Midwife – scope of duties, choice, specialization. What does a midwife’s visit look like?

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A midwife is an important profession for every woman because she is the one who is concerned with women’s health at every stage of a woman’s life. She conducts sexual education, education on women’s health, disease prevention, and can advise on family planning or motherhood. What else does the midwife do?

Midwife – responsibilities

The scope of duties and the general nature of the entire profession of midwife governs Act of 15 July 2011 on the professions of nurse and midwife. Under the act, the scope of the midwife’s duties focuses in particular on:

1. diagnosing pregnancy, caring for a woman in the course of a physiological pregnancy, as well as conducting certain tests necessary to monitor a physiological pregnancy,
2. referral to tests necessary for the earliest possible diagnosis of high-risk pregnancy,
3. conducting physiological delivery and monitoring the fetus with the use of medical equipment,
4. accepting natural births, including, if necessary, incision of the perineum, and in emergency cases, also from the pelvic position,
5. taking the necessary emergency measures until the doctor arrives, including manual removal of the placenta and, if necessary, manual examination of the uterus
6. caring for the mother and the newborn and monitoring the course of the postpartum period,
7. examining and caring for newborns and taking all necessary measures, if necessary, including immediate resuscitation,
8. execution of medical orders in the process of diagnosis, treatment and rehabilitation,
9. independent provision of preventive, diagnostic, therapeutic and rehabilitation services to a certain extent,
10. prophylaxis of female diseases and obstetric pathologies,
11. recognizing the symptoms of abnormalities in the mother or child requiring referral to a doctor,
12. exercising obstetric and gynecological care over a woman,
13. conducting educational and health activities in the field of:

1. preparation for family life, methods of family planning and protection of motherhood and fatherhood,
2. preparation for parenthood and full preparation for childbirth, including counseling on hygiene and nutrition. 

The following profession is also considered to be a midwife:

1. teaching the profession of a midwife or nurse and performing work for the professional development of midwives or nurses,
2. conducting scientific and research work in the field of practicing the profession of midwife, in particular caring for a woman, newborn baby or family,
3. managing and managing teams of nurses or midwives,
4. employment in a medical entity in administrative positions, where activities related to the preparation, organization or supervision of the provision of healthcare services are performed,
5. employment in entities obliged to finance health care services from public funds within the meaning of the Act of 27 August 2004 on health care services financed from public funds or in offices of these entities, under which activities related to the preparation, organization or supervision are performed over the provision of healthcare services,
6. employment in public administration bodies whose scope of activities includes supervision over health protection,
7. employment in nursing homes specified in the provisions on social assistance, taking into account the professional qualifications of a midwife specified in the Act,
8. employment as a midwife in a nursery or children’s club, referred to in the Act of February 4, 2011 on care for children up to 3 years old,
9. performing elected functions in nurses and midwives’ self-government bodies or performing work for the self-government,
10. appointment to perform a trade union function by election outside the midwife’s work establishment, if the election results in the obligation to perform this function as an employee, or to perform a function on the board of a company trade union organization, if exemption from the obligation to perform work is related to performing this function.

Midwife – choice

Choosing a midwife is an important decision. It can be done by submitting the so-called midwife selection declaration. The decision as to the midwife can be changed even twice a year, but it involves a fee of PLN 80 to the NHF account. However, it is worth knowing that it does not have to be a midwife who visits our clinic, so you can choose the person whom you trust the most.

Regarding the choice of a midwife present at birth, you can only choose from among those working in the maternity ward. The smaller the hospital, the smaller the choice. However, in larger establishments, where more staff are hired, it is possible. If a woman decides to give birth in a private institution, she can have her own, trusted midwife, but this involves additional fees.

During childbirth, a woman may also benefit from the help of the so-called an independent midwife who provides private paid services. She helps by assisting in childbirth, learning the right way to breathe and dealing with pain during labor.

See: With or without a partner? About the advantages and disadvantages of family childbirth

Community midwife – responsibilities

A primary health care midwife (POZ) looks after women of all ages. It is comprehensive nursing care – obstetric and gynecological. She also looks after newborns up to the second month of life. A GP midwife’s visit may take place:

1. on an outpatient basis, e.g. in a clinic,
2. at the patient’s home (patronage and prophylactic visit).

The community midwife provides services:

1. from Monday to Friday, between 8:00 a.m. and 18:00 p.m., excluding public holidays,
2. on a date agreed with the patient,
3. within the time specified in the content of the order or referral,
4. on the day of reporting – if the patient’s health condition requires it.

A community midwife looks after pregnant women:

1. Once a week from week 1 to week 21 of pregnancy – maximum 31 visits
2. Twice a week from the 2nd week of pregnancy to delivery – maximum 32 visits.

Midwife’s visits include:

1. recognition of health problems,
2. planning and implementation of preventive services,
3. educating pregnant and high-risk pregnant women, preparing them for childbirth and parenthood.

A primary health care midwife prepares an antenatal education plan for pregnant women, including high-risk pregnant women. It is an integral part of the patient’s medical records. It includes practical and theoretical preparation for childbirth, puerperium, breastfeeding and parenthood (also in the form of group services).

Community midwife – caring for a newborn baby

Up to 2 calendar months of a child’s life, the primary care midwife is obliged to make 4–6 patronage visits. The tests are performed in the presence of legal or actual guardians at the orphanage. The first visit takes place no later than 48 hours after the mother and child leave the hospital.

A visit of a community midwife in the 1st – 4th day of a child’s life

1. examination of the child, taking into account the assessment of the general condition immediately after birth according to the Apgar scale – if the midwife performed physiological delivery on her own,
2. help in creating a bond between mother and baby and in starting breastfeeding,
3. taking measurements of body weight and length, as well as the circumference of the child’s head and chest,
4. prophylaxis of infections of the anterior segment of the eye.

A visit by a community midwife in the 1st – 6th week of a child’s life (at least 4 patronage visits)

I. Caring for a newborn or infant, including:

1. observation and assessment of physical development in the field of: adaptation of the child to the external environment, the condition of the skin and mucous membranes, the navel, excretions, secretions, psychomotor development, functioning of the sensory organs,
2. assessment of the newborn’s reflexes, feeding method and techniques,
3. detection of pathological symptoms,
4. assessment of the relationship of the family with the newborn.

II. Health education and advice to parents on:

1. newborn care,
2. breastfeeding,
3. protective vaccinations,
4. preventive examinations,
5. medical and social care,
6. lactation, fertility control, self-care.

III. Promotion of pro-health behavior of parents.

IV. Identification of risk factors in the family.

V. Diagnosis and hierarchy of actions taken.

After the patronage visits are completed, the midwife hands over the baby to the primary care nurse.

Midwife – specializations

A midwife may have a number of specialties:

1. a midwife involved in health promotion and health education;
2. a midwife working in the neonatal ward;
3. specialization in family or midwifery nursing;
4. organization and management specialization;
5. specialization in epidemiological nursing;
6. specialization in gynecological nursing.

It should therefore be remembered that the midwife should not be treated as a doctor’s subordinate. We often forget that the midwife should work closely with the doctor on the same level. During labor, when the doctor is absent, the midwife can even take over the duties of the doctor and make many difficult decisions because she is fully competent to do so.

So there is a lot of truth in saying that the midwife is the most important thing in the delivery room. The doctor has many responsibilities related to childbirth, but it is the midwife who is with the woman throughout the labor. Therefore, its role should not be underestimated.