UNIT 8 - THE ROLE OF THE Midwife IN Antenatal CARE PDF

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The role of the midwife in antenatal care, this unit ensures you have an understanding of the job roles are for a midwife....

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THE ROLE OF THE MIDWIFE IN ANTENATAL CARE 18/05/2021 Salma Khan

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The aim of this essay is to illustrate knowledge of midwives' roles and responsibilities during the antenatal period. This can be accomplished by looking at developments that can affect pregnancy and the implications for the midwife's position as well as the midwife's role. The essay will also address the role of the midwife in addressing a woman's physical, mental, and psychological needs, as well as the role of the Nursing and Midwifery Council in the role of the midwife and the ramifications of The Code of antenatal treatment. Finally, the essay will discuss the role of the midwife supervisor in supporting student midwives and qualified midwives. Pregnancy has three trimesters and the role of a midwife changes with each one, especially if there are concerns regarding the baby or mother's health. A midwife plays a big part in a woman’s pregnancy; therefore, a woman should feel comfortable, safe and be able to trust the midwife. Once the pregnancy is confirmed, an appointment should be made with the midwife, this is called a booking appointment. The first trimester is week 1 to week 13. The midwife will carry out a risk assessment to determine what kind of treatment will be needed during the pregnancy and if there will be any concerns. The midwife must follow guidelines given by the National Institute for health and care Excellence (NICE). The midwife will inquire about: Living arrangements, the baby's father, any previous pregnancies, smoking, alcohol, substance use, physical and mental wellbeing, treatment that has been received in the past, and any health problems in the family. The midwife will also ensure that the expecting mother has people around that can assist her. The midwife will check and calculate body mass index by measuring height and weight (BMI, Check the blood pressure and urine for pre-eclampsia symptoms, she will also Check if the mother has HIV, syphilis, or hepatitis B, get a blood test. If they suspect a high chance that the mother may have them, they will give the mother a blood test for sickle cell and thalassaemia (blood diseases that can be passed on to the baby), (Your first midwife appointment, 2021). The second trimester is week 14 to 27, the midwife will check the baby’s growth and development and mother’s health. The mother will have routine appointments that include checking weight, blood pressure, urine, fundal height, foetal heart rate along with screening tests if needed or if the mother wants them, the midwife must listen to what the mother’s choices are and respect them. The mother will have an 18–20-week scan which will check for physical development and abnormalities, at this stage a birth plan will be made, this would include where the mother wants to give birth, pain relief, and just support around giving birth. If the mother works and if she is going on maternity leave, she must notify her boss 15 weeks before the baby's due date. If they are eligible for Maternity Allowance, they can start claiming from 26 weeks. The midwifes is to help and advise the best options there are. The midwife will give information about signs of labour. (Pregnancy: What you need to know for the second trimester | Hull University Teaching Hospitals NHS Trust, 2021). The third trimester is 28 weeks to full term, check-ups become more regular, the midwife will check baby’s development and the mother’s health, urine and blood pressure, the position of the baby will be checked to ensure the baby is not breech, if the baby is, the midwife will give information and support that is needed. The mother may want a c-section if the baby is breech position. The midwife will point the mother and family to the antenatal classes which are support session for parents, giving lots of information and preparing the parents on the birth and how to care for a new-born along with techniques for breathing and relaxation. These classes help parents mix with other parents from different backgrounds, parents will also get a chance to meet other professionals that maybe involved in the birth of the baby. If the pregnancy goes over 40 weeks the midwife is to discuss and give information on induction, this is to bring labour on, by membrane sweep, insertion of a virginal tablet or gel containing hormones.

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According to NICE clinical standards, the Antenatal Assessment Tool should be used to categorise patients as low risk, needing only midwifery treatment, or high risk, requiring both obstetric and midwifery care. This allows midwives to design a personalised course for each patient, determining if she requires additional obstetric treatment for medical purposes or additional social support for a range of reasons. General, past obstetric history, previous medical history, family history, and current obstetric history are the five types of risk assessment. When there are risks or causes in a pregnancy that could endanger the mother or the baby's welfare, this is referred to as a high-risk pregnancy. A high-risk pregnancy may be caused by high blood pressure, diabetes, maternal age and weight, or genetic disorders. Pre-eclampsia is classified as having a "current obstetric history," which necessitates a rigorous risk assessment to determine the best course of treatment. During appointments, the midwife will check urine and if at any point the midwife has any concern regarding pre-eclampsia, a referral would be made to see a specialist along with ensuring the mother and baby are continuously checked to ensure their safety, this pregnancy would then be classed as a high-risk pregnancy. Breech position in pregnancy can cause complications. Prior to 32-35 weeks, the diagnosis of breech presentation has no significance (as the foetus is likely to revert to a cephalic presentation before delivery). Medical analysis typically detects breech presentation. The oval foetal head can be felt in the upper portion of the uterus, and an abnormal mass (foetal buttocks and legs) can be felt in the pelvis while palpating the abdomen. Breech presentation has a significant impact on execution. External cephalic variant can be used to transform the baby to cephalic presentation via the maternal abdomen. In about half of the cases, this is successful. If the baby is breech, Caesarean section or vaginal delivery are the only choices for delivery. The midwife is to reassure and give plenty of information and advice. (Breech Presentation - Risk Factors - Management - TeachMeObGyn, 2021) Being pregnant changes all aspect of life, physically the body is changing and advice that the midwife will give and will support with is Backaches, Morning sickness, Haemorrhoids, Screening tests, Blood tests, Ultrasounds, Exercise and Nutrition. Woman that are expecting may need psychological support, as large amounts of progesterone and oestrogen is produced throughout the pregnancy and effect everything in the body these effects can be that the body and baby may need iron, oxygen, weight gain, Heart rate will increase and decrease, Blood volume will increase, and Vital organs are pressed down on by the baby. The midwife must consider that other family members may need support too, for example, how is the other parent feeling, they may be overwhelmed. There may have other children in the family, that feel anxious about the new arrival. A midwifes duty is to ensure she is reassuring and giving the right information and advice. A midwife would advise to attend antenatal classes that the family can attend and open to other parents that have same concerns. The Nursing and Midwifery Council is a statutory regulatory body that governs the midwifery profession and supports midwives' professional practise by enforcing a set of standard principles of conduct, ethics, and practise that were published in the NMC code in 2009. It underlines how statutory oversight of midwife organisations is an important part of leadership and clinical governance, as it helps to control risk by monitoring the evolution of maternity services and midwifery practise standards. Midwives must be familiar with these structures to work effectively as autonomous responsible midwives who give the best possible care to all childbearing women and their families while adhering to legal and ethical standards and being current and safe. The NMC's powers are outlined in the Order, and its major mission, as with the CMB and UKCC, is to create and enhance standards of midwifery and nursing care to protect the public by: -establishing and maintaining a registry of all certified midwives. -Establishing criteria for all midwives' education and practise to guarantee that they have the necessary abilities and attributes. The NMC has the Page 3 of 6

authority to remove a registrant from the register permanently or for a specific amount of time if they do not satisfy the requirement for skills, education, or behaviour. (The role of the midwife within the NMC | Request PDF, 2021) The Nursing and Midwifery Council is a national regulatory body that governs the midwifery profession and supports midwives' professional practise by enforcing a series of uniform codes of behaviour, ethics, and practise that were published in the NMC code in 2009. It highlights how regulatory oversight of midwife organisations is an important part of leadership and clinical policy, as it helps to mitigate risk by tracking the evolution of maternity care and midwifery practise standards. Midwives must be familiar with these structures to work effectively as independent accountable midwives who give the best possible treatment to all childbearing women and their families while adhering to legal and ethical standards and remaining current and secure. The NMC's powers are outlined in the Order, and its primary duty, as with the CMB and UKCC, is to define and enhance quality of midwifery and nursing care to protect the public by: -establishing and maintaining a registry of all trained midwives. -Establishing guidelines for both midwives' preparation and practise to ensure that they have the necessary qualifications and qualities. The Nursing and Midwifery Council (NMC) Code lays out the fundamental "laws and ideals" that a midwife should adhere to throughout her career. (The role of the midwife within the NMC | Request PDF, 2021). The four foundations of the Code apply to the position of the midwife in antenatal care: prioritise patients, practise efficiently, protect wellbeing, and foster leadership and trust. Facilitated the provision of holistic treatments. Following the Code, however, is not always easy; organisational demands often clash with NMC principles. (British Journal of Midwifery - The NMC Code and its application to the role of the midwife in antenatal care: a student perspective, 2021) Midwives get support and recommendations from the Supervisor to ensure that their profession is compliant with the regulatory system. The Midwifery Officer is responsible for and appoints supervisors. They are licenced midwives who have worked in the field for at least three years. Within the LSA's regional boundaries, each midwife must have a designated Supervisor, which is chosen from those who have been appointed as Supervisors by the LSA. In 2011 and 2012, the NMC conducted exceptional evaluations of the Morecambe Bay NHS Foundation Trust. In 2012, it updated the Midwives guidelines and practises in response to the lessons learned from the incidents at Morecambe Bay and other instances of poor treatment. These reforms may be defined as steps to reduce the risks associated with the Supervisors' dual position of support and regulation. A new regulation reinforced the LSA's standards for investigating, monitoring, and exchanging information about adverse events and concerns. The reforms were made to minimise the risk of bad case management due to misunderstanding or a lack of information on the part of the LSA and the employer/service provider. (Current midwifery supervision and regulation – the Nursing and Midwifery Council’s role | Parliamentary and Health Service Ombudsman (PHSO), 2021) Reading through the information and doing my own research I have concluded that a midwifes role is to help and settle a family with a new arrival along with taking care medically, the midwife must continue to do trainings to keep updated with the new regulations and the way new conditions are being treated ensuring they have up to date information is vital.

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Reference British Journal of Midwifery. 2021. British Journal of Midwifery - The NMC Code and its application to the role of the midwife in antenatal care: a student perspective. [online] Available at: [Accessed 9 May 2021]. Hull University Teaching Hospitals NHS Trust. 2021. Pregnancy: What you need to know for the second trimester | Hull University Teaching Hospitals NHS Trust. [online] Available at:

[Accessed 7 May 2021]. nhs.uk. 2021. Your first midwife appointment. [online] Available at: [Accessed 7 May 2021]. ResearchGate. 2021. The role of the midwife within the NMC | Request PDF. [online] Available at: [Accessed 9 May 2021]. ResearchGate. 2021. The role of the midwife within the NMC | Request PDF. [online] Available at: [Accessed 17 May 2021]. TeachMeObGyn. 2021. Breech Presentation - Risk Factors - Management - TeachMeObGyn. [online] Available at: [Accessed 9 May 2021].

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Bibliography British Journal of Midwifery. 2021. British Journal of Midwifery - The NMC Code and its application to the role of the midwife in antenatal care: a student perspective. [online] Available at: [Accessed 9 May 2021]. Hull University Teaching Hospitals NHS Trust. 2021. Pregnancy: What you need to know for the second trimester | Hull University Teaching Hospitals NHS Trust. [online] Available at:

[Accessed 7 May 2021]. nhs.uk. 2021. Your first midwife appointment. [online] Available at: [Accessed 7 May 2021]. ResearchGate. 2021. The role of the midwife within the NMC | Request PDF. [online] Available at: [Accessed 9 May 2021]. ResearchGate. 2021. The role of the midwife within the NMC | Request PDF. [online] Available at: [Accessed 17 May 2021]. TeachMeObGyn. 2021. Breech Presentation - Risk Factors - Management - TeachMeObGyn. [online] Available at: [Accessed 9 May 2021].

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