Health promotion in pregnancy: the role of the midwife.

Health promotion is of particular importance to midwives who promote health rather than manage disease and ill health. Although the midwife has always had a role in public health, there is now an explicit need for the profession to direct its attention to teenage pregnancy, smoking cessation, drug awareness and domestic violence. Much of the role of the midwife during pregnancy is in health promotion and a more explicit application of such may carry benefits in meeting Government policy on public health. Some activities undertaken by midwives may not be identified as health promotion, though there is evidence that the interaction generated by routine examinations is of benefit to the mother's health. Midwives should work in partnership with women and families, facilitating decisions about the care that they feel they may require. Social disadvantage may impede participation where formal education was not valued or ethnic background or language impaired access to traditional childbirth education. Tackling this is at the heart of current public health policy around childbirth and child care. Education can take place during any interaction and this gives midwives huge scope to provide an educational experience for women each time they meet. For the pregnant teenager the extended family may need to be included in health promotion activities particularly if breastfeeding targets are to be met. A united health and education policy to inform and educate children and teenagers about the benefits of pre-conceptional care and breastfeeding may be needed. In this way young women come into contact with midwives before they are pregnant, before attitudes to breastfeeding are established and before the concept of pre-conceptional care is lost. Although breastfeeding improves health for women and their infants it can become another burden and expectation which they fail to achieve. Professionals need to be sensitive to the possible negative impact on a woman's health, which could be reduced if the emphasis was moved from individual behaviour change to the inequalities within society. Midwives should seek to respond positively to service changes to achieve the goal of multidisciplinary, non-hierarchical patient-centred services. In facilitating change midwives seek to use their influence to the benefit of the pregnant woman.