Role and Function of the Midwife

BY: Rose Ann Mecija

a) Counselor/ Motivator

• Family Planning Counselor Provides individual counseling to female, male and

adolescent family planning clients regarding basic anatomy and physiology, human reproduction, contraceptive methods, pregnancy testing, pregnancy options, and appropriate referral(s).

Provides information to clients about establishing and maintaining optimum health practices, safe sex practices, HIVIAIDS prevention, violence prevention and intervention, and routine health care and screening recommendations.

Counselor Characteristics:

• Believes in and is committed to the basic values and principles of family planning and client rights

• Is accepting, respectful, non-judgmental and objective when dealing with clients

• Is aware of her/his own values and biases and does not impose them on clients

• Understands and is sensitive to cultural and psychological factors (such as family or community pressures) that may affect a client's decision to adopt family planning

• Always maintains clients' privacy and confidentiality

Counselor Skills

An effective counselor possesses strong technical knowledge of contraceptive methods:• Knows all technical aspects of family planning methods thoroughly• Is prepared to answer contraceptive and non-contraceptive questions comfortably on subjects such as myths, rumors, sexuality, STDs, reproductive and personal concerns• Is able to use visual aids and explain technical information in language that the client understands• Is able to recognize when to refer the client to a specialist or other provider

An effective counselor possesses and is able to apply good interpersonal communication skills and

counseling techniques:• Relates/empathizes• Listens actively• Poses questions clearly, using both open- and close-ended

questions• Answers questions clearly and objectively• Recognizes nonverbal cues and body language• Interprets, paraphrases, and summarizes client comments

and concerns• Offers praise and encouragement• Explains points in language the client understands in

culturally appropriate ways

Counseling

• An important prerequisite for the initiation and continuation of an FP method.

• An interactive process between the service provider and client; it allows for information exchange and support, so that clients can make decisions, design a plan, and take action to improve their health.

Essentials of Good CounselingA good counselor is trained to:Understand and respect the client’s rights.• Earn the client’s trust.• Understand the benefits and limitations of all contraceptive methods.• Understand the cultural and emotional factors that affect a client’s (or a couple’s) decision to use a particular contraceptive method.• Encourage the client to ask questions.• Use a nonjudgmental approach, which shows respect and consideration to the client.• Present information in an unbiased, client-sensitive manner.• Actively listen to the client’s concerns.• Understand the effect of nonverbal communication.• Recognize when she or he cannot sufficiently help a client and refer the client to someone who can.

To be effective, counseling must be based on the establishment of trust and respect between the client and counselor. All clients have certain rights,

including:

• The right to decide whether to practice FP• The freedom to choose which method to use• The right to privacy and confidentiality• The right to refuse any type of examination• The freedom to choose where to seek services

The Counseling Process

• When discussing contraceptive options with clients, service providers should briefly review all available methods of FP. Service providers should be aware of a number of factors about each client that could be important when selecting a method. These factors might include:

• The reproductive goals of the woman or couple (i.e., the spacing, timing, or limiting of births)

• Personal factors, including the time, travel costs, pain, or discomfort likely to be experienced

• The need for protection against STIs and HIV

Steps in FP Counseling• The GATHER Approach• GATHER is a useful memory aid to help us to remember the basic

steps in the counseling process and to add structure to a complex activity. It can be adapted to meet each individual client’s needs.

• The following are elements of a successful counseling session:• G = Greet client in a friendly, helpful, and respectful manner.• A = Ask client about family planning needs, concerns, and previous

use.• T = Tell client about different contraceptive options and methods.• H = Help client to make decision about choice of method s/he prefers.• E = Explain to client how to use the method.• R = Return: Schedule and carry out return visit and follow-up of client.

b) Service Provider

• Should be competent in counseling for all methods of FP and should have basic counseling skills appropriate to individual client needs.

• Who are counseling for and providing FP might encounter clients who are coming for FP services, but have other needs as well.

• Should be prepared to counsel clients about sex and sexuality, fertility, childbearing, prevention of HIV and other STIs, and PMTCT of HIV.

Provision of Contraceptives

• Contraceptives should be provided to clients in accordance with approved method-specific guidelines and job-aids, by providers who have been trained to provide that method. A “supermarket” approach should be adopted; that is, clients should have a wide range of methods (method mix) from which to choose. These guidelines recognize task-shifting as an important mechanism for increasing access to services (especially at levels 1, 2, and 3), and specify which cadre of service providers may provide which method, subject to appropriate training.

Follow-up and Referral System

• All clients who choose an FP method must be informed of the appropriate follow-up requirements and encouraged to return to the service provider if they have any concerns. Clients that require or choose a method that is not available at a facility must be advised where they can obtain the method. Providers should follow the established referral system.

Record Keeping

• All FP providers should maintain proper records on each client and the distribution of contraceptives. Non-governmental organizations (NGOs) and the private sector also should follow the Ministry of Health’s record-keeping and service provision guidelines.

Supervision

• Supervision is an essential component of program monitoring and evaluation; it ensures that guidelines are being followed and clients’ needs are being met. Facilitative (supportive) supervision should be encouraged, and the supervisor should be seen as a team member who motivates staff and guarantees the rights of providers and clients. Supervision activities should extend to private-sector.

Logistics

• Service providers are expected to have a consistent supply of methods available in order to offer a choice to clients.

Categories of FP Service Providers

• Many categories of people can be involved in the provision of FP services after they have received the necessary training and instruction. Similarly, FP services can be provided at various levels of the health care system (e.g., from community to tertiary care levels) and within facilities that are operated by varying providers (e.g., public, faith-based, private). However, certain standards must be met before providers can offer a particular FP method.

Values and Attitudes

• Attitudes, opinions, and beliefs (including misconceptions among health service providers) can affect the way providers interact with clients. Everyone has a right to her or his own beliefs, but health care providers have a professional obligation to provide care in a respectful and non-judgmental manner. Every interaction between health care staff and clients—from the moment clients enter the health care setting until they leave the facility—affects the clients and has an impact on their:

• Willingness to trust and to share personal information and concerns

• Ability to listen and to retain important information• Capacity to make decisions that accurately reflect

their situation, needs, and concerns• Commitment to adopt new health-related behaviors• Willingness to continue using the facility• Ability to be agents of positive change in the

community

Clients’ Rights

• InformationService providers should ensure that clients receive adequate information regarding the services provided. Clients need to be informed about the workings of the SDPs—their opening hours, services provided, and costs involved (if any). Clients interested in a particular method need to know how it works and how to obtain/ use it, the importance of follow-up, information about potential side effects and how to manage them, warning signs, and the protection from STIs (including HIV/AIDS) that it may or may not offer. Clients also need to be informed about how to switch to another method if they so desire.

Access to Services

• All clients, including adolescents and PwDs, have the right to FP services at all levels of care. The SDPs should be clean, well-organized, and adequately supplied with quality contraceptives. Clients should not have long waiting times and should be able to obtain the contraceptive of their choice.

Informed Choice

• Clients should be counseled on the range of contraceptive options and methods that are available at all levels of care, and should be provided with accurate and complete information to enable them to make an informed decision.

Safety of Services

• Service providers should adhere to infection-prevention practices and client instructions for effective use of the contraceptive method.

Privacy and Confidentiality

• Care should be individualized and discrete. Clients should be protected from both auditory and visual exposure. Client information should be protected from access by anyone who is not directly involved in his or her care.

Dignity, Comfort, Expression of Opinion

• Clients should be treated with dignity and friendliness. Precautions should be taken to ensure minimal discomfort. Clients’ opinions should be sought and their wishes and perspectives respected.

Continuity of Care

• The clients’ records and follow-ups should be accurately and completely documented to ensure appropriate client management and clinical safety.

Provider Staff’s Needs

• Supportive Supervision and ManagementThe work environment and facilitative supervisory system should be supportive and emphasize mentoring and joint problem solving. The system should help staff provide the best possible FP services.

Information, Training, and Development

• Staff should be knowledgeable and skilled in providing FP, and have ongoing opportunities for training to update and maintain a high level of performance.

Supplies, Equipment, and Infrastructure

• Staff should have sufficient and appropriate supplies, instruments, and logistics infrastructure to ensure uninterrupted FP services and the safety of service providers.