Abstract
Midwifery practice involves an intermediary role of promoting collaboration between all stakeholders, especially between family members and health care practitioners. Midwives inform the patient and family about the possible risks associated with the pregnancy, coordinate advanced care for complicated cases, and offer family support. They quell anxiety and stress by informing the family about the pregnant woman’s health situation. Concerns over the safety of the pregnant woman build anxiety and stress among family members. In this regard, constant communication with family members is crucial in reducing stress and anxiety. Besides, family members, as the main financiers of maternity care, need regular updates on the health condition of their loved ones. This helps in advance financial planning, which ensures that the pregnant woman receives optimal care to alleviate undesirable health outcomes. In addition, less stressful conditions enable a pregnant woman to mentalise and reflect on her feelings. Mentalisation is an essential process in the intellectual development of the unborn child. Therefore, effective communication skills are at the heart of midwifery practice. Maternity care providers need to be emotionally intelligent and empathic to respond to the emotional needs of a pregnant woman in an optimal way. Using a grounded theory approach, this paper evaluates the main communication challenges and tools used in midwifery practice. A mixed-methods design is proposed for obtaining quantitative and qualitative data on communication efficacy in maternity care. The study’s findings will have implications for the communication strategies and tools employed by midwives in their practice.
Introduction
One of the core roles of midwifery practice is to relieve the stress associated with antenatal care by informing the patient of the possible risks and referring complicated cases to specialist medical care. Less stressful conditions improve the pregnant woman’s ability to ‘mentalise’, which is essential in the unborn child’s intellectual development. Effective communication is required to inform the patient and family of possible risks and offer appropriate support. Good communication skills, including emotional intelligence and empathy, enable midwives to be sensitive to their patient’s emotions and respond appropriately.
Patients with complex care need to express different feelings and emotions at different times. Therefore, responding to each patient’s feelings at any given time requires the midwife to be in constant communication with the patient and family members. In addition, communication skills in midwifery practice aid in accurate and appropriate information exchange that is vital in the decision-making process (Arnold & Boggs 2007). Communication enables midwives to understand a pregnant woman’s feelings, involve the family, decide on the appropriate level of care, and refer complicated pregnancies to expert care. This helps avert potential health risks and improve the outcomes of the patient. If midwives are not proficient in their communication skills, many problems can arise and compromise the quality of midwifery services.
Problem
The patient’s family is an important stakeholder in healthcare practice. As such, the family needs regular updates on the medical condition of their loved one. Pregnancies carried by chronically ill women are often risky and thus, cause stress among family members. Effective communication is therefore crucial in alleviating family stress and enhancing calm despite the existing tensions. It ensures that accurate updates are made to the family on time. Communication between the maternity care teams is also important.
As pointed out by Kunyck and Olson (2001, p. 317), effective communication is essential, especially in maternity care due to the “multiple handovers made during the labour 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, it is important to inform and involve the family members to ensure that they are prepared financially and emotionally, especially when complicated pregnancies are involved. The failure to deliver accurate information to any of the involved parties can compromise the safety of care offered and might have devastating implications for the well-being of the patient.
Objectives
One objective of this paper is to review the present global communication requirements in the health care system, especially in the midwifery practice. The second objective is to explore the present and future challenges in midwifery practice. 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. Effective communication will empower midwives to provide support to families, especially when complicated pregnancies arising from chronic illnesses are involved. Therefore, the third objective of the research is to define the tool that will foster a more efficient communication process among midwives as well as between nurses, patients, and their families.
Methodology
The quality of midwifery services depends largely on the qualifications of the midwives and the efficacy of information transfer between midwives and patients/families. This underscores the need to research the present communication tools and assess their efficiency as a feedback system involving midwives, patients, and their families. Thus, a mixed-methods study that integrates qualitative and quantitative techniques is appropriate in this research.
The qualitative design will generate basic information about the theory of communication and the methods that midwives use to communicate amongst themselves, retrieve feedback from patients, and update patients’ families. An extensive analysis of the latest journal articles will generate data regarding the communication tools in use and those still under design and testing. The analysis of this data will involve the grounded theory approach to develop a new tool or theory of communication between midwives, pregnant women, and families.
The quantitative method will help assess communication efficacy among midwives and between nurses, patients, and their families. This will involve the use of three types of surveys, one for each target group, i.e., nurses, patients, and family members. The surveys will contain several types of questions, each designated for assessing a specific aspect of the midwives’ work. The survey questionnaire will contain seven-point Likert-scale questions for measuring the quality of midwifery services. It will also include ten multiple-choice questions that will address the issue of communication tools that midwives and patients prefer or use to exchange information. Open-ended questions will be included to allow the respondents to express their views about the subject matter.
Quantitative data analysis will involve the Pearson Correlation tool to determine the correlation between the key variables. In particular, the correlation between midwifery service quality, integration of technology in communication, and involvement of family members will be determined. Studies indicate that the Pearson Correlation tool helps identify the correlation between variables with a high precision, which facilitates a detailed study to test hypotheses (Prion & Hareling 2014). Thus, this data analysis tool will be imperative in processing the gathered information to identify the problems associated with the current communication approach.
Representation
Midwives make referrals to advanced care for complicated pregnancies and act as mediators between obstetricians and the pregnant woman’s family (Bradley & Bray, 1996). In the Netherlands, most women, including those with chronic illness, prefer to nurture their pregnancies in the home setting with the help of midwives. If health complications that endanger the safety of the woman and that of the foetus arise, then special care is sought. Thus, midwives should facilitate effective communication and coordination to improve the health outcomes of the mother and foetus.
Effective communication promotes clear distribution of responsibilities, risk selection, and coordination, which characterise the Dutch midwifery practice. According to Bradley and Bray (1996), this system ensures cost-effective care for pregnancies carried by chronically ill women and reduces exposure to unnecessary medical interventions. Family members supply important information that midwives use to monitor the pregnant woman’s condition and recommend advanced care if necessary. As such, clear communication channels between family members and midwives are vital. Unlike in the Netherlands, in the US midwives play a supportive role with obstetricians coordinating most of the delivery processes, which results in relatively better outcomes (Bradley & Bray 1996). However, the Dutch system has the advantage of being cost-effective and responsive to the care needs of both high- and low-risk pregnant women.
Pregnant women under maternity care and 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 at each step of the care planning process. This requires a patient-centred approach to incorporate patient/family views, values, and preferences in care planning. As such, healthcare management should aim at enhancing communication between the involved parties to make sure that the input of all the concerned people is not only respected but also considered when making important decisions. Failure to consider this factor might have detrimental repercussions on the wellbeing of the patient, especially when one of the involved parties is neglected and made to believe that his or her views are insignificant. This can even result in families neglecting and abandoning their members in hospitals. In this regard, 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 essential in midwifery practice. It enables midwives to comprehend and appreciate a patient’s views, feelings, experiences, and perspectives. Empathy can be achieved through communication with the patient as well as with her family. Family members can provide the necessary information if the patient is unable to do so. Empathy is particularly important when practical interventions are involved. As Kunyk and Olson (2001) point out, showing empathy for the patient entails practical actions like regular communication with the patient’s family. This protects the patient and family members from emotional suffering. Empathy also entails taking into consideration the views, beliefs, and attitudes of the patient when making clinical decisions. This can be achieved through regular communication with the patient and family members.
Besides showing empathy, midwives should communicate politely to the family and the pregnant woman, especially when the pregnancy involves complications. Inappropriate language directed to the patient or the patient’s family members can cause unnecessary panic and stress. In particular, if surgical procedures are anticipated, 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. Inappropriate language can cause emotional change, which can affect a pregnant woman’s ability to deliver safely (Cornelis & Coop 2014). 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.
Solution
Trends in the health care system indicate that midwives will face new challenges in their work as partners, practitioners, and leaders in maternity care provision. One of the key areas of midwifery practise that is expected to be challenging is in ensuring effective communication among all stakeholders involved. Midwives not only give maternity care to pregnant women but also provide psychosocial support to family members. In this regard, future midwifery managers should undertake to enhance communication as one way of empowering midwives to provide appropriate family support, especially when the pregnancies involve complications due to chronic illnesses.
Research evidence suggests that communication occurs between the mother and the unborn child (Cornelis & Coop 2014). Quality maternity care reduces stress, which enhances the mother’s ability to reflect on her feelings and achieve happiness. Evidence shows that when a pregnant woman is excited, her unborn child normally displays calmness (Cornelis & Coop 2014). The unborn child is also highly responsive to the mother’s voice and emotional state, indicating that there is a strong emotional bond between the two. Bonding can be achieved through talking, playing music for the child, and daydreaming about the newborn’s development. This means that quality maternity care enhances mentalisation, which improves bonding as well as the unborn child’s emotional and intellectual development.
Contemporary midwifery practice faces multiple challenges that necessitate changes in the practice to conform to emerging trends. Quality is central to midwifery practice and as such, effective communication should be embraced to protect patients’ safety. According to Arnold and Boggs (2007), quality health care delivery requires the joint participation of all relevant stakeholders in a concerted action. The key stakeholders include the health care practitioners and the patient’s family. Family members are often the financiers of health care and therefore, their input is important. A breakdown in communication between the financiers and the health care providers can cause delays and affect the health outcomes of the patient (Arnold & Boggs 2007). Additionally, regular communication will enable the financiers to source funds in time to avoid delays that may lead to the loss of lives.
Conclusion
Effective communication between midwives, patients, and family can help reduce stress, instil confidence, and enhance the mother’s ability to mentalise, which create a positive relationship between her and the unborn child. Positive emotions during pregnancy depend on tiredness and exposure to stressors. Effective communication in midwifery practice enhances the quality of maternity care, the level of support received by the family, and the outcomes of complicated pregnancies. Thus, midwives should develop proficiency in emotional intelligence and empathy that are essential in communication.
References
Arnold, E & Boggs, KU 2007, Interpersonal Relationships. Personal Communication Skills for Nurses, Saunders Elsevier, St. Louis, Missouri.
Bradley, PJ & Bray, KH 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.
Cornelis, H & Coop, D 2014, ‘Afference Copy as a Quantitative Neurophysiologic Model for Consciousness’, Journal of integrative neuroscience, vol. 13, no. 2, pp. 363-402.
Kunyck, D & Olson, JK 2001, ‘Clarification of Conceptualisations of Empathy,’Journal of Advanced Nursing’, vol. 35, no. 3, pp. 317-325.
Prion, S & Hareling, K A 2014, ‘Making sense of methods and measurement: Pearson product-moment correlation coefficient,’ Clinical Simulation in Nursing, vol. 10, no. 11, pp. 587–588.