Midwifery and medical models: do they have to be opposites?
01 Mar 2010-The practising midwife (Pract Midwife)-Vol. 13, Iss: 3, pp 14
About: This article is published in The practising midwife.The article was published on 2010-03-01 and is currently open access. It has received 3 citations till now.
01 Mar 2013
TL;DR: It is only a matter of time before the legal eagles call for the data generated through the social media communication network to be available for medico-legal cases, according to midwives and doctors.
Abstract: My granddaughter is 20 months old and I am amazed at herability to press the precise buttons on the iPhone to answerit. Of course, her language skills are crude, but the garbledwords are definitely aimed at the picture of her father ormother that appears with the ringtone. Why am I writingabout this in an editorial to my midwifery colleagues? Weneed to gear ourselves up and be ready to support the digitalnatives coming into our maternity services today and, moreimportantly, tomorrow. The new mothers preparing forbirth are from a unique generation of technologically savvycitizens – ‘generation z’, born after 1995 and referred to as‘digital natives’ (Howe and Strauss, 2000).Technology permeates every aspect of modern life for thez generation and as soon as the pregnancy is confirmed,tweets herald the announcement to the global e-community.Pictures of the 3D scan posted on Facebook follow.During pregnancy, mothers-to-be download apps forexercise monitoring and preparation for labour and birth.When labour begins, or if a caesarean birth is planned, thedate and time are posted on the network(s) and, duringlabour, tweets, emails and texts keep everyone informed.When the midwife or doctor pronounces a statementof progress on the labour, this becomes a social mediacommunication for global access.Midwives and doctors need to be conscious of this asnot only is there an opportunity for these conversations tobe recorded on smartphones, they can be tweeted, textedor emailed immediately to the eagerly-awaiting family andfollowers. As midwives, it is vital for us to be conscious ofthe layers of technology now surrounding every aspect ofour work and the social media technology that is there, butalmost invisible. I would predict it is only a matter of timebefore the legal eagles call for the data generated throughthe social media communication network to be availablefor medico-legal cases.Almost 30 years ago, I can remember the very firstbirthing video request by a doctor when I was assisting hiswife, who was in labour with their first child. This eventwas indeed novel and it was the talk of the tea room formany days. Professional opinion was polarised into twocamps: those who felt it was perfectly acceptable, and thosewho thought it was totally unacceptable; an intrusion intothe private world of the birthing space. I was not asked toconsent to being part of their everlasting memory of theevent and was never privy to viewing the footage.Today, I have the rights, and we have ethical andgovernance procedures, to ensure that consent is takenfor every person caught on camera. However, less obvioustechnologies are a natural part of everyday life and we seehow much mobile phone footage is used when disasters occurand people instantly switch on the camera that now comesas standard on nearly all mobile phones. Speed cameras,surveillance cameras and now birthing room cameras.Mobile phones are being increasingly used to access theinternet, and recent data from Fox and Duggan (2012)reports 85% of adults in the US own a mobile phone, morethan half of which are smartphones. Furthermore, 52% havesearched for health-related information online and one infive smartphone owners have downloaded health apps. Ourprevious research (Lagan et al, 2011) provided importantevidence to support perceptions of increased use of theinternet for seeking health information by pregnant women.Data from the UK Office for National Statistics (2011) showthat 46% of female internet users and 38% of males had usedthe internet in the three months prior to the survey in searchof online health information. While global data indicate thatalmost a quarter of all females who have been online havesearched for health information (Fox, 2011).The acceptability of social media has had an enormousimpact on our behaviour and you can switch on thetelevision to observe this in action as you watch mothersand midwives showcase birth to the global audience. Themodern woman does not seem to have any inhibitions aboutcameras recording her birth, as evidenced by the increasingnumber of programmes following birthing journeys.The mobile is switched on in our birthing worlds,regardless of whether the birth is taking place in the home,midwife-led unit, obstetric labour ward or theatre. Weneed to be ready for this becoming the ‘social norm andthe professional status quo’ and we need to train our newmidwives and doctors to expect ‘big brother to be watching’.I believe that there is mounting evidence to support theglobal acceptance of social media platforms and onlinesupport systems. As such, maybe we need to look intostrategic planning and the formation of guidelines to addressthe effective use of information communication technologiesin practice, so that we can be ready for generation z?
TL;DR: The Francis Report recognised the influence of a dysfunctional culture as a major factor in system-wide failings and their devastating consequences for patient care and the report's recommendations are set to impact all NHS institutions and influence policy for the foreseeable future.
Abstract: Organisational culture is a recognised problem in the NHS and can have significant impact, positively or negatively, on patient welfare and care. Although maternity services were not implicated, the recent Francis Report (2013) recognised the influence of a dysfunctional culture as a major factor in system-wide failings and their devastating consequences for patient care. The report's recommendations are set to impact all NHS institutions and influence policy for the foreseeable future. In a more recent and damning review of Furness Hospital's maternity service, cultural and professional failings have been brought to public attention. Morecambe Bay NHS Foundation Trust, along with the Care Quality Commission, has been indicted for a cover up of serious incidences within the maternity services, which included the deaths of 16 babies (BBC, 2013). Sadly, these cases implicate midwives and also cast a shadow over the effectiveness of statutory supervision of midwives; the latter of which has been subject to N...
TL;DR: The historic, political, social, legal and ethical aspects of medication management for midwives in the context of medicines legislation, the midwifery profession, clinical governance and existing midWifery supervision framework are explored.
Abstract: Medicines management for midwives is confusing and evidence suggests that widespread drug administration in the absence of valid prescriptions occurs in midwifery practice. This article explores the historic, political, social, legal and ethical aspects behind this in the context of medicines legislation, the midwifery profession, clinical governance and existing midwifery supervision framework. The function of the prescription is also considered. Synthesis of these concepts offers an explanation for the professional milieu in relation to the issues, demonstrating historic lack of attention. Supervisors of midwives are ideally placed to influence change in this area at a local level by promoting multi-professional team engagement and safe midwifery practice. Consideration of the national picture is needed to generate understanding and a consistent approach to medication issues, in order to improve safety and promote informed, integrated, individualised care for women.