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Professional power and maternity care: The many faces of paternalism
Abstract
Paternalism in the wider health services, though frowned on by many practitioners and consumers, has been widespread in the past and remains endemic in some areas in the present. This may be because it has a benevolent face: the desire to protect the public from information or situations that the professionals deem potentially injurious to them.
... The Nursing and Midwifery Board of Ireland (2015) states that a midwife must promote and protect the safety and autonomy of a woman and support her choices and beliefs throughout her pregnancy and birth. A woman's choice, however, may be restricted to what is "allowed" by the health-care practitioner (Walsh, 2005). Devane et al. (2007) suggests that within a medicalized birth model, choices and decisions are governed by risk. ...
... Devane et al. (2007) suggests that within a medicalized birth model, choices and decisions are governed by risk. This does not facilitate true choice but encourages women to choose the option that the health-care practitioner is most comfortable with (Devane et al., 2007;Walsh, 2005). ...
... One hundred and sixteen (75.8%) respondents agreed that they would discuss the timing of cord clamping with the mother and support a request for DCC, unless in an emergency. Supporting a woman's right to control her birth experience is indicative of the holistic philosophy of midwifery, which opposes the often paternalistic attitude of obstetrics (Walsh, 2005). ...
Background
At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord. A delay in cord clamping is physiologically beneficial to the neonate as they receive an increase in blood volume (30%–40%), increased iron stores (20–30mg/kg), and an easier transition to extrauterine life. Active management of the third stage of labor, in order to prevent maternal postpartum hemorrhage, may contribute to early cord clamping practices in Ireland.
Objective
To describe the current practices and attitudes of midwives in Irish hospitals toward delayed cord clamping in term neonates.
Methods
A cross-sectional descriptive survey was distributed to three maternity hospitals and two Irish online midwifery groups.
Results
One hundred and fifty-three valid responses were received. One hundred and eleven midwives (72.4%) defined delayed cord clamping as “clamping after the cord ceases to pulsate.” One hundred and forty (91.5%) respondents practiced delayed cord clamping. Moreover, 62.7 % (98/153) of participants routinely clamp the umbilical cord >1 minute when practicing active management of the third stage, with 49.1% (48/98) of those waiting until cord pulsations have ceased. Awareness of research, practice guidelines advising delayed cord clamping, and experience of practicing physiological third stage are associated with increased delayed cord clamping practices. Early cord clamping is influenced by a deteriorating neonatal or maternal condition and the cultural context within clinical sites. Delayed cord clamping times during active management of the third stage differ significantly between clinical sites and maternity care pathways.
Conclusion
A variety of midwifery practices were identified with differing attitudes toward cord clamping practices. Diverse influences included the practice environment, awareness of research, and availability of adjunct resuscitation supports. Recommendations for future practice include a synchronized approach to delayed cord clamping in the third stage of labor, including the provision of a national guideline.
... They also wished to see written approval from the Trust's consultant gynaecologists (sic) that: "they are happy for their patients to be included in the trial and similar approval from the patients' GPs". The terminology used highlighted the predominance of the medical model and the paternalism of the medical profession towards their clients (Walsh, 2005). Clearly the use of the word 'trial' also suggests a preoccupation with more quantitative methods rather than the qualitative approach which was to be used. ...
... We suggest two areas in current provision that fail to reflect this ideal. One is the persistent paternalism that is exhibited from time to time in care encounters (Walsh, 2005a), and the other is the response of the service to assertive women who challenge policies and protocols. Recently a woman expecting her 12th baby came into a birth suite in labour and refused a venflon. ...
Feature 'The time is right... for a comprehensive review, not simply in legislative and statutory terms, but in a contextual appraisal of the meaning and outworking of the role in practice environments.' The role of the midwife: time for a review Reader in midwifery Denis Walsh and research fellow in midwifery Mary Steen at the University of Central Lancashire and the RCM examine both the current situation of impersonalised midwifery and the ideal of combining holistic care with evidence-based practice.
In this paper, we briefly outline the many contributing factors to the nursing shortage and corresponding theory–practice gap. We then present initial research on addressing these shortfalls. In contrast to other treatments of this issue (e.g., Institute of Medicine [IOM], 2011), we specifically emphasize how advancements in medical simulation and its systematic integration could contribute to a solution. Additionally, we emphasize the importance of Human–Systems Integration processes for this course of action.
Stillbirth occurs in approximately 1 out of 110 births in the United States, yet little is understood about this experience. Unexplained stillbirths are major contributors to the developed world's perinatal mortality, as only about half have an identifiable cause of death. Because stillbirths are unpredictable and thus unpreventable, given the current state of science, researchers have called for more uniform definitions, a stricter postmortem protocol, standardized data collection, and increased funding to aid in prevention. The macrosystem for stillbirths includes epidemiology and public health systems that gather statistics on the incidence of stillbirth and its known causes and state record keeping related to both birth and death. Legitimation for women who have experienced stillbirth, through legislative and terminological changes, education, and research, is overdue, despite fears that related policy will trump reproductive rights. This article explores recent policy changes promoted by grassroots organizations relating to how stillbirths are recorded.
to explore how a range of midwives experienced and managed emotion in their work.
a qualitative study using an ethnographic approach. Data were collected in three phases using focus groups, observations and interviews.
South Wales, UK.
Phase One: self-selected convenience sample of 27 student midwives in first and final years of 18-month (postnursing qualification) and 3-year (direct entry) programmes. Phase Two: opportunistic sample of 11 qualified midwives representing a range of clinical locations and clinical grades. Phase Three: purposive sample of 29 midwives working within one NHS Trust, representing a range of clinical locations, length of clinical experience and clinical grades.
community and hospital environments presented midwives with fundamentally different work settings that had diverse values and perspectives. The result was two primary occupational identities and ideologies that were in conflict. Hospital midwifery was dominated by meeting service needs, via a universalistic and medicalised approach to care; the ideology was, by necessity, 'with institution'. Community-based midwifery was more able to support an individualised, natural model of childbirth reflecting a 'with woman' ideology. This ideology was officially supported, both professionally and academically. When midwives were able to work according to the 'with woman' ideal, they experienced their work as emotionally rewarding. Conversely, when this was not possible, they experienced work as emotionally difficult and requiring regulation of emotion, i.e. 'emotion work'.
unlike findings from other studies, that have located emotion work primarily within worker/client relationships, the key source of emotion work for participants was conflicting ideologies of midwifery practice. These conflicts were particularly evident in the accounts of novice midwives (i.e. students and those who had been qualified for less than 1 year) and integrated team midwives. Both groups held a strong commitment to a 'with woman' ideology.
understanding the dilemmas created by conflicting occupational ideologies is important in order to improve the quality of midwives' working lives and hence the care they give to women and families. In the short term, strategies involving education and supervision may be of assistance in enabling midwives to reconcile these conflicting perspectives. However, in the long term more radical solutions may be required to address the underpinning contradictions.