Midwifery Case Study

Midwifery philosophy.

Being a midwife does not only defined by assisting women in childbirth. The general dictionary definition are the misconception of how people view midwives. Being a midwife means to be ‘with women’ and this leads the construction of the midwifery philosophy, Page (2006) 5 steps and Nursing and Midwifery Board of Australia (NMBA) competency standards, in order to provide the best women centred care (Australia Collage of Midwives, 2017). This essay will cover a constructive overview of what Page (2006) 5 steps of being a midwife means, it will also defined what women centred care is and emphasis on the importance it has for the woman. Understanding Page (2006) 5 steps and women centred care helped build the pathway for midwifery philosophy to correlate with NMBA competency standard in order to support midwifery practice. For

Midwifery Continutity of Care Essay

The ANMC states that midwives should promote safe and effective practice. This competency standard involves: Applying knowledge, skills and attitudes to enable woman centred care, provide or support midwifery continuity of care and manage the midwifery care of women and their babies. Midwives providing continuity of care are able to provide safe and effective practice. They know there patients well from the woman’s blood test results to the woman’s birth plan. The midwife can provide safe and effective practice because she knows the woman best. Midwifery Continuity of care is associated with a reduction in the rate of a number of interventions, without compromising safety of care (Spiby &

Questions On Professional Midwifery Portfolio Essay

Being a midwife refers to a profession where the midwife would work in partnership with the women throughout her pregnancy, labour and the postpartum period. Not only is being a midwife women-centred, however, their role also includes ensuring the partner and family members are prepared and aware of the process. Within a women’s health, the midwife should focus on health, family planning, nutrition, domestic and other health issues as the main priority is the

Unit 9: M2/D2 Values and planning in health and social care

Midwives identify high risked pregnancies and they make referrals to doctors and other medical specialists.

The Model Of Maternity Care

Within Victoria there are multiple models of maternity care available to women. An initial discussion with the woman’s treating GP during the early stages of her pregnancy is critical in her decision-making about which model of care she will choose and this key discussion is essential in allowing a woman to make the first of many informed decisions throughout her pregnancy. According to a survey conducted by Stevens et al. (2010) only 43% of women felt ‘they were not supported to maintain up-to-date knowledge on models of care, and most reported that model of care referrals were influenced by whether women had private health insurance coverage.’ Many elements of these models of care differ: from location of care, degree of caregiver continuity, rates of intervention and maternal and infant health, outcomes access to medical procedure, and philosophical orientation such as natural or medical (Stevens, Thompson, Kruske, Watson, & Miller, 2014). According to the World Health Organization (1985) and Commonwealth of Australia (2008) there is a recognition that ‘85% of pregnant women are capable of giving birth safely with minimal intervention with the remaining 15% at potential risk of medical complications’ (McIntyre & Francis, 2012).

Continuum Model Of Midwifery Education

The international Confederation of Midwives (ICM) defines the midwife as a person who has successfully completed a nationally recognized midwifery education program, is qualified for registration, and competent to practice in midwifery. As a midwifery student, I will explore the philosophies of this profession whilst working with my first continuity of care experience woman and her family. In this essay, I will examine the roles of the midwife, the scope of the practice for midwives and midwifery students, and search the value of the midwifery partnership and the importance of the woman centered care. I will also clarify the legal, professional and ethical responsibilities of the midwife in accordance with national standards and code. Analyzing

The Continuity Of Midwifery Care

In this article, the authors explored the continuity of midwifery care using the caseload approach that was established in Queensland. This was to address the development of care for women experiencing inequalities and to improve birth outcomes. The authors objective was to investigate midwife’s responsibilities within their scope of practice when applying a caseload model (Midwifery Group Practice [MGP]).

Roles And Responsibilities Of A Midwife

This report will evaluate the roles and responsibilities of a midwife. “Midwifery encompasses care of women during pregnancy, labour, and the postpartum period, as well as care of the new-born.”(WHO, 2015) This is a recent definition and clearly points out that a midwife has many roles and responsibilities. The NMC Codes of Conduct will be evaluated with specific emphasis on recent changes within healthcare. These changes took place as a result of the tragedies at Mid-Staffordshire Hospital in 2005-2009 and are the outcome of the Francis report in order to improve care given to patients.

Business of Being Born

For hundred of years, women have wrestled with their womanhood, bodies, and what it means to be a woman in our society. Being a woman comes with a wonderful and empowering responsibility--giving birth. What sets us aside from other countries is that the process and expectations of giving birth has changed in our society; coming from midwifery, as it has always been since the early times, to hospitals where it is now expected to give birth at. Midwifery was a common practice in delivering babies in

Medical Guideline Policy And Carilion Clinic Policies On A National Level

Cesarean section (C/S) births can occur in the hospital for several reasons. Some women choose to have elective C/S birth and others require C/S births out of infant or maternal safety, complications, or by necessity. This paper discusses both elective and emergency C/S deliveries and reviews both National Guideline policy and Carilion Clinic policies on C/S births. The problem statement is: in pregnant women (population), does C/S delivery following National or Carilion policies (IV: exposure vs. none-exposure) differ in terms of patient care and outcomes concerning maternal and neonatal health (DV)?

Research Critique in Midwifery

A constructive critique of the research into women’s experiences of becoming a mother after prolonged labour.

The Role of a Midwife in Maternity Care

This essay will be relating to an episode of care that was provided to a woman, her partner and their baby on day five during the postnatal period. It will examine the role of the midwife in relation to breastfeeding and how this was not achieved in the case study which is shown in the appendix. Throughout the essay it will look at the following outcomes: the role and responsibility of the midwife within current maternity care provision, the importance of sensitive midwifery, key legal and ethical dimensions of the midwife's role and key sociological and psychological agendas impacting on current maternity care.

First Antenatal Appointment In Australia

This is the beginning of the mother’s involvement with the midwife. This is an opportunity for both parties to establish a personal relationship, partnership. This is where education exchange can occur, recognition of responsibilities, options and choices are determined which are supported and discussed with the mother and her supporters. (Pairman, 2010, pg. 431-432)

What A Postnatal Abdominal Palpation Is Important For A Successful Birth Experience Essay

This essay will first describe partnership and how a midwife working in the continuity of care model develops and maintains it. Secondly, this essay will describe what a postnatal abdominal palpation is, why it is done and what the outcomes may be. It will also describe the anatomy and physiology of a uterus and involution. Lastly, a description of how the assessment is conducted and how during this partnership and cultural safety is maintained by the midwife.

Vaginal Birth After Caesarean ( Vbac )

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.

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MIDW113 – Jodie Sparke S00163149_assess2 b). Postnatal case study – Gina is a 34 year old G2 P2 woman, day 2 post caesarean section. You enter her room to find her teary and upset; she tells you she had planned on having a natural birth in a midwifery led model of care. However, she experienced an emergency caesarean section after her baby showed signs of fetal distress. Describe and discuss the role and responsibilities of the midwife in providing pre and post-operative care to a woman in Gina’s position. You are expected to demonstrate, plan and evaluate safe, holistic, woman centred evidence-based midwifery care. This paper considers a postnatal case study of Gina, a day two post-operative, 34 year old Gravida 2 Para 2 woman. She experienced an Emergency Caesarean Section (ECS) resulting from fetal distress. This essay will investigate why birth can become an emergency and the evidence-based indications involved in decision making. It will explore the roles and responsibilities of a midwife in both the pre and post-operative support of a woman; based on a safe, woman centred and holistic approach to maternal care. It will discuss the emotional effects an ECS can have on a woman and her family as a crucial aspect in this case. An integral part of the preparation for birth is a birth plan. This allows the woman to detail how she would like her labour/birth to progress. It often includes the expectation of a natural vaginal birth. However, due to a variety of physiological complications which occur during labour, birthing may result in an ECS (Oxford University Press, 2011, p. 379). Walsh (2011) explains ‘normal labour naturally follows a sequential pattern that involves painful regular uterine contractions stimulating progressive effacement’ (p. 485). When labour is not following the normal signs of progression, the midwife monitors for indications of fetal...

midwifery case study essay

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Midwife Diaries

Essay Writing for Student Midwives

Below is an essay by one Melissa Newman. She’s a qualified midwife doing her PhD. This is one of her undergraduate essays that scored a 1st. Cheers Melissa!

There’s a version of Melissa’s essay with nicer formatting here.

Complications Around Childbirth: Pre-eclampsia Toxaemia

Word count: 3,292

This essay will firstly look at the diagnosis of pre-eclampsia toxaemia (PET) in the case study of Lucy and describe the subsequent care she received. The pathophysiology section will explore the causes of this progressive disease and then analyse the role of the midwife in caring for a woman with PET, with particular consideration given to why taking accurate blood pressures is so pivotal. The use of Magnesium Sulfate (MgSO4) in caring for pre-eclamptic women will then be discussed before moving onto how the midwife can look after a woman’s psychological wellbeing at this stressful time in her life. 

The table below demonstrates that Lucy had an uncomplicated pregnancy up until her routine 34 week appointment with her community midwife. 



Booking blood pressure (BP)

122/70 mmHg

Booking Body Mass Index 

Booking Haemoglobin (Hb)

Booking Platelets 

350  109/L

28/40 platelets 

300  109/L

Family history

Her sister had PET, although Lucy herself has no relevant medical history

Ultra sound scans (USS)

All normal, no apparent abnormalities and growth within normal range. Singleton pregnancy. 

It was at the 34 week appointment the midwife found Lucy's BP was raised at 157/104mmHg and she had +++ protein in her urine. Lucy also commented that her hands and feet were swollen but she thought it was caused by the heat. The midwife referred Lucy to the Day Assessment Unit (DAU), where midwives took her blood, attached her to a cardiotocograph (CTG), sent a Protein-Creatinine Ratio and did her observations. A Registrar was bleeped to review Lucy and arrived when her blood results were back, as displayed in this table. The abnormal results are highlighted. 




95 beats per minute

Respiration rate 


250  109/L

Alanine Transaminase

Alkaline Phosphate 

Serum creatinine

Serum uric acid

0.41 umol/L

International Normalised Ratio

Blood group

A positive 

The trace on the CTG was considered reassuring so the Registrar admitted Lucy to the antenatal ward and prescribed 200mg Labetalol twice daily. BP readings were taken 4 times a day and ranged from 146/88-151/92. Lucy consented to a course of Dexamethasone to mature her baby’s lungs should she deliver early. She wore anti-embolic stockings and was prescribed Tinzaparin once daily to reduce the risk of thrombosis, which is in line with Royal Berkshire Foundation Trust (RBFT) (2015) guidance. Lucy had an USS that showed consistent growth, a good volume of amniotic fluid surrounding the baby and normal umbilical artery Doppler’s. 

Despite RBFT (2015) and the National Institute for Health and Clinical Excellence (NICE) (2011) guidelines advising that CTG tracing should not be carried out more than weekly if fetal monitoring results are normal, Lucy was attached to the monitor for 30 minutes every morning. The traces were all reassuring. 3 times a week Lucy had blood taken for Urea and Electrolytes, Liver Function Tests and a Full Blood Count, as per RBFT (2015) protocol stipulates. The results remained steady and Lucy was otherwise well so the Registrar decided to continue with conservative management, as a Cochrane review by Churchill et al (2013) found that delaying delivery is more beneficial for the baby. 

The RBFT guideline (2015) advises USS every 2 weeks for women with PET, so at 36 weeks gestation Lucy had an USS. It was found that fetal growth was now on the 20th percentile when it had previously been on the 64th. The Doppler’s also showed some degree of impairment. Lucy complained of grossly swollen feet that did not improve even when elevated. She felt nauseous and reported epigastric pain, a headache and blurred vision. Her observations were as follow: 

Blood pressure


110 beats per minute

20 breaths per minute

++++ protein

Fetal movements


CTG trace 

Reduced variability despite multiple changes in maternal position

The Consultant was called to review and by the time he arrived bloods had been taken and the results back:

170  109/L

0.51 umol/L

The consultant transferred Lucy to delivery suite and gave 4g MgSO4 intravenously. She was attached to a CTG, which showed a prolonged deceleration of 3 minutes and so the decision was made to deliver the baby by Category 1 caesarean section under general anaesthetic. The APGARS were 7 at 1 minute and 9 at 5 minutes and there was meconium in utero. The estimated blood loss was 550ml and the 2.5kg baby was not admitted to Special Care. 

Lucy was transferred to the high risk postnatal ward, where her BP medication was slowly reduced over 24 hours and her BP returned to pre-pregnancy values. She had a PET screen 48 hours post-delivery, as per RBFT (2015) protocol, the results of which were normal. 

Occurring in an estimated 5% of pregnancies (National Health Service Choices 2015) and presenting after 20 weeks gestation, PET is an idiopathic condition characterised by proteinuria and hypertension (Robson et al 2014). Boyle and McDonald (2011) describe it as multi-organ affecting with progressive detrimental effects to both mother and fetus. 

Although PET presents in the later stages of pregnancy, its origins lie in the earlier phases, with abnormal placentation. In normal placental implantation, trophoblast cells invade the decidua and myometrium and the spiral arteries’ muscle coating is eroded, dilating them to ensure plentiful blood supply to the fetus (Bewley 2012). BP is lowered because maternal blood pools in the intervillous spaces of the placental bed (Bewley 2012). In PET spiral artery tone is retained, meaning they only dilate to 40% of what they should do (Stables and Rankin 2005). As the blood is forced through constricted arterioles, BP rises, the placenta becomes under perfused and the fetus may become hypoxic (Bothamley and Boyle 2009). This results in oxidative stress, which alters cell membranes and triggers the placenta to release cytokines which activate platelets, damage endothelial cells and cause capillary leakage (Coad and Dunstall 2011). The platelets aggregate in the damaged blood vessels, putting the woman at an increased risk of thrombosis (Boyle and McDonald 2011). Oedema is caused by tissue fluid accumulating as the capillaries leak, meaning women with PET are at risk of fluid overload (Jordan 2010). 

In pregnancy uncomplicated by PET, there is increased synthesis of prostacyclin, thromboxane A2 and nitric oxide, which alters homeostatic balance and ultimately causes uterine artery vasodilation.  However, in PET there is an imbalance of these vasodilators due to the endothelial dysfunction that occurs as a consequence of poor placentation (Boyle and McDonald 2011). Prostacyclin is under-produced and thromboxane is relatively over-produced, encouraging vasospasm of the spiral arteries, which in turn leads to atherosclerosis and raised BP (Stables and Rankin 2005). 

Due to the multisystem nature of PET and variability in presentation, endothelial damage can occur throughout the body, affecting multiple organs with the deposition of fibrin in the blood vessels (Jordan 2010). These fibrinous deposits cause further damage by stimulating the clotting cascade, meaning eventually clotting factors and platelets become depleted, leading to haemorrhage and disseminated intravascular coagulation (Morley 2004). The incoordination of the haematological system is further emphasised by haemoglobin levels appearing elevated due to haemocentration (Morley 2004). PET can quickly evolve into HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), which is associated with poor maternal and neonatal outcome (Fraser and Cooper 2012), so they midwife must be mindful of this and alert to signs the woman is deteriorating. 

One of the diagnostic manifestations of PET is proteinuria, caused by glomerular endothelial damage allowing plasma proteins to pass into the urine. The glomeruloendotheliosis occurs because hypertension induces vasospasm of the arterioles, equalling decreased blood flow and eventually hypoxia and oedematous endothelial cells in the glomerular capillaries (Fraser and Cooper 2012). Plasma urates rise and clearance of uric acid is reduced, showing that tubular function is damaged (Stables and Rankin 2005). Ultimately, PET can lead to acute renal failure if left untreated (Cowan 2011). 

Raised liver enzymes in women with PET reflect the hepatic damage that occurs when the liver cells become hypoxic and oedematous due to vasoconstriction of the hepatic blood vessels (Fraser and Cooper 2012). Vasospasm within the liver is caused by small haemorrhages and hypoxic swelling, which the woman interprets as epigastric pain (Lavellee 2015). 

Due to acute cerebral complications, PET is largely responsible for the world’s high maternal mortality rates (Zeeman 2009), although deaths from PET are at a record low (Nelson-Piercy et al 2014). Combined with cerebrovascular endothelial dysfunction, hypertension causes an impairment of the blood-brain barrier, allowing cerebral oedema and micro-haemorrhaging, which is characterised by visual disturbances and headaches (The Pre-eclampsia Community Guideline 2004). 

In the first half of pregnancy fetal development will not be affected as maternal blood supply is sufficient. In the second half of a normal pregnancy the placenta increases the vascularisation of its villi, as oxygen demands increase. However, in a pregnancy complicated by PET, this mechanism cannot happen and this is where intrauterine growth restriction (IUGR) occurs (Reister and Kingdom 2004). Research shows that growth restricted fetuses adapt themselves to a limited nutrient supply, hereby altering their metabolism permanently and predisposing them to hypertension, cardiovascular disease and diabetes in later life (Lapidus 2011). IUGR often co-exists with Oligohydramnios, which can cause babies to become hypoxic in labour if the umbilical cord becomes compressed, the effects of which are heightened by the fact that the baby is already oxygen deprived to a certain degree due to the PET. This can cause the baby to become distressed and pass meconium in utero, putting them at risk of meconium aspiration (Coutts 2007). 

Nelson-Piercy (2010) says PET is the commonest cause of iatrogenic preterm delivery, meaning many newborn complications are not specific to PET but rather the consequences of the disease, such as IUGR and prematurity, with the risks increasing the earlier the gestation. 

As the primary caregivers for pregnant women, midwives are the practitioners most likely to initially suspect PET. A midwife should refer the woman to the hospital for further testing and Registrar review, as diagnosis of PET is outside the scope of practice which a midwife works within (Nursing and Midwifery Council (NMC) 2015). One warning sign of PET is hypertension, defined by NICE (2011) as moderate when the diastolic is 100-109mmHg and the systolic 150-159mmHg. Lucy fit into this category when the midwife referred her to DAU. See appendix 2 for PET symptoms. 

The British Hypertension Society (2012) advise it is best practice to measure arm circumference prior to taking BP to ensure the correct sized cuff is used, as a Cochrane review by Banner and Gravenstein (2011) found that using a cuff too small for the woman can increase the systolic value by up to 80mmHg. In a disease where the focus is hypertension, this false increase can greatly impact on the clinical decisions made by health care professionals and therefore outcomes for mother and baby. It is good practice to document in the notes the cuff size used (RBFT 2015) to ensure consistency and good communication with colleagues, which is in line with what the NMC (2015) say about working in partnership to deliver seamless care. Members of the multidisciplinary team all have the common objective of providing the best possible service for the woman (Day 2006). The safety of mother and baby depends on the midwife’s knowledge and skills in recognising the abnormal and her ability to act on this, for example referring to a Registrar if BP becomes unstable & medication requires altering. 

In community, where Lucy’s hypertension was revealed, midwives take manual BP’s but in hospital Dinamaps tend to be used because they are perceived as being easier and can be set to automatically take BP at set intervals, which frees up busy midwives’ precious time. Greeff et al (2010) found Dinamaps to be accurate and recommends their use in pregnancy and PET. Another benefit of using a Dinamap is that it is more consistent than lots of different midwives taking the BP and this allows a trend to be shown. Dinamaps also monitor heart rate and oxygen saturation levels, which are vital for detecting fulminating pulmonary oedema (Robinson and Scullion 2009). Antihypertensive medication is often titrated against Mean Arterial Pressure, which is automatically calculated when a Dinamap takes a BP, therefore saving time and reducing the risk of calculation error occurring.

RBFT (2015) state that when BP rises above 160/110mmHg a loading dose of 4g MgSO4 should be given intravenously for eclampsia and stroke prophylaxis. Recommended as first-line treatment of eclampsia, it has a strong hypotensive effect, although its primary function is as an anticonvulsant (British National Formulary 2015).

Clotting bloods should be taken regularly as MgSO4 increases clotting times by slowing down platelet activity and reducing thrombin production, putting the woman at increased risk of haemorrhaging (Jordan 2010). 

Urine output must be closely monitored and exceed 25ml/hour (RBFT 2015) to ensure infusion rate is in line with renal function. This is because PET causes renal impairment, reducing glomerular filtration rate and increasing the time it takes for the drug to be eliminated from the body, potentially causing toxicity (Fraser and Cooper 2012). Toxicity symptoms are varied due to MgSO4 affecting all body systems, but can include flushing, sweating, hypothermia, bradycardia, cardiac arrest and pulmonary oedema due to cardiac depression, hence the need for the woman to be continually monitored with an electrocardiogram, BP machine and pulse oximeter (RBFT 2015). MgSO4 affects the baby similarly to its mother, so should be continually monitored with a CTG (Guidelines and Audit Implementation Network 2012). Because MgSO4 inhibits muscle contraction, the midwife should be aware that fatigue and muscle weakness are initial signs of impending toxicity, necessitating the need for respiratory rate, consciousness and patellar reflex monitoring (Jordan 2010). 

The midwife should record these vital signs on a High Dependency chart, as per RBFT (2015) protocol and document all events clearly in the notes (NMC 2015), staying forever alert to signs of deterioration and deviation from the norm. This ensures optimal communication between members of the multidisciplinary team caring for the woman, for example Registrars, Consultants and Anaesthetists, and promotes collaborative working with input from each area of expertise to provide safe, evidence-based care.

The midwife should look at the woman as an individual case and treat her accordingly, not just acting upon what is considered to be abnormal by the Trust’s standards, but by the woman’s personal history and what is normal for her. She can do this by referring to the woman’s booking BP and blood results and how her observations have changed since. 

The World Health Organisation (WHO) (2011) recommends women at risk of developing PET should take 75mg Aspirin daily from 12 weeks gestation as a Cochrane review by Duley et al (2010) found that doing so reduces the risk of PET by 17%, as pre-eclamptic women have increased coagulation systems in their blood, which can be inhibited by taking Aspirin (Action on Pre-eclampsia 2012). See Appendix 1 for risk factors for PET. Lucy did not receive optimal care because although she is at increased risk of acquiring PET because she is over 40 years old, her sister had PET and there is a 10 year age gap between this baby and Lucy’s other child (Royal College of Obstetricians and Gynaecologists 2012), she was not advised to take low-dose Aspirin. This is not in accordance with what the NMC (2015) say about practising effectively using evidence-based guidelines and advising on medication administration to preserve the safety of patients. 

Pre-eclamptic women might feel they are not in control of their lives and that their disease controls them and a multitude of health professionals are trying to control the disease, without  perhaps, seeing the woman as a person. This could negatively affect an emotionally stressed woman who feels guilty she is putting her baby at risk. In conjunction with being told the realities of how dangerous PET can be, this may leave the woman fearful and feeling that achieving a healthy pregnancy is an impossible task. 

Occurring in 1-2% of women postnatally, post-traumatic stress disorder (PTSD) is a psychological disorder that develops in response to experiencing or witnessing a traumatic event (The Birth Trauma Association 2015). It is characterised by intrusive flashbacks and nightmares of the event that leave sufferers feeling panicked, distressed and intensely fearful (Gamble and Creedy 2005). Alder (2006) found that 33% of women are affected by pregnancy/birth trauma, although they do not meet all the diagnostic criteria for PTSD, meaning they do not receive the help and support they need. Because PTSD symptoms must present for more than a month in order to make a diagnosis and midwives usually hand over care to the health visitor around 10 days postnatally, diagnosis usually takes place with other professionals, leading to lack of awareness of the condition and possible misdiagnosis as postnatal depression (Hunter 2013). This could cause delay in treatment and potentially fatal consequences for mother and/or baby, as deaths from mental illness have now overtaken sepsis (Nelson-Piercy et al 2014). Fragmented postnatal care and lack of continuity only confound this as relationships between midwife and woman cannot be established. Mapp (2005) discusses how women may avoid engaging with health professionals for fear their baby will be removed if it is realised they are struggling.  This can prevent women seeking medical help when they need it, so it is fundamental a partnership is formed with women in order to promote their health (International Confederation of Midwives 2014). 

Ultimately, if health professionals are not aware of PTSD then they cannot know how to prevent it. Midwives need to work in conjunction with other health professionals to lessen the traumatising effects of emergency situations, in order to reduce the risk of PTSD occurring. WHO (2007) say health care professionals should preserve dignity and use supportive non-verbal communication to demonstrate they are listening, which will encourage the woman to allay her fears candidly. The supportive presence and advocacy role of the midwife can be reassuring for a woman and her family while dramatic events are unfolding. Cowan (2011) says that once a pregnancy becomes complicated and an array of health professionals become involved, the midwife can alleviate some anxieties by being honest, encouraging her to ask questions and explaining what will happen next. Mapp (2005) says women are understanding that emergencies arise but the effect of them can be lessened by receiving sensitive care and being kept updated so that stress and overall negative impact of the situation is reduced. 

Women like Lucy do not anticipate to go through potentially traumatising emergency events, particularly if they have had a low-risk pregnancy before, but having PET and an emergency caesarean (EMCS) may alter their ability to cope with stress and put them at risk of PTSD. 14.1% of women at RBFT had an EMCS between 2013-2014 (RBFT 2014), which is a lot of women at increased risk of developing PTSD. Women may experience inner conflict between expectations and reality and withhold emotions from health care professionals as they are perceived as the ones having caused this trauma. Connell (2015) says health care providers use medical jargon and abbreviations that women do not understand, leaving them feeling powerless, isolated, vulnerable and not involved in decisions made about their care, hence why informed consent is so important. Instead, information needs to be offered through a platform women can engage with so she understands what is happening to her and why (Sully and Dallas 2010). The feeling of helplessness is only fuelled by lack of continuity of care and care appearing clinical and not person-centred, as health professionals tend to focus on physical wellness, with less consideration given to psychological and emotional wellbeing (Hunter 2013). Health care professionals have targets to meet in terms of successful births, but success is measured by low rates of physical mortality rather than psychiatric morbidity, which is not the best approach (Hunter 2013). 

Women may feel detached and find it difficult to bond with their baby because they associate their baby with the trauma they experienced (BTA 2015), which can impact negatively on the physical and psychological development of the baby. They may struggle to breastfeed, adding to feelings of failure that they couldn’t have a healthy pregnancy or vaginal birth. NICE (2015) advise women should not be offered formal debriefing because it has been suggested that they may be soothed and placated while having their experience relayed to them in medical terms in order to avoid litigation for health care professionals. 

It is clear that this poorly understood, multisystemic, multifactorial disease has no one cause, although treatment is always the same: delivery of the baby and placenta. It is the responsibility of the midwife to work in conjunction with other members of the multiprofessional team to provide individualised care that will optimise outcome for women and babies. However, psychological wellbeing should not be ignored and simple measures can be taken by all involved in her care to minimise the risk of lasting impact of what could otherwise be a truly traumatic experience. 

Action on Pre-eclampsia (2004) PRECOG: The Pre-eclampsia Community Guideline . Worcestershire: Action on Pre-eclampsia. 

Action on Pre-eclampsia (2012) What is pre-eclampsia [Online]. Available at: [Accessed: 28 July 2015]. 

Alder, J., Stadlmayr, W. and Tschudin, S. (2006) Post-traumatic symptoms after childbirth: what should we offer? Journal of Psychosomatic Obstetrics and Gynecology , 27(2), p.107-112. 

Banner, T. and Gravenstein, J. (2011) Comparative effects of cuff size and tightness of fit on accuracy of blood pressure measurements. [Systematic Review]. Cochrane Database of Systematic Reviews . [Online]. Available at: [Accessed: 28 July 2015]. 

Bewley, C. (2012) Medical disorders of pregnancy. In: Macdonald, S. and Magill-Currden. (eds.) Mayes’ Midwifery . London: Bailliere Tindall Elsevier, p.771-786.

Billington, M. and Stevenson, M. (2007) Critical care in childbearing for Midwives . Oxford: Blackwell. 

Bothamley, J. and Boyle, M. (2009) Medical conditions affecting pregnancy and childbirth . 1st ed. Oxford: Radcliffe Publishing. 

Boyle, M. and McDonald, S. (2011) Pre-eclampsia and eclampsia. In: Boyle, M. (ed). Emergencies around childbirth . London: Radcliffe Publishing, p55-69. 

British Hypertension Society (2012) Blood Pressure Measurement [Online]. Available at: [Accessed: 28 July 2015]. 

British National Formulary (2015) British National Formulary 69. 69th ed. London: Pharmaceutical Press. 

Churchill, D., Duley, L. Thornton, J.G. and Jones, L. (2013) Interventionist versus expectant care for severe preeclampsia between 24 and 34 weeks’ gestation. [Systematic Review]. Cochrane Database of Systematic Reviews . [Online]. Available at: [Accessed: 28 July 2015]. 

Coad, J. and Dunstall, M. (2011) Anatomy and Physiology for Midwives . 3rd ed. Dawsonera [Online]. Available at: [Accessed: 9 June 2015].

Connell, E. (2015) The importance of person-centred care in reducing birth trauma. MIDIRS Midwifery Digest , 25(2), p.218-222. 

Coutts, J (2007) Pregnancy-induced hypertension – the effects on the newborn. In: Belfort, M. and Lyall, F. (eds). Pre-eclampsia . Cambridge: Cambridge University Press, p.506-521. 

Cowan, J. (2011) Blood tests for investigating maternal wellbeing. The Practising Midwife . 14(3), p.40-46. 

Day, J. (2006) Interprofessional Working: an essential guide for health- and social-care professionals : Expanding Nursing and Health Care Practice. 1st ed. Dawsonera [Online]. Available at: [Accessed: 29 July 2015]. 

Duley, L., Henderson-Smart, D.J., Meher, S. and King, J.F. (2010) Antiplatelet agents for preventing pre-eclampsia and its complications. [Systematic Review]. Cochrane Database of Systematic Reviews . [Online]. Available at: [Accessed: 28 July 2015]. 

Fraser, D. and Copper, M. (2012) Survival guide to midwifery . 2nd ed. London: Churchill Livingstone Elsevier. 

Gamble, J. and Creedy, D. (2005) Psychological trauma symptoms of operative birth. British Journal of Midwifery , 13(4), p.218-224. 

Greeff, A., Ghosh, D. and Anthony, J. (2010) Accuracy assessment of the Dinamap ProCare 400 in pregnancy and preeclampsia. Infection Control and Hospital Epidemiology, 31(6), p.198-205. 

Guidelines & Audit Implementation Network (2012) Management of severe pre-eclampsia and eclampsia [Online]. Available at: [Accessed: 28 July 2015]. 

Hunter, A. (2013) Working with postpartum post-traumatic stress disorder: potential challenges for midwives and other health practitioners. MIDIRS Midwifery Digest, 23(3), p.367-372. 

International Confederation of Midwives. (2014) ICM International Definition of the Midwife [Online]. Available at: [Accessed: 30 July 2015]. 

Jordan, S. (2010) Pharmacology for midwives . 2nd ed. Basingstoke: Palgrave Macmillan. 

Lapidus, A. (2011) Effects of preeclampsia on the mother, fetus and child. [Online]. Available at: [Accessed: 11 June 2015]. 

Lavellee, L. (2015) Clinical presentation, assessment and management of pre-eclampsia. Nursing Standard, 29(45), p.51-59. 

Mapp, T. (2005) Feelings and fears post obstetric emergencies. British Journal of Midwifery, 13(1), p.36-40. 

Morley, A. (2004) Pre-eclampsia: pathophysiology and its management. British Journal of Midwifery, 12(1), p.30-37. 

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National Institute for Health and Clinical Excellence (2015) Postnatal care [Clinical Guideline]. London: National Institute for Health and Clinical Excellence. 

Nelson-Piercy, C. (2010) Handbook of Obstetric Medicine . 4th ed. Dawsonera [Online]. Available at: [Accessed: 10 June 2015].

Nelson- Piercy, C., MacKillop, L., Williamson, C. and Griffiths, M on behalf of the MBRRACE-UK (2014): Medical complications chapter writing group. In Knight, M., Kenyon, S., Brocklehurst, P., Neilson, J., Shakespeare, J. and Kurinczuk, J.J (eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mother’s Care – Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012 . Oxford: National Perinatal Epidemiology Unit, University of Oxford p.83. 

Nursing and Midwifery Council (2015) The Code [Online].  Available at: [Accessed: 28 July 2015]. 

Resister, F. and Kingdom, J. (2004) Screening for pre-eclampsia. In: Baker, P. and Kingdom, J. (eds). Pre-eclampsia : current perspectives on management. London: The Parthenon Publishing Group, p.119-132. 

Robinson, T. and Scullion, J.E. (2009) Oxford Handbook of Respiratory Nursing . 1st ed. Oxford: Oxford University Press. 

Robson, S.E., Marshall, J.E., Doughty, R. and McLean, M. (2014) Medical conditions of significance to midwifery practice. In: Marshall, J. and Raynor, M. (eds.) Myles’ Textbook for Midwives. London: Saunders Elsevier, p.243-286. 

Royal Berkshire Foundation Trust (2013) Possible complications in pregnancy [Online]. Available at: [Accessed: 30 July 2015]. 

Royal Berkshire Foundation Trust (2014) Maternity Services V6 Report 2013-14 [Online]. Available at: [Accessed: 30 July 2015]. 

Royal Berkshire Foundation Trust (2015) Hypertension management in

Pregnancy [Clinical Guideline]. Reading: Royal Berkshire Foundation Trust. 

Royal College of Obstetricians and Gynaecologists (2012) Pre-eclampsia [Online]. Available at: [Accessed: 29 July 2015]. 

Stables, D. and Rankin, J. (2005) Physiology in Childbearing. 3rd ed. Dawsonera [Online]. Available at: [Accessed: 10 June 2015].

Sully, P. and Dallas, J. (2010) Essential communication skills for nursing and midwifery . 2nd ed. Dawsonera. [Online]. Available at: [Accessed: 30 July 2015].

The Birth Trauma Association (2015) Postnatal post-traumatic stress disorder [Online]. Available at: [Accessed: 29 July 2015]. 

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Appendix 1 – risk factors for developing PET

If a woman’s sister or mother had PET then she is 40% more likely to develop the disease herself

A three-fold risk if there has been a 10 year age pregnancy interval 

Multiple pregnancy

Risk is doubled if over 40 years old

Under 16 years old

First pregnancy

First pregnancy with new partner 

Previous pre-eclampsia

Body Mass Index of 35 or above at booking 

Hypertensive disease in a previous pregnancy

Chronic hypertension

Renal disease

Type 1 or 2 diabetes

Autoimmune disease, for example Lupus or Antiphospholipid syndrome

Connective tissue disease, form example rheumatoid arthritis 

Donor egg pregnancy

Sickle cell disease

Rhesus incompatibility

Molar pregnancy

Billington and Stevenson (2007)

NICE (2011)

RBFT  (2013) 

Symptoms of PET

Headache which tends to be frontal and not alleviated by over the counter analgesia 

Visual disturbances such as flashing lights and blurred vision 

Liver tenderness and epigastric pain that can be specifically left-sided 



Oedema in the face, hands and feet


Abnormal liver enzymes  

Falling platelet count 

Reduced fetal movements 

A baby that is small for gestational age and may have impaired Doppler’s

  Bothamley and Boyle 2009

Coad and Dunstall 2011 

Appendix 3 – peer review feedback from case study presentation

1. Was the handover communicated in a clear and logical manner?

2. Did the handover contain all the pertinent information required?

3. Were the key aspects of the case covered in the presentation of the case study?

4. What aspect of care (physical or psychosocial) was discussed?

PTSD very good and in depth (X3)

5. Were the relevant aspects of midwifery care included?

6. Were key references provided?

7. Any suggestions for improvement that may help in preparation for your essay

• Very good! (X2)

• Highlight ‘abnormal blood results

midwifery case study essay

Writing Your Application for your First Midwifery Job (Band 5)

[𝐃𝐚𝐲 𝟐𝟏] 𝐓𝐌𝐈.


Midwifery Case Study

Within the Midwifery Professional Practice discipline, there are various issues similar to any other health professional practices. In particular, a central issue within Midwifery is providing suitable women-centred care for everyone including those who are vulnerable and live in a low socioeconomic environment. By aiding women-centred care presents elements of the dignity of the human being and the common good in relation to the midwifery practice. Within the midwifery profession, we are faced with pregnant women from different cultures some who are seen as vulnerable due to their socio-economic background, their age and gender. Therefore, discrimination is often seen and increase the women pain tolerance, fear of the unborn child. This …show more content…

In this case, the dignity of the human person whether it’s the midwife respecting the women’s privacy demonstrates the idea of common good. In which midwifes’ should perform their roles and duties according to their professional’s guidelines and take in consideration the publics interest. However, by applying common good into midwifery presents challenges needed to overcome, such as the advance development in midwifery as an individual profession and practice. Over the years, midwifery has started to strengthen and grow with the help of professional education for students in order to promote the common good in society. It is important for midwives to provide benefits for the public whilst promoting the common good as it reduces the burden of nurses and allows for midwives to dedicate their knowledge and skills according to their profession. Therefore, when women-centred care is applied appropriately for both the women and the midwife, only then can the women flourish throughout the bond of a therapeutic …show more content…

In doing so as a midwife there are times when certain boundaries are put in place in order to treat the women with respect and care within certain aspects of their life, such as maintaining the women’s dignity in a foreign hospital environment. It is illustrated that when women aren’t given their specific needs or wishes, they may resort to other techniques in order to gain what they want therefore leading to avoidance and confrontation (Clark, 2010). Another quality is by providing a therapeutic relationship with the women. According to Widang et al (2008) when women are treated as an individual and not an object to be treated, their experiences during pregnancies and labour and choices are greatly valued. This allows the women to feel inclusive throughout their pregnancy journey although women who come across discrimination and disrespect would increase the chance of negative experiences, therefore the women would need greater support to overcome certain issues. Therefore, in order for women to feel safe and participate without fear effective communication between health professionals is needed for better care. In the end, it is important for health professionals to reinforce the need for evidence-based practice and overcome the obstacles that midwives will be faced within their practices. These include providing a suitable model of care for

In this essay, the author

  • Explains that the midwifery professional practice discipline has issues similar to any other health professional practice, such as providing suitable women-centred care for vulnerable people.
  • Opines that it is important to maintain human dignity with women to reduce the risk of dignity in maternity settings and decline adverse outcomes.
  • Explains that the principle of common good relates to issues within the midwifery discipline as it connects with the women and the community.
  • Opines that women should be treated with respect and care in a women-centred care setting, and that effective communication between health professionals is needed for better care.

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In every culture health play an essential part of life but means to achieve that healthy being may vary from one country to another depending on their belief system. It is important that professional healthcare providers obtain a proficiency in different cultures and respect these customs as they may influence patient’s behaviors towards receiving care. Birthing is a very important stage in the life of a Vietnamese woman . the Vietnamese culture is very diverse as many of their cultural practices have been influenced by the country’s’ strategic located between china and India. The Vietnamese people religiously observe their traditions and beliefs especially in pregnancy and during and after delivery.

The Pros And Cons Of The Midwife

In the early nineteen-hundreds, the American Medical Lobby was almost successful in stopping out its competition: Midwives. The Journal of the American Medical Association (AMA) published an article in 1912 “The Midwife Problem”, which analyzed a survey given to obstetricians of their thoughts on midwives were. The article states “a large proportion admit that the average practitioner, through his lack of preparation for the practice of obstetrics, may do his patients as much harm as the much-maligned midwife.” This statement demonstrates the discrimination of skilled midwives. Comparing a trained midwife to a unprepared obstetrician. “doctors are the main reason women don’t have midwives.” says Cristen Pascucci the Author of “ Why Are We Asking Doctors if Women Should Have Midwives?”. Midwife led care is the norm all around the world for mothers and babies, so why not in the United States you may ask. Many may say that the United States has a dysfunctional system of maternity care, leading to poor outcomes for mothers and babies. After the 1912 “Midwife Problem”, prenatal mortality has been higher in hospitals and lower in at home births. (Pascucci, 2014) The doctors employed by the AMA in 1912, failed to take down the glorious, strong willed midwives. Even after 100 years of scrutiny, midwives are still going strong and proving their ways of doing things are

Analysis Of A Walk To Beautiful

The videos depicted the reality of life in poor developing countries where the basic necessities of life are unavailable and inaccessible resulting in high infant/maternal mortality rates, diseases, and disability. The experience also broadened my knowledge in terms of how to communicate and educate this population of women who are so ingrained in the existing traditional, harmful practices and beliefs that cause unsafe health outcomes for themselves. Cultural awareness and communication will be key components to prevent early marriage, childbirth, and obstetric fistulas. The activity also increased my awareness of the limited resources, information, and support available for the low income population to meet their daily needs and health necessities. As trained health care providers, we are an important source of information, aide, and support system for our vulnerable clients especially during hard times. Based on this course learning, I will continue to make an effort to provide accessible health information (e.g., treatment, monetary resources, medications, etc); basic self care needs (e.g., ADLs); and socio-psychological support to my patients in my nursing practice.

Cultural Diversity in Patients

This essay will focus on outlining the fundamental principles of cultural diversity and how effective nursing interventions are used when providing an adequate amount of care for an individual from a culturally diverse background and how this may collide with the nursing therapeutic engagement. This essay will give the reader an insight upon culture whilst giving a significant explanation of cultural differences within a health setting. The patient’s real name will not be used and will be referred to as Mr. X. This is in line with the Nursing and midwifery Council 2008 (NMC, 2008) requirements to maintain confidentiality at all times.

The Importance Of Consent In Health Care

The purpose of this essay is to introduce the concept of consent, briefly identify its types and legal fundaments, examine significance of consent in a healthcare provision and illustrate the main issues involved with patients’ consent with midwifery practice as the focal point of interest.

Nursing Ethics: The Role Of Ethics In Nursing

(9) United Kingdom Central Council for Nursing, Midwifery, and Health Visiting. (UKCC) (1992). Primary Health Care, Code of professional conduct for the nurse, midwife and health visitor. London: UKCC.8 (2)

Applying the Sociological Imagination to Sole-parent Familes

Pairman,S., Tracy, S., Thorogood, C., & Pincombe, J. (2013). Theoretical frameworks for midwifery practice. Midwifery: Preparation for practice.(2nd ed, pp. 313-336). Chatswood, N.S.W. : Elsevier Australia

Certified Nurse Midwife

Throughout history mankind has come up with some wonderful inventions and innovations, but out of all the creations by far the most beautiful and precious is human birth. I first developed an interest in nursing and in particular midwifery years ago. I believe it is a great service within the health profession because of the privileged position to assist in human childbirth. The word midwife means with woman. Centuries before obstetricians delivered babies, midwifes assisted women in having at home births. But it was only formally established as a profession in the early 1900’s. A nurse-midwife is a registered nurse that specializes in midwifery. The job of midwife is to assist in family planning and birth control advice, provide general gynecological services (such as pap smears and breast exams), aid women in childbirth, and help women by providing prenatal and postpartum care. Nurse-midwives are required to have a Master’s of Science in Nursing (MSN) degree and pass the American College of Nurse Midwifery (ACNM) board examination to obtain certification.

Midwife Vs Home Birth Essay

For one woman, this vision of childbirth is not the norm. Ana Rhodes is a midwife, and she is one of the only birth attendants available to...

Midwife Reflective Account

I initially considered midwifery when I attended an antenatal scan with my auntie and heard the heartbeat of the unborn baby for the first time. Listening to discussions regarding health concerns and family support highlighted the importance of the midwife and mother relationship. Two years ago I was given the opportunity to be my mum’s birthing partner alongside my dad. I saw how the midwives interacted and were supportive through the birthing and decision making process. It was found that the baby was breach and the safe option was a caesarean section, and with the complications discussed mum was able to make the right decision. I attended pre and postnatal appointments and listened to the midwives offering advice and guidance, develop a birthing plan as well as check and monitor the health and wellbeing of mum. These first hand experiences have given me a deeper understanding of the role of a midwife and how communication and building trusting relationships is key during these emotional and vulnerable times for a woman, and inspired me to become a midwife.

Abortion: Pro-Life and Pro-Choice

The debate concerning abortion still exists and is causing a lot of controversy. One of the biggest is an issue concerning mother’s who are experiencing health compilations during p...

The Importance of Nursing in American Culture

"The Role of a Nurse / Midwife." Irish Nursing Board, An Bord Altranais. N.p., n.d.

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Midwifery Focused Option - Essay Example

Midwifery Focused Option

  • Subject: Environmental Studies
  • Type: Essay
  • Level: College
  • Pages: 6 (1500 words)
  • Downloads: 2
  • Author: edna60

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Litigation and midwifery, analysis of an ethical dilemma - working in the antenatal clinic, midwifery: guidance during a third stage physiological delivery, options for deliveries: vaginal breech deliveries, a technique to reduce pain during labor: the midwife's in the administration of epidural anesthesia, the role of the midwife in the normal process, informed consent in midwifery, the process of registration as a nurse.

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