With woman – midwives at the heart of maternity care

The relationship between a midwife and the woman she’s caring for is central to maternity care. Midwife actually means ‘with woman’.

Where changes have been made across different countries to ‘improve maternity care’, it’s often been the birth environment or the overall model of care that have been the focal point of change. But what we need to really focus on are the relationships between the woman and care providers, particularly the midwife. Ignoring the integral nature of the actual relationship between midwife and woman comes at a cost.

The midwife-woman relationship is key

The relationship between midwives and the women they care for affects women’s birth experiences in countless ways – a good midwife-woman relationship can create a positive experience from even the most challenging birth, while a negative one can leave scars that last for decades.

The midwife-woman relationship is unique. Not quite a friendship, but closer than the usual health professional to patient relationships, a midwife’s care spans physical, emotional and social realms and brings her in close contact with the most private aspects of a woman’s life. A midwife works in partnership with the woman – each bringing expertise into the relationship toward a common goal. This is a relationship that thrives on reciprocity – the give and take inherent in any good relationship.

Traditionally, midwives were part of a woman’s life and community. She understood the woman’s circumstances and could appreciate the context in which she lived. In the current fragmented care system, the midwife-woman relationship may be one that’s established in the context of a 20-minute hospital check up, or starts when the woman is already in active labour.

Challenges: what happens without relationships

By nature, any health care provider is in a position of power in any relationship with the person requiring the service: she or he has more experience and knowledge about pregnancy and birth in general, and is often seen as the ‘expert’. Because of these power dynamics, it’s easy for a woman to accept what a health care professional tells her without question. When a relationship is based on a shared history of trust and mutual respect, that acceptance can allow a woman to relax and surrender in her labour, knowing she’s being cared for by someone who knows her deepest wishes and desires in birth. Without that established relationship, though, it’s easy for women to feel an imbalance of power and that she needs to acquiesce to the demands or needs of the health service or care provider (as we saw last week in Janet’s story) rather than what is right for her unique situation.

On the other hand, sometimes the relationship is challenged in the opposite direction – because of past experiences, or what’s she’s heard about the health system, a woman may have little trust in her midwife and be resistant to the advice and care offered. Many midwives are dealing with the phenomenon of ‘google experts’ – women who have read countless articles and blogs – of variable quality. Women may feel skeptical of wholesale acceptance of a care provider’s suggestion when it’s someone she’s never met before and who knows little about her situation.

Good for women, good for midwives

At the core of all of these challenges is a breakdown in relationship. Relationships take time to build, but without them the heart of the midwife-woman connection is lost. There are amazing midwives all over the world supporting women they’ve never met before through their labour and birth, or helping them triumph through breastfeeding challenges. These midwives have a special skill in developing a rapport – a relationship – with those they’re caring for. To the women in their care, it makes a world of difference. But to keep caring, day in day out, in a system where you may never see that woman again (as we saw in Week 1) is just hard. We’re wired to be social creatures, not isolated or separate.

As the fragmented care system has been so detrimental to women, so too is it hurting midwives. The research is clear that midwives working in continuity of care models where they create relationships with a woman – especially with self-determined schedules and supportive backup arrangements – are more satisfied and less prone to burnout than midwives who work in a fragmented system (Dixon et al, 2017).

Intuitively, this makes sense. When a midwife journeys with a woman and her family through pregnancy, birth, and the early weeks of parenting, there is an inherent satisfaction and desire for that woman to have the birth she wants, to support her through her parenting challenges. It’s just easier to care when it’s someone you know, someone you’ve built up a relationship with. Because that’s at the centre of maternity care: the relationship between midwife and woman.

Over to you

What do you see as the heart of the midwife-woman relationship? Can it be achieved during the space of one prenatal visit? A birth?

What do you see as the conditions necessary for an ideal midwife-woman relationship? Share your ideas in the comments, and see if your suggestions match the kinds of things other people have thought of.

References

1. Dixon, L., Guilliland, K., Pallant, J., Sidebotham, M., Fenwick, J., McAra-Couper, J. & Gilkison, A. (2017) The emotional wellbeing of New Zealand midwives: Comparing responses for midwives in caseloading and shift work settings. New Zealand College of Midwives Journal, 53, 5-14.
2. Jepsen, I., Juul, S., Foureur, M., Sorensen, E., & Nohr, E. (2017). Is caseload midwifery a healthy work-form? – A survey of burnout among midwives in Denmark. Sexual & Reproductive Healthcare, 11, 102-106. doi:10.1016/j.srhc.2016.12.001