Midwifery Practice, Social Support And MDGs/SDGs: A Comprehensive Review

History of Childbirth and Institutionalization of Maternal Care

Question:

Essay: Critique of the Sustainable Development Goals 1 or 2: Midwives’ role in providing economic, environmental and social support. How do these SDG’s translate from the Millennium Development Goals 4 & 5? Think about your answer in relation to developed and developing countries, differentiating between which Goals relate to each countries.
 

This paper tries to emphasize strongly on this point while considering midwifery practice and research in context to the social support stigma. Let’s start with walking down the lanes of history to learn about childbirth and institutionalization. This would be followed by a discussion process that would try to bring out the goals of MDG and SDGs in context to midwifery – social support during the time of pregnancy and child birth. The paper would also try to provide light on the social support being provided to women during the period of antenatal care.  This would be followed by a research work thesis that would try to recognize the importance of women in regards to social support and how the midwives can effectively meet these needs.  Going through survey works carried out by experts and indulging their own selves into research works, midwives would be able to determine the requirements and needs of women during the critical scenario. A more holistic approach needs to be taken to treat women during time of pregnancy. It is necessary to give importance to the opinion of conceived women or the newly-became moms. Caring approach for every woman would definitely differ in terms of their needs and requirement while focusing on their opinion. Midwives need to focus strongly on this issue. And only then can they be able to facilitate the best restoration process in terms of autonomy, fulfillment and dignity for a woman. “Having support is one thing; being satisfied with it is another”. 

The new millennium witnessed signing of the Millennium Declaration. It was conducted on the month of September, 2000, when leaders from 189 countries signed the declaration at the headquarters of United Nations (Beeman & Bhattacharyya, 1978). The declaration comprised of a set of 8 measurable goals ranging from controlling extreme poverty, hunger to reducing child mortality and promoting gender equality, the deadline being targeted at 2015. This declaration is often termed as Millennium Development Goal (MDG). The concept was successful reaching the goals and meeting them with one global language that ensures realistic approach and easy communication with an authentic monitoring and measurement system. Although the concept and measures were drastic, it failed to achieve fully even results in every sector. The unevenness caused a point of concern. Moreover, the tenure for the MDG has an expiry date by the year of 2015 (Cott, 1992). Necessary steps would have to be taken to dissolve the discrepancy.

On June 2012, the United Nations organized a conference on sustainable development in Rio De Janeiro. This initiative tried to form a new set of goals for sustainable development process that would ensure that the MDG remains stable post the expiry date along with inclusion of some additional improvement. The ultimate point is: never lose on the momentum that got generated through the introduction of MDG. It’s a great initiative for the betterment of the society (Evans & Mitchell, 2014). Joining hands to make the globe a better place to sustain living is what matters truly. Respect the idea and proceed with a positive attitude. 

Goals of MDG/SDG in Context to Midwifery-Social Support

SDG 1 & 2 are more or less associated with one another and deals with dissolving poverty and hunger, while achieving food security, improved nutrition, and promoting a sustainable agricultural pattern. Yes, initiatives have started to make these two goals a success. More importantly, MDGs 4 and 5 that deals with reducing child mortality and improving maternal health have been perfect merged with the SDG 1 and 2. It’s quite an obvious scenario; proper nutrition and reduced food deficiency would definitely help maternal health and improvise on child mortality rate. In places like Bolivia, Sri Lanka, Bangladesh, Ethiopia, Ecuador, Colombia, Vietnam, Samoa, Peru, Guatemala, Cote D Ivory, Honduras, Palestine, Vanuatu, Fiji, Tanzania, Sierra Leone, Peru, Philippines, Mozambique, Paraguay, and El Salvador work is progressing at a steady rate (Gharaibeh, Oweis, & Hamad, 2010). 

This is the most important question. How would the goals be funded? According to rough calculations, the cost to eradicate extreme poverty and social safety would be somewhere around $66bn annually. The cost would also cover creation of funded and valued models of care where women and midwives would work in partnership mostly at the primary care level. The process is still at its initial stage. Nothing has been finalized yet. The latest report suggests that the major funding would be carried out via public finance and aid. They would be the arsenal to support and give shape to SDGs (Lucke & Heinze, 2015). However, supporting hands from private sector through tax reformation is also thought to be valuable in this context. The SDG Funding policy is trying to act as a necessary connection point to transform MDGs to SDGs through concrete level of experiences to highlight different ways to achieve sustainable and inclusive world post the year of 2015.   

Prior to the 19^th century or better to say, late 19^th century, the female community were only attached the area of childbirth.  Gelis, in his book History of Childbirth, tried to define pregnancy as a “collective experience” where relatives, friends, and neighbors involved used to be always females (Magill-Cuerden, 2006). For village community, calling outside help during the time of giving birth seemed to be a totally alien idea to deal with.  By the time of WWI, changes started to happen. Safeguarding the women’s health was a major point of discussion – “safe-guarded in the interests of family and nation”. Necessary initiatives were taken in promoting the idea of maternal welfare. More research works were carried out in maternal mortality and morbidity.  A large part of Australia witnessed the introduction of antenatal care facilities. Melbourne was probably the first city where maternal clinics were formed at Alfred Women’s, and Queen Victoria Hospitals (Managing occupational stress and fear of HIV/AIDS among nurses and midwives in Namibia, 2013). According to Kobrin, “argued again and again that normal pregnancy and parturition are exceptions and that to consider them normal physiological conditions was a fallacy”. These developments definitely affected the concept of child birth in a positive way and eliminated a large amount of risks that was earlier associated with the same. 

Providing Antenatal Care, Recognizing the Importance of Women in Regards to Social Support

So far, the scenarios seem to be perfectly ideal. It would look like that the social welfare systems and institutional structures have tried to incorporate goals that aim at reducing the maternal mortality while promoting safe birth passage. But, was it really so? Many of the authors were of different opinions:

“Introduction of maternity institutions provided a steady supply of patients, usually working class, for physicians to practice upon and improve their skills” As stated by (Nuttall, 2008), “the pauper element of society…for educational purposes would ultimately result in more finished doctors”.

“Institutional settings were a major strategy toward gaining male control over childbirth and stamping out the occupation of independent midwifery” (Nan & Heo, 2007).

“Infant and maternal mortality did not significantly decrease with prenatal admission to hospital, indicating that introduction of such institutional structures was more likely to establish male control rather than to make therapeutic advances in medicine” (Mizuno, 2011). 

Personal care is what that’s expected during the time of pregnancy. At least, this is what (“Midwives’ royal role overlooked”, 2013), claims to be. But there’s a thin line separating expectation from reality. Researchers have shown that institutionalized antenatal care have mostly failed to meet the expectation of the pregnant midwives. The ugliest scenarios that add to the cause include poor facilities in the clinic, different types of caregivers at every visit, and prolonged waiting time to meet the medical expert. Add to it very minimal scope to seek information through suitable question and answering sessions (Roberts, 2001).

“Visit to the antenatal clinic is like being in the conveyor belt; the entire experience is very dishumanising” (Sheikh & Beiseâ€ÂZee, 2011). Midwives Research (Stewart, Sidebotham, & Davis, 2012), came up with conclusion that it’s absolutely impossible for a certain segment of women to enjoy resting days at home while being unmarried and financially and socially isolated with the responsibility to care for children. 

Be it physical pain, psychological problems, or social stigmas, the experiences of a pregnant women could often be some kind of substantial. Remember, the problems would widen if those who are offering support and care during these critical time are not well aware of the problems and effects. How pregnancy can affect a girl’s life, what consequences are awaiting, and how to take proper care during the period along with strong focus on the hygiene and safety are the points that need to be well versed with (The 25th Triennial Congress of the International Confederation of Midwives, 1999). But what makes the scenario critical is little or no knowledge in the proceedings while emphasizing more on myths and ancient believes. Social stigma and painstaking moments faced by midwives and underprivileged female section of the society (especially during the time of pregnancy) is a serious point to consider. Steps need to be taken to change the way the society behaves. A liberal mindset is required (“The role of the midwife in Australia: Views of women and midwives”, 2009). It is not only about providing education; what matters most is offering the right kind of education along with the correct mindset to grasp them and implement the same for the right cause and empowerment to the society for both the genders.   

Initiatives for Achieving SDGs and Funding Policy

Research work was important. It helped in understanding the exact position of the midwives in the Australian society. The research highlighted the fact that midwives are definitely in a sort of ideal position to understand the social circumstances that would influence largely the outcome of childbirth and pregnancy. According to (Towle, Rappaport, & Anderson, 1962), there would be a major role to play by the midwives in achieving substantially positive perinatal outcome while ensuring better experience during the time of childbirth and pregnancy period. However, also points out the fact that the certain medical involvement would hinder the role of midwives.  It might differ from one nation to another, but the skills and efforts of midwives are mostly underutilized and neglected, most commonly in areas where there seems to be decision making and assessment of the situation involved. 

Yes, there are and seems to be lots of varied measures taken to implicate these restrictions. But the most important part: what kind of care is available to women being in their pregnancy stage? In case of normal pregnancy (after been assessed by medical professionals), there seems to be a segregation of tasks in relation to caring for the woman (Mizuno, 2011). However, it also varies from place to place. Societies play a strong role. Robinson states that no matter what the situation is, midwives always face shortage of time as well opportunity to develop a certain kind of continuous and supportive relationship to discuss their state of condition as well the concerning problems and betterment.

If the accepted definitions need to be followed in regards to the role and position of midwives, they have an integral role to play while handling situations of childbirth and pregnancy. The role is based primarily on a holistic approach where clinical assessment, monitoring, along with suitable provisions for supportive measures and healthy advices are well integrated. If the midwives would be allowed to follow this approach as per the definition, the constraints laid upon them needs to be removed (Magill-Cuerden, 2006). In fact, it is the midwives who need to overcome these constraints. And all this can be facilitated only through research work along with some positive mindset and help from the society.

Midwifery practice is something where success can be achieved only through proper research along with continuous evaluation of the informative material. It is not something that can be achieved merely through some traditional believes and custom sayings but not so well versed health professionals and society heads. 

“It is a well-known observation that institutional structures and systems can  often be subversive of the goals they were set up to meet (Cott, 1992).”  

7. Conclusion 

Leave aside what scholars and philosophers have quoted. Forget about the belief of elders. Ignore the traditions and customs of society. It is time to be rational and think positively. Acquiring knowledge is the key. Carrying out proper research and development to seek truce is what matters. Thinking logically with proper scientific explanations is important to bring improvement to the lives of pregnant women in modern-day society. Midwives should not go by the theory; they need to carry out deep research and question their inner selves while thinking logically. Remember midwives have an important role to play in the society. Their positive involvement in serving women during pregnancy and childbirth could bring about a striking positive difference to the society.   

References

Beeman, W. & Bhattacharyya, A. (1978). Toward an Assessment of the Social Role of Rural Midwives and Its Implication for the Family Planning Program: An Iranian Case Study. Human Organization,37(3), 295-300.

Evans, M. & Mitchell, D. (2014). Exploring Midwives’ Understanding of Spiritual Care and the Role of the Healthcare Chaplain within a Maternity Unit. Hscc, 2(1). 

Gharaibeh, H., Oweis, A., & Hamad, K. (2010). Nurses’ and midwives’ knowledge and perceptions of their role in genetic teaching. International Nursing Review, 57(4), 435-442. 

Lucke, S. & Heinze, J. (2015). The Role of Choice in Cause-related Marketing – investigating the Underlying Mechanisms of Cause and Product Involvement. Procedia – Social And Behavioral Sciences, 213, 647-653. 

Magill-Cuerden, J. (2006). Social support in pregnancy: Midwives have a crucial role to play. Br J Midwifery, 14(3), 156-156. 

Managing occupational stress and fear of HIV/AIDS among nurses and midwives in Namibia. (2013).

Midwives’ royal role overlooked. (2013). Nursing Standard, 27(48), 10-10. 

Mizuno, M. (2011). Confusion and ethical issues surrounding the role of Japanese midwives in childbirth and abortion: A qualitative study. Nursing & Health Sciences, 13(4), 502-506.

Nan, X. & Heo, K. (2007). Consumer Responses to Corporate Social Responsibility (CSR) Initiatives: Examining the Role of Brand-Cause Fit in Cause-Related Marketing. Journal Of Advertising,36(2), 63-74.

Nuttall, A. (2008). Scottish Midwives: Twentieth-Century Voices. Social History Of Medicine, 21(3), 598-600.