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It occurs every day and everywhere. It happens whether accidentally or intentionally, meticulously planned or not at all, and to those of an elder age or younger demographic. The birth of a new life requires aid during the process, along with receiving assistance before and post pregnancy. Individuals offering such service are known as a midwife. The World Health Organization or WHO recognizes midwifery as a role that "encompasses care of women during pregnancy, labour, and the postpartum period, as well as care of the newborn."
Community midwives vary from those that work in hospitals. The former are involved from the beginning by scheduling the initial appointments, and manage and administer the workings of the clinic. As well, community midwives are present during the postnatal care at the mother's home, and are there for home births. Community midwives are to see women who are newly pregnant and take a detailed health assessment, which can be in a client's home. The midwife conduct an antenatal screening in the antenatal period so the mother to be may be informed of what's to come in the next couple of months. Once the assessment is conducted, the midwife is to assess and evaluate the risks for the client and the fetus. Afterwards, a way of care is then designed and discussed with the mother that's suitable for her and the baby. Midwives that give antenatal care to women in a clinical setting tend to be routine appointments. As aforementioned, such meetings can take place in the client's home if a problem or dilemma has been identified and recognized. Antenatal appointments with the community midwife "discuss issues such as diet, smoking and work…you may also be weighed" (BBC, 2012). Furthermore, these appointments include "blood pressure, weight, palpation -- feeling your [pregnant woman] tummy, listening to your baby's heart, questions about your baby's movement, urine tests, checking for any swelling in your legs, arms or face, questions about how you feel" (BBC, 2012).
Community midwives offer birth-planning meeting to pregnant mothers, which is usually done in the vicinity of the client's home. Intrapartum care is offered and given by midwives so they are on-call in a particular area of the community. The schedule of community midwives is full since some may do on-call nights two to three nights per week, and some will also work on the weekends. There are also times when the hospital is short staffed in giving intrapartum care to women, especially to those pregnant who want a midwife to deliver the baby so such professionals are called to help. Intrapartum care involves "prolonged labor, caesarean birth, or TENS (transcutaneous electrical nerve stimulation) use for pain relief" (University of Manchester). Community midwives work in pairs and it is about teamwork so he or she will be on-call in one area but also be on-call for another group. It is because midwives are to work in pairs during birth. Such professionals give postnatal support to mothers and babies at home. As well, community midwives center their focus on public health so recommendation and services to mothers include screening, discourage smoking, and encourage breastfeeding when and if possible.
Community midwives offer natal services, which include pre and post birth to mothers and their babies in a localized neighborhood and area. It is to help women give birth the way they want to, which is not being in a hospital setting but rather in the comforts of their own home. It is offering future mothers a natural proves of birth and life. Community midwives may also offer lab work and ultrasound assessments done within the clinics they work at. In addition, mothers are to trust the midwives and do not suggest medical interventions unless it is necessary during the birthing process. Furthermore, as mentioned before, midwives will continue to assist the client post birth, and be present at scheduled appointments, and answer any questions the mother may have for a certain time.
Women may consider having a midwife is the pregnancy is determined to be a low risk. The option of having a midwife is opened up, and community midwives offer a more holistic and personal care to one's pregnancy. The responsibility and role of such midwives are to answer any concerns the mother and/or couple may have concerning about their baby. Such professionals are seemingly more approachable and offer an alternative to doctors. Prenatal care is very important so community midwives are very involved in this period, which is why prenatal visits with midwives are more common than with doctors. Furthermore, community midwives not only offer medical help but also psychological and holistic services. Community midwives encourage and utilize a variety of non-invasive methods to induce delivery. Such strategies include walking or using a birth ball. However, since some but not all midwives are certified as nurses, when the time calls for it, the midwives may prescribe drugs to initiate the labor process, administer epidurals, or other medical interventions such professionals see as fit. Unlike doctors and being in a hospital, community midwives oversee the entire pregnancy; from the time the mother schedules an appointment to such midwife to the birth, and then beyond.
Furthermore, it has been studied that those who deliver their babies with a midwife have a lower mortality rate. It has been investigated that "After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower" (MacDorman, 1998, p. 310). In the same study, it was concluded that a "Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women" (MacDorman, 1998, p. 310). In a study led by Buhler, it was found that there was a "A highly significant difference was found in the proportions of NM [nurse-midwives] and FP [family physicians] charts that were rated adequate, superior or inadequate: 77% v. 24%, 7% v. 16% and 16% v. 60% respectively" (1988, p. 397). The same study concluded that "NMs provide prenatal care to low-risk women that is comparable, if not superior, to the care provided by FPs" (Buhler, 1988, p. 397).
Community midwives also educate women on prenatal health and nutrition, offer education classes, provide coaching, encouragement, and comfort to pregnant women. Such professionals are identified as working outside a hospital setting, usually in homes, at clinics or birth centers. Community midwives work "in the country's provincial and district health centers to predominantly deliver reproductive health care services to women…applying up-to-date knowledge and skills in caring for each woman and family. She works as a member of a team" (WHO, 1999).
They have to be certified by the American College of Nurse-Midwives, which include being a certified nurse-midwife (CNM), and a certified midwife (CM). In the United States, despite the overwhelming percentage of women choosing to give birth with a midwife in hospitals, the number of women opting for a community midwife is increasing. The statistics "reported a 35% increase in planned home births between 2007 to 2008 (from 1,687 to 2,278)" (Rochelle, p. 2). The position and profession of having a community midwife is supported and advocated by the World Health Organization or WHO. They are also the key figures for pregnant mothers, especially in rural neighborhoods and impoverished nations. Community midwives offer a reduced cost of maternity care but increased quality of care, and not just because of the medical attention. As well, it has been cited that pregnant women who worked with midwives had "high levels of maternal satisfaction and that supportive relationships with midwives in a caseload scheme are highly valued by women" (Midwifery 2020, 2010, p. 20).
Some of the challenges community midwives face includes balancing the challenges with quality and working within the practice. It is about being able to think and act quickly, being creative, and learning how to address the issues present. Red tape is an issue, for example, the NHS. It is because new methods and technologies are discovered and new strategies are introduced to the NHS, which they then have to bear the cost, and then it increases the financial pressure. As a result, there are restraints and constraints that are laid upon the midwifery profession, which influences the equilibrium of quality and efficiency of the work. Despite how satisfying being a midwife can be, it is demanding and it isn't simply a career but a lifestyle. It is because there aren't definite schedules surrounding mothers giving birth, which can happen at any minute and any time so being on-call for a midwife is the constant.
Another challenge is the funding and inclusion for a midwife in an insurance policy. In Canada, it took years and years of lobbying by both, midwives and consumers to advocate public funding for midwifery. As a result, it is now part of the health…[continue]
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