Independence of midwives in a therapeutic team - a midwife as a coordinator of the patient's stay at St. Sophia Hospital in Warsaw, Poland
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Department of Obstetrics and Gynaecology Didactics, Medical University of Warsaw, Warsaw, Poland
St. Sophia Hospital, Warsaw, Poland
Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
Department of Practical Obstetric Science, Poznan University of Medical Sciences, Poznan, Poland
Publication date: 2023-10-24
Corresponding author
Grażyna Bączek   

Department of Obstetrics and Gynaecology Didactics, Medical University of Warsaw, Warsaw, Poland
Eur J Midwifery 2023;7(Supplement 1):A22
The professional training of a midwife in Poland is regulated by law and system. The profession of midwife is an independent and fully settled profession. The midwife education system in Poland prepares graduates equipped with numerous competences. Unfortunately, the health care system, both closed (hospital) and open (environmental and family care), does not use the numerous competences of midwives, does not notice them, and even limits their actions. St. Sophie Hospital in Warsaw (Poland) is one of the few units that has been breaking the clichés for many years in favor of a modern model of work organization, management and patient care, taking into account the midwife's independence and the use of their competences. The aim of the work is to present a project entitled "Midwife - coordinator of the patient's stay" - its assumptions, the process of implementation, development, evaluation and changes. The main objective of the project is to use the midwife's competence and independence in organizing the work of the obstetrics ward.

Material and Methods:
The project was started on 01/10/2021. The implementation of the project was proceeded by multi-stage analyzes concerning the characteristics of patients under the independent care of midwives, the scope of midwives' tasks, organization of work in the ward, principles of cooperation with the medical team, keeping medical records. In the course of the project these methods were used: the methods of direct observation, participant observation, analysis of medical records, focoused group interview and individual interviews. The project covered two hospital wards: maternity ward A and maternity ward B located in the St. Sophia Hospital in Warsaw.

The core of the project was to provide independent midwife care to healthy postpartum women and newborns- from the moment of admission to the ward until discharge home. The final assumption is the lack of medical consultation in a situation where the well-being of the mother and the child is secured by a midwife (physiological postpartum). The midwife admitting the mother and the child to the ward collects data, recognizes their condition, plans and implements care, monitors the health condition, orders examinations, consultations, and medications if necessary. Prepares the patient for discharge home, educates her, prepares documentation and discharges the patient home. Consultation with a doctor (or other specialist) is possible at the request of a midwife or at the explicit request of the patient (which does not happen). Initially, the project raised many concerns in the community of senior midwives. The most important of them is the fear of new duties (so far carried out by doctors) and of responsibility. The graduał and multi-stage implementation of the project was aimed at reducing midwives' fears, enabling them to adapt to changes, identify with the project and finally undertake new tasks independently and actively. The strength of the project was the integration of the environment of doctors and midwives, who jointly undertook tasks, educated each other, consulted and made decisions.

The systemic definition of the midwife’s role as an independent specialist in the care of the mother and the child in the postpartum period allows for the maximum use of her competences, strengthens her professional position and increases the quality of care. A patient in such a care system is provided with individualized and comprehensive care, a sense of security and educational support. Such organization of work is also beneficial for public finances - the care of a gynecologist is directed only to patients whose health condition requires it. All others are within the competence of the midwife.

The authors have no conflicts of interest to disclose.
There is no funding for this research.
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