Hand on or Hands Off the Perineum? a Reflective Essay

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Reflection can be defined as “a process of reviewing an experience of practice in order to describe, analyse and evaluate and so inform learning from practice.”(Reid, 1993) It is an important factor when working within any health profession and midwifery is certainly no exception. Schon (1991) defines a reflective practitioner as “someone who learns by reflecting on current experience and applies that learning to future practice.” Reflection allows midwives to grow and develop professionally as well as personally (Kirkham, 1994) and can guide her into moulding her sphere practice in a positive way to benefit the women she is caring for (Church & Raynor, 2000). It also allows midwives to continue with lifelong learning and put theory to practise (mayes pp 1201-1202).

However being a reflective practitioner is learned skill and Rayner (2005, p.154) states that developing reflective skills is not easy but once mastered have a lot of benefits on the midwives ability to make informed decisions. The Nursing and Midwifery Council (NMC, 2004) state that all midwives need to provide evidence on their continuous learning, which includes reflecting on their practice so that they can link theory with experience to create better care towards women.

The NMC code (2008) states that “you must deliver care based on the best available evidence or best practice.” Which suggests that midwife’s need to find a balance in using the best available evidence as well reflective learning to gain the best possible outcome for the women (Raynor D., Marshall E. & Sullivan A. 2005). Schon (1991, p.12) uses a metaphor to describe how professionals take into account professional issues: “High ground” uses manageable issues which can be solved by applying evidence based research and theory. For example when administering an injection, a midwife could read the most up to date evidence on what different areas are available on the body for administration for that individual women. “Swampy lowland” is used to describe confusing problems which usually are the crucially important problems. They tend to defy technical solutions and therefore rely on trial and error and intuition to solve them. Evidence based practice (EBP) is widely used in health care, because government policies have incorporated EBP into the structure of the National Health Service to improve the quality of care, making treatments cost effective and to create rational decision making (DoH, 1997). Sackett et al (1996, p.169) defines evidence based practice as; “The conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients.” EBP prevents health professionals from basing their practice on tradition and belief, but information which is found in research and scientific development which means the information is constantly changing and updated. (DoH, 1995).

Adults learn at different rates and in different ways, depending on their education, ability and their personalities. What skill level you are at can also affect what learning style a midwife has. Patricia Benner published the “Novice to Expert Theory” in 1982 which has 5 levels of experience, novice, advanced beginner, competent, proficient and expert. Each level of experience had 3 different levels of skills within it and as the midwife moves through the level of experience she will then stop using abstract principles and use past experiences as well as moving from just being an observer to becoming actively involved (Current Nursing, 2010). Reflection is a means of learning and these learners tend to think things through before acting, they enjoy observing and tend to look at a situation from a different perspective and collect relevant evidence before coming to a conclusion (Hills, 2001. p.154).

In this essay I will be writing a reflection from practice regarding whether or not a midwife should have her hands on or off the perineum in the second stage of labour. I...
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