One-to-One Midwifery: Restoring the "With Woman" Relationship
One-to-One Midwifery: Restoring the "With Woman" Relationship
One-to-One Midwifery, a model of care developed in the United Kingdom, provides a continuous and personal relationship between each woman and her midwife. The organization of care and the outcomes are relevant to midwifery policy in all industrialized countries. One-to-One Midwifery is not solo practice. An important principle of the organization of the practice is to enable individual midwives to take time off and to provide supportive structures for the midwives. Here the implications of One-to-One Midwifery for childbearing women and their families, and the midwives involved, are explored. The One-to-One Midwifery model has particular relevance for Canada because it is very similar to the model of practice being developed in at least two provinces. It may also be of importance in the United States, particularly for midwives working shifts in hospitals who may want to develop a system that allows them to provide continuity to the women they serve.
The roots of midwifery lie in the support given by one woman to another around the time of birth. Until recently, midwives were at least a part of the woman's life or community, kith and kin, or neighbors. Thus, the midwife worked alongside the woman, or as the word midwife means, "with woman," understanding her life and circumstances. Even after the professionalization of midwifery, most births in the United Kingdom took place at home, and the midwife was a part of the woman's community.
In much of the industrialized world, the growth of obstetrics, the move from home to hospital birth, the increased medicalization of birth, and fragmentation of care has led not only to reduced autonomy for midwives but also to a destruction of the individual relationship established over time between women and their care providers. Yet this relationship is the crux of effective, sensitive, and autonomous care. Although we may improve midwifery without restoring the personal relationship that is crucial, improvements will be limited and will miss an essential source of fulfillment for both childbearing women and midwives. The redevelopment of this personal professional relationship between women and their midwives is an important step in the humanization of birth and has never been more necessary.
In the United Kingdom, policy at the national and local level stimulated a large number of innovations in practice that seek to create an organization of care that enables what has come to be called continuity of carer, meaning a continuing relationship that allows the woman and her midwife to get to know each other and develop a relationship of trust over time. This article describes the development of a program, One-to-One Midwifery, which sought and achieved a very high level of continuity of carer. It is noteworthy that this model provides a supportive structure for midwives. The outcomes of the evaluation of this innovation are summarized, and some of the implications of this pattern of practice for women and midwives are described.
One-to-One Midwifery, a model of care developed in the United Kingdom, provides a continuous and personal relationship between each woman and her midwife. The organization of care and the outcomes are relevant to midwifery policy in all industrialized countries. One-to-One Midwifery is not solo practice. An important principle of the organization of the practice is to enable individual midwives to take time off and to provide supportive structures for the midwives. Here the implications of One-to-One Midwifery for childbearing women and their families, and the midwives involved, are explored. The One-to-One Midwifery model has particular relevance for Canada because it is very similar to the model of practice being developed in at least two provinces. It may also be of importance in the United States, particularly for midwives working shifts in hospitals who may want to develop a system that allows them to provide continuity to the women they serve.
The roots of midwifery lie in the support given by one woman to another around the time of birth. Until recently, midwives were at least a part of the woman's life or community, kith and kin, or neighbors. Thus, the midwife worked alongside the woman, or as the word midwife means, "with woman," understanding her life and circumstances. Even after the professionalization of midwifery, most births in the United Kingdom took place at home, and the midwife was a part of the woman's community.
In much of the industrialized world, the growth of obstetrics, the move from home to hospital birth, the increased medicalization of birth, and fragmentation of care has led not only to reduced autonomy for midwives but also to a destruction of the individual relationship established over time between women and their care providers. Yet this relationship is the crux of effective, sensitive, and autonomous care. Although we may improve midwifery without restoring the personal relationship that is crucial, improvements will be limited and will miss an essential source of fulfillment for both childbearing women and midwives. The redevelopment of this personal professional relationship between women and their midwives is an important step in the humanization of birth and has never been more necessary.
In the United Kingdom, policy at the national and local level stimulated a large number of innovations in practice that seek to create an organization of care that enables what has come to be called continuity of carer, meaning a continuing relationship that allows the woman and her midwife to get to know each other and develop a relationship of trust over time. This article describes the development of a program, One-to-One Midwifery, which sought and achieved a very high level of continuity of carer. It is noteworthy that this model provides a supportive structure for midwives. The outcomes of the evaluation of this innovation are summarized, and some of the implications of this pattern of practice for women and midwives are described.
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