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Midwives as doctor's handmaidens?

There has been a fascinating debate amongst midwives on the ozmidwifery list around the tasks that midwives are asked to perform during labour and whether this constitutes stepping over the line to become obstetric nurses.

It began with a request for hospital policies on the topping up of epidurals, which prompted a spirited response that this was not a midwifery task but a medical one, and should therefore be performed by an anaesthetist. This raised the point that epidurals are also used post caesarean and that anaesthetists are not always on site - should midwives let women suffer because an anaesthetist wasn’t available?

The discussion then extended to other clinical tasks such as cannulation and the giving of antibiotics in labour (usually for the treatment of Step B infection in labouring women - GBS). Some midwives felt that this was well within the scope of practise of a midwife and others felt that it was perilously close to a medical treatment and that by performing these tasks, midwives risked becoming “doctor’s handmaidens”.

Another contributor raised the point that if an intervention was required, such as an ARM, or even a vaginal examination (which could be seen as an intervention in some situations) then it would be better done by a midwife, who was often a lot more gentle than some doctors or residents. The idea of protecting the woman from unnecessary discomfort or disruption to her labour was an important issue in this midwife’s mind.

Midwives in rural areas pointed out that they regularly carry out these treatments in other areas of the hospital where they work as nurses when not required in the maternity unit. To refuse to use these skills in the labour ward would severely limit their employability in remote areas.

Then a discussion arose around the condition of GBS, and whether women who carry this normally harmless bacteria are in fact sick (and requiring medical care) or well, and therefore suitable for midwifery care, which may result in the siting of a drip and the giving of antibiotics in labour. This discussion is on-going, with various points of view being aired.

Describing the role and scope of midwifery is a tricky exercise. I find myself agreeing, in one way or another, with most of the correspondents as the discussion swirls around in a very energetic fashion. I do think that midwives need to guard against performing tasks ordered by the doctors when they are not necessary, such as inductions, vaginal examinations, and rupturing membranes. Taking care of a woman’s comfort in labour is also very important, and if a necessary task, such as topping up an epidural (if the more satisfactory continuous infusion is not available) is required in the absence of medical help, then common sense may suggest the midwife should help.

Email discussion lists are such a useful forum for airing views and canvassing help and opinion. If you would like to follow these threads, please feel free to join the list - we have members from allover the world taking part by now! Click here for details on how to link yourself in.....

Posted by andrea at May 23, 2005 03:17 PM