In 1946 the World HealthOrganisation (WHO) defined health as a ‘state of complete physical, mental andsocial wellbeing. This definition integrates the main concepts of health andidentifies that health can be viewed differently by individuals and groups(Bowden, 2006). Health and well-being are a combination of physical, social,intellect and emotional factors (Dunkley,2000).
The concept of health promotionhas emerged with the increasing realisation that our health is one of our mostvaluable personal assets. The health promotion agency (2008) describes healthpromotion as a process enabling people to exert control over the determinantsof health and thereby improve their health. Similarly, the WHO identifies thathealth promotion involves equipping people to have more power, enabling them tomake choices regarding improving their wellbeing (WHO,). Ewles andSimnett(2003) determine from this that the fundamental elements of healthpromotion are improving health, empowerment and education. Health promotion isnot an extended role of the midwife but a core competency. In its code ofprofessional conduct (2008), the Nursing and Midwifery Council (NMC) outlinesthe role of the midwife to include supporting women in caring for themselves toimprove and maintain their health. Davis (2002) points out that everyinteraction with a woman is an opportunity to improve long-term health asmidwives are trusted as authoritative figures in the delivery of healthpromotion.
The royal college of midwives ‘Vision 2000’ describes the midwife asa public health practitioner, and relevant models and approaches can enhancethe way that midwives deliver care. A health promotion approach can bedescribed as the vehicle used to achieve the desired aim (Dunkley-Bent, 2004).This essay will focus on applying Beatties (1991) model of health promotion tobreastfeeding; analyses the challenges midwives may encounter when promotingbreastfeeding and health promotion in general and evaluates the effectivenessof the midwife in promoting breastfeeding.` Theword ‘midwife’ simply means ‘with women’ (Alberta Association of Midwives2012). According to the International Confederation of Midwives Council (2005)the midwife is a conscientious and accountable trained specialist in ‘normal’pregnancy and birth. They work in ‘partnership’ with the woman, her partner andfamily to offer the vital care, support and advice required during theantenatal, intrapartum and postpartum period to independently guide the womenthrough the pregnancy and birthing process and provide care for both and the new born.
The scope of the midwifeincludes the support and encouragement of normal birth, identifyingcomplications with the pregnancy and performing emergency procedures. Midwivesplay a significant and critical role in the delivery of health counselling andeducation which should include antenatal education not only with the women butwith the family and network and wider community. Itis the midwives’ role to promote health and wellbeing to women and their babies(NMC, 2008).
Health promotion, as described by Scriven (2010), is said to be’improving, advancing, supporting, encouraging and placing health higher onpersonal and public agenda’s’. Midwives use health promotion models andapproaches to enable a common value to be made clear; allowing all team membersto work towards the same goal. As a result, effective communication betweenmidwives is more likely, and therefore the quality of health promotion given towomen is improved (Bowden 2006). Commonly, Tannahill’s model of healthpromotion, developed by Downie et al (1996), lends itself well to midwiferypractice. The model mainly focuses on health education, health protection andpreventing ill-health. These three main topics overlap; in which healthpromoting activities may fall.
Child vaccination programmes implemented by theNHS is an example of health protection overlapping with ill-health preventionthat occurs in practice (Bowden 2006).This example emphasises the positivefeature of the model; being able to carry out both objectives of improvinghealth and preventing disease (Sykes 2007). The educational approach is oftenused within this model whereby the midwife gives facts and information to thewomen who may then choose to act on the information given, or not (Bowden2006). Similarly, the behaviour change approach is commonly used in midwiferywhen encouraging women to change her attitudes or beliefs to adopt a healthierlifestyle (Bowden 2006). There are many health promotions approaches andmodels. However, no specific model is relevant to every woman. Each woman willhave individual needs and therefore requires an individual assessment inrelation to health promotion.Healthpromotion is an essential part of a midwives’ responsibility; “the nature ofhealth promotion work in midwifery is geared toward promoting the health of themother and ensuring optimum environment for mother and baby” (Dunkley,2000).
Breastfeedingcan be a controversial topic; it can bring about mixed opinions and responsesfrom mothers and midwives. The reason for the promotion regarding breastfeedingis that apart from being economically friendly, it also holds many benefits forthe baby and for the mother (Dunkley,2000). Health promotion is predominately aproactive process. It is a process that is done with people not at people,either on an individual basis or within groups, Participation and partnershipare key components of the process. Beattie’smodel is appropriate as it provides a structured framework to guide, map andcontextualise health promotion intervention related to breastfeeding (Seedhouse,2003).Beattie’s (1991) has two dimensions; “mode of intervention” and “focus of intervention”.
The “mode of intervention ranges from authoritative which is top-down andexpert-led: to negotiated, which is bottom-up and values individual’s autonomy.The “focus of intervention” ranges from a focus on the individual to a focus onthe collective. The model uses these dimensions to generate four strategies forhealth promotion – health persuasion, legislative action, personal counsellingand community development (Tonnes and Tilford, 2001).
The health persuasiontechnique utilises the medical and educational approaches to inform women ofthe research-based health benefits of breastfeeding. This intervention istop-down, directed at individual women and led by midwives as health experts(Perkins,1999). It relies on persuasive tactics to ensure compliance. Beingmedical-based, it aims to reduce mortality and is conceptualised around theabsence of disease. As midwives do not regard pregnancy and childbirth asstates of ill-health, its validity in midwifery care must be questioned (Dunkley,2000).The benefits of breastfeeding are well-documented; however, difficulties arisein making this information relevant and personal to each woman’s ‘information’.According to Condliffe (2005) midwives’ reported a lack of confidence withinmidwifery practice but Mezey and Laazenbatt (2009) said that it was due toconcerns with lack of experience on the relevant subject area and discussion.(……1).
It would appear that thechallenge for midwives is having the time and resources readily available. Positivemessages about breastfeeding should be evident in the midwives practice room (Ewlesand Simnett,2003). Literature and posters that promote breastfeeding can beprominently displayed. All magazines and literature in the waiting room can beexamined to ensure that there are no unwanted advertisements or promotions offormula. Health persuasion assumes that women make rational, consciousdecisions about how to feed in response to factual health-related information(Crater,2002). Personal attitudes will affect the woman’s decision more thananything; and changing beliefs, values and attitudes is difficult and requiresmore time, resources and dedication than most midwives have, due to over-loadof work. According to Crossland (2015) he stated that breastfeeding is costfree and other health incentives could be spent on other poor health choicesbut Whelan (2014) stated that breast feeding needed all the support it couldget so midwives could encourage it within their practice.Itis important in the midwifery profession that a Continuity Model of Care isadopted as this encourages a close professional relationship to develop betweenboth the midwife and the woman throughout the birth process.
Continuity of Careallows the midwife to provide personal care that is tailored specifically tothe woman and her family’s needs with the ability to address any furthercomplications or issues that may arise, improving both the quality of her careand her birthing experience. Continuity of Care is advantageous as it can beprovided in a wide variety of settings, both formal and informal environments,in order to set the woman at ease, making her feel more comfortable. (Pairman,et al 2010) The midwife must be aware of all relevant aspects in respect to theculture of the woman they are providing care for. A barrier that may existwithin the Midwife-Woman partnership may be age. Another observation that mayhave to be observed regarding cultural sensitivity includes ethnicity. Thisshould be permitted unless there is a clinical reason which prohibits it.(Health Care Providers Handbook, 2010).
Birth is universal to all women;however, the experience differs in many cultures as births are considered sacredevents in many countries (Robinson & Thomson2009,p142). There are dangers in the midwife being unaware of, or misunderstandinga culture, the most serious is stereotyping people, when it is assumed that aculture makes all members of the cultural group think, feel, and behave in acertain way. (Bowden and Manning 2006). The relationship between the Midwife -Woman partnership differs within our own culture as our upbringing, education,experiences, location and our general way of life impacts on us all differently.
Therole and responsibility of the midwife is to work with evidence based practice”with evidence based practice” with effective communication to provide advice,support, encouragement and education to facilitate the woman’s ability to breastfeed(Johnson and Taylor,2006). Support throughout pregnancy can have a long-lastingeffect no matter the scale the task maybe. A good example of this is the midwives’role in health promotion and in supporting women in feeding theirbabies(Crafter,1997). When a woman needs more general sources of advice andsocial support than those provided through the maternity services, midwivesstill play a key role in providing relevant information and advice andreferring her to other professionals and organisations for support.
(Cooper& Fraser 2003). If the chosen method of feeding an infant is breastfeeding,a mother should expect midwives to assist them in the latching on of the babyand in the correct way so it is not painful or uncomfortable for the mother. Woman- centred care is the overarching framework for the National CompetencyStandards for the Midwife (2006). Woman-centred care is a concept that impliesthat midwifery care, is focused on the woman’s individual, unique needs,expectations and aspirations, rather than the needs of institutions orprofessions recognises the woman’s right to self-determination in terms ofchoice, control, and continuity of care encompasses the needs of the baby, the woman’s family, significantothers and community, as identified and negotiated by the woman herself followsthe woman between institutions and the community, through all phases ofpregnancy, birth and the postnatal period is ‘holistic’ addresses the woman’ssocial emotional, physical, psychological, spiritual and cultural needs andexpectations (ANMC, 2006). By adhering to rules, standards and guidelines the midwife canensure that the care provided is of the highest standard. Midwives understandthat each woman is an individual and her needs are assessed on an individualbasis, with a non-judgmental, caring nature. Ewles and Simnett (1999) list thefollowing activities that could be seen as health promotion practices; Massmedia advertising, campaigns on health issues, patient education, self-helpgroups environmental safety measures, public policy issues, health educationabout physical health, preventative medical procedures, codes of practice onhealth issues, health enhancing facilities in local communities, workplacehealth policies and health and social education for young people in schools.
Ewles and Simnett (2003) also identify approaches to health promotion. Theseall flow from a set of aims which hope to be achieved. They emphasise that noone aim or approach to health promotion is right but that it is important forus, as health care workers to consider which is appropriate for us, andrelevant to our work. However, one of the most important factors is educatingpeople, to allow them to make informed, healthy choices according to ……….
In conclusion, the RCM Vision 2000 describes the midwife as apublic health practitioner. Midwives have always enhanced, facilitated andsupported factors, which promote physical health, psychological, social andspiritual wellbeing for the woman and her immediate family. Some of the keypoints that should be considered for the future of midwifery health promotionpractice, is that it needs to be clearly defined, ‘national and politicalrecognition of the midwife’s contribution to public health should be improvedand midwives should promote health within the socio-cultural and economiccontext of how individuals live their everyday lives’. Providing antenatal careto woman and fetus demonstrates a unique opportunity to enhance holistic healththrough advice, guidance, support and social networks where the woman can beoffered further specialised care if needed.
This assignment has discussed theconcept of health and health promotion. Beattie’s and health care model wasused to show the importance that a supportive environment is created in whichpeople can challenge ideas and question beliefs. Beattie’s model is adaptableand could be applied to many scenarios; the model shows knowledge of awarenessof adult education by provoking a deep understanding of processes and problemsolving, and therefore the quality of teaching and the learning process. Thereare many ethical issues involved in parent education. Participants need to belistened to carefully and their questions answered truthfully, which gives a positiveeffect on the woman and leads to the skills and confidence to take more controlover their health. The Midwife woman partnership is a complex relationship thatbalances on understanding and acceptance factoring in the beliefs, rituals,lifestyle, ethnic values and the risks associated of the woman or mother to be in order toachieve both a positive and empowering labour, as well as a favourable andhealthy outcome for all involved.
This understanding makes it essential forMidwives to be aware of all the cultural differences apparent and possessknowledge pertaining to the cultural expectations and lifestyles of allcultural groups. It is important for Midwives to continually undertake furthertraining and education, to maintain their professional development, as well asbroadening their existing knowledge and skills. Good health is not just thephysical wellbeing of an individual, but the social, emotional, culturalwellbeing of the whole community in which everyone is able to achieve theirfull potential as a human being thereby bringing about the total wellbeing oftheir community.