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- Community-based maternity care from the view of Iranian midwives: A phenomenological study
This included abortion prohibition that caused women with unwanted pregnancies and illegitimate relationships to have unsafe and illegal abortions. Moreover, this method can result in serious health injuries and even death. Most participants considered this issue as an important concern in their profession:. She wanted me to help her, but there was nothing that I could do. I was certain that she would have an unsafe abortion and her life was in danger. The law had tied my hands, and there was no support and legal system that I could refer her to. I just explained to her about the risks of septic abortion.
Later, she came to me with severe bleeding and fever. Today, more than ever, there is a need for midwifery to become community-based. This is due to the changes that have occurred, in recent decades, in science and human communities and, consequently, have affected moral and social values.
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Moreover, the health needs of women in social and cultural contexts should be extracted, and services appropriate to their needs should be designed. These services should be given to women who do not have access to them. Thus, obstetric services should be fully community-oriented and midwives should gain many skills in this way. Community-based midwives should have the ability to make decisions for the specific social conditions. This requires sufficient knowledge of community needs, and legal and supportive networks.
Midwives, over time, reach a maturity in their career and are able to provide their experiences to community health planners. Participant 3 stated as follows:. I tried to find solutions for my client's social problems, and it did not damage the norm of society and religion, and yet it did not harm the patient's health. Participant number 7 talked about the maturity that she reached in her profession during time:. But now I have gained maturity through time and try to view the matters from the community perspective and try to help the patient and help them avoid being damaged.
If the midwives want their services to match with the needs of women in society, they must have a complete understanding of their community and learn the ways to influence public opinion and change their behaviors. In other words, midwives should be able to provide and design their services based on specialized knowledge of their profession and their social and cultural context. Participant 13 stated thus:. The patient referred to me later really ill and pale. She told me that she got scared of going to a hospital, since she had to have cesarean, so she delivered the baby at home.
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At that point I realized that although the midwifery science suggested cesarean because of the fetal condition, I had to consider the patient's culture that did not approve cesarean, and explained the situation to her. Effective communication with the mothers in professional midwifery not only is an expression of respect for the dignity and rights of clients but also an important factor in understanding their problems that need to be solved with regard to cultural and ethical sensitivities of the society.
The community-based midwives should be able to communicate with the women who have experienced social damage in the same way as addicted women, prisoners, and women with high-risk behaviors, in order to provide health services, because these women rarely refer for care and often leave the services incomplete.
Hence, midwives must screen and identify these women with their professional and communication skills and provide them with necessary health services. They must also have communication with other relevant organizations in the field and refer patients to them. She referred to me for checkup and she was really concerned about dangerous female diseases, and asked about STD. I felt that I should have a better relation with her and have more information about her. So she told me that her husband was sentenced to life imprisonment and they had been divorced, and she had been a concubine to make a living, and now she had concerns about her health.
I talked to her about the prevention of unwanted pregnancy and sexually transmitted diseases, and introduced her to social welfare for financial assistance. The main role of midwives in advancing women's health is based on their participation with respect and dignity, and by defending their rights, considering the cultural sensitivities, and is focused on promoting health and preventing disease.
Community midwives, in carrying out their mission, should have complete understanding of the society and take steps with regards to the health care delivery system. They should identify the obstacles that reduce the benefits of the services for women. Furthermore, consistent with the changes of the society, they should have a holistic view of women's health and be aware of the risks that threaten the mental, physical, and spiritual health of the mothers.
In the study by Keramat et al. Therefore, the midwives had found that despite their scientific and professional mission, they had heavier social responsibilities. Hanna,[ 23 ] Surtees,[ 24 ] and Davies[ 25 ] emphasized the social role of midwives, in addition to their scientific activities as part of the feminist program. Most of the problems and difficulties of the community midwives raised in this study were rooted in social issues. Nevertheless, the participating midwives, despite being fully aware of the issue, were not unaware of the importance of their role.
In the study by Graser, the role of the midwife was mentioned as challenging that required many skills. It was also said that if the midwife wanted to deliver care with quality, they should have knowledge about coping and adapting to the risk of medical, emotional, social, political, cultural, economic, and environmental factors that endanger the health of women. In their study, Thompson and Thompson noted the challenges that midwives have regarding insufficient resources to care for women and their infants.
In this study, the midwives were suffering from internal contradictions and moral dichotomy in accomplishing their social mission. In the study by Thompson and Thompson, these internal contradictions were noted, and they stated that since midwives are an integral member of the society in which they live in, sometimes they face challenges during their performances, which badly affects their personal beliefs.
According to the Commission on Social Determinants of Health, the majority of preventable deaths and disabilities that women experience are related to gender discrimination. In addition, these damages can only be prevented with a considerable transformation in various aspects of the economic and social structure.
Eliminating gender discrimination in accessing resources is one of the important steps in achieving equity in health. The remaining of these social discriminations will show their effects on women's health. However, Choudhury et al. They showed that it has deep cultural roots and the women's status in the community was much lower than men.
In order to improve the women's health status, in addition to health interventions, there is a need for changes in values and attitudes. At a conference in October in Rio de Janeiro, which was held on decisive social health, it was stated that governments, politicians, and leaders of health are responsible for the provision of public health, and this matter shows the necessity and importance of intervention on the factors and social determinants of health. In addition, interventions can be performed in any country with any social context, in a way that it would promote health and reduce health inequalities.
This had affected their thoughts and performances, and caused severe internal conflicts for them. In this study, participants had expressed that they had gained the community-based vision that is required for their practice over time. Currently, in academic health care programs, this serious problem is discussed. Melinda Cook pointed out that a kind of mature professional community in which awareness of the social conditions that cause problems for pregnant women is considered essential in providing effective care.
The ability to adapt to approved ethical and scientific standards with the social and cultural context was another skill that the participating midwives considered necessary for community-based midwifery. Hresanova mentioned culture as an extremely important determinant of the mother's care, and stated that it has a direct effect on the health of mothers and babies. The participating midwives considered the art of verbal and nonverbal communication skills as essential in achieving a community-based midwifery. Having good communication skills and effective communication with clients is one of the good midwifery criteria.
Since the role of social determinants of health on the promotion and recovery of health of women and children is undeniable, the community midwife must meet certain qualifications and have a holistic vision of society and health. Our appreciation goes to all the participants who assisted in this research, especially the professors of the School of Nursing, Isfahan University of Medical Sciences, Iran, and the respected midwives who participated in this research. This article was derived from a master thesis of Midwifery with project number , Isfahan University of Medical Sciences, Isfahan, Iran.
Conflict of Interest: Nil. National Center for Biotechnology Information , U. Iran J Nurs Midwifery Res. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: ri. Received Sep 30; Accepted Aug This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Abstract Background: Midwifery cares take place in diverse communities with different ethnics groups.
Materials and Methods: This qualitative study was conducted by descriptive phenomenological approach. Keywords: Iran, midwifery, phenomenology, qualitative method, socialization. Open in a separate window. Theme 1: Characteristics of community-based midwives Individual characteristics of midwives; family environment; society with its cultural, political, economic, and social characteristics; experiences that were gained during years of interacting with patients; their thoughts about social issues; and their perspective toward society have led the midwives to achieve a community-based vision.
Gender sensitivity in providing services Midwives, while being informed of the existing inequalities between women and men in the society, along with providing gender- sensitive reproductive health services, are trying to use every opportunity to reduce gender discrimination and violence against women and restore their reproductive rights.
Solving moral problems in their profession While providing care to clients, midwives were repeatedly exposed to ethically difficult circumstances.
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