Midwives as Partners in Primary Health care
Effective partnerships and knowledge translation (KT) are needed to encourage the ongoing inclusion of midwives in primary health care teams in Canada. Midwives are cost-efficient and effective members of any health care team, and may serve as brokers for knowledge translation (Tracy et al, 2013). However, there is resistance among health professionals, policy makers, and government and to fully embrace midwifery’s role in primary health care. Midwifery primary care focussing on nutrition, exercise and healthy breastfeeding with mothers is an important part of their work. Health promotion, an important component of public health, enables people to increase control over and improve their health (WHO, 1986). Education and informed choice (the mother makes the decisions about her care after being explained the choices by her midwife) are cornerstones of midwifery care, and are also part of health promotion. KT may increase knowledge among policy makers and local governments of the scope and abilities of midwives to play a role in primary health care teams.
To advance this change of practice, health systems decision-making can be enhanced by deliberative dialogues between members of the primary health care team, midwifery associations and regulatory bodies, community members, local government representatives and policy makers. Boyko et al (2012) have studied deliberative dialogue as a KT strategy and how it can support evidence-based decision-making. Key features of deliberative dialogue include an appropriate meeting environment, mix of participants and use of research evidence. Intended effects of the dialogue were to build mutual understanding, alternative ways of thinking about the problem, developing policy alternatives and health system capacity to make evidence-informed decisions (Boyko, 2012).
Lessons learned from KT around partnerships in a Canadian public health context may be perhaps be transposed to the midwifery and primary health team context. Knowledge from KT research may help us to know what works and what does not work to form and maintain effective partnerships that in turn, improve primary health care (Sibbald, 2012). There are many definitions of partnerships but some work better to increase capacities of teams. ‘Intra-partners’ involve partners from different domains working together to achieve a common goal. They can be professional in nature or partnerships between professionals, researchers and the community. Working with partners is thought to contribute to individual and community empowerment, and to lead to the use of research in decision making.
Partnerships have been found to be beneficial because they provide additional resources in time, personnel and funding (Sibbald, 2012). Health units in northern and remote areas need additional resources, including midwives who could share health promotion, maternal, infant and well woman education and clinical duties. Partnerships provide fresh ideas and an entrance to the community. A midwife partner in a rural health unit would make inroads to the community, because of her ability to work with women and their families, providing education and birthing assistance to parturient women.
Sibbald (2012) found that public health centers also formed community partnerships using integrated KT whose strength was based on trust, time and insider know-how.
Relationships are a key ingredient for effective knowledge translation. Integrated knowledge translation favouring a community centered participatory model, empowering individuals and increasing control of their health fits the role of midwives.
Partnerships are an essential feature of effective KT, and can transform practices or modes of intervention. Midwives could transform the way health units work with mothers or the interventions used in maternal infant care, such as the emphasis on personalized care and home visits. When midwives began to work with obstetricians teaching interdisciplinary courses, such as ALARM (Advances in Labour and Risk Management; SOGC) new knowledge was added to the course in handling some maternity concerns in physiological ways (such as the ‘Gaskin’ manoeuver to deliver a baby whose shoulders are stuck).
Knowledge translation on how to initiative, maintain and sustain partnerships may break down the barriers among health professions and encourage midwives to play a role as a full member of primary health care teams.
Advances in Labour and Risk (ALARM). SOGC. http://sogc.org/continuing-medical-education-cme/alarm/
Boyco J, Lavis J, Abelson J, Dobbins M, Carter N. (2012). Social Science & Medicine 75, 1938-1945.
Sibbald S, Kothari A, Rudman D, Dobbins M, Rouse M, Edwards N, Gore D. (2012). Partnerships in Public Health: Lessons from knowledge Translation and Program Planning. Western University. From the SelectedWorks of Anita Kothari. http://works.bepress.com/anita_kothari/29.
Tracy S, Hartz D, tracy M, Allen J, Forti A, Hall B, While J, Lainchbury A, Stapleton H, Beckmann M, Bisits A, Hommer C, Foureue M, Welsh A, Kildea S. (2013). Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. The Lancet. Retrieved from http://dx.doi.org/10.1016/S0140-6736(13)61406-3
World Health Organization (1986). Ottawa Charter for Health Promotion. World Health Organization: First International Conference on Health Promotion, Ottawa, Canada.