The screening and tests during pregnancy are integral part of the entire physical development of the mother and the child. It is always important to be under professional supervision while a woman is undergoing pregnancy. By means of upgrade technological support the other and her family get update about the conditions and status of the upcoming child. In a country like Australia where every effort has been led by medical authorities in bringing up a healthy child, the support from doctors and midwives are very obvious and continuous. The medical support and related education about the importance of screening and tests and childbirth are often initiated by well trained mid wives. These midwives are responsible for managing the mental and physical status of the pregnant woman and the way they provide her and the family with enough support in developing a healthy child (Queensland Health. 2008).
This paper in particular is making and analytical survey over the roles and the responsibilities maintained by the midwives, especially during the sessions and screening and various tests in pregnancy. The basic motive is to identify the ways the midwives handle different situations and encourages the pregnant woman in following absolute ways of undergoing the screening and tests. The major concept that this paper is going to highlight is the importance of screening at different levels and the demands for various tests during pregnancy. All these activities are important for a pregnant woman, but to make them realize these importances, the roles of midwives will be analyzed. The mental and physical preparations for every ultrasound or tests need proper speculation over the woman and the cooperation shared by her family. This is something that a midwife manages to get in the right way. The screenings at different levels helps in keeping an eye on the developments of the child in the womb and every single deviations needs to be handled properly. In such cases the support from a medical expert turns compulsory and the role of the midwives turn mandatory.
Common Tests During pregnancy
For the welfare of the child and the pregnant mother, there are several tests and stages of screening conducted by the medical authorities. These tests and stages of screening are integral part for coming up with a healthy child. As the procedures are accomplished the gynecologist keeps a record of the entire process of development. Along wit the gynecologist, the midwife too plays a vital role in maintaining these records and supports the pregnant woman in dealing with the hurdles if any. The foremost among all these processes are the preliminary Ultrasound scan (CYH, 2009). It is a process where the ultrasound uses some specific sound waves in the womb. The process helps in creating the image of the fetus. The need for ultrasound in the first trimester is very vital as it helps in detecting the abnormalities that might harm the fetus (First trimester screening. 2009). This is a general process. However in some cases the preliminary ultrasound gets followed by 'fetal and umbilical doppler ultrasound' that is recommended in a stage when high-risk pregnancies are detected (Fetal and umbilical Doppler ultrasound in high-risk pregnancies, 2009). High risk for pregnancy gets detected if the mother is having some diseases like high blood pressure, diabetes or kidney or heart problems. The process adds the testing and diagnosis of the collected images for any unexplained status for antepartum haemorrhage (Antepartum Haemorrhage.2009). In many cases these diseases proves to be dangerous for the child in the womb. It can even have negative impacts over the growth of child. The risk can increase to a level, where the child gets trapped and could not attain necessary growth. The next level of screening and tests are done to make an assessment regarding fetal wellbeing of the pregnant woman during the third trimester (Assessment of fetal wellbeing in the third trimester. 2009). The process is a specialized procedure that adds screening of algorithm measures for the establishment of fetal well-being in the later part of pregnancy. There is the need for tests for ectopic kind of pregnancy (Suspected ectopic pregnancy. Aug 2009).
Tests and screening for pregnant women after 35 years of age increases (Pregnancy after 35 years of age. 2009). Since these women are more likely to have fragile and disease affected babies, it is important that regular medical checkups and tests are considered seriously. The process of undertaking of tests related to infections in the genital track is important to assure healthy childbirth (Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. 2009). These cautions add the process of analyzing different tests and screening programs of different kinds. These specialized forms can be marked as following-
- AFP (Alpha-fetoprotein) tests
- Amniotic fluid index
- Chorionic villus sampling (CVS)
- Cervical assessment
- Preconception and antenatal screening
- Finding problems before birth
Role and Responsibilities of the Midwives
The roles and responsibilities of midwives are more concerned about being human and providing care and support to women in the process of child birth. A midwife is more than a friend or guardian. As she is responsible for taking care of a pregnant women her training and education makes her very important in maintaining proper health of the pregnant woman and her child. The roles of midwives are usually recognized as professionals who work as a partner to the pregnant woman and offer her necessary physical and mental support. Her process of care and advice during the phase of pregnancy is very vital as she needs to keep record of every tests and screening levels. A midwife need to be very well balanced and sincere personality. As the pregnant woman and the gynecologist depend a lot on her, she needs to be extremely sincere and responsible. Her performances for ultrasounds and all the other tests related her directly to the pregnant woman.
She makes the pregnant woman understand the importance and related concerns about every screening and every test (Boud, 2000). She should be able to make the pregnant woman know that ultrasound or physiological screening is a vital process of understanding the status of the child that is developing within the womb. The realization of this knowledge in the woman prepares her mentally about the value and the possible solutions for any critical situation, if faced. The process of ultrasound is done -
Ø For adding nuchal translucency screening. This screening helps in identifying the situation where the baby can be at the risk of having chromosomal problems. If there is any such problem than the pregnant woman will be referred for tests for assessing Down syndrome in the child.
Ø The process is also very supportive in checking the development of mental and spinal growth of the baby. In case of possibilities related to increased risks of spina bifida there is the possibility for screening tests to understand the neural tube defects.
Ø To get the actual image of the baby for the purpose of appropriate CVS (Chorionic Villus Sampling) or amniocentesis assessments.
During the preliminary stages of ultrasound, the role of the midwife though seems minimal, yet at the same time is very important. For a new mother this is a stage of great excitement and she always needs someone to share her feelings. The role of the midwife here is to prepare the pregnant woman in realizing the importance of the process and add necessary steps for achieving a success. If under certain circumstances, the pregnant woman is recommended for 'fetal and umbilical doppler ultrasound', the role of the midwife increases. As it is done for high risk pregnancies, the midwife needs to take more care of the woman. More than physical status, the midwife should be more conscious about the mental status of the woman. If the pregnant woman is having any disease, then it becomes very necessary that the midwife prepare her with right kind of physical status to provide the child in the womb the right growth. Proceedings related to algorithm assessments are important for the fetal well being in the later stage of pregnancy and thus need proper midwifery supports.
It is important to note that the midwife plays an important role in health counseling the pregnant woman and her family. Her approach is directly related towards the creation of a positive and healthy atmosphere for childbirth. Her importance increases in terms of situations where the women undergo experiences that deviate normal circumstances during pregnancies. Consultations with midwives support in creating right kind of proceedings towards the attainment of specialized medical attentions and treatments. Collaborations with gynecologist or obstetrician, midwives can offer absolute health care assistance with specialist's speculations. Instances of detected antepartum haemorrhage or down syndromes are very critical for a pregnant woman to handle. In such occasions the role of the midwife increases as she needs to make the pregnant woman realize that the critical condition and the ways to deal with it. Mental support and proper maintenance of instructions declared by the gynecologist are very important and the midwife can help in marinating the instructions in the best possible way. During the screening of infections in the antenatal lower genital tract the pregnant women can come under the risk of infectious diseases like bacterial vaginosis; including trichomonas, chlamydial and gonorrhoeal infections (Roberts, Tracey and Peat, 2000). The midwife thus needs to support the pregnant woman in dealing with these infections and offering options for a healthy child. Late pregnancy needs more screenings and testing. Support from midwives in such cases is of great help. The midwife is efficient enough in dealing with every complicated situation and thus is important to deal with any kinds of emergencies. It is under her supervision that a pregnant woman can rely a lot about a balanced development of the child in the womb.
Ethical and Philosophical Aspects
It is important to understand that the roles played by midwives are much different from the one that gets played by a doctor. The philosophical perspectives of considering midwifery relate itself to diversified substantial perspectives. It is very traditional medical profession that has been much developed and made much sophisticated in modern medical scenario. For a medical practitioner, the state of pregnancy is a physical condition that undergoes natural developments. On the other hand the midwives understand the emotional, psychological and physical conditions of a pregnant women and thus deals with the medically defined physical status on personal basis. As declared by Turkel "birth is something that women do, not something that is done to them" (1995). Midwifery follows this ideology and considers the state of a pregnant woman as an important development of life. As she gives birth to life, midwifery considers it as an event that should be treated with excessive care.
In Australia the importance of midwives are increasing as they are of great support to a pregnant woman and even after the birth of the child. As the midwives in Australia are trained with immense medical backdrop and with both exclusive and inclusive modes of handling cases, they are acquiring hold over every issue related to pregnant women. Though diversifications are there regarding the preferences of midwives in early pregnancies. However the importance of the same arises; whenever some complicacies or problem get detected. As the midwife is efficient in handling emergencies and pressures, her presence always proves to be supportive for all kinds of complicacies. The Australian structure of midwifery is highly encouraged in the later days of pregnancy and especially after child birth. But this is actually not the proper way of taking the assistance. A midwife should be appointed just after the detection of pregnancy.
Since the responsibilities of midwifery are related to the mental and physical set up of the pregnant woman it is important that both get enough time to understand each other. It is true to note that women need support more at the later stages of pregnancies, but a midwife who comes to assist a pregnant woman in the later stage, hardly gets enough idea to handle her in the initial days. It again takes some more days to create the bonding between the two (Hatem, et.al. 2008).
On ethical grounds, the professions of midwives are all about providing necessary care and mental support to the pregnant woman. A midwife who is with a pregnant woman fro her initial days of pregnancy can keep track of every positive and negative nature and get acquainted with the pregnant woman in the best possible way. As she keeps track of every single test and screening, the midwife should accompany a pregnant woman from the initial days of pregnancy. In this way she will get enough time to prepare the pregnant woman about different tests and the enquiries related to same. She also can turn up to be of great support in case of something that is totally unexpected. Preparing the pregnant woman for all kinds of tests need mental preparations and a midwife can provide her with the same, once she gets appointed. Added to the process of educating the pregnant woman about the process of tests, screenings and conditions of pregnancy, a midwife also takes the responsibility of creating positive and cheerful environment for the pregnant woman (NATSHIHC. 2003). She makes the family and the community conscious of the pregnant woman and makes them realize their importance around the pregnant woman. To a great extent the midwife insists the family and the community to offer their support and cooperation in making pregnancy a lifetime experience. With good communication skills, the midwife adds all kinds of important aspects around the pregnant woman.
It is very appropriate to conclude with the woman-centred declarations and approaches made by Pairman, S. Pincombe, J. and Thorogood, C. (2006). According to these authors, it is important to analyse the roles and responsibilities of midwives as per the modern socio-political environmental conditions. With the development of science and technology the need is to offer best of the services and supports to the pregnant woman. When it comes to tests and screening part of a pregnant woman there are possibilities of facing some hurdles. The role of midwife is to make the entire process comprehensive and easy to handle. As the midwife attains the task of handling the mental status of the pregnant woman she adds the elements of being obvious in every hurdle faced by the woman. Being aware of the physiological conditions and the probable status of the pregnant woman, a midwife prepares her for all kinds of tests and screening levels. It gets very clear that the role and the responsibilities of midwives are much more than any family member or any doctor. A midwife deals more with the psychological side of the pregnant woman than the doctor. At the same time she deals more with the physiological anxiety of the pregnant woman than any of the members of the family or the community (Guilliland, 1999). Her role is unique. She is a blend of professional medical expert and a very closely attached friend. For a pregnant woman it is also not easy to keep track of every medical and physical attention. In such cases the responsibilities of the midwives helps the pregnant woman realize the importance of every aspects that gets recommended. The process of dealing with complicacies and complicated physical and mental conditions get balanced by midwives support.
The role and the responsibilities of a midwife in terms of handling medical tests and screenings at different levels are inevitable. As declared by Australian Nursing and Midwifery (2006) a midwife is in total charge of preparing the pregnant woman for all kinds of tests and to share the happiness of being in perfect condition. She is also responsible to take charge of the mental stress and anxiety faced by a woman in references to some hurdles discovered during the tests and screenings. With her good communicative skills, a midwife educates the pregnant woman about the demands and the needs of tests and screenings. This further gets followed by the understanding of dealing with situations where the pregnant woman is going to have some complicacies. As she has been educated by the midwife there is always the scope to accept that might occur unexpectedly. It is necessary to consider the importance of from the initial days of pregnancy as it gives her the room to share and educate the pregnant woman for a healthy childbirth.