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Reflective Profile - The Practice of Midwifery

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Candidate Number: 1309261 Reflective Profile The Practice of Midwifery The following reflective profile will address the use of fetal monitoring during antenatal visits and specifically the use of the hand held Doppler and Pinards stethoscope. This topic relates to competencies numbers 8.2 and 8.3 as documented in the Midwifery Practice Assessment, Year 1, Week 12. In the interest of anonymity, pseudonyms have been used in compliance with NMC (2002). To facilitate in the construction of this work the Gibb. (1988) reflective cycle has been utilised (see appendices). The Gibb. (1988) reflective cycle initially suggests that in order to reflect successfully, the event which took place should be described. Present at the event were a midwife called Christine and a student Emma whose roles on this particular day were to see a number of women at an antenatal clinic. A woman, Jo, who was a primigravida and 36 weeks gestation, had an appointment to see the midwife. She was known to Christine and had seen her on a number of previous occasions. Christine and Emma performed the antenatal check but explained to Jo that the NICE guidelines, (NHS, 2003) now suggest that the fetal heart is not auscultated routinely as it had been previously. Jo conveyed that she would not be happy with this arrangement and requested it was performed irrespective of these guidelines. ...read more.


the type of equipment used to auscultate should also be documented and this was not done. An advantage of using both Sonicaid and Pinards stethoscope is that Christine would have been maintaining her skills, which is recommended by NMC (2002). Henderson & Jones (1997) state that the fetal heart is always auscultatated on clinical examination and it would be extremely difficult to change habits if a midwife has been practising for years. However, the choice of listening in to the fetal heart rate meant that Christine did not follow the clinical guidelines which are, after all evidence-based and suggest that although auscultation of the fetal heart confirms that it is alive at that present moment it is unlikely to predict any outcomes, therefore recommending the termination of this routine practice at antenatal visits (NHS, 2003). This routine observation may also use up valuable time that might be spent on other midwifery duties but this could be at the expense of an unhappy and anxious expectant mother. Feeling anxious about her baby may have other implications upon the mother, as all pregnancies should be as stress free as possible. Gibb, (1988) continues with an analysis of the incident in order to make sense of it. ...read more.


It appears that women need to be better informed about this practice; that hearing a heartbeat does not necessarily guarantee a safe outcome for the pregnancy. The maintenance of a midwife's skills should be considered and if this practice is not upheld both the practice of midwifery in this particular area and the mother's wishes will subsequently suffer. A student can only learn these skills if they are used in practice frequently and therefore the future of using these particular types of equipment is also being challenged. Gibb (1988) rerflective cycle concludes with an action plan. As a student it is apparent that decisions and guidelines for midwives are not always clear-cut and may often conflict. There are dilemmas that midwife faces that place her in a difficult position regarding her role and her duties as such. Should she follow the guidelines or listen to what women want regardless of what the recommendations state? It appears there are no definite answers but happily the guidelines do give a little scope in the interpretation of the recommendations regarding fetal heart monitoring. The very fact that there is a clause which states that if a mother requests for her baby's heart to be monitored suggests a recognition that this is still a reassuring feature in the antenatal check for the expectant mother and it would seem from this particular incident that it will remain so. ?? ?? ?? ?? 1 ...read more.

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