Journal of Women's Health Care
Open Access

Intimate face of Midwifery

Effat Jalilian^{* *}Correspondence: Effat Jalilian, Consultant and Instructor of Midwifery, Turkey, Tel: +9046389054, Email:

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Short Communication

Many efforts based on the science of midwifery have been fortunately done to encourage mothers and midwives to choose and follow the physiologic childbirth rules while physical and psychological aspects are considered. This method supposed to be continued and upgraded to maintain the level of maternal and infant health [1].

On the basis of physiological childbirth, the concept of newborn birth is not merely taking the infant out of the uterus but, in addition empowering the mother and infant physically and comforting them mentally are considered even before pregnancy. I would like to have the opportunity to mention some of the barriers that suppress the function of midwifery personnel or the mothers. Then, some solutions are suggested that is hoped to be completed and actualized by the authorities, experts and colleagues.

I bring up a simple question for a better discussion and consensus while the answer is quite clear for health care colleagues to open up the honest explanations and feelings.

Do all mothers equally benefit required supportive care such as verbal and non-verbal communication based on physiological childbirth training in both governmental and private hospitals in urban and rural areas?

Although the statistical numbers on papers declare a high rate of satisfaction, we may sometimes confront mothers who have not receive sufficient supportive cares or some might be totally unfamiliar with those kind of cares. In return, sometimes midwives may complain that some mothers are so fastidious and uncooperative while it is their own natural pain to endure [2].

Are these emotional thoughts true, according to your experience? If yes, what is the cause? What are the right solutions?

The preventive factors of the qualified midwifery care and supportive communication based on physiological childbirth rules

• Dissatisfaction with the job’s description

• Midwives’ Personal anxiety

• Non-satisfactory salary

• Non-cooperative behavior due to the mother’s anxiety

Dissatisfaction with the job’s description

• A negative competitive atmosphere between health workers arisen from an uncertain extent of authority in decisionmaking with more diversity of authority in public and private hospitals.

• The confusing concept between the qualified midwife’s role in terms of her authority according to the educational capability and the actual permissible activities in some hospitals. The noted case is in a direct relationship with the dissatisfaction with salary as well, which will be given a more complete description.

• The existence of a bossy, high-low-class directorate system between health personnel instead of a supportive leadership to strengthen team working atmosphere in hospital wards. Usually, this system is coexisting with the regional culture in society.

• Lack of legal and occupational security of midwives, especially seen in the private sector. It is sometimes seen that unwritten rules exist between personnel. The midwife as an employee might be obliged to perform oral orders without recording nursing notes to hold the position and the artificial friendly cooperative atmosphere, where will lose the job in case of defiance. In case of occurring any problem the midwife in front of the law is completely defenseless.

Midwives’ Personal anxiety

• Personal mental stresses and concerns related to family or social problems.

• Suffering from physical illness or pain

Non-satisfactory salary

The sense of job satisfaction is highly influenced not only by the person's interest in the type of activity and professional position but also by an equitable salary along with fair benefits. Financial factors encourage personnel to maintain the spirit of hard work to keep up the professional activities, developmental effective creativity.

In countries like Iran, briefly a midwife is responsible to provide the physiological care services during pregnancy, to create a supportive environment with a sense of intimacy, mental support, maternal and infant health control during labor and childbirth, helping mother to give a normal childbirth and also postpartum care, that usually take a long period of time accordingly while the process of final stage of child birth might ends within an hour or even less. In some hospitals, all duties except for conducting last stage are midwife’s responsibility. If the payment is not fair in comparison to the one who merely conducts child birth, usually the mentioned midwife will not be motivated enough to do the tasks efficiently because of the sense of being exploited [3].

You also may have heard from a colleague:

"Let her/him do the job since she/he is the one paid for? I have to work two shifts per day to afford my daily expenses. The arthritis of neck will be mine after a while without any money to treat? "

All three preventive factors are perceptible in this phrase without any sign of desire of team working.

Non-cooperative behavior due to the mother’s anxiety

It is unlikely that you judge any mother without psychological analysis, but hopefully long long time ago and not recently, maybe you also have heard from a colleague that:

"That's a show off, she's so spoiled! Not much pain! Well, it’s a normal labor pain! "Or directly mother is told:

"Ma'am, why would you be so fussy?"- "Well, you have to endure normal pain!" Come on! I'm tired! You are not the only patient that I have "Why do you do like this? You made a mess, see the bed and linen! You've got blood everywhere!" and “Other more unpleasant sentences that I prefer not to write."

Mother suffers from this kind of verbal or non-verbal violence when she usually has a confusing, hectic and stressful condition and does not know how to focus and cope with the labor pain. Analyzing the atmosphere of the labor room with such scenarios and judging on the action and reactions is a complex subject which should be investigated in different dimensions and appropriate solutions should be found.

There are two individuals interacting with each other who should be studied if, the best condition is imagined based on the one-to-one care (rarely happens except for private sectors):

• The first person is the midwife or the physician who is expected (without the three preventive factors) to perform the professional responsibilities according to the trained physiologic knowledge as well as the routines of the hospital. Regardless of the experience, it is observed that not all midwives of a hospital have the same performance in accordance with the self-control level, patience, Physical body strength, their relationships with colleagues or mothers and their type of reactions in specific situations.

Regardless the proficiency a physician, a midwife or a nurse is a human being who has one or a combination of personality types based on the classification of psychology. Of course, people who are attracted to a common profession normally are more similar in personalities.

Thus, a midwife need to have more mastery on personology whereas, theoretical and clinical courses of psychology are usually limited for midwifery students. Familiarity with nine personality types according to the Anagram knowledge leads students to understand the reason of any individual’s tendency to have a particular reaction for responding a specific stimulus based on one’s mental orientation in each type of personality. Additionally, it will increase student’s behavioral and emotional control skills [4].

The Anagram knowledge empowers medical staffs to work on their strong and weak aspects of their mental and emotional understandings by self-recognition, and also enables them to establish more effective and supportive relation with mothers who each of which has different reactions in different situations.

• The second person is a mother who has the specific reaction due to her personality type while in certain circumstances will look for a particular supportive cares accordingly.

For example, imagine a dramatic, histrionic mother with a low self-confidence. She needs to attract attention. They may have many show offs to attract attentions while an expert midwife can use psychological strategies to make them cooperate and also can make them aware of their physical and mental strength in controlling pain. In the same situation, another mother with a perfectionist type personality whose reactions are different and requires different approaches. The relevant midwife will not reach the desirable outcome of physiologic care without mastering those strategies.

In case of vulnerable mothers, the issue is much more serious, for example:

• A mother with an upset mind as she is getting divorced and doesn’t know how to manage the crisis while looks for shortterm and long-term hopes.

• Or an addicted mother who is assured that after discharge from the hospital, will return to a harsh, stressful house without any connected relationship in family.

• Or a mother who will return back to prison after childbirth or even she, her husband or one of her loved ones is sentenced to death after a while.

In such cases, a psychotherapist and a social worker can help a lot, but at the same time, the midwife should have appropriate verbal and non-verbal skills to control the condition with a positive affection.

Proposed Solutions and conclusions

• Inclusion of an abstract of person ology as well as the wise verbal and non-verbal skills in the list of theoretical and clinical modules of Bachelor in Midwifery and Nursing curriculum.

• Providing the possibility of a one to one maternal care in all hospitals, even in deprived areas, considering the workload and the number of midwives in public hospitals or in remote areas.

• Utilizing various innovative methods such as watching mother’s wedding video for instance or a film made from short videos and slideshows from the happy moments of family as a surprise during the active phase along with the and physiological exercises for a relaxing and pleasure labor. Of course, this method is possible for happy families that usually have a good financial condition.

In the case of vulnerable mothers, the governmental and nongovernmental organizations should actively identify and attract vulnerable mothers to provide maternal care based on physiological childbirth as well as trainings related to individual empowerment and psychotherapy during pregnancy and labor. Moreover, tailoring smart correspondent videos and making relevant films for these group of mothers will give a sense of peace and pleasure during labor as well as a courage to restart a better future.

• An appropriate insurance and social-work services play an important role in social and individual satisfaction so that medical staffs can concentrate on their professional duties confidentially otherwise, without a personal and occupational peace of mind the activities won’t be mother centered and patient centered.

• To level out the income of nursing and midwifery personnel worldwide. Generally, medium rate of expenses in the country should be determined by the authorities such as the Ministry of Labor Insurance, department of tax and finance in order to provide linear net income equality in any position while fair payments of hardship allowance and other bonuses will encourage staffs to work hard and to progress in different professions.

In some countries, there is a paradox due to human resources such a way that the number of unemployed midwives is high while at the same time, the rate of shortage for midwives is high too! This problem can be solved by providing welfare facilities according to the staffs ’ position and a qualified distance education for their children in remote regions. The other paradox is professionals’ tendency to migrate abroad despite the lack of human source of the same proficiency!

Normally, the attractive countries for immigration are those where are well known for having reasonable civil rights and social services along with minimal class distinctions because of regulated and balanced proportion of taxes and the final income of individuals.

• Undoubtedly, structural improvement in a society will not take place easily in a short period of time, unless the policymakers, investors and the people align in efforts to make fundamental changes in society. Establishing a modern leadership to build up honesty, sense of social responsibility sense of being open to criticism problem solving skills in professional challenges eradicating pathological behaviors such as band creation (mafia) and flattery promoting the level of body and mental health of personnel as well as internal motivation for the use of skills and team working will happen if a committee consists of noble experts of various sciences, compassionate managers, executives, precise supervisors formulate the law of justice in the entire society to follow it strictly by themselves as the national models as well as people. Then, the documented results of all activities should be reported honestly and clearly.

The noted concepts should be constantly transmitted to the social life through training courses and counseling sessions, content based educational-recreational activities to practice team working skills, retraining efficient communication skills in various professions can be very effective.

I would like to share one of my slogans which became a rule in my family. “We buy goods and consume as much as we need.” Of course, demands are assessed and prioritized with consensus to be considered neither extravagance nor deprivation.

Frankly speaking, the definition of a need in a corner of the common home the planet Earth is dramatically equal with the definition of the extravagance in another.

Many people orally but rarely in practice believe that if wealth and facilities are accumulated along with consumerism increase in one corner, the same resources will dwindle in another, it has been reported for years that governmental and nongovernmental organizations are trying to create justice.

So, why problems are not really solved and eradicated? If some people would not arrange problems for others, solving would be easy.

This is where fair financial management comes into play the role to work on equilibrium to help other organizations such as health providers to restore the physical and mental health of mankind who live on the common planet influencing each other. Just recently all were proved practically by Corona virus.

What is your idea and solutions? Let's truly intervene to relieve the pain of women, men, children, and our common mother the beautiful EARTH!

References

1. Nicopoullus JDM. Midwifery is not a fit occupation for a gentlemen. J Obstet Gynaecol. 2003;23(6):589-593.
2. Casssidy T. Birth: The Surprising History of How We Are Born. New York, N.Y.: Atlantic Monthly Press; 2006:131-137.
3. Schuilling KD, Sipe TA, Fullerton J. Findings from the analysis of the American College of Nurse-Midwives’ membership surveys: 2000-2003. J Midwifery Womens Health. 2005;50(1):8-15.
4. Kennedy HP, Erickson-Owens D, Davis JAP. Voices of diversity in midwifery: a qualitative research study. J Midwifery Womens Health. 2006;51(2):85-90.