Group Dynamics: Working as a Nurse-Midwife Working

Group dynamics: Working as a nurse-Midwife

Working as a midwife requires me to function as a member of a team, not simply an individual nurse. The midwife must coordinate her advice with other components of the patient's obstetric treatment team. The midwife must also work well with the patient's family. Groups are often said to be either task-oriented or person-oriented (Group Dynamics 1 PowerPoint, Slide 8). In the case of the groups in which I work when I am dealing with a client, the group has both characteristics. On one hand, the task is to deliver a healthy baby, with as few complications (preferably none) as possible. But the team is also person-oriented, to help the mother navigate pregnancy and delivery. "CNMs/CMs are a vital part of the healthcare team and collaborate closely with physicians. When CNMs/CMs and physicians work together as a team, women receive an optimal combination of primary and preventive care, with specialized services as needed" (Nurse Midwife, 2011, Explore Health Careers).

Description of the experience

My most recent client was a woman who, as is typical of many persons who consult nurse-midwives, had one previous pregnancy. She was seeking a more 'natural' birth with her second. As well as assisting during the delivery, I also provided assistance throughout her pregnancy, including her routine gynecological exams and care. The effectiveness of nurse-midwives is becoming increasingly accepted within the field of obstetrics and even doctors are more open and accepting of treatment by nurses than they have in the past. Using nurse-midwives like myself can be more cost-effective, from the point-of-view of the healthcare system.

But most importantly, from the patient's point-of-view, women often experience a sense of intimacy and comfort as part of the birthing experience. Their family can be more involved, and they feel as if they have more of a voice in terms of how their care is given. They feel as if they are truly part of the treatment team. My patient says she chose a nurse-midwife because she wanted someone with medical training to deliver her baby, but she also wanted the unique perspective of a patient-focused nurse to be her primary caregiver.

Reflection

Being part of my patient's treatment team was an extremely positive experience. When concerns arise, such as the number of ultrasounds the patient should receive, I discuss with the patient's other healthcare providers our rationales and perspective, so we can come to a consensus without confusing or distressing the patient.

I make myself available to my patient as much as possible. For example, with my most recent patient, she felt comfortable calling me on my cellphone when she had a concern. Reducing patient stress is a critical component of nursing care.

The patient's partner had some concern with using a midwife initially. But I was able to express to him my credentials and instill confidence in him about the process. Sometimes people need to understand that being a midwife today is not something medieval and that midwives are well-versed in contemporary techniques of childbirth. It is essential that midwives are not offended, but are able to deal with such criticisms in an effective manner. The family and the treatment team are all part of the same team, not adversaries.

Influencing factors

Without a doubt, the most profound influence upon my actions as a midwife is my background as a nurse, and the stress this places upon putting the patient first, before my ego. But this also means I must stand my ground, if I feel that my advice is being contradicted. I base my decisions on the needs of the mother, and her physical and personal beliefs and desires. In this instance, I thought that a midwife-assisted birth was appropriate, although for some patients with a history of complications, I might not have made the same recommendation.

Could I have dealt with the situation better?

Every situation that I deal with as a nurse-midwife is unique. For my last patient, because of her history of an uncomplicated, vaginal delivery, and her expressed desire for a more natural and intimate birthing experience, I believe I was appropriate in offering myself as her primary care provider during her pregnancy, particularly since I also coordinated my work with an obstetrician. For a patient who is having her firth birth, is having a C-section, or wants a home birth and does not live near a hospital, I may have provided different advice. There is no cookie-cutter formula for the correct birthing experience.