Midwifery is as old as humanity itself. Throughout history, the importance of midwifery and midwives has been diminished due to the development of other medical fields. Now the time has come again for midwifery and midwives to regain the reputation and autonomy we have lost through history. Therefore, it is important to present the midwifery profession and raise awareness about the competencies of a midwife. Even more important is that the healthcare system be restructured so that midwives can exercise their competencies and midwifery becomes a profession.
What does it mean to be a midwife?
Being a midwife is much more than just delivering babies. A midwife is usually the first and primary contact for women during pregnancy, childbirth, and the postpartum period. A midwife provides assistance and support to women in decision-making during pregnancy and after birth. The role of a midwife is very diverse. She performs clinical examinations, provides health information and parenting information, supports the pregnant woman and her family through the process of pregnancy and childbirth, and helps with adjustment to the new parental role. A midwife collaborates with other health and social workers to meet the needs of the expectant mother, whether she is a teenager, a socially vulnerable woman, a woman with special needs, or a woman from a different ethnic background.
There are a number of important skills and competencies required for practicing midwifery (NHS UK, 2017 and Brown, 2014):
* Professional knowledge and patience for working with people: a baby “happens” to different people, so a midwife provides professional support and offers help to a large number of different women, with their own needs, wishes, and characteristics, during the most emotionally intense periods of their lives. A midwife comes into contact with women, family members, and other healthcare workers. Being able to work effectively with people at different levels with different characteristics is an important aspect of midwifery work. While she does not have to “love everyone” she encounters, it is important that a midwife does not judge or condemn different people and needs, so she can provide appropriate care in a professional manner.
* Good communication and observation: a midwife is good at listening and communicating with women, their partners, and families. Most people are aware that good communication skills are needed for medical and healthcare professionals. One part of communication is sometimes pushed aside, and that is listening. Being able to listen to patients helps to better understand their needs and also helps establish a connection.
* Interest in the physiology and psychology of pregnancy and childbirth: a midwife has in-depth professional knowledge about the course of childbirth and child development. It is also important that she builds on her knowledge and compares theory and practice.
* Problem-solving ability: A midwife encounters various situations and problems in her work. Some problems have simple solutions, others require “out of the box” thinking using clinical knowledge and require objective examination of the situation.
Good judgment and assessment of circumstances: In addition to problem-solving skills, good judgment is of utmost importance. Pregnancy and childbirth do not always proceed as they should, and circumstances can be unclear, without definitive solutions. Therefore, it is important that a midwife can assess the situation. Good judgment also means knowing when to seek help, for example, complications may arise during childbirth and the help of other healthcare workers may be needed before further complications occur.
Balance between empathy and objectivity: midwives maintain a balance between empathy and objectivity and know when to show both. Some situations require empathy, while in other cases it is important to simply state the facts. Care recipients want compassion and empathy. But a midwife must not allow either to compromise the necessary care or treatment. In some cases, information needs to be given directly to users, without “sugarcoating,” as this is not in the patient’s best interest, but being straightforward certainly is. Good midwives know how to be straightforward and direct in a compassionate way.
* Ability to answer questions and provide advice: midwives are the most common point of contact for expectant parents, so they must be able to answer their questions and share their knowledge with patients, their families, and friends.
* Enjoyment of teaching: If you intend to become a midwife, you should also enjoy educating care recipients. Pregnant women and their partners may need information about health during pregnancy, complications to consider, and nutritional recommendations. Women need information about pain relief options during childbirth and topics such as breastfeeding, infant care, etc. A midwife has the knowledge to explain complex health information in a way that women can understand.
* Multitasking: a midwife performs multiple tasks simultaneously, for example, monitoring contractions in a woman, monitoring the baby’s heartbeat, while providing information to the woman, etc. The ability to focus on multiple things at once is a very useful skill and is essential in midwifery work.
* Enjoyment of teamwork: midwives are part of a multidisciplinary team that includes various medical and healthcare professions and workers.
* Dealing with emotionally charged situations and maintaining calmness: during times of stress, a midwife remains calm and attentive, enabling women to feel confident and in control. In rare cases when something goes wrong, a midwife is prepared to respond quickly and effectively. Like other healthcare workers, midwives must work well under pressure. Childbirth does not always proceed as planned. Circumstances change and complications can arise. A midwife must remain calm so she can perform her work optimally and calm the woman. The woman then relaxes and focuses on proper breathing and pushing.
* Confidence in your knowledge: a midwife must trust in her professional knowledge and abilities. If you trust yourself, women will also find it easier to trust you.
Adaptability: sometimes circumstances change during childbirth. A good midwife understands that she cannot control every situation, but she can adapt if necessary to bring the birth to a safe conclusion.
* Patience: A midwife often has to provide certain information multiple times and explain circumstances repeatedly, and women may ask many questions. Pregnancy and childbirth may represent daily routine for an experienced midwife, but for a woman it may be her first pregnancy, first child, or first birth. The patience and time a midwife dedicates to the woman in labor help ease fears.
NHS UK (2017) specifically lists the following important qualities and values of midwifery and healthcare:
– care
– compassion
– competence
– communication
– courage
– commitment
Nicholls and Webb (2006) in the article “What makes a good midwife? – An integrative review of methodologically diverse research,” state that good communication skills contribute the most to a midwife being a “good midwife,” while compassion, kindness, support (affective domain), knowledge (cognitive domain), and skill (psychomotor domain) also contribute. They further list the following essential requirements for a “good midwife”:
– education and research,
– the midwife’s ability to treat women as individuals,
– a care-based approach,
– being “available” to women.
They conclude that a good midwife can compensate for poor systemic healthcare solutions, and women should have the option to choose who their midwifery/healthcare provider will be, with partners included in the decision.
I also wrote about the importance of communication in midwifery in my master’s thesis. Communication in midwifery plays an important role in the birthing process. Due to the organization of work in Slovenia, a woman typically has no contact with a midwife before childbirth, which can negatively affect the trust-building process. Upon admission of a woman to the delivery room, there is no room for mistakes. A midwife must approach the woman appropriately, professionally, and sensitively, instill hope, and establish trust. The first contact is most important in establishing trust. In addition to verbal communication, nonverbal communication is also important. We are always under the watchful eye of the partner, who closely monitors our actions, facial expressions, and gestures. To meet the woman’s wishes, maternity ward policies must be oriented toward this. Knowledge and experience can help us greatly in this. It is important that women receive appropriate information about childbirth itself during pregnancy. Their task is to find out, based on the information received, which maternity ward best meets their wishes. We are therefore talking about informed choice. She can communicate her wishes and thoughts about childbirth to healthcare staff verbally or with the help of a birth plan. This should be discussed upon admission to the delivery room. This way, healthcare workers will get an idea of what the woman wants and encourage her in this. Nevertheless, based on knowledge and experience and depending on the woman’s behavior, a midwife sees what could be changed to make the woman more comfortable and at ease. Let’s also include the partner or birth companion in the birthing process. We guide the woman through childbirth, our instructions should be short and clear. If we have followed the first rule that the first impression is important, we have done the most. We have gained her trust, which means we have prevented excessive secretion of adrenaline, which could hinder the progress of labor, and at the same time the woman trusts us about what works for her and what doesn’t, and we can more easily meet her wishes. Communication between the midwife and the woman/couple is very important in the birthing process.
SOURCES: Source1, Source2, Source3, Source4, Source5, Source6
Based on Article 87 of the Healthcare Activities Act, the Slovenian Chamber of Nursing and Midwifery – Association of Professional Associations of Nurses, Midwives and Healthcare Technicians of Slovenia, in accordance with Article 4 of the Statute, adopted at the Assembly on 26. 3. 2011
CODE OF ETHICS for Midwives of Slovenia
*Definition of the midwifery profession*
A midwife is a person who has successfully completed a publicly recognized midwifery study program based on ICM (International Council of Midwives) core competencies for midwifery practice and ICM standards for midwifery education; is registered in the register of healthcare workers, has obtained a license to practice midwifery, uses the professional title of midwife, and demonstrates competence to perform midwifery practice.
A midwife is recognized as a responsible and reliable professional who works in partnership with a woman, supports, cares for, and advises her during pregnancy, childbirth, and the postpartum period. She accompanies the woman during childbirth, being aware of her own responsibility, and also provides midwifery care for the newborn and infant.
This care includes preventive measures, promotion of normal childbirth, recognition of complications in mother and child, access to healthcare or other appropriate assistance, and implementation of emergency measures. A midwife has an important role in health education and training of the woman, family, and wider community. Her work includes prenatal education, preparation for responsible parenthood, and also extends to women’s health, sexual or reproductive health, and children’s health. A midwife can work at home, in the community, in hospitals, clinics, or health centers.
Definition of the midwifery profession adopted by the International Confederation of Midwives (ICM) in June 2011, Durban, South Africa.
A midwife in the Slovenian context encompasses all previous professional titles related to the midwifery profession: nurse-midwife, senior nurse with specialization in obstetric nursing, graduate midwife, graduate male midwife, master of midwifery.
The term midwife used in the text refers to both genders.
Code of Ethics for Midwives of Slovenia
PRINCIPLE I: In her work, a midwife respects and advocates for fundamental human rights, the rights of the mother, child, and family.
PRINCIPLE II: A midwife respects a woman’s right to choice and decision-making.
PRINCIPLE III: A midwife respects the privacy and dignity of the woman, child, and family. She is bound by professional confidentiality.
PRINCIPLE IV: A midwife is independent within the scope of her professional competencies. She is obliged to provide quality and safe midwifery care based on research and is morally, ethically, professionally, and legally responsible for it.
PRINCIPLE V: A midwife works in health education and promotes health.
PRINCIPLE VI: A midwife is aware of interdependence in the professional field and collaborates with other professionals.
PRINCIPLE VII: A midwife strives for lifelong learning, expansion of professional knowledge, and research work.
PRINCIPLE I
In her work, a midwife respects and advocates for fundamental human rights, the rights of the mother, child, and family.
- A midwife respects the principle of equality and ensures equally high-quality midwifery care for all, regardless of nationality, race, gender, language, religion, political conviction, education, or social status. At the same time, she ensures that no one is deprived or harmed because of their health condition, physical or mental disability, appearance, age, culture and values, marital status or sexual orientation, and health-damaging habits. She is impartial in treating marginalized groups.
- When providing midwifery care, a midwife approaches the woman and her family holistically; she considers their physical, psychological, social, and spiritual needs and is their confidante and advocate.
PRINCIPLE II
A midwife respects a woman’s right to choice and decision-making.
- A midwife supports a woman’s right to actively participate in decisions about her healthcare. She respects her right to choice based on full information and consent and encourages the woman to become aware of her own responsibility for the outcome of her decisions.
- A midwife ensures the legal and moral right of every woman to self-determination during pregnancy, childbirth, and early parenthood.
- A midwife enables and encourages the supportive role of the partner and family during pregnancy, childbirth, and early parenthood. Limitations:
- A midwife is aware that circumstances may arise when a woman’s decision based on informed consent cannot be fully fulfilled. In cases where a woman’s decision would endanger her life and/or the child’s life, the midwife is obliged to explain the situation to the woman in a way she can understand and act in accordance with professionally justified and valid doctrine.
PRINCIPLE III
A midwife respects the privacy and dignity of the woman, child, and family. She is bound by professional confidentiality.
- A midwife considers and respects a woman’s right to privacy and dignity when providing midwifery care.
- A midwife is obliged to protect as a professional secret all information about the woman and child that is of a health, personal, family, or social nature.
- A midwife respects and ensures confidentiality of data in accordance with the woman’s wishes and current legislation and discloses certain data only when the health or safety of the woman or child is at risk. When disclosure of data is necessary, she informs only those colleagues in the midwifery or healthcare treatment of the woman who could prevent harmful consequences of respecting confidentiality.
- A midwife ensures privacy and confidentiality of data regardless of the form in which the data is stored.
PRINCIPLE IV
A midwife is independent within the scope of her professional competencies. She is obliged to provide quality and safe midwifery care based on research and is morally, ethically, professionally, and legally responsible for it.
- A midwife provides individuals in her care with the best possible professional treatment based on research evidence and in accordance with the philosophical positions of the midwifery profession.
- A midwife is aware of a woman’s internal potentials, so in caring for her she respects her own intuitive knowledge about herself.
- The primary concern of a midwife is the woman and her child; in doing so, she must not neglect their immediate social network – partner, family, and significant others who form the individual’s support system.
- A midwife is responsible for her professional decisions, actions, and outcomes to her conscience, the woman and her family, the midwifery profession, and society.
- If a midwife determines that the quality of health and social care for the woman, child, and/or their family is not adequate in a particular area, she is obliged to initiate improvements. This includes (re)formulating standards, as well as reporting unethical attitudes or behavior of professional colleagues and other healthcare professionals or coworkers to her superiors, and if necessary, to appropriate authorities.
- A midwife never refuses midwifery care to a woman and her family during a sudden birth. She also always provides emergency medical assistance and help to people in exceptional circumstances and, within the given circumstances, advocates for the best possible quality of healthcare. Limitations:
- A midwife may refuse midwifery care or participation in healthcare when she believes it is ethically or religiously unacceptable to her (conscientious objection). She also refuses to perform procedures and/or treatments for which she does not have appropriate professional knowledge and experience. In doing so, the individuals she treats must not be deprived.
- A midwife refuses any bonus or gift if it can be understood as an effort to obtain any advantage for an individual in her midwifery care or for herself.
PRINCIPLE V
A midwife works in health education and promotes health.
- A midwife directs health education toward women, their families, and the wider community. In doing so, she encourages a healthy lifestyle, informs about activities that promote health, and raises awareness about the harmfulness of bad habits.
- A midwife presents pregnancy, childbirth, and the postpartum period as physiological states in a woman’s life, while encouraging her realistic expectations regarding safe childbirth.
- A midwife is irreplaceable in preparing for responsible parenthood, and her health education role also extends to women’s health, sexual and reproductive health, and children’s health.
- A midwife is aware of the impact of harmful environmental factors on health, so she is committed to caring for a healthy environment. She uses all resources (water, energy, materials) thoughtfully and economically. She is environmentally conscious and promotes ecology in society.
PRINCIPLE VI
A midwife is aware of interdependence in the professional field and collaborates with other professionals.
- A midwife never refuses help to a colleague. She is bound to this by professional duty and professional affiliation.
- A midwife contributes to good interpersonal relationships within the healthcare team through assertive behavior.
- In her work, a midwife collaborates with various professionals, respecting the professional role and knowledge of each individual.
- A midwife is in solidarity with other midwives around the world. She provides them with professional support in the development of the profession. In case of natural disasters and other emergencies, she supports them and offers help.
- A midwife acts in accordance with the document Personal and Professional Image of a Midwife.
PRINCIPLE VII
A midwife strives for lifelong learning, expansion of professional knowledge, and research work.
- A midwife takes care of her professional and career development.
- A midwife follows professional progress and advocates for the introduction of new working methods that ensure higher quality midwifery services.
A midwife supports and conducts research work in the field of midwifery and advocates for evidence-based practice. She also actively participates in research in other fields of science.
A midwife participates in the education of midwifery students, students of other health sciences, and midwives in practice.
Ljubljana, 2011 Slovenian Chamber of Nursing and Midwifery – Association of Professional Associations of Nurses, Midwives and Healthcare Technicians of Slovenia Source
