In the midwife in promoting breastfeeding. ` The

            In 1946 the World Health
Organisation (WHO) defined health as a ‘state of complete physical, mental and
social wellbeing and not the absence of disease or infirmity. This definition
integrates the main concepts of health and identifies that health can be viewed
differently by individuals and groups (Bowden, 2006). Health and well-being are
the result of a combination of physical, social, intellect and emotional
factors (Dunkley,2000). The concept of health promotion has emerged with the
increasing realisation in society that our health is one of our most valuable
personal assets, as well as an asset for society. The health promotion agency
(2008) describes health promotion as a process enabling people to exert control
over the determinants of health and thereby improve their health. Similarly,
the WHO identifies that health promotion involves equipping people to have more
power, enabling them to make choices regarding improving their wellbeing
(WHO,). Ewles and Simnett(2003) determine from this that the fundamental
elements of health promotion are improving health, empowerment and education.
Health promotion is not an extended role of the midwife but a core competency.
In its code of professional conduct (2008), the Nursing and Midwifery Council
(NMC) outlines the role of the midwife to include supporting women in caring
for themselves to improve and maintain their health. Davis (2002) points out
that every interaction with a woman is an opportunity to improve long-term
health as midwives are trusted as authoritative figures in the delivery of
health promotion. The royal college of midwives ‘Vision 2000’ describes the
midwife as a public health practitioner, and relevant models and approaches can
enhance the way that midwives deliver care. A health promotion approach can be
described as the vehicle used to achieve the desired aim (Dunkley-Bent, 2004).
This essay will focus on applying Beatties (1991) model of health promotion to
breastfeeding; analyses the challenges midwives may encounter when promoting
breastfeeding and health promotion in general and evaluates the effectiveness
of the midwife in promoting breastfeeding.

`           The
word ‘midwife’ simply means ‘with women’ (Alberta Association of Midwives
2012). According to the International Confederation of Midwives Council (2005)
the midwife is a conscientious and accountable trained specialist in ‘normal’
pregnancy and birth. They work in ‘partnership’ with the woman, her partner and
family to offer the vital care, support and advice required during the
antenatal, intrapartum and postpartum period to independently guide the women
through the pregnancy and birthing process and provide care for both and  the new born. The scope of the midwife
includes the support and encouragement of normal birth, identifying
complications with the pregnancy and performing emergency procedures. Midwives
play a significant and critical role in the delivery of health counselling and
education which should include antenatal education not only with the women but
with the family and network and wider community. It
is the midwives’ role to promote health and wellbeing to women and their babies
(NMC, 2008). Health promotion, as described by Scriven (2010), is said to be
‘improving, advancing, supporting, encouraging and placing health higher on
personal and public agenda’s’. Midwives use health promotion models and
approaches to enable a common value to be made clear; allowing all team members
to work towards the same goal. As a result, effective communication between
midwives is more likely, and therefore the quality of health promotion given to
women is improved (Bowden 2006). Commonly, Tannahill’s model of health
promotion, developed by Downie et al (1996), lends itself well to midwifery
practice. The model mainly focuses on health education, health protection and
preventing ill-health. These three main topics overlap; in which health
promoting activities may fall. Child vaccination programmes implemented by the
NHS is an example of health protection overlapping with ill-health prevention
that occurs in practice (Bowden 2006).This example emphasises the positive
feature of the model; being able to carry out both objectives of improving
health and preventing disease (Sykes 2007). The educational approach is often
used within this model whereby the midwife gives facts and information to the
women who may then choose to act on the information given, or not (Bowden
2006). Similarly, the behaviour change approach is commonly used in midwifery
when encouraging women to change her attitudes or beliefs to adopt a healthier
lifestyle (Bowden 2006). There are many health promotions approaches and
models. However, no specific model is relevant to every woman. Each woman will
have individual needs and therefore requires an individual assessment in
relation to health promotion.

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promotion is an essential part of a midwives’ responsibility; “the nature of
health promotion work in midwifery is geared toward promoting the health of the
mother and ensuring optimum environment for mother and baby” (Dunkley,2000). Breastfeeding
can be a controversial topic; it can bring about mixed opinions and responses
from mothers and midwives. The reason for the promotion regarding breastfeeding
is that apart from being economically friendly, it also holds many benefits for
the baby and for the mother (Dunkley,2000). Health promotion is predominately a
proactive process. It is a process that is done with people not at people,
either on an individual basis or within groups, Participation and partnership
are key components of the process.

model is appropriate as it provides a structured framework to guide, map and
contextualise health promotion intervention related to breastfeeding (Seedhouse,2003).
Beattie’s (1991) has two dimensions; “mode of intervention” and “focus of intervention”.
The “mode of intervention ranges from authoritative which is top-down and
expert-led: to negotiated, which is bottom-up and values individual’s autonomy.
The “focus of intervention” ranges from a focus on the individual to a focus on
the collective. The model uses these dimensions to generate four strategies for
health promotion – health persuasion, legislative action, personal counselling
and community development (Tonnes and Tilford, 2001). The health persuasion
technique utilises the medical and educational approaches to inform women of
the research-based health benefits of breastfeeding. This intervention is
top-down, directed at individual women and led by midwives as health experts
(Perkins,1999). It relies on persuasive tactics to ensure compliance. Being
medical-based, it aims to reduce mortality and is conceptualised around the
absence of disease. As midwives do not regard pregnancy and childbirth as
states of ill-health, its validity in midwifery care must be questioned (Dunkley,2000).
The benefits of breastfeeding are well-documented; however, difficulties arise
in making this information relevant and personal to each woman’s ‘information’.
According to Condliffe (2005) midwives’ reported a lack of confidence within
midwifery practice but Mezey and Laazenbatt (2009) said that it was due to
concerns with lack of experience on the relevant subject area  and discussion.(……1). It would appear that the
challenge for midwives is having the time and resources readily available. Positive
messages about breastfeeding should be evident in the midwives practice room (Ewles
and Simnett,2003). Literature and posters that promote breastfeeding can be
prominently displayed. All magazines and literature in the waiting room can be
examined to ensure that there are no unwanted advertisements or promotions of
formula. Health persuasion assumes that women make rational, conscious
decisions about how to feed in response to factual health-related information
(Crater,2002). Personal attitudes will affect the woman’s decision more than
anything; and changing beliefs, values and attitudes is difficult and requires
more time, resources and dedication than most midwives have, due to over-load
of work. According to Crossland (2015) he stated that breastfeeding is cost
free and other health incentives could be spent on other poor health choices
but Whelan (2014) stated that breast feeding needed all the support it could
get so midwives could encourage it within their practice.

is important in the midwifery profession that a Continuity Model of Care is
adopted as this encourages a close professional relationship to develop between
both the midwife and the woman throughout the birth process. Continuity of Care
allows the midwife to provide personal care that is tailored specifically to
the woman and her family’s needs with the ability to address any further
complications or issues that may arise, improving both the quality of her care
and her birthing experience. Continuity of Care is advantageous as it can be
provided in a wide variety of settings, both formal and informal environments,
in order to set the woman at ease, making her feel more comfortable. (Pairman,
et al 2010) The midwife must be aware of all relevant aspects in respect to the
culture of the woman they are providing care for. This sensitivity may include
being aware of modesty in the Muslim culture requiring a midwife that is of the
same sex origin as themselves as they are uncomfortable exposing their bodies
to the opposite sex. Another barrier that may coexist within the Midwife-Woman
partnership may be age. When a Midwife is providing care for a woman who is a
minor, in the midwives eyes the young woman is too young to be in this
predicament. Another observation that may have to be observed regarding
cultural sensitivity includes the various rituals of ethnicity. This should be
permitted unless there is a clinical reason which prohibits it. (Health Care
Providers Handbook, 2010) Giving birth is universal to all women; however, the
experience differs in many cultures as births are considered sacred events in
many countries, as they celebrate the birth and welcome the arrival of the new
member of the family with specific rituals. It is important to show respect for
diverse cultural traditions as well as the diversity of that community, by
acknowledging and accepting that the rituals of one cultural community are
equally valid and worthy of the same regard as our own cultural practices.
(Robinson & Thomson2009,p142). There are dangers in
the midwife being unaware of, or misunderstanding a culture. Perhaps the most
serious is that of stereotyping people, when it is assumed that a culture makes
all members of the cultural group think, feel, and behave in a certain way.
(Bowden and Manning 2006). The relationship between the Midwife – Woman
partnership differs within even our own culture as our upbringing, education,
experiences, location and our general way of life impacts on us all differently.

role and responsibility of the midwife is to work with evidence based practice
“with evidence based practice” with effective communication to provide advice,
support, encouragement and education to facilitate the woman’s ability to breastfeed
(Johnson and Taylor,2006). Support throughout pregnancy can have a long-lasting
effect no matter the scale the task maybe. A good example of this is the midwives’
role in health promotion and in supporting women in feeding their
babies(Crafter,1997). When a woman needs more general sources of advice and
social support than those provided through the maternity services, midwives
still play a key role in providing relevant information and advice and
referring her to other professionals and organisations for support. (Cooper
& Fraser 2003). If the chosen method of feeding an infant is breastfeeding,
a mother should expect midwives to assist them in the latching on of the baby
and in the correct way so it is not painful or uncomfortable for the mother. 

– centred care is the overarching framework for the National Competency
Standards for the Midwife (2006). Woman-centred care is a concept that implies
that midwifery care, is focused on the woman’s individual, unique needs,
expectations and aspirations, rather than the needs of institutions or
professions recognises the woman’s right to self-determination in terms of
choice, control, and continuity of care 
encompasses the needs of the baby, the woman’s family, significant
others and community, as identified and negotiated by the woman herself follows
the woman between institutions and the community, through all phases of
pregnancy, birth and the postnatal period is ‘holistic’ addresses the woman’s
social emotional, physical, psychological, spiritual and cultural needs and
expectations (ANMC, 2006). By adhering to rules, standards and guidelines the midwife can
ensure that the care provided is of the highest standard. Midwives understand
that each woman is an individual and her needs are assessed on an individual
basis, with a non-judgmental, caring nature. Ewles and Simnett (1999) list the
following activities that could be seen as health promotion practices; Mass
media advertising, campaigns on health issues, patient education, self-help
groups environmental safety measures, public policy issues, health education
about physical health, preventative medical procedures, codes of practice on
health issues, health enhancing facilities in local communities, workplace
health policies and health and social education for young people in schools.
Ewles and Simnett (2003) also identify approaches to health promotion. These
all flow from a set of aims which hope to be achieved. They emphasise that no
one aim or approach to health promotion is right but that it is important for
us, as health care workers to consider which is appropriate for us, and
relevant to our work. However, one of the most important factors is educating
people, to allow them to make informed, healthy choices according to ……….

In conclusion, the RCM Vision 2000 describes the midwife as a
public health practitioner. Midwives have always enhanced, facilitated and
supported factors, which promote physical health, psychological, social and
spiritual wellbeing for the woman and her immediate family. Some of the key
points that should be considered for the future of midwifery health promotion
practice, is that it needs to be clearly defined, ‘national and political
recognition of the midwife’s contribution to public health should be improved
and midwives should promote health within the socio-cultural and economic
context of how individuals live their everyday lives’. Providing antenatal care
to woman and fetus demonstrates a unique opportunity to enhance holistic health
through advice, guidance, support and social networks where the woman can be
offered further specialised care if needed. This assignment has discussed the
concept of health and health promotion. Beattie’s and health care model was
used to show the importance that a supportive environment is created in which
people can challenge ideas and question beliefs. Beattie’s model is adaptable
and could be applied to many scenarios; the model shows knowledge of awareness
of adult education by provoking a deep understanding of processes and problem
solving, and therefore the quality of teaching and the learning process. There
are many ethical issues involved in parent education. Participants need to be
listened to carefully and their questions answered truthfully, which gives a positive
effect on the woman and leads to the skills and confidence to take more control
over their health. The Midwife woman partnership is a complex relationship that
balances on understanding and acceptance factoring in the beliefs, rituals,
lifestyle, ethnic values and the risks associated  of the woman or mother to be in order to
achieve both a positive and empowering labour, as well as a favourable and
healthy outcome for all involved. This understanding makes it essential for
Midwives to be aware of all the cultural differences apparent and possess
knowledge pertaining to the cultural expectations and lifestyles of all
cultural groups. It is important for Midwives to continually undertake further
training and education, to maintain their professional development, as well as
broadening their existing knowledge and skills. Good health is not just the
physical wellbeing of an individual, but the social, emotional, cultural
wellbeing of the whole community in which everyone is able to achieve their
full potential as a human being thereby bringing about the total wellbeing of
their community.