurse-midwifery school. This school was founded in 1932, with the central aim of “…incorporating the necessary medical training into midwifery’s traditional approach to pregnancy and labor” (Castlenovo, para. 4). This event was to lead to the formal acceptance and accreditation of the modern nurse-midwife into the fold of institutionalized and professional healthcare.
However, midwifery was initially seen as suspect and as a cause of increased infant mortality by the medical fraternity. As a result of this situation and perception there was a concerted effort from medical institutions and professionals to “eliminate traditional midwives” (Nurse-Midwifery in the United States and Its 1940s Expansion…)
While midwifery was criticized by the medical profession in the late nineteenth and early twentieth century’s it has become more accepted for a number of reasons. One of reasons for this these is the more holistic and care-orientated view of modern healthcare and medicine. In this context the nurse — midwife is seen as proving a care-centered approach to the problematics that surround birth and labor.
Modern medical and nursing theory therefore suggested that a more caring and involved approach that take an inclusive and holistic view of the patient is more appropriate than an approach that is centered on scientific premises and methods alone.
This theoretical view suggests that problematic aspects of birth, such as undergoing a cesarean section can be assisted and even reduced by the particular role of the midwife. This theoretical viewpoint is underscored by Shields, and Candib ( 2010) in their book entitled Women-Centered Care in Pregnancy and Childbirth. In this study they state that;
As technical advances become more complex, care has come to be increasingly controlled by, if not carried out by, specialist obstetricians. The benefits of this trend can be seriously challenged. It is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by obstetric specialists, even if the required personnel were available. (Shields, and Candib, 2010, p. 461)
This view stresses the importance of the midwife and the role that she can play in reducing aspects and tensions may lead to problematic issues in childbirth. The above study also emphasizes that;
Midwives and general practitioners, on the other hand, are primarily oriented to the care of women with normal pregnancies, and are likely to have more detailed knowledge of the particular circumstances of individual women. The care that they can give to the majority of women whose pregnancies are not affected by any major illness or serious complication will often be more responsive their needs than that given by specialist obstetricians. (Shields, and Candib, 2010, p. 461)
We can refer to an earlier study in this regard, a Randomized, Controlled Trial of Nurse-Midwifery Care (1996). In this randomized test of midwifery programs in the 1990s it was found that the results “… clearly support the effectiveness of the pilot nurse-midwifery program and suggest that more extensive participation of midwives in the Canadian health care system is an appropriate use of health care dollars” (Harvey et al. 1996, p. 165). A study which questions the formal medical model of birth and suggests the important and often neglected role of the midwife is, Complicated pregnancy? find a midwife ( 2005). The study refers to a recent Swedish study published in the Journal of Perinatal Education which deals with the theory of midwifery care. Key aspects of this model include “…protection of a woman’s individuality, promotion of a deep-rooted knowledge of childbirth, and support for a balance of the natural and medical perspectives” ( Star, 2005, p.23), the researchers determined that “…both normal and high-risk pregnancies benefit from midwifery care” ( Star, 2005, p.23)
If we take the theoretical trajectory suggested by the above articles and relate it studies of requests for cesarean section, we find some interesting results. In a study entitled Elective Cesarean Section and Decision Making: A Critical Review of the Literature (2007) it was found that “Women’s preference for a cesarean section ( is) related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors” (McCourt et al., 2007, p. 65). Furthermore, McCourt et al. found that Research between 2000 and 2005 shows evidence that women who requested cesarean section did so because of a “…range of personal and societal reasons, including fear of birth and perceived inequality and inadequacy of care, underpinned these requests” (McCourt et al., 2007, p. 65).
What this finding and others from the literature suggest is that caesarian section if often requested as a result of fear, insecurity and perception of safety. If we take into account that modern studies on midwifery finds that factors such as fear are in effect reduced by the intervention of the midwife, this strongly suggests that midwifery may be instrumental in reducing the number and complications and dangers of childbirth
In addition, there is also the theory put forward by some advocates of midwifery that modern childbirth and labor is dominated by paternalistic male views and neglects the more intuitive view of healthcare praxis. This would also tend to suggest that complications such as cesarean section could be reduced by the midwife in terms of a more holistic and caring perspective. It is also argued by some exponents of midwifery that “…convenience contributes to high cesarean rates… Doctors are described as preferring to perform elective cesareans for “convenience in scheduling” (Lee and Kirkman, 2008, p. 456)
Conclusion
In conclusion, the contemporary theoretical approach to nursing and healthcare praxis tends to emphasize a more inclusive and holistic view of medical care. This view is strongly supported by theories of modern midwifery, which focus on an intimate and caring approach. If we translate this theory into practice we find that in a number of studies there are strong indications that midwifery can be effective in reducing stress and fear as well as other complicating factors in labor and birth. There are also studies that suggest that midwifery can reduce the necessity for cesarean section.
References
Castlenovo G. Mary Breckinridge (1881-1965). Retrieved from http://www.nursingadvocacy.org/press/pioneers/breckinridge.html
Lee a. And Kirkman M. ( 2008) Disciplinary Discourses: Rates of Cesarean
Section Explained by Medicine, Midwifery, and Feminism. Melbourne Health Care for Women International, 29, pp.448 — 467.
Harvey S. et al. ( 1966) Randomized, Controlled Trial of Nurse-Midwifery Care
Midwifery, 12(4), pp.65-73.
McCourt C. Et al. ( 2007) Elective Cesarean Section and Decision Making: A Critical
Review of the Literature. BIRTH, 34(1).
Nurse-Midwifery in the United States and Its 1940s Expansion: Early Twentieth Century
Origins: Frontier Nursing Service and Maternity Center Association. Retrieved September 1, 2009, from http://www.medscape.com/viewarticle/452738_2
Seaton Helen J. (2006) Mapping the literature of nurse-midwifery. J Med Libr Assoc.
94(2 Suppl.). Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463041
Shields S. And Candib L. (2010) Women-Centered Care in Pregnancy and Childbirth.
London: Radcliffe Publishing.
Star K. ( 2005) Complicated pregnancy? find a midwife. Mothering, 131, p.23-23.
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