An Introduction to the

Care of women
Jan M. KRIEBS

Midwife means with woman

Midwifery is both art and science-and above all midwifery is care for women and
their families. As discussed in the first chapter of this text, midwifery in the United
States has grown from local efforts to care for women with few resources, into a well
respected profession that offers women primary care and gynecologic services, as
well as maternity and birth care, including newborn care. These services are
provided in interdisciplinary settings because midwives rely on the skills of
gynecologists and obstetricians, nurses, social workers, and other health
professionals, just as they rely on other midwives for their respective expertise. One
key to understanding midwifery care is to recognize the interweaving of skills and
knowledge from many sources, and the willingness to work with others to achieve
the best possible health a woman.
The evidence based studies and expert opinions that underpin the science
of midwifery are the same as those from which medicine and nursing draw their
understanding of health care. In brief, most clinicians practice similarly, often based
on the preferences and experience of those who have taught them. Unfortunately,
relatively few of the expert recommendations on which clinicians rely are drawn
from high quality research.
The flawed perception that guidelines are consistently based on solid
evldence and lack bias has been acknowledged. 1 for example, the American college
of obstetricians and gynecologists has documented of obstetricians and
Gynecologists has documented that fewer than one-third of its practice bulletins are
based on good and consistent evidence. 2 further, much of pregnancy care cannot
be evaluated safely and ethically using the types of research recognized as being
most rigorous. Midwifery research continues to account for only a small percentage
of scholars are contributing knowledge in this area. Examples range from
development of Centering Pregnancy as a model of care to the research done on
delayed cord-clamping after birth.3,4 Deciphering the evidence, acknowledging the
quality of information from which recommendations are made, and recognizing
biases-both from midwives and others-are all key components of midwifery care.
Midwifery is distinguished by characteristics that define a partnership wit
women. A willingness to listen; sensitivity to cultural, sexual, and generational
issues; informed/shared decision making; the patience to be with woman all

combine with professional behaviors to describe midwifery practice. This chapter

addresses both clinical tasks and behaviors. In these pages, the goal is to identify
those core skills needed to be a midwife.
Essential skills begin with an understanding of the midwifery management
process. Developed by midwifery education programs in Mississippi and New Jersey
in the mind-1970s, 5,6 its seven steps serve as guide to the process of care at an
individual level and offer an opportunity to evaluate the effectiveness of care [Box
4-1 the midwifery management process emphasizes the midwifes responsibility as
an independent care provider and is based on the scientific process. The overlap
with the common flow of an individual health care visit is obvious ; this process
Box 4-1 The Midwifery Management Process
1. Investigate by obtaining all necessary data for complete evaluation of the
woman or newborn.
2. Make an accurate identification of problems or diagnoses and healthcare
needs based on correct interpretation of the data.
3. Anticipate other potential problems or diagnoses that might be expected
because of the identified problems or diagnoses.
4. Evaluate the need for immediate midwife or physician intervention and/or for
consultation or collaborative management with other healthcare team
members, as dictated by the condition of the woman or newborn.
5. Develop a comprehensive plan of care that is supported by explanations of
valid rationale underlying the decisions made and is based on the preceding
steps.
6. Assume responsibility for the efficient and safe implementation of the plan of
care.
7. Evaluate the effectiveness of the care given, recycling appropriately through
the management process for any aspect of care that has been ineffective.
Also recognizes that most care is provided not in discrete sessions but rather
over time, and that continuity over time is essential to improve quality of
care.