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Discuss The Following Statement In Relation To Birth. Midwifery Expertise ...


Title: Discuss the following statement in relation to birth.
Midwifery expertise is as much about knowing when not to interfere in the physiological process of pregnancy and birth as it is about recognising when and how to intervene in a way that will facilitate and enhance the woman's ability to give birth.

Undergraduate Degree Level Outline

1,250 words

Essay
Women have been giving birth throughout the ages. On the one hand this can be regarded as a normal physiological process which has evolved over the millennia to be a successful method of perpetuating the species and like most evolutionary honed processes, is likely to work well most of the time. On the other hand, as any experienced clinician knows well, any physiological process has the ability to malfunction. A large proportion of professional medical care in any field of medicine is to be able to recognise the normal variations and differentiate them from the abnormal. As a general rule it is only the abnormal that requires treatment or intervention. (Hunt T 1994)

Hippocrates is reputed to have said that it is the first rule for a physician that one should do no harm. (Carrick P 2000). In a modern context, this often means leave the normal alone as the ability to produce iatrogenic complications is well known. (Halpern S D 2005)

If we restrict ourselves to the consideration of the field of midwifery, the preceding statement can be well illustrated in the writings of Dr Ignaz Semmelweis who was horrified by the levels of puerperal fever that was killing nearly 40% of the pregnant women on his wards. (Semmelweis I P. 1861). Although he discovered the concept of asepsis from his observations, we note that on a simple level, the vast majority of the morbidity and mortality in this case was caused directly by the intervention of the healthcare professionals in what were otherwise normal pregnancies.

On a matter of more immediate concern we can consider the issues relating to stress incontinence as being an excellent illustrative example of how midwives can elect to intervene during pregnancy and the birth process in order to facilitate not only the birth process but the whole area of potential morbidity surrounding maternity in general.

Pregnancy itself is an independent variable risk factor for stress incontinence (Rortveit et al 2003). Although the midwife is not generally involved in the very early stages of pregnancy, there is good evidence that prenatal involvement in terms of preparation of the woman for the process of childbirth will reduce the incidence of stress incontinence post partum. (Reilly E T C et al. 2002). Instruction in the practice of antenatal pelvic floor exercises has been shown to reduce both the incidence and severity of pelvic floor damage during parturition (Salvesen et al.

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