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Compound midwifery: the holistic specialist.



Midwives are associated with the normality of birth, and with safeguarding the innate capacity for all women to give birth regardless of risk-status. Midwives may need to proactively acquire new skills to support women making higher-risk birth choices in a birth culture which is disproportionately focussed on risk. However being all things to all women may be unrealistic in modern maternity care. The role of the specialised midwife may provide an appropriate space in which to attend to specific needs for each unique woman within complex categories. In this role some midwives may be better able to provide both the helicopter normality view focussed on the person alongside specifically tailored and specialised skills particular to the woman’s risk-factors and in addition be a source of specialised knowledge and referral for her colleagues. The advantages of specialisation may enable midwives to see the unique situation in the midst of a risk that is well understood and of which she has in-depth, familiar and continuously developing knowledge. This approach acknowledges the risk without allowing it to dominate the woman’s experience of birth. The midwife is thus able to respond to the specific instance of this particular woman and her journey. Further research into specialised midwifery roles which include salutogenic outcomes will help us to better understand the value of specialised midwifery care in higher-risk situations.
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