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Medicalization Of Childbirth In Cyprus

Medicalization Of Childbirth In Cyprus



This is a presentation by Eleni Hadjigeorgiou as part of the virtual International Day of the Midwife 2009.

This is a presentation by Eleni Hadjigeorgiou as part of the virtual International Day of the Midwife 2009.



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Medicalization Of Childbirth In Cyprus Medicalization Of Childbirth In Cyprus Presentation Transcript

  • An exploration of midwive’s perceptions advocating normal childbirth. Eleni Hadjigeorgiou Cyprus
    • The aims of intrapartum care are a healthy mother and child, and a positive birth experience for the women with the least possible number of interventions (Sandin- Bojo 2005).
    • In Cyprus, women are complaining for the increased intervention during childbirth as well as the high caesarean section rates, which reach up to 56% in private sector and 30.1% in the public sector (POLITIS newspaper 31/3/2009, 1,2,3,4/4/2009, SIMERINI 2/4/09, Cyprus Ministry of health 2009).
  • Normal Childbirth
    • ‘ Normal’ Childbirth is a labour where a woman commences, continues and completes labour physiologically at term (ICM 2006).
  • Natural childbirth
    • Natural’ childbirth is an approach characterised by bias towards physical and mental hygiene in the management of pregnancy and birth (Moscucci 2002).  There are no interventions and the woman may follow her instincts and behave as she chooses.
  • Medicalisation
    • Medicalisation is an approach to labour characterised by increased intervention following medical philosophy about childbirth (Johanson et al 2005).
  • What is advocacy?
    • Advocacy is often considered a buzzword (Alison 2004). Mallik (1998) opined that the Latin meaning of the word is “call” while the legal use of the word means “ to plead or to counsel”. Gates (1994) states that: ‘An advocate is an individual who is willing to speak up for any person with as much conviction as if the person were one of the advocate’s own relatives.’
  • AIM
    • The main aim of this research was to explore the factors surrounding the extent to which midwives in Cyprus are advocating ‘normal’ childbirth.
    • 1. To explore key literature related to the subject area of this project.
    • 2.  To identify the concerns of midwives in relation to advocating ‘normal childbirth’ via semi-structured interviews.
    • 3. To explore and to address the concerns identified, through amendments to programmes of continuing professional education.
    • 4.To identify the ‘gaps’ in current policy regarding midwifery in Cyprus, with a view to making recommendations to appropriate bodies.
  • Key questions
    • 1.What are the key factors which motivate and drive midwives more effectively to act as advocators?
    • 2. What are the discouraging factors?
    • 3. How can the development of advocacy practice be built, based on the findings of this research?
    • The Qualitative Research approach was identified as the most appropriate methodology for this project due to its nature of being a strategy that provides the researcher with comprehensive knowledge and insight about human beings (Holloway &Whweeler 1997).
    • If the focus was on in-depth exploration of subjective experience, then phenomenology would be suitable. The choice to include a phenomenological approach for this project was driven by the need to identify the aspects of the experiences of midwives advocating normal childbirth from the participants’ viewpoint in order to interpret the totality of the phenomenon (Bailey et al 2002).
    • Midwifery leaders to nominate 10 exemplars midwives across Cyprus due to their clinical expertise, experience and midwifery philosophy in order to get rich data . As Patton explains: “ the logic of power of purposeful sampling lies in selecting information-rich cases for study in depth”.
    • The knowledge from the observations was used to frame the interview questions for the interviews. Semi-structured interviews were used because they allow the flexibility to probe for more information and offer the interviewee the feeling that his or her personal opinion is being taken into account (Silverman 2005).
    • list of all topics covered
    • found the most descriptive wording of topics
    • turned them into categories.
    • interpret and support findings with literature.  
    • The concept of trustworthiness includes four alternatives: credibility, transferability, dependability, and conformability (Talbot 1995). Credibility was established when I reviewed with my participants the interpretations of my data and I made the necessary changes, prolonged involvement, persistent observation, peer debriefing and member checks (Robson 2002) .
    • A significant limitation of the study is the researcher’s predisposed beliefs relative to midwifery , which may be perceived to lead to agreement with the participants or misinterpretation of data collection. To ensure an objective position, a second researcher, with fundamentally less pre-disposed believes of midwifery has been engaged to assist with the study.
    • Effort to remain objective, during interviews and participant observation will fundamentally minimize any potential or perceived bias.
    • Ethical issues were concerned with the participant’s autonomy, c onfidentiality and anonymity during the study period. All participants informed of the purpose and design of the study and also the voluntary nature of their participation. The interviews were anonymous using a code number. Transcribing was carried out solely by myself as another way to safeguard confidentiality.
    • The research proposal was approved by the Middlesex University and the Ministry of Health. Consent for data collection obtained from the Ministry of Health and from Hospital Managers, since there is no ethics committee available.
  • Project findings ADVOCACY Midwives status Skills , knowledge attitudes Medicalization of childbirth Physician leading Luck of support- Shortage of staff Basic and continuing education midwife-woman relationship Preparation of parenthood
  • Discussion
    • The factors that were identified as facilitator to advocacy were midwives status, development of functional midwife-woman relationship, preparation for parenthood and Continuing Professional education . The findings of this study were congruent with O'Connor and Kelly (2005) results whose point out that t he nurse’s role as patient advocate accords high status to nursing practice.
    • Midwives mentioned that preparation for parenthood lessons would facilitate their role as advocator because midwife as the prime educator in all aspects of childbirth she is in a unique position to act as advocate, to assist and empower woman to have normal childbirth. They also revealed the importance of midwives good relationship with the woman which provide mandate in their best interest.
  • Continuing Professional education
    • Midwives believe that Continuing Professional education will help them to improve the midwifery care and to actively advocate normal childbirth. P rogrammes about law, patient rights and advocacy skills are essential for them.
    • Midwife with Continuing Professional education will be able to account for, explain and justify her actions as being dictated by her professional knowledge and judgment (Etuk 2001).
    • .
  • The factors that were identified as barrier to advocacy were, Physician attitudes, medicalisation of childbirth, Lack of support and shortage of staff.
    • Almost all of the midwives believed that “Physicians leading” was the most important factor that produced obstacles to advocacy.
    •   All midwives noted that obstetrician had the authority and they therefore realized the vulnerable position of midwives in Cyprus health system. The medical monopolies lead to medicalization of childbirth.
    • Medicalisation of childbirth as a crisis that affect mothers, their babies and the midwifery profession
    • Stapleton et al. (2002) highlights the difficulties midwives face in trying to fulfil their role and meet women’s needs within the medicalised, institutionalised childbirth culture
  • Luck of support-shortage of staff
    • It was evident from the data that the midwives’ perceived inability to observe and administer proper care to the mother due to time pressure, their communication with women tended to be inadequate and might result in unclear information. Luck of support and Shortage of staff identified as barriers to advocacy. Participants expressed their definite need to feel valued by their seniors:
    • All organizations should realize that stress and burnout can be costly both to individuals and to the organization itself (Omdhahl and O’donnell, 1999).
  • Conclussions
    • This project has accomplished its goal in exploring and identifying the concerns of midwives in relation to advocating ‘normal ‘childbirth. Participants in this study believed that in these circumstances and by taking in consideration barriers mentioned , taking an advocacy role is difficult for the midwives.
    • Therefore, midwives opined that key factors facilitate midwives act as advocators must be promoted. This research confirms that there is a real need to set objectives, review progress and pursue follow up actions
    • Midwives, in order to be effective advocates, need to be recognized, and to recognize themselves, as equal partners within the multidisciplinary team. They also need to be confident in the support of their employer and professional organizations.
    • Midwives should have more knowledge about law, patient rights and advocacy skills. Extending midwives knowledge is best achieved through effective continuing professional education programs.
    • Support for research and dissemination of information – to develop the knowledge and evidence base for practice in midwifery principles-- to influence policy-making
    • Midwives should promote care that fosters normality during pregnancy and childbirth . They should empower the women with preparation of parenthood, to ask for their rights.
    • A regulatory body, governed by midwives, whose sole interest is the education, registration and standard of practice of midwives would surely better serve the needs of the midwives. Midwives should have more knowledge about law, patient rights and advocacy skills
  • I envision a future where midwives have the power to advocate normal childbirth. For the world to see birth as the wonderfully natural life event it is. Thank you