Essay in Midwifery (PDF)

Running Head: ESSAY IN MIDWIFERY
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Essay in Midwifery
11/29/2018

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The essay brings about the discussion on the aspects and impact of the intimate
partner violence in context to the childbearing woman. The components of the PHC
philosophy will also be discussed, in this analysis. Intimate partner violence (IPV), is one of
the most common issue in different sections of society, is referred to the violence against
women by their current or former spouse or the partner in the intimate relationship. Thus,
there is a greater role of the nurse midwifery in the context of prevention of illness. In
addition, the concept of advocacy and the interventions will give readers an idea towards to
prevent such issues, and introduce a change in the family planning method adopted by the
families in the rural or urban areas (Baum, White, Hopkins, Potter & Grossman, 2016). The
case study outlines about Aamira, 19 year old girl who arrived in Australia 5 years ago, and
14-weeks’ gestation has been experiencing the problem of IPV. She is the victim of intimate
partner violence, and later on faced the problem of abortion because of her husband’s
dominance. Thus, it will be discussed in detail with the impact on her wellbeing, and the
relevant rules in this context in the later part of essay.
IPV (Intimate Partner Violence), refers to the behaviour by a man or woman within an
intimate relationship, inclusive of their (current, or past marriages, domestic and family
relationship), which causes physical, sexual or psychological harm to the person involved in
the relationship. One in every three women globally, experienced violence from their current
or former partner in their relationship (Alhusen et al., 2015).
Discussing about the IPV in Australia, one in six Australian women is the victim of
physical, emotional, and sexual abuse from current or former partners (Smith et al., 2017).
Intimate partner violence harms the women’s physical, mental, emotional, and social health
and wellbeing, and is considered as one of the major cause of disability and death of the
child-bearing women. This is linked to the case Aamira child-bearing women, a child- who
experienced the issue of IPV, from her spouse Faheem. It can be characterised from the case
study, as she felt difficult to stand straight, and discomfort when she was about to be
ambulated. Thus, it has been observed that 68% of women who had their children
experienced violence in Australia from their current or previous partners, and 25% of the
adult women at child-bearing age experienced the same problem (World Health Organization,
2018).
IPV or Violence against the pregnant women is found to have serious impact not only
on the women, but also the foetus. The experience of IPV, to the pregnant women is

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associated with many negative consequences, which also includes decreased infant birth
weight, and increase in rates of prematurity. Thus, a women during the period of gestation
experiencing partner violence, has negative influence on their physical, social and
psychological wellbeing. These impacts include the abuse involving the abdominal trauma,
which further leads to the problem of premature labor, rupturing of membranes, placental
abruption, and ruptured uterus. This all leads to the preterm birth or even foetal demise. Thus,
to enlist major impacts to the physical wellness of child-bearing women, it includes injury,
physical impairment, difficulties in attachment with the child (Gunderson et al., 2018).
Injuries from IPV to the pregnant women consist of broken bones, cuts, burns, broken
teeth, haemorrhages, and persistent headaches. It has been found that the physical, sexual and
psychological violence on the pregnant women, have impact on their mental health. Women
facing IPV are found with the higher levels of depression, and other mental health problems.
Mental health issues amongst them also include suicide attempts, post-traumatic stress
disorder, anxiety disorders, poor maternal nutrition, or use of alcohol. During the period of
pregnancy, women often think of harming themselves, due to the severity of violence
experienced by their partners. IPV, also impacts the psychological wellbeing of pregnant
women, as it leads to anxiety, irritability, impact on the quality of sleep or sleep disorders.
The psychological distress to the child-bearing women due to the experience of intimate
partner violence also includes weight loss, weight gain, stomach pain, musculoskeletal
conditions, stress, cardio-vascular diseases, and several other health problems (Beydoun,
Williams, Beydoun, Eid & Zonderman, 2017).
It has been also found that long-term sexual violence and associated trauma to the
pregnant women may also increase the risk of urogenital infections and the chronic pelvic
pain, and other related health problems. Thus, women around the world, and Australia
especially are the victims and likely to feel shame, guilt, and self-blame for being abused by
their partners in their intimate relationship. Hence, the above listed physical, mental, or
psychological issues are commonly found to be the major impact of the intimate partner
violence (Hooker, Samaraweera, Agius & Taft, 2016).
PHC Components
PHC (Primary Health Care) can be defined in terms of philosophy and an approach
both, as it is a philosophy of a healthcare, following the approach of providing healthcare

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services. The approach of primary healthcare consists of the five approaches, which includes
promotive, preventive, curative, rehabilitative, and supportive. The concept of primary
healthcare aims to help people or patients build self-reliance at the individual and community
level. The other objective of this approach also includes developing a cooperative approach
for the patients, with the help health related agencies. Thus, looking at above discussion the
components of the PHC can be stated effectively and their relationship with the midwifery
care to the patients, especially child-bearing women as relevant to the given case study
(Hewitt & Cappiello, 2015).
Components of the Primary health care includes public education, proper nutrition,
clean water & sanitation, maternal & child health care, immunization, local disease control,
accessible treatment, and drug provision. The healthcare services which are aimed to be given
to the patients, under the PHC includes the use of scientifically sound and socially acceptable
methods of treatment and technology. PHC philosophy states, that health is an integral factor
and fundamental related to availability & distribution of resources.
The concept of women-centred midwifery care described as the primary care provided
to the women during the period of pregnancy, labour, and birth to both women and child in
their immediate postpartum period. Main focus of the care is to enhance the physical,
emotional, and psychological health and wellbeing of both child and mother. The two
concepts, i.e. PHC (primary health care) components and the midwifery care to the
childbearing women. Midwives provide primary health promotion services to the women’s
health throughout each cycle. In context to Australia, the leading nursing or midwifery
organisations strongly support adopting the primary health care service as the main feature of
the health policy. For an example, a midwife who is well-educated will be able to handle the
diseases as per their location. Thus, these above mentioned components state that nurses or
midwives dealing with the child-bearing patients are skilled, educated, regulated, and trusted
health professional (McKittrick & McKenzie, 2018).
In context to case study it has been analysed that the girl, experienced the issue of
violence i.e. IPV (Intimate Partner violence) as her husband dominated himself and took the
decision of aborting the baby on his own. She was unable to express her situation when asked
to, and found to be reluctant as it was also observed that Faheem answered all the questions.
Thus, a suitable model of care appropriate to this case for the child-bearing women is MLCC
(Midwife led continuity of care) model. This model is applicable to the women during

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pregnancy, in which the midwives support the women through her antenatal, intrapartum, and
postnatal continuum. The model has been recommended by WHO (World Health
Organisation), aimed to reduce the risks or complications in pregnancy and birth. A midwife
led continuity of care model is emphasized to providing several health benefits to the women
(Taft et al., 2015).
In the case of Aamira, model of ‘Safe mom, Safe baby’ is a collaborative model of
care for the women experiencing IPV. Aamira displayed the role of victim of the IPV,
therefore working at the maternity services, for the women it has been analysed that SMSB, a
nurse-led clinical program can contribute effectively in helping her recover from this
situation and improve health condition, which would make her baby secure. The program has
been implemented with the primary goal of enhancing the health and safety of the abused
girl/women through providing help towards engaging with the health care providers. First
objective included quantifying the prevalence of IPV, within the healthcare clients, and next
to increase the knowledge about the same issue. Healthcare providers in this case would help
Aamira by providing her a phone number or brochure for any domestic violence agency in
the local community. In addition, to making the availability of SMSB will help Aamira to
obtain services in the healthcare settings and community. As the members of this program
will interact the patients like Aamira at emergency departments, clinics, private offices, labor,
and delivery units. SMSB accepts the invitation to provide the education in concern to IPV.
For an example, it can be stated that tailored programs, has been formulated to the groups,
and communities in school providing services to the teens and women to improve the health
and safety of the pregnant women, affected by IPV (Intimate Partner Violence) (Schmied et
al., 2015).
Certain ethical, legal, and cultural issues exist in the midwifery practice for the cases
of termination of emergency. Some of the issues which occur in these cases involve that the
right to the life of woman and the unborn remains to lie in tension. The ethical or legal issues
for the nurses or midwives state about the Abortion act 1967, which declares an objection
clause for the doctors stating that they are not allowed to participate in the terminations , at
the same time obliges them to take part in such emergency cases (Coleman, 2017). Especially
in the cases when the life of the woman is jeopardised. One of the other legal issues include
that the midwives need to consider that the treatment must be provided to the patients
according to their choice; that means they have legal choice of their treatment (Renfrew et al.,
2014).

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Cultural issues in the midwifery practice for the childbearing woman and the unborn
child, states that the midwives in Australia must acknowledge the presence of diversity in the
Australian society. It means they must provide equal respect, dignity, and same treatment to
the woman, those who are immigrants, asylum seekers, refugees, and detainees. Thus, the
cultural differences must be considered by the health professionals, as in the case study,
Aamira who was a refugee therefore, she must be treated well irrespective of her cultural
status, and midwives must help her recover from the trauma of IPV affecting her childbearing
age, and the unborn (Kruger & McCann, 2018).
Advocacy refers to an important role of the nurses, along with the other aspects of
healthcare. As it has been analysed that nurses are the individuals who interact most with
their patients, therefore they remain crucial playing the role of patient advocates. Nurses
apply several techniques and methodology to serve their patients becoming excellent patient
advocates. It can be stated that the principles of advocacy must be considered by midwives
while treating her. However, she was abused and continued to be at risk thus, the mentors
must provide non-judgemental support, friendship, and maintain contact with her regularly at
phone (Hannon, 2017).
Advocacy aim at reducing the risk and impact of IPV to the women especially during
their pregnancy. Thus, two interventions for Aamira may include nurse-led home visitation
program, and Domestic Violence Home Visitation Program are the two interventions which
can be applied to this case. Routine screening applied in way by taking her examining the
violence will act as intervention reducing partner violence during pregnancy. Moreover, one
intervention which can help reduce the risk and overcoming from the impact of domestic
violence to the women, engaging her in the prenatal care, and implementing midwifery care
as per her needs will help most to reduce violence (Sapkota et al., 2017).
The concept of family planning is defined as the woman’s ability to decide as if and
when she became pregnant. In other words, it is the practice of controlling the number of
children one has and the gap between their births by the means of contraception or voluntary
sterilisation. In addition to the contribution of midwives providing maternity care and
attendance, certified nurses in Australia are vital as they provide counselling and family
planning services to the woman (Gomez, 2016). These services consist of prescribing for
taking oral contraceptive pills, IUD insertions, and removal, insertion and removal of the
hormone which releases birth control implants. They discuss with the patient about the health

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benefits and risks associated, and tell them about fertility awareness and barrier methods as
options for family planning (García-Moreno et al., 2015).
Discussing about the laws and regulations related to abortion it can be stated that
Abortion I Australia is largely stated by the states and territories instead of Federal
government. Allowing the act of termination of pregnancy differs as per the jurisdiction. In
context to the case of Aamira, located in the New South Wales and Norfolk Island, it is
considered as criminal offence. This is subjected to the case of CES v Superclinics Australia
Pty Ltd (1995) 38 NSWLR 47. However, it is legal as well in the circumstances when the
doctor explores any economic, social, or medical reasons which require abortion as an
essential act to be performed. In these cases, where nonconformity to abortion may put
serious danger to the life of pregnant women or her physical and mental health (Bohren et al.,
2015).
To conclude the above discussion it has been analysed that the prevalence of domestic
or intimate partner violence in Australia has been increasing over years. Women (80%) from
the age of 15 years are found to be the victim of IPV from their current or former spouse,
during their pregnancy. The report highlighted the case of a woman located in Sydney,
experiencing the issue of IPV during her childbearing age from her current partner. Thus,
midwives are crucial in such cases to implement appropriate interventions to help woman to
recover from the impact of violence. Hence, implanting interventions will help the health
professionals secure the health and wellbeing of women as well as the unborn.

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