The antenatal period is a time when as midwives we are continuously giving women information relating to their pregnancy and birth. It is a known fact that women have identified that good communication during the antenatal period is vital and most importantly that women are listened to. Page1 identifies that “listening is a fundamental skill since it is a foundation for good communication and will give the best idea of what a woman wants and needs to know”. It is vital during this period that we give evidenced based, non biased, informed, and relevant information. The midwife (Australia) is bound by legislation that is the Nurses and Midwives Act 2006 to abide by the ANMC Code of Conduct 2008, Competency Standards 2006 and Code of Ethics 2008. The Code of Ethics in value statement 5, states that “Midwives value informed decision making”. This therefore means that the midwife ensures their decision making is based on contemporary, relevant and well-founded knowledge and practice, which includes the woman’s knowledge of herself and her infant. The Code of Conduct, states that “Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products”. Finally the ANMC Competency Standards state “ Communicates effectively with the women, her family and friends” and “Promotes safe and effective midwifery care”, these two competencies particularly pertain to communication, knowledge, skills and listening to the women’s needs.
You might ask how this refers to the Nurses and Midwives Act 2006, well in breaching these Codes you are breaching the Act by
- Acting carelessly, Acting improperly and or
- Acting incompetently
- Therefor leading to disciplinary action, section 49 of the above Act.
This leads on to an interesting case in Virginia US (Written By: Dawn Collins, JD -2) where a woman delivered her first child in 1997 with brain damage and later developed cerebral palsy. In 2000 the same woman was considering a second child and sort advice from her physician. During this consult it was discovered that she had in fact got “lupus, migraine headaches and supraventricular tachycardia that was treated with Beta-blockers. The woman was informed that the risk of a brain hemorrhage like the one that caused her first child's damage could be reduced by regular monitoring for fetal growth, tracking of fetal movements, and FHR testing. The woman was asked about the results from those tests in her first pregnancy, she informed them she had no such studies done. She said her physicians involved with the first delivery told her the child's problems were due to a placental abruption.”
The woman then made some enquires and learned this type of testing was standard of care for women with her medical conditions, she discovered further that a specialist had been consulted during her first pregnancy who did recommend testing, but these suggestions were not discussed with her nor were the tests performed.
The woman sued those involved with the first pregnancy care and “claimed that IUGR had occurred due to her lupus and the beta-blocker she took and that additional fetal monitoring was required when this was recognized. The child was born about a month early due to fetal distress and at age 9 had an IQ of 48 and functioned at the level of a child less than 3-years-old. A $28 million award was granted. “
This case is an example of how the incorrect information can lead to possible unnecessary harm to both the mother and the fetus. Also that if women are not informed correctly in the first instance, the chances are the second time around they will want more information especially if they have had a poor outcome or their expectations have not been met.
Where would you stand, if you were the midwife who provided the care in the first pregnancy?
It is very important to document the discussions you have with the women you care for, this is not only for your own protection, but for the women that you care for, so that they know you are accountable for these discussions.
REMEMBER THAT CASES COME TO FRUITION MANY YEARS AFTER THE EVENT – SO THE ONLY WAY TO PROTECT YOURSELF IS CLEAR COMPREHENSIVE DOCUMENTATION.
References:
1.Page, L,. The New Midwifery Science and Sensitivity in Practice. Churchill Livingstone,2004.
2. Collins, D. No antepartum testing in first pregnancy results in CP. Risk management in obstetrics and gynaecology. 2009. Contemporary OB/GYN
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