Roles and responsibilities of midwife in antenatal care
During the antenatal period, midwives care for a pregnant woman by providing regular check-ups that allow treatments and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both mother and unborn child. The health care professionals will give advice and information to help the patient have a healthy pregnancy (information such as impact of diet, alcohol, smoking, exercise and other drugs) and answer any questions the patient or family may have.
Midwives have specific roles and responsibilities in taking care of the patient, baby and her family during the antenatal period of care. They have to educate, weather the pregnant woman is a teen or and experienced mother, the midwifes have to provide information for them through the antenatal appointments educating them of diets and exercises. Making the mothers be aware of the risks of smoking, alcohol and drugs during her pregnancy. And informing them of the possible diseases and infections (such as diabetes, Urinary Tract Infections, yeast infection and etc.) and the treatments and medications available for them.
Midwives should provide emotional and psychological support to patient and family. Midwives should be aware of the patient’s well being outside the appointments, such as emotional, psychological, physical abuse or domestic violence, which female patient hide sometimes afraid of telling anyone (this is evidenced, and according to a swedish study – Stenson et al 2001). Midwives has to acknowledge this and encourage them to speak out about it as well as informing them of the risks they put themself or their baby in.
The roles of the midwife in relation to other key professionals Midwives have to work as part of a team of professionals who each bring particular skills and perspectives to the care of the women and their families. Midwives are involved with patients who want to have a baby, during their pregnancy, during labour and birth, and for up to 28 days after the baby has been born. But with relation to other healthcare team such as the MSW and obstetricians at all times.
During pregnancy midwives provide antenatal care, if any risk or abnormality is seen they would refer the patient to a specialist, the obstetrician to handle the case. And during the the antenatal care, midwives arrange and provide parenting and health education to the patient and family and a MSW can also be there assisting the midwife and patients. When a woman goes into labour, all different types of health care professionals team up to provide care and if anything goes wrong they are there to step in to save the lives of the baby and mother, this includes all :- the midwife, MSW, Obstetrician, anaesthetic, surgeon, nurses and etc.
In case of miscarriage, termination, stillbirth, abnormality and even death, midwife and obstetrician are ready to offer support and advice to the family and patient at anytime. After birth, the midwife has to continue to see the mother and baby for one month, to examine and check that the mother is healthy, e.g. no infection or bleeding, and that there is no problems with the baby e.g. no sign of Jaundice or any other abnormalities. After one month the mother and baby is passed on to the health visitors.
In maternity wards, a midwife will not be looking after just one woman who is about to give birth. There are many other different patients dependent on only one midwife, the patient’s’ age, experience and other health factor could affect her birth and therefore some need to be monitored more often than the other. And this is why a MSW is so important, they are the right hand of the midwife, they supports patients and midwifes with small jobs, making routine observations (temperature, pulse, blood pressure, breathing, etc), taking blood and reporting any problems to the midwife or obstetrician. They are also involved with the mother, baby and families; educating parents one-to-one or in groups and promoting breastfeeding. Their role is focused in around helping women right before and after giving birth.
An obstetrician, a specialist doctor, usually contract with hospitals and sometimes are called into the hospital at odd hours to care for a woman in labor that they never before met. Also midwives can refer patients to the obstetrician if they see a particular concern or abnormality. Obstetricians make hospital rounds anytime their patient is in the hospital, whether in labor-and-delivery, postpartum or antepartum departments. When it is time for the patient’s’ baby due, a Obstetrician help get the baby out of the mother’s body and into her arms. Obstetricians deliver babies both naturally and through Caesarean section. During a C-section delivery, an obstetrician typically has a team of nurses, anesthesiologists and other health professionals prepared to help with the delivery.
Role of the midwife in promoting a healthy lifestyle during pregnancy
The main purpose for having a healthy lifestyle during pregnancy is to maximise the likelihood of having a healthy baby, and to avoid indirectly harming the baby by being unaware of potential hazardous behaviour. women need information so they can make decisions about how they can alter or adapt a lifestyle.
Some women have no problem in relation to the health and have a spontaneous labour, giving birth to a healthy baby without making any changes in their diet or lifestyle choices. Although there women who need information and advice to a healthier lifestyle from a midwife.
In the U.S it is a criminal offence for women to potentially put an unborn baby at risks by smoking or drinking during pregnancy and result in them being imprisoned, however it is not currently a criminal offence in the UK yet, nevertheless, it is part of the Midwives role to advise women during pregnancy and offer health counselling and education (ICM 2005). The Midwives should guide patients of the risks of smoking, alcohol and drug.
Diet According to the midwifery essentials antenatal journal, it has been reported that maternal nutrition during pregnancy may have a significant impact on future adult health (Barker 1992). A healthy diet during pregnancy is very important as it can affect both the mother and baby. And the significant the quantity and quality of food during pregnancy has also been emphasised with supporting research and media.
Quantity It is obvious that women will have additional nutritional requirements during pregnancy such as, increase caloric intake, increase protein, folate supplementation and increased dietary calcium and iron. But it is important that women know the importance of eating the right food during their pregnancy.
Severe dietary restriction is never the case in any pregnancy as it results in significant reduction in birth weight. Restricting the energy and protein intake of obese women may be harmful too. Many women with low income are known to be malnutrited, this can results in significant reduction in birth weight. In UK women with low income are entitled for Healthy Start vouchers to enable them to buy fruit and vegetables (department of health 2004). It is evidential that dietary supplementation with both calories and protein intake result in both maternal weight gain and increased birth weight.
Quality During pregnancy, women are faced with many daily food that are now advised not to eat because of the potential risks to the developing baby and the mother. At the beginning of a woman’s pregnancy, midwife should advise about the different types she should avoid and the ones she could increase in her diet.
During pregnancy it is crucial for women to increase intake fruit and vegetable, and even though some women are recommended by their midwife to take supplements. All fruit and vegetable should be washed before eaten because they may have bacteria (called Listeria monocytogens) from the soil. The bacteria can cause infection, it has flu-like symptoms in the pregnant women and can be transferred to the fetus by the placenta or during birth. Bacteria can be also found on raw meat however it is killed by heat and women should be advised to ensure that all meats are cooked completely and also that takeaway food is eaten hot.
Fishes like swordfish, marlin and shark should be avoided by pregnant women, due to their high methylmercury content, which could affect the nervous system of the developing fetus. However other seafood is recommended as women consuming a low seafood diet are more at risk of premature labour.
According to the Midwifery Essentials, Antenatal journal, the Food Standards Agency (FSA 2008) recommended that pregnant women should not consume more than 300mg of caffeine per day (3 mugs of coffee), too much can lead to low birth weight and miscarriage. The FSA also recommends that women abstain from drinking alcohol during pregnancy. A consistently high intake of alcohol is linked to fetal alcohol syndrome (FAS). The series of characteristics of FAS include mental retardation, microcephaly, small eyes, hearing disorders, large ears, shallow philtrum, small for gestational age, thin lip and congenital abnormalities
Exercise The Royal College of Obstetricians and Gynaecologists recommended that all women should be encouraged to ‘participate in aerobic and strength conditioning exercise as part of a healthy lifestyle during their pregnancy’. Moderate exercise, for example, walking, swimming or mowing the lawn, during pregnancy is encouraged because it helps women maintain flexibility, enhance self esteem and has beneficial cardiac and respiratory effects. However contact sports and intense workout should be avoided, women should be careful not to put too much stress on her body and avoid over-heating to reduce the risk of hypoglycaemia by limiting workout sessions to no more than 45 minutes.
Smoking Cigarettes contain over 4,000 chemicals, however 3 are the most harmful chemicals are nicotine, tar, and carbon monoxide. It is widely known by the people of the public about the effects of smoking on a person such as the on the Lungs causing COPD, pneumonia. And its effects on appearance, e.g. premature aging and wrinkles, tooth loss, stretch marks – smoking causes the skin to lose elasticity and strength.
Pregnant women should also know the effects of smoking during pregnancy on their unborn baby. Since in UK the women can choose to continue to smoke however it is the midwife’s job to inform them of risks and encourage and help them quit. According to the NHS Choice website these are the effect of smoking on unborn fetus;- brain damage, high risks cot death, stillbirths or miscarriage, babies born with defects, poor fetal growth and Lower birth weights and premature delivery. However babies are also affected after birth; infant respiratory problems – breathing problems such as asthma or bronchitis.
Drug According to the Midwifery Essentials, Antenatal Jurnal, pregnant drug users have a range of social, emotional and physical needs that require expert attention. The vulnerable group of women requires individualized care. Accidental drug overdose can lead to death. The babies of drug users are also at risk of a range sequelae, depending on the type of drug and degree of abuse (Baston & Durward 2001). Women can be referred to local drug dependency service for care and treatment.
