Shortly, midwives are expected to face new challenges in perfecting their responsibilities as partners, practitioners, and leaders in maternity care provision. Among the areas where the practice of midwifery is anticipated to be extremely challenging is in ensuring effective communication with all involved stakeholders. Since midwives provide vital care not only for pregnant women but also for their families, future midwifery managers must focus on enhancing communication as a way of empowering midwives to provide essential family support especially when complicated pregnancies are involved as a result of chronic illnesses.
The increasing burden of chronic illnesses is expected to be one of the leading public health catastrophes in the coming years. Even though, the 21st Century has seen great developments in the healthcare practice (Gardner 2014, p.308). As a result, it is increasingly becoming possible for women with chronic illnesses to nurture pregnancies through the appropriate medical assistance. However, this does not exempt these pregnancies from being categorized as complicated pregnancies that require critical care through the help of midwives and other medical experts. In the past few decades, these pregnancies were considered extremely risky and were associated with high mortality rates. The concerns for the safety of these pregnant women still cause a lot of stress among their family members. At critical times such as childbearing, constant communication with the family members is appropriate to alleviate stress and enhance calm despite the existing tensions. Effective communication among the maternity care providers is therefore crucial in achieving this end.
Among the most important stakeholders in healthcare, practice is the family of a patient. The patient’s family needs to be informed of any developments in the medical state of their beloved. Families of chronically ill pregnant women need to be updated on every perceivable health-related development that their beloved makes. Effective communication in the midwifery practice is required to ensure that accurate updates are made on time. As pointed out by Kunyck and Olson (2001, p.317), effective communication is essential especially in maternity care where multiple handovers are made as per the labor duration. These include the patients’ transfers from home settings to the hospitals as well as the referrals made between the midwives and obstetricians according to the development of the cases. In all these instances, the family must be informed and taken on board to ensure that they are not caught off-guard especially when their input is required. The failure to deliver accurate information to any of the involved parties can amount to unsafe care and might have devastating implications on the well-being of the patient.
Midwifery management in the contemporary setting is faced with the daunting task of ensuring that the practice is overhauled to conform to the emerging requirements. Quality care cannot be compromised in the midwifery practice and, as such, patients’ safety should be protected through effective communication. According to Arnold and Boggs, the process of ensuring that a patient receives quality health care involves the joint participation of all the relevant stakeholders (2007, p.43). These include the health practitioners as well as the patients’ families. In the case of chronically ill women who are expectant, quality health care requires the cooperation of the health care providers and the family who are mostly the financiers of the health care. When effective communication fails to occur between the financiers and the healthcare givers, this might cause unnecessary delays that can be devastating. The financiers might also be caught off-guard when funds are urgently required. Considering the logistical challenges that might be involved in securing the funds, the delays can lead even to the loss of lives.
Pregnant women patients or their families should be treated with the utmost respect by the health care providers including midwives. The views of these parties should be sought at all times and taken into consideration if they are deemed relevant. As such, healthcare management should aim at enhancing communication between the involved parties to make sure that the views of all the important people are respected and considered. Failure to consider this factor might have detrimental repercussions especially when one of the involved parties is neglected and made to believe that his or her views are insignificant (Sully and Dallas 2010, p.69). This can even result in families neglecting and abandoning their members in hospitals. However, to enhance the cooperation between maternity care providers and the family of a pregnant woman, effective communication should be encouraged and coordinated by the midwives.
Empathy is considered a key concern in midwifery practice. It refers to the preemptive attempt to comprehend and appreciate a patient’s views, feelings, experiences, and perspectives. In the case of chronically ill women whose pregnancies are classified as complicated, this can be achieved through establishing communication with the family as well as the patient. In instances where the patient is unable to provide the necessary information, members of her family can provide such information. However, empathy can only be achieved when practical interventions are involved. As pointed out by Kunyk and Olson, showing empathy to the patient can also involve taking practical actions such as constantly contacting the family of the patient (p.322). This measure is considered essential in reducing the emotional suffering of both the patient and the family members. In addition, empathy entails checking to determine whether the views, beliefs, or attitudes of the patient are clearly understood. This can be determined by both the patient and the family through both verbal and non-verbal communication, especially before undertaking any procedures. When this is done, the members of the family feel at ease throughout the process and any existing stress is cleared beforehand.
The ability to communicate politely by the midwives is essential in their practice especially when they are caring for women with complicated pregnancies. Inappropriate language directed to the patient of the patient’s family members can cause panic in times when surgical procedures are awaited or even during normal birthing. The patient’s attitude towards the process might be negatively affected when rude and inappropriate language is used by the midwives or any other maternity care providers. The ability of the woman to deliver safely can also be affected as a result of the emotional damage that inappropriate language causes (Gardner 2014, p.309). To the family of the patient, the midwives should communicate politely in a language that can promote the confidence of the family in times when sensitive processes are anticipated. Inappropriate language can cause unnecessary tensions, panic, and stress thereby endangering the life of the patient or others in her family.
In a bid to improve the outcomes of individualized health care of chronically ill pregnant women, midwives must strive to effectively understand their patients and also demonstrate high levels of courtesy, sincerity, and politeness. This can only be achieved through devoting enough time to interact with both the woman and her family. As argued by Brown and Draper (2003, p. 17) the communication strategy that they adopt should be inclusive to include all the people who surround the patient. As such, the method and the language that should be used have to be understood not only by the patient but also by those who surround her. The ability to communicate effectively among midwives is not only determined by their abilities but also by their experience and training. In light of the communication burden that is increasingly being heaped on the midwives, their training should also focus on the dissemination of good communication skills.
The midwifery practice is very dynamic and new challenges are emerging with time. The advances in the medical technologies of the 21st Century are giving many women the courage to get pregnant despite having chronic illnesses. The women as well as their families are kept under tension and stress throughout the pregnancy terms. This makes the tasks undertaken by midwives extremely sensitive and demanding. By communicating efficiently and constantly, midwives are capable of alleviating this stress and ensuring that quality care is provided for the patients. The use of appropriate language, enhancing empathy, and keeping all the stakeholders informed are essential especially when dealing with complicated pregnancies. Proper communication can trigger confidence among chronically ill pregnant women and make normal delivery a possibility. This can also foster the ability of chronically ill women in the future to have children without prompting unnecessary tensions and stress in them or their families.
Midwifery Practice: The Case of Netherlands
The maternity system in the Netherlands is to a large extent different from most of the Western nations. According to Bradley and Bray (1996, p.471), the country has the highest record of homebirths in Europe with midwives taking a significantly big role in the maternity system. However, homebirths are only recommended for low-risk women. Women with complicated pregnancies are referred to obstetricians and hospital deliveries are more preferable due to their condition.
The maternity care system in the Netherlands is classified into three major categories according to the level of complexity. Primary care involves care for low-risk women while secondary and tertiary care involves women with complicated pregnancies. The participation of midwives is limited to the primary and secondary care levels (Wiegers, Zee & Keirse 2008, p.192). In the primary care level which mostly involves homebirths, the midwives are in charge of the entire process. However, when complications emerge, referrals are made to obstetricians or hospitals in the proximity. In secondary and tertiary care, midwives play supportive roles with obstetricians being more in charge of the processes.
For a system like the Netherlands maternity care to succeed, an effective communication model is essential to support the need for correspondence between the midwives and other service providers as well as with the pregnant woman and her family. As pointed out by Bradley and Bray (1996, p. 473), midwives in the Netherlands are more empowered to preside over child delivery processes than anywhere else in Europe and North America. They are relatively autonomous and capable of making independent decisions in the management of the entire process, especially in the primary care category that involves less risky deliveries. Effective communication with the woman’s family is essential in making the procedures a success. For instance, in cases where the patients prefer home delivery to hospital delivery, the midwife has the task of constantly communicating with the family to ensure that all the essential plans are made in good time. Perinatal care in the Netherlands is significantly different from the other Western nations in that the community is more involved in the provision of care and the midwives take important roles in facilitating the processes.
According to Bradley and Bray, in the case of women whose pregnancies are complicated, the midwives make referrals to more qualified professionals and take the role of mediators between the obstetricians and the pregnant woman’s family (1996, p.473). Since home care is more encouraged and part of the culture in the Netherlands, even some chronically ill pregnant women choose to nurture their pregnancies in the home setting. As such, the midwives tend to their needs while at home and only involve other health experts where there is a need to do so. This happens mostly when the health problem of the woman escalates causing concerns about her safety and that of the fetus.
As opposed to other countries such as the United States and China where most deliveries take place in hospitals, the demands for effective communication in the midwifery practice in the Netherlands are greater (Wiegers, Zee & Keirse 2008, p.195). This is because, during the entire perinatal care period, the midwives are supposed to keep close contact with the pregnant women and their families. Without the necessary communication competencies, the coordination of the process might be problematic. This is not to imply that the demands for effective communication are less in countries where most deliveries take place in hospitals such as the US, China, and other Western countries. However, the need for coordination with the family of the pregnant women is more in the case of the Netherlands.
The clear distribution of responsibilities, risk selection, and the effective coordination that is made possible through effective communication are the major strengths of the Dutch midwifery practice. Among the profound benefits of this system is the fact that the process makes pregnancy for chronically ill women less costly while at the same time reducing the need for unnecessary medical interventions (Bradley & Bray 1996, p. 474). To closely monitor any changes in the condition of the pregnant woman that might require advanced medical interventions, the midwives in charge of the woman relies upon other family members for information. As a result, the communication channels between them and the family members are vital for ensuring optimal care during pregnancy, childbirth, and after birth. In other western countries such as the US, the role of the midwife is mostly supportive as most of the delivery processes are coordinated by obstetricians. Despite that the outcomes are relatively better in these countries; the Dutch system makes perinatal care considerably cost-effective while at the same time enhancing the provision of quality services to both high-risk and low-risk pregnant women.
Through the role played by the midwives, the coordination of the processes is made easy and efficient. The home delivery option that s emphasized in the Dutch maternity system enhances collaboration between the family of the pregnant patient and the caregivers. As such, essential information is attained in the process of the interaction. Other countries that emphasize hospital deliveries lessen the chances of coordination between the patients’ families and the caregivers especially during intense moments such as childbearing. As a result, the stress levels on the part of the families are much higher in those countries than in the Netherlands.
Arnold, E. & Boggs, K. U 2007. Interpersonal Relationships. Personal Communication Skills for Nurses. (5th Ed.). Saunders Elsevier. St. Louis, Missouri.
Bradley, P.J. & Bray, K. H 1996. ‘The Netherlands’ Maternal-Child Health Program: Implications for the United States’. Journal of Obstetric, Gynecologic, & Neonatal Nursing. Vol.25 no.6 pp.471-475.
Brown, A. & Draper, P 2003. Accommodative Speech and Terms of Endearment: Elements of a Language Mode Often Experienced by Older Adults. Journal of Advanced Nursing. Vol 41, no.1, pp.15 – 21.
Gardner, S 2014, ‘Communication is a two-way street’, British Journal of Midwifery, vol. 22, no. 5, pp. 308-309.
Kunyck, D. & Olson, J.K 2001. ‘Clarification of Conceptualisations of Empathy.’ Journal of Advanced Nursing. Vol 35, no.3, pp.317-325.
Sully, P. & Dallas, J 2010. Essential Communication Skills for Nursing and Midwifery (2nd Ed). Mosby, London.
Wiegers T.A, Zee J, & Keirse M.J 2008. ‘Maternity care in The Netherlands: the changing home birth rate’, Birth. Vol. 25 no.3 pp. 190-197.