Seminar on theories ,

models and approaches

applied to midwifery
practice.
Presented by:
Parneet kaur
 Theories for midwifery practices
INTRODUCTION
The term theory is used in many ways. For
example nursing teachers and students use the
term theory to refer to the content covered in
class room , as opposed to the actual practice of
performing nursing activities.
• Sometimes the term theory is used to refer to
someone's ideas as in my theory is not to tell
lie or not to bluff any body. Whatever the uses
the term theory almost always connoted an
abstraction or generalization.
Definition:
• Theory is an imaginative grouping of
knowledge, ideas, and experience that are
represented symbolically and seek to
illuminate given phenomenon.(Watson , 1985)
Purposes of theory:
• To make scientific finding meaningful and
generalizable.
• To knit together observations and facts into
orderly system.
• For drawing together and summarizing
accumulated facts from separate and isolated
investigations.
• Method of classifying and organizing data in a
logical and meaningful manner.
Importance of theories in nursing
• Aims to describe, predict and explain the
phenomenon of nursing.
• Provide the foundations of nursing practice,
help to generate further knowledge and
indicate in which direction nursing should
develop in the future.
• It helps us to decide what we know and what
we need to know.
• The benefits of having a defined body of
theory in nursing include better patient care,
enhanced professional status for nurses,
improved communication between nurses,
and guidance for research and education
• The main exponent of nursing caring cannot
be measured, it is vital to have the theory to
analyze and explain what nurses do.
 Birth Territory: A theory for
midwifery practices
Birth Territory is the central, overarching
concept of the theory. In particular, Birth
Territory refers to the features of the birth room,
called the ‘terrain’, and the use of power within
the room, called ‘jurisdiction’
TERRAIN
‘Terrain’ is a major sub-concept of Birth
Territory. It denotes the physical features and
geographical area of the individual birth space.
 Two sub-concepts, ‘surveillance room’ and
‘sanctum’, lie at opposite ends along this
continuum called ‘terrain’.
SANCTUM
• ‘Sanctum’ is defined as a homely environment
designed to optimize the privacy, ease and
comfort of the women.
SURVEILLANCE ROOM
• It denotes a clinical environment designed to
facilitate surveillance of the woman and to
optimize the ease and comfort of the staff.
clinical-looking room where equipment the staff
may need is on display and the bed dominates.
It has a doorway but no closed door, or the door
has a viewing window.
JURISDICTION
• ‘Jurisdiction’ means having the power to do as
one wants within the birth environment.
‘Power’ is an energy which enables one to be
able to do or obtain what one wants.
 ‘JURISDICTION’ IS COMPRISED OF
FOUR SUB-CONCEPTS
• INTEGRATIVE POWER
• DISINTEGRATIVE POWER
• MIDWIFERY GUARDIANSHIP
• MIDWIFERY DOMINATION
There is one continuum of ‘integrative power’
and ‘disintegrative power’ and another
continuum of ‘midwifery guardianship’ and
‘midwifery domination’
 Integrative power
• Integrates all forms of power within the
environment.
• For Birth Territory,‘integrative power’ may
refer to the use of power by the woman, the
midwife and any other person in the
environment.
• The primary aim of using ‘integrative power’ is
to support integration of the woman’s mind
and body so that she feels able to respond
spontaneously and expressively to her bodily
sensations and intuitions.
 MIDWIFERY GUARDIANSHIP
• Midwifery Guardianship’ is a form of
‘integrative power’ that involves guarding the
woman and her Birth Territory; this entails
nurturing the woman’s sense of safety
through the respect of her attitudes, values
and beliefs.
• Midwifery guardianship’means controlling
who crosses the boundaries of the birth space
and preventing, as far as possible, any person
within the Birth Territory from using
‘disintegrative power’.
DISINTEGRATIVE POWER
• ‘Disintegrative power’ is an ego-centred
power that disintegrates other forms of power
within the environment and imposes the
user’s self-serving goal. ‘Disintegrative power’
may be used by the woman, the midwife
and/or any other person in the territory.
• When it is used by the woman it is an ego-
based determination to have a particular
experience or outcome.
• ‘Disintegrative power’,when used by
professionals, undermines the woman as the
decision-maker in her own care
MIDWIFERY DOMINATION
• ‘Midwifery Domination’ is a form of
‘disintegrative power’ that is based on the use
of disciplinary power.
• ‘Midwifery domination’ is disturbing because
it interferes with the woman’s laboring
process by inducing the woman to become
 Conclusion

• The central proposition of the theory of Birth

Territory is that when midwives create and
maintain ideal environmental conditions
maximum support is provided to the woman
and fetus in labour and birth which results in
an increased likelihood that the woman will
give birth under her own power, be more
satisfied with the experience and adapt with
ease in the post-birth period.
 A THEORY OF MENSTRUAL CARE
ACTIVITIES OF DAILY LIVING
INTRODUCTION:
• It is a Making Sure: Integrating menstrual care
practices into activities of daily living (1985).
This is derived from a grounded theory study
to inductively develop a substantive theory
about integrating menstrual care practices
into daily activities.
CONCEPT:
• Making sure, the core concept of the theory, is
defined as the process that enables
menstruating women to continue their daily
activities, knowing that their practices of
menstrual care are effective and that the
menstrual care demand can be met efficiently
and effectively.
• Accidents are errors in making sure.
• Day of flow is a condition affecting making
sure. Backup mechanisms are the strategies
used to enhance making sure. Public and
private are the contexts affecting making sure.
 Sub processes of making sure
• Attending
• Calculating
• Juggling
The concepts of the theory are analogous to the
concepts of Orem's general theory of self-care
(1980).
 Menstrual
care

Calculating Attending

Juggling
 Purpose
• To provide insight into nursing care that can
enhance a woman's self-care ability,
particularly in the early experience with
menstruation.
• Implications for education related to self-care
activities, particularly with anticipating
menarche and in preventing toxic shock
syndrome.
 A THEORY OF PERIMENOPAUSAL
PROCESS
• It refers to a theoretical model of the
perimenopasual process, (1991).
• This is a qualitative study to generate theory
related to women's experience of
perimenopausal processes.
• The core variable of integrating a “changing
me” was the central concept.
 SUB PROCESSES

TUNING IN TO
ME

INTEGRA FACING A
MAKING TING A
ADJUSTMEN “CHANGI
PARADOX OF
TS NG ME” FEELING

CONTRASTING
IMPRESSIONS
• Twelve women who were not on hormone
therapy and who had varied backgrounds of
marital status, education, and parity
participated in the study. Women were
interviewed and kept daily logs for 2 months
 The Philosophy and Model of
Midwifery Care
BACKGROUND
• A midwife is a person who, having been
regularly admitted to a midwifery educational
programme, duly recognised in the country in
which it is located, has successfully completed
the prescribed course of studies in midwifery
and has acquired the requisite qualifications
to be registered and /or legally licensed to
practise midwifery.
STATEMENT OF BELIEF
• As midwives we believe that
• Childbearing is a profound experience, which
carries significant meaning to the woman, her
family and the community.
• Birth is a normal physiological process.
• Midwives are the most appropriate care
providers to attend women during pregnancy,
labour, birth and the postnatal period.
• Midwifery care empowers women to assume
responsibility for their health and for the
health of their families.
• Midwifery care takes place in partnership
with women and is personalised, continuous
and non-authoritarian.
• Midwifery care combines art and science.
Midwifery care is holistic in nature, grounded
in an understanding of the social, emotional,
cultural, spiritual, psychological and physical
experiences of women and based upon the
best available evidence.
• Midwives have confidence and trust in, and
respect for women and their capabilities in
childbirth.
• The woman is the primary decision-maker in
her care and she has the right to information
that enhances her decision-making abilities.
As a result:
• 1. Midwifery care promotes, protects and
supports women's reproductive rights and
respects ethnic and cultural diversity.
• 2. Midwifery practice promotes and advocates
for non-intervention in normal childbirth.
• 3. Midwifery practice builds women's self
confidence in handling childbirth.
• 4. Midwives use technology appropriately and
effect referral in a timely manner when
problems arise.
• 5. Midwives offer anticipatory and flexible
Health Promotion Models in
Midwifery
 Introduction
• Midwives should adopt a higher role in
promoting health to the women and the
families that they care for.(Roch & Downie1993).

• Traditionally, preventative methods such as

health education and screening have been
considered the most appropriate ways of
improving health in midwifery practice.
• We need to work out for ourselves, which aim
and which activities we use according to our
profession code of conduct and our own
considered needs and assessment.

(Ewles & Simnet 1985)

• Ewles & Simnet, in 1985, developed a frame
work of five approaches in midwifery.

• It allows the midwife to clarify their aims and

values when using them.
 Domains of Health Promotion.

Three areas were identified:

• Health education
• Health prevention
• Health protection
 Health
protection

Health Health
prevention education
 Health Education

• Is defined as all influences that determine

knowledge, belief and behaviour related to
promotion, maintenance and restoration of
health.
• E.g “stop smoking” campaigns,
• breast feeding workshops,
• Improving living and working conditions for
pregnant women.
 Health Prevention

• Encompasses avoiding or reducing the risk of

different forms of disease, accidents and other
forms of ill-health.
 HEALTH PREVENTION

Sexual health Child vaccination Folic acid

contraception Breast & cervical cancer

 Health protection

• Incorporates the environmental aspects

safeguarding health by political legislative and
social control.
• It includes both individual and community
actions in attempting to make environment
hazards free.
• It excludes curative medicine.
• E.g. systematic antenatal care, employment
law for pregnant women.
Health Promotion Approaches
 1- The Medical Approach

• The aim:
• Freedom from medically defined disease,
illness and disability.
• Involves active medical participation to
prevent or improve ill-health.
• Physical well-being is the marker.
• Minimal or no reference to psychological, ,
social or economical aspects of the cause and
effect of disease.
• It values medical preventive procedures.
• There has been much debate in recent years
on the role and place of medical approach in
normal child birth.

• It is now rejected by midwives and the

government as un suitable for women.
 2- The Behaviour Change Approach

• The midwife attempts to change the individual

attitude and behaviours of a woman.
• The midwife encourages the woman to adopt
a healthier life style, e.g. eating the right
foods, and stopping smoking.
 3- The Educational Approach

The aim:
• It is educationalist.
• The midwife will give the facts and
information, with a few personal values.
• The recipient of this information is trusted to
use it in whatever way she chooses.
• The educational issue is to raise issues.
it is a two-directional approach:

The midwife will provide information

The woman will ask for information

 4- The client-centered approach

• “A bottom-up” rather than “a top-down

approach”.
• Here the woman her self decides what the
issues are and sets the agenda.
• The woman is seen as equal and the
knowledge and skills that she brings to the
interaction are valued.
• Some aspects of antenatal are amenable to
this approach,
• While BP readings and other physical
observations are important, their
interpretation will demand the expertise of
the midwife.
 5- The Social Change Approach

• Doesn’t directly concern the individual.

• Society is seen central to health in that
changes need to be made on social and
environmental fronts.
• Making the healthier option easier to achieve
for most of the population.
• E.g. banning smoking in public areas.
 Using models in midwifery
• Crafter 1997 took Smoking cessation as an example
of how these models and approaches can be applied.
• She used as an example the midwives of Newplace
Hospital who note high cigarette smoking rate
among pregnant women.
• They wish to make a plan to reduce these rates, and
tackle the related problems of longer term ill health
and prematurity in the babies
 Evidence

• In a study conducted to describe the

feasibility of implementing
e-Health program into standard midwifery
care and to investigate use and user
perceptions of the online program
among pregnant women.
• Result
it seems feasible to integrate an eHealth program
into standard midwifery care.
Therefore, this eHealth program may be a feasible
communication channel to promote a healthy
lifestyle to pregnant women after suggested
revisions have been carried out.
 evidence
• In a systemic review to assess the effects of
antenatal, intrapartum and postpartum care
by midwives (intervention) vs. usual care by
multiple caregivers,
 Results
• that midwifery training programs:
• reduce intrapartum complications
• reduction in stillbirth incidence.
• Improvements in practical obstetric skills
• manage low-risk births
• reducing rates of perinatal mortality.
 Bibliography

• www.sciencedirect.com
• www.internationalmidwives.org
• www.hsag.com
• Basavanthapa BT,Nursing theories,1st
edition,2007,Jaypee publisher, PG No. 389 to
95.