The role of a midwife in low and high-risk pregnancies

Midwives are trained professionals, with years of specialised studying and training in pregnancy, vaginal births, and the post-partum period. We birth low-risk clients at home, birthing units, and hospitals. Midwives work in clinics, private sectors, and provincial sectors. Some midwives choose to go into independent practice whilst others choose to work in hospitals, clinics, or birth centers. Our specialty includes low-risk management, however, we are trained in identifying when a low-risk pregnancy advances to high risk.

High-risk pregnancies may include a range of medical conditions, preterm labour or birth, or factors affecting the maternal and fetal well-being, where medical intervention, neonatal ICU, hospitalisation and medical management of mum, baby, or both are needed.

According to the World Health Organisation, all pregnant mums need to see an obstetrician twice during the pregnancy. This is an overall standard in our practice , be it in the provincial or private sector, where mums are under antenatal care with a midwife. The expectant mum is generally assessed by the OBGYN at 28weeks and then again at 36 weeks to ensure that the pregnancy is progressing well and the mums are low risk.

Midwives do not do diagnostic scans, and caesarean sections, therefore it is vital that an assessment with an obstetrician is done to rule out any high-risk factors. If the mum is diagnosed as a high-risk pregnancy, she then continues to care with her obstetrician and gynaecologist(OBGYN). The midwife then offers a supportive role and often assists where need be.

Other important assessments and scans that should be done are at 12-14 weeks of the pregnancy for the first-trimester screening (this is a prenatal screening test that offers early detection about a baby’s risk to certain chromosomal conditions, specifically, Down syndrome )

At 20 weeks an anomaly scan with the fetal specialist or OBGYN is done. This is to ensure that the baby’s development is in keeping with that of a normal pregnancy. If any high-risk factors are picked up, the obstetrician will take over the care to ensure overall well-being and close monitoring. This does not necessarily mean that the mum would have a Cesarean section. A normal birth may be possible under close monitoring, care, theatre standby, and neonatal ICU, however, the OBGYN will advise on the safest method of birth.

If the expectant mum becomes a high-risk pregnancy, and a cesarean section or preterm birth is needed, the midwife may accompany her to the theater depending on the hospital rules and policies. The midwife can then ensure that all birth requests are respected, assists with breastfeeding, and mostly provides support and reassurance throughout.

If the midwife isn’t allowed to be with the mum due to hospital policies, she may continue home care and support after the mum and baby are discharged. This can provide much-needed support and guidance during the first few days where mum’s feeling overwhelmed and need assistance. Doulas are also a great help during this time offering assistance with baby baths massages and overall support too. Support and care of a midwife during the post-partum period is important in early detection of postnatal depression but also minimizes the possibility of postnatal depression.

When High-risk pregnancies are taken over and monitored by the OBGYN, a 6 week postnatal follow up is also done with the OBGYN to ensure that postnatal healing has taken place. An ultrasound may be done to assess the size of the uterus size, a Pap smear is done, contraception is discussed and overall postnatal assessment is done.

The relationship between a midwife, their client, and their family is long-lasting not only for their current pregnancy but for all future pregnancies.

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Ruwaida Moola has been practising midwifery since 1999, working in various hospitals and clinics. She currently practices midwifery with Genesis as her main birthing clinic. She has practising rights at Garden City Clinic, Oxford Rd Day Clinic, Brenthurst Clinic and Parklane Hospital and utilizes these hospitals as the emergency back-up hospitals.

She works closely with Obstetricians, Doulas, Chiropractors, Homeopaths, Herbalists, Reflexologists, Acupuncturists, Psychologists, and Paediatricians and believes in a multi-disciplinary approach. I also practice as a senior fertility sister at the BioART Fertility Clinic. She is a Registered Nurse and Fertility Nursing Sister, Nurse Educator and Advanced Midwife.

Find Ruwaida at www.miraclebirths.co.za.