Midwifery Care Models and Cultural Safety

The provided text discusses different midwifery care models, focusing on caseload midwifery and its benefits in increasing women's satisfaction with antenatal, intrapartum, and postpartum care. It also highlights the importance of cultural safety in maternity care for Aboriginal women and culturally and linguistically diverse women in Queensland. The text references several studies and articles that emphasize the significance of midwives as primary care providers for women and the need for continuity of care models to improve maternal and newborn health outcomes.

Running head: ESSAY IN MIDWIFERY
ESSAY IN MIDWIFERY
Name of the Student
Name of the university
Author’s note

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Midwifery
Midwives are specialized health care professionals that are responsible for providing
health care services to women including gynecological assessment, prescriptions, counseling
regarding the contraceptives and take care of the labor and the delivery of the baby (King et al.,
2015). They are the one who are responsible for providing rich quality of antenatal and post natal
care for maximizing the health of woman at the time of pregnancy (Phillippi & Barger, 2015).
The leading role of the midwives actually lessens the rate of the hospital admissions and thus
fewer interventions at the time of birth. Midwives believe in developing therapeutic relationship
of trust with the patient and the family members (Phillippi & Barger, 2015). They provide a
cultural safe care to the women irrespective of their cast and creed (King et al., 2015). Midwives
often encompass the role of a family planner and helps out a couple to take important decisions.
The culture and the practice of midwifery had been there in the world for centuries yet the role
has evolved differently as per the regional cultures, their needs and the increased knowledge of
the midwives.
This essay aims to describe the roles of the midwives in providing Primary and
community based care to the neonates and the women. The paper will also focus on the
midwifery philosophy of care and how do they contribute to the maternal and the neonatal
health.
Midwifery care is based on certain philosophies. There are two key school of thoughts on
childbirth are followed. One is the physio-social midwifery and another is the medico-technical
approach. As per the medico-technical approach, birthing is viewed as a risky procedure

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requiring medical interventions, whereas the physio-social midwifery concept views childbirth as
a social and a normal event (Berg et al., 2012).
The continuity care of the midwives is associated with the advantages for the mother and
the neonates. This involves the reduction of the epidural anesthesia, episiotomies and the
instrumental births, increased vaginal births other than caesarian baby, breastfeeding. There are
certain philosophies of midwifery care by ICM, such as pregnancy is a normal physiological
process yet a special one for every mother ("ICM - Ethics and Philosophy for Midwives", 2018).
As described by the philosophy of the midwifery care, they are the one that promote
supports and protects reproductive and the sexual health status of a woman, keeping in mind her
ethnic and the cultural diversity. Midwifery care helps to provide holistic, social, emotional,
spiritual, cultural and psychological care to women. They are the one to build the self confidence
of a woman by helping them to cope up with childbirth ("ICM - Ethics and Philosophy for
Midwives", 2018).
Before 1990s, the scope of the midwifery care was mainly centered on reproductive or
sexual health, but there are several studies that have emphasized on the fact that the midwives
wanted to expand the core competencies. Recent studies have provided evidences that the
midwives were actually providing care by reaching beyond the reproductive and sexual health.
There are studies that have demonstrated the fact that Primary care is the first level of care
provided of the individuals, family and the community to the health care system. (Lassi et al.,
2014). The advanced core competencies of the midwives were that the accredited midwifery
programs should give independent management of the menopause, peri-menopause and primary
health care screening (Lassi et al., 2014). The new midwives should also be prepared to manage

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the common problems of the triage and manage them independently. The midwifery practice has
expanded its horizon including the management of the infections and chronic conditions
(Phillippi & Barger, 2015). The certified midwives should be able to use collaboration,
consultation and referral to the other health care providers. Midwives should be competent
enough to perform the gynecological testing such as pap smears, pelvic exams, diagnosis and
education regarding the STD, helping in managing the chronic diseases (Phillippi & Barger,
2015).
The community midwives provide the antenatal and the postnatal care to the mothers
who choose home birth. With the increase in the birth rate, especially in the rural areas, the
increasing high risk maternal population and the propensity of getting discharged from the
hospital have increased the workload of the community. Midwives are the pioneers of
community health as they discuss wider health issue with the patient or the family (Sandall et al.,
2013).
Care can be providing to mothers by using both a mid wife led continuity model of care
or the care taken in midwife settings. The difference between the two is that a continuity of care
that is led by a midwife who follows a woman throughout her pregnancy, birth and the post natal
period. A midwife led care can be provided in a midwife led settings like home or self-
supporting alongside the hospitals with low clinical risks. The main philosophy of the midwife
led continuity of care is that it emphasize on the capability of the woman to give birth in natural
interventions with minimal interventions (Hartz et al., 2013). The continuity of care led by a
midwife is generally provided in a network of multidisciplinary teams with referrals and
consultations with the other health care providers (Beake et al., 2013).

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Continuity of care provided by a primary midwife during antenatal, intrapartum and
postpartum period has been suggested by the doctors. Many of the clinical settings have
introduced a caseload midwifery model of care for the pregnant woman (Beake et al., 2013). The
case load midwifery care have been compared with a primary standard care in a randomized
control study and it was found that the women allocated to the case load midwifery are less
likely to have caesarean birth, analgesia during the delivery and epistomy (Forster et al.,2016).
The studies have showed an elevated level of patient satisfaction. The continuity of care
is essential for the mothers, whether it is considering the same clinician at each visit or involving
the same team of midwives. Forster et al.,(2016), have argued, that apart from the physical care
provider, there are other factors like faith and reliable advice that appears to be more important
for a woman. Women receiving the midwife led continuity of care were 9 times more likely to be
attended by a particular midwife. Women receiving midwife led continuity care have reported
higher levels of maternal satisfaction regarding advice, information, explanation and the venue of
the delivery, choice of the painkillers and the behavior of the midwives. Jones et al., (2014),
have suggested that the women carrying social complexity, who cannot reach out to all the
services, particularly the value midwifery continuity models of care, have also found to receive
empathic care from the midwives. This kind of an act is in compliance to the ICM model of the
midwifery care, which states that midwives should be able to provide an anticipatory, respectful
and flexible care encompassing the requirements of a woman, family and the society. According
to the ICM models of midwives a midwife should be able to empower women to take care of
herself and her families ("ICM - Ethics and Philosophy for Midwives", 2018).
According to Jones et al., (2014), the birth in atmosphere should be something that
radiates a feeling of trust and safety, that is provided by the midwives. It is the midwives that

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give feeling of being at the home. In a woman centered care it is necessary that the knowledge of
the mid wife is embodied and is grounded within her. As stated by the author Alden et al.,
(2013), a midwife's duty is to radiate the confidence in women regarding the women’s capability
to give birth. In order to give care that is women centered, a midwife has to perform a balancing
act that describes that one needs to create a reciprocal relationship to provide the patient centered
care. A midwife should be in partnership with the woman in a personalized and a non-
authoritarian way for assuring a safe childbirth (Mander & Miller, 2016).
A study has been considered for assessing the perception of the midwives towards the
caring of those pregnant women having cognitive problems (Jones et al., 2013). The study has
reflected the fact that there are perceptions that hinder the emotional care to the mothers with
mental disabilities. The study has been done by conducting interviews and as per the versions of
the midwives all of them share the attitudes of sympathy and love towards the patients. The
limitation of the study is that the congruency between their answers and their actual behavior
cannot be understood. Hence it was difficult to assess the authenticity of their attitudes.
Midwives are responsible for providing a culturally safe care to the culturally diverse
background of people (Brown et al., 2015). The maternal and the infant health of the aboriginal
population are always worse than the non aboriginal counterparts in Australia (Josif et al., 2014).
The aboriginal pregnant women had been receiving less antenatal care, low birth weight infants
and are most likely to develop preterm babies. The midwifery group practices (MGP) provide
group of midwives for providing ante, intra and postpartum care to the patients. As per the study
conducted involving the aboriginal women, lack of community carer was described as the sole
problem followed by isolation in hospitals (Brown et al., 2015). This emphasizes on the

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importance of one-on- one care to the aboriginal pregnant women. After the establishment of the
MGP the remote dwelling aboriginals could actually access the birth centre.
Motherhood and the period following the delivery of the baby are very special to a
mother yet the period is associated with several complications. Midwives are the healthcare
professionals that provide a continuity of safe care to the pregnant women. Women receiving
continuity care has had better experiences and good clinical outcomes. Midwife led models of
care as a part of the multidisciplinary model of care can provide care to the women with serious
obstetric and medical complications.

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References
Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Perry, S. E. (2013). Maternity and women's
health care-E-book. Elsevier Health Sciences.
Beake, S., Acosta, L., Cooke, P., & McCourt, C. (2013). Caseload midwifery in a multi-ethnic
community: the women's experiences. Midwifery, 29(8), 996-1002.
Berg, M., Ólafsdóttir, Ó. A., & Lundgren, I. (2012). A midwifery model of woman-centred
childbirth care–in Swedish and Icelandic settings. Sexual & Reproductive Healthcare,
3(2), 79-87.
Brown, A. E., Middleton, P. F., Fereday, J. A., & Pincombe, J. I. (2016). Cultural safety and
midwifery care for Aboriginal women–A phenomenological study. Women and Birth,
29(2), 196-202.
Forster, D. A., McLachlan, H. L., Davey, M.-A., Biro, M. A., Farrell, T., Gold, L., …
Waldenström, U. (2016). Continuity of care by a primary midwife (caseload midwifery)
increases women’s satisfaction with antenatal, intrapartum and postpartum care: results
from the COSMOS randomised controlled trial. BMC Pregnancy and Childbirth, 16, 28.
http://doi.org/10.1186/s12884-016-0798-y
Hartz, D. L., Foureur, M., & Tracy, S. K. (2012). Australian caseload midwifery: the exception
or the rule. Women and Birth, 25(1), 39-46.

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ICM - Ethics and Philosophy for Midwives. (2018). Internationalmidwives.org. Retrieved 14
March 2018, from
http://internationalmidwives.org/who-we-are/policy-and-practice/code-of-ethics-
philosophy-model-midwifery-care/
Jones, C. J., Creedy, D. K., & Gamble, J. A. (2012). Australian midwives' attitudes towards care
for women with emotional distress. Midwifery, 28(2), 216-221.
Josif, C. M., Barclay, L., Kruske, S., & Kildea, S. (2014). ‘No more strangers’: investigating the
experiences of women, midwives and others during the establishment of a new model of
maternity care for remote dwelling aboriginal women in northern Australia. Midwifery,
30(3), 317-323.
King, T. L., Brucker, M. C., Fahey, J., Kriebs, J. M., & Gegor, C. L. (Eds.). (2015). Varney's
midwifery (p. 3). Burlington, MA: Jones & Bartlett Learning.
Lassi, Z. S., Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Evidence from community level
inputs to improve quality of care for maternal and newborn health: interventions and
findings. Reproductive health, 11(2), S2.
Mander, S., & Miller, Y. D. (2016). Perceived safety, quality and cultural competency of
maternity care for culturally and linguistically diverse women in Queensland. Journal of
racial and ethnic health disparities, 3(1), 83-98.
Phillippi, J. C., & Barger, M. K. (2015). Midwives as primary care providers for women. Journal
of Midwifery & Women’s Health, 60(3), 250-257.

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Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife‐led continuity
models versus other models of care for childbearing women. The Cochrane Library.