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MIDWIFERY CONCEPTS OF COMMUNICATION

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INTRODUCTION

Using Walker and Avant's eight-step approach, this article examines and discusses the

subject of communication in the midwifery context (1983, 2005, 2011). It will also include a

detailed clinical study to show the theory and relevant research to back up the findings. A

reflection on the Enquiry Based Learning (EBL) process, which was utilized to write this

article, will also be addressed.

“It is critical to state that this essay contains no violation of privacy. All personal

information from this case study essay has been removed. Unauthorized personnel have not

been given access to any personal information. As a student midwife, I am aware of my need

to maintain identity and discretion (NMC, 2015).

CRITICAL ANALYSIS OF CONCEPT OF COMMUNICATION

Concept analysis is a method for determining defining characteristics. Wilson (1963)

explored the hypothesis of concepts, which contained eleven phases, which were later

changed into eight stages by Walker and Avant (1983).

The Walker and Avant (2011) eight-step technique is the most well-known, and it will

be used to investigate the idea of communication. The main goal of concept analysis is to

break down, describe, and investigate an idea into simpler pieces, which leads to a clear

operational description that represents its conceptual underpinning and is easy to

understand (Walker and Avant, 2011).

Before delving into the concept of communication, it's necessary to first define it.

“The activity or process of expressing thoughts and feelings of giving others information” is

how communication is defined (Oxford Learners Dictionary, 2019). Varied scholars have
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different definitions and meanings for the term. Communication, according to Newman and

Summer (1977), is the interchange of facts, thoughts, views, or emotions between two or

more individuals.

Communication, as per Myers and Myers (1982), is a type of structuring that is

conveyed in symbolic form. They went on to say that in order for persons to communicate,

they must establish a symbolic system, or a common ground. Brown (2012) also described

communication as "the transmission of knowledge from one person to another, whether or

not it evokes confidence, but the knowledge must be comprehensible to the recipient."

Additionally, communication entails the transfer of both verbal and nonverbal

messages via a source, recipient, and a medium that can be hampered by obstacles

(Munodawafa, 2008). These descriptions lead to the conclusion that communication is the

process of providing, obtaining, or sharing ideas and information through appropriate means,

either verbally or non-verbally.

The next phase in Walker and Avant's (2011) strategy is to determine the ideas'

defining features, which are the traits that appear in the definition several times. The

following are the distinguishing characteristics that will be investigated in regard to the

definition of communication:

 Transfer of information between two or more people

 Active listening

 Body language

 Mutual understanding

 Collaboration and empowering with evidence-based information

Communication is viewed as particularly important in the profession of midwifery in

order to achieve patient well-being. Effective communication, according to Byrt (2014), is

essential to optimal healthcare because it facilitates holistic patient care and allows the

midwife to accept and appreciate their patient's feelings and viewpoints.

Walker and Avant (2011) then proposed using a situational analysis and connecting it

to the structure's defining characteristics. The following is a practical case study of

communication in a midwifery context:

Grace has visited for her examination at 25/40 weeks. She is G2P1 with a history of

diabetes (GDM) and an emergency C-section due to fetal discomfort and inability to

progress. Penicillin and nuts are also irritants for her.

Her midwife reviewed her test findings, which revealed that she had GDM once more.

Grace was quite concerned about this and became uneasy and unstable as a result. Grace's

behavior was observed by the midwife, who paused her documentation to comfort Grace by

bringing her a bottle of water and then asking why she was anxious. Grace continued to open

up to the midwife, explaining that she was afraid that the situation might lead to another C-

section, as she had previously experienced.

  Grace was reassured by the midwife that this was not the only reason for a C-section,

and she learned more about diabetes. She also went through healthy nutrition with her, as

well as the complexities of her disease, and gave her GDM pamphlets. Grace  was also

informed about the Vaginal Birth After Caesarean (VBAC) clinic by the midwife, who

obtained her agreement before referring her and telling her that a regular vaginal delivery

was still possible. Grace  felt relieved and thanked the midwife after hearing this.

This case study is an example of effective communication. Effective communication

between the midwife and the patient fosters trust and a shared sense of social responsibility,
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which necessitates active listening. Active listening is the basis of effective communication,

and it entails paying attention to the speaker's material, purpose, and feelings. It's a

combination of nonverbal and vocal communication that makes individuals feel heard and

appreciated.

Active listening, according to Levitt (2001), is a therapeutic intervention that entails

thorough listening and empathic responses so that a patient feels heard. It contains comments

that show that the speaker understands what he or she is trying to teach the audience.

Listening to the client allows the midwife to gain a deeper grasp of their requirements and

establishes rapport.

The midwife in the research scenario engages in active listening during her interaction

with Grace. A midwife must communicate to the client and attend to their needs and

concerns, which I feel she did in the case study by being able to listen to Grace carefully

despite the paperwork.

Another aspect of good interaction is body language. Body language is defined as a

“type of nonverbal communication that depends on physical behaviors to communicate

signals, such as attitudes, eye movements, movements, and so on” (Cambridge Dictionary,

2019). Midwives must communicate properly utilizing a variety of verbal and nonverbal

communication skills to comprehend and react to people's needs, including recognizing when

individuals are frightened or distressed, according to the Nursing and Midwifery Council

(NMC, 2015). Grace's body language was observed by the midwife in the case study, and she

was able to recognize her anxiousness, resulting in effective and constructive communication.

Midwives must acknowledge their own qualities, views, and ideas, as well as how

these affect their job while dealing with clients, in order to be good counsellors and

communicators. Our values guide us in deciding what is right and wrong, good and terrible,
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and what is significant in life. In general, persons who work with others in any capacity, such

as counselling or midwifery, need to be conscious of their own beliefs and values in order to

understand their mental, physical, and emotional responses. Internal conflict evaluation of a

given scenario and response requires a professional to take time to focus on their beliefs, then

the implications of those beliefs on their emotions and feelings: internal conflict assessment

of a particular situation and response.

Nonverbal communication is important in developing patient-midwife connections,

bolstering verbal statements, and eliciting unstated thoughts and opinions (Montague et al.,

2013). Midwives should express their involvement with the patient's communication by

sitting up straight and alertly, maintaining significant eye contact, and using prolongation

noises such as "ohh" and "yeah," as well as moving the head (Butler and Jackson, 2014).

It's worth noting that Walker and Avant (2011) make a counter-argument in order to reinforce

and prevent duplication in the identifying characteristics. A case on the other hand lacks all of

the distinguishing characteristics.

A counter-example to the case analysis would be if the midwife, rather than being

conscious of Grace's nonverbal indications, thought that Grace was familiar with diabetes

because she had it before. She didn't fully explain and display the information, instead

rushing through the appointment and being more focused with the documentation, which

limited Linda's ability to express her reservations.

According to Kacperck (1997), the capacity to perceive and use nonverbal

communication, often known as body language, is a strong tool that can assist healthcare

practitioners communicate successfully with patients while also improving collaboration and

teamwork.
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Identifying consequences is the next stage. Antecedents are occurrences or happenings

that must occur prior to the concept's occurrence (Walker and Avant, 2011). Mutual

comprehension is one of the prerequisites for communication. Shared agreement means that

the recipient must get the information in the same way that it is supplied, making it more

important to understand rather than execute the knowledge.

In patient-centered midwifery practice, communication based on mutual trust is critical in

order for the midwife and the woman to reach mutual understanding (Hantho, Jensen and

Malterud, 2002). As the midwife and patient work collaboratively, establishing a professional

relationship and common cooperation will help to facilitate successful communication. The

midwife in the scenario above was able to establish a cordial relationship with Linda and

retain mutual knowledge of the nature of the problem and treatment approach.

Intact assessments and teamwork with an evidence-based methodology are also antecedents.

Midwives must apply adequate understanding and play a critical role in providing clients

with available evidence and medical information (NMC, 2009). Because medical and health-

care information can be difficult for people to comprehend, it is critical that they access

worldwide and comprehensible information.

In the research study, the midwife communicated with Grace using evidence-based

facts. She was able to provide Grace with adequate guidance by handing her brochures on

diabetes and discussing the illness with her using her technical expertise and abilities,

resulting in more effective communication. Grace's approval was gained, and the midwife

was able to collaborate with her by referring her to the VBAC facility.

The occurrences or situations that happen as a consequence of the design's existence

are known as consequences (Walker and Avant, 2011). Increased client contentment is one of

the benefits of successful communication. Customer experience increased in a prior study

when midwives and health care teams paid attention to the matter, conveyed information

properly, and offered viable solutions (Wanzer, Booth-Butterfield and Gruber, 2004). Grace

was grateful and pleased with the information she received from the midwife in the given

scenario.

Improved compliance to treatment procedures and health outcomes are another

benefit of communication. According to Zolnierek and Dimatteo (2009), midwife

interpersonal skills and a client's ability to follow medical advice have a strong favorable

association. Because the midwife discussed food and treatment regimens to Grace in the case

scenario above, her adherence to tracking her blood glucose may improve as a result of the

information being adequately explained to her.

Despite the fact that excellent communication is critical in healthcare services,

evidence suggests that communication breakdown is a commonly mentioned feature of

maternity services (Dunkley-Bent, 2000). Effective communication between midwives and

customers is hampered by a number of obstacles. Effective communication can be hampered

by physical and psychosocial limitations such as time and location. The medical environment

can influence a patient's ability to speak, for example, a lack of privacy, noise levels, and

disruptions can obstruct efficient communication between midwives and clients (Ali, 2018).

Norouzinia et al. (2016) discovered that time constraints create a significant barrier to

communication. Rushed communication is not as effective as attentive communication but in

pressured clinics, midwives facing competing demands may disregard the quality of

communication. In the case study, the midwife was able to communicate further with Linda

and gave time for her to explain the situation even though she had paperwork thereby

empowering effective communication.

Cultural and linguistic boundaries are also obstacles. Knowing and understanding

cultural demands also enables for the development of trust between the patient and the

midwife, and the best way to do so is to build a trusting relationship and genuine verbal

communication, which includes constant checking for clarifications in all areas required

(Rampur, 2011).

Language is widely regarded as the most significant impediment to efficient

communication. Because verbal communication is so critical in every situation,

comprehending the definition of words is also crucial. Ali and Watson (2017) emphasize the

need of providing adequate treatment to patients with language challenges in any healthcare

environment. The study also reveals that using expert translators and bilingual services can

help patients overcome communication obstacles and receive good care.

Communication is undeniably critical in maternity services, and it is essential to

guarantee that each patient receives comprehensive and well-rounded treatment. Midwives

are frequently the main caregivers of maternity and child health care, and how they

communicate has a big effect on health outcomes. Chang et al. (2018) discovered that

professional experience training programs can help midwives communicate more effectively,

and that include communication training programs in the curriculum can help enhance

outcomes.

As patients and midwives collaborate alongside self-awareness, communication fosters

relationship building through therapy. This is a professional partnership in which mutual

tolerance and affection are used to define expectations and restrictions. Professionals are

required to have faith in their customers' abilities and strengths, as well as an interest in their

values and beliefs.

Additionally, more study and attention should be focused on key issues such how

scientific evidence is obtained and conveyed if midwives and healthcare practitioners are to

be effective in delivering evidence-based information (Alimoradi et al., 2013).

Establishing empirical referents is the final stage. Empirical referents are a set of real-world

events that are used to verify a design's reality by measuring its occurrence (Walker and

Avant, 2011). Communication is a wide notion that is not always easy to quantify. Although

there are procedures in place to monitor communication through customer assessment, such

as ‘Friends and Family' exams and questionnaires, these may not always be accurate and

reliable due to partiality and a lack of consistency. A prior study, on the other hand, used a

methodical scale construction procedure known as the communicating evaluation tool, which

focused on a five-point response scale, with five being outstanding. (Makoul, Krupat and

Chang, 2007). They discovered that this strategy was accurate and dependable in assessing

patients' perceptions of physicians' communication skills. Patients are less likely to recollect

technical interventions than communication and human connection, according to Jones

(2010), since they have more trust in health providers who communicate successfully. A

midwife will always be on the lookout for any obstacles and will seek out adaptable

alternatives. She will carry out her job as efficiently and effectively as feasible after learning

the variable possibilities. In midwifery, a variety of situational and cultural antecedents can

induce behavioral change, which has a variety of implications. Based on the continually

changing healthcare services, the prompted behavior could lead to numerous future benefits.

Finally, because the relationship between patients and midwives is the foundation of care, the

significant element of viable and constant trust and communication occurs in that

relationship.
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