The A health promotion approach can be described as

The World Health Organisation (WHO) defined
health as a ‘state of complete physical, mental and social wellbeing. This
definition integrates the main concepts of health and identifies that health
can be viewed differently by individuals and groups (Bowden, 2006). Health and
well-being are a combination of physical, social, intellect and emotional
factors (Dunkley,2000). The concept of health promotion has emerged with the
increasing realisation that our health is one of our most valuable personal qualities.
The health promotion agency (2008) defines health promotion as a process
enabling people to have control over the determinants of health and  improve their health. Similarly, WHO
identifies that health promotion involves equipping people to have more power
over there life’s, enabling them to make informed decisions about improving
their wellbeing (WHO,). Ewles and Simnett(2003) determine from this that the
elements of health promotion are improving health, empowerment and education.
Health promotion is not an extended role of the midwife but a core competency.
In the  code of professional conduct
(2008), the Nursing and Midwifery Council (NMC) included that  the role of the midwife is to support women in
caring for themselves to improve and maintain their health. Davis (2002) points
out that every interview with a woman is an opportunity to improve long-term
health as midwives are trusted professionals in the delivery of health
promotion. The royal college of midwives ‘Vision 2000’ describes the midwife as
a public health practitioner, and relevant models and approaches can aid the
way that midwives deliver care. A health promotion approach can be described as
the vehicle used to achieve the desired aim (Dunkley-Bent, 2004). This essay
will focus on applying Beatties (1991) model of health promotion to
breastfeeding; analyses the challenges midwives may encounter when promoting
breastfeeding and health promotion in general and evaluates the effectiveness
of the midwife in promoting breastfeeding.

`           The
word ‘midwife’ simply means ‘with women’ (Alberta Association of Midwives
2012). According to the International Confederation of Midwives Council (2005)
the midwife is a conscientious and accountable trained professional in ‘normal’
pregnancy and birth. Midwives work in ‘partnership’ with the woman, her partner
and family to offer important  care,
support and advice during the antenatal, intrapartum and postpartum period to
independently guide the women through the pregnancy. The nature of the midwife
includes the support and encouragement of normal birth, identifying
complications with the pregnancy. Midwives play a significant and critical role
in the delivery of health counselling and education which includes antenatal
education not only with the women but with the family.
It is the midwives’ role to promote health and wellbeing to women and their
babies (NMC, 2008). Health promotion, as described by Scriven (2010), is said
to be ‘improving, advancing, supporting, encouraging and placing health higher
on personal and public agenda’s’. Midwives use health promotion models and
approaches to enable a common value to be made clear; allowing all team members
to work towards the same goal. Effective communication between midwives is more
likely, and therefore the quality of health promotion given to women is improved
(Bowden 2006). Tannahill’s model of health promotion, developed by Downie
(1996), helps itself well to midwifery practice. The model mainly focuses on
health education, health protection and preventing ill-health. The three topics
overlap; in which health promoting activities may fall. The educational
approach is often used within this model whereby the midwife gives facts and
information to the women who may then choose to act on the information given,
or not (Bowden 2006). Similarly, the behaviour change approach is commonly used
in midwifery when encouraging women to change her attitudes or beliefs to adopt
a healthier lifestyle (Bowden 2006). There are many health promotions
approaches and models. Although, no specific model is relevant to every woman.
Each woman will have individual needs and therefore requires an individual
assessment in relation to health promotion.

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Health
promotion is an essential part of a midwives’ responsibility; the nature of health
promotion work as a midwife is geared toward promoting the health of the mother
and ensuring optimum environment for mother and baby” (Dunkley,2000). Breastfeeding
can be a controversial topic; it can bring about mixed opinions and responses
from mothers and midwives. The main  reason for the promotion regarding
breastfeeding is that apart from being economically friendly, it also holds
many benefits for the baby and for the mother (Dunkley,2000). Health promotion
is a proactive process. It is a process that is done with people not at people,
either on an individual basis or within groups, Participation and partnership
are key components of the process.

Beattie’s
model provides a structured framework to guide, map and contextualise health
promotion intervention related to breastfeeding (Seedhouse,2003). Beattie’s
(1991) has two dimensions; “mode of intervention” and “focus of intervention”.
The “mode of intervention ranges from authoritative which is top-down and
expert-led: to negotiated, which is bottom-up and values individual’s autonomy.
The “focus of intervention” ranges from a focus on the individual to a focus on
the collective. The model uses these dimensions to generate four strategies for
health promotion – health persuasion, legislative action, personal counselling
and community development (Tonnes and Tilford, 2001). The health persuasion
technique utilises the medical and educational approaches to inform women of
the research-based health benefits of breastfeeding. This intervention is
top-down, directed at individual women and led by midwives as health experts
(Perkins,1999). It relies on persuasive tactics to ensure compliance. Being
medical-based, it aims to reduce mortality and is conceptualised around the
absence of disease. As midwives do not regard pregnancy and childbirth as
states of ill-health, its validity in midwifery care must be questioned (Dunkley,2000).
The benefits of breastfeeding are well-documented; however, difficulties arise
in making this information relevant and personal to each woman’s ‘information’.
According to Condliffe (2005) midwives’ reported a lack of confidence within
midwifery practice but Mezey and Laazenbatt (2009) said that it was due to
concerns with lack of experience on the relevant subject area and discussion. It
appears that the challenge for midwives is having the time and resources
readily available. Positive messages about breastfeeding should be evident in
the midwives practice room (Ewles and Simnett,2003). Literature and posters
that promote breastfeeding should be p displayed. All magazines and literature
in the waiting room can be examined to ensure that there are no unwanted advertisements
or promotions of formula. Health persuasion assumes that women make rational,
conscious decisions about how to feed in response to factual health-related
information (Crater,2002). Personal attitudes will affect the woman’s decision
more than anything; and changing beliefs, values and attitudes is difficult and
requires more time, resources and dedication than most midwives have, due to
over-load of work. According to Crossland (2015) he stated that breastfeeding
is cost free and other health incentives could be spent on other poor health
choices but Whelan (2014) stated that breast feeding needed all the support it
could get so midwives could encourage it within their practice.

It
is important in the midwifery profession that a Continuity Model of Care is
adopted as this encourages a close professional relationship to develop between
both the midwife and the woman throughout the birth process. Continuity of Care
allows the midwife to provide personal care that is tailored specifically to
the woman and her family’s needs with the ability to address any further
complications or issues that may arise, improving both the quality of her care
and her birthing experience. Continuity of Care is advantageous as it can be
provided in a wide variety of settings, both formal and informal environments,
in order to set the woman at ease, making her feel more comfortable. (Pairman,
et al 2010) The midwife must be aware of all relevant aspects in respect to the
culture of the woman they are providing care for. A barrier that may exist
within the Midwife-Woman partnership may be age. Another observation that may
have to be observed regarding cultural sensitivity includes ethnicity. This
should be permitted unless there is a clinical reason which prohibits it.
(Health Care Providers Handbook, 2010).Birth is universal to all women;
however, the experience differs in many cultures as births are considered sacred
events in many countries (Robinson & Thomson2009,p142). There are dangers in the midwife being unaware of, or misunderstanding
a culture, the most serious is stereotyping people, when it is assumed that a
culture makes all members of the cultural group think, feel, and behave in a
certain way. (Bowden and Manning 2006). The relationship between the Midwife –
Woman partnership differs within our own culture as our upbringing, education,
experiences, location and our general way of life impacts on us all differently.

The
role and responsibility of the midwife is to work with evidence based practice
“with evidence based practice” with effective communication to provide advice,
support, encouragement and education to facilitate the woman’s ability to breastfeed
(Johnson and Taylor,2006). Support throughout pregnancy can have a long-lasting
effect no matter the scale the task maybe. A good example of this is the midwives’
role in health promotion and in supporting women in feeding their
babies(Crafter,1997). When a woman needs more general sources of advice and
social support than those provided through the maternity services, midwives
still play a key role in providing relevant information and advice and
referring her to other professionals and organisations for support. (Cooper
& Fraser 2003). If the chosen method of feeding an infant is breastfeeding,
a mother should expect midwives to assist them in the latching on of the baby
and in the correct way so it is not painful or uncomfortable for the mother. 

Woman
– centred care is the overarching framework for the National Competency
Standards for the Midwife (2006). Woman-centred care is a concept that implies
that midwifery care, is focused on the woman’s individual, unique needs,
expectations and aspirations, rather than the needs of institutions or
professions recognises the woman’s right to self-determination in terms of
choice, control, and continuity of care 
encompasses the needs of the baby, the woman’s family, significant
others and community, as identified and negotiated by the woman herself follows
the woman between institutions and the community, through all phases of
pregnancy, birth and the postnatal period is ‘holistic’ addresses the woman’s
social emotional, physical, psychological, spiritual and cultural needs and
expectations (ANMC, 2006). By adhering to rules, standards and guidelines the midwife can
ensure that the care provided is of the highest standard. Midwives understand
that each woman is an individual and her needs are assessed on an individual
basis, with a non-judgmental, caring nature. Ewles and Simnett (1999) list the
following activities that could be seen as health promotion practices; Mass
media advertising, campaigns on health issues, patient education, self-help
groups environmental safety measures, public policy issues, health education
about physical health, preventative medical procedures, codes of practice on
health issues, health enhancing facilities in local communities, workplace
health policies and health and social education for young people in schools.
Ewles and Simnett (2003) also identify approaches to health promotion. These
all flow from a set of aims which hope to be achieved. They emphasise that no
one aim or approach to health promotion is right but that it is important for
us, as health care workers to consider which is appropriate for us, and
relevant to our work. However, one of the most important factors is educating
people, to allow them to make informed, healthy choices according to ……….

In conclusion, the RCM Vision 2000 describes the midwife as a
public health practitioner. Midwives have always enhanced, facilitated and
supported factors, which promote physical health, psychological, social and
spiritual wellbeing for the woman and her immediate family. Some of the key
points that should be considered for the future of midwifery health promotion
practice, is that it needs to be clearly defined, ‘national and political
recognition of the midwife’s contribution to public health should be improved
and midwives should promote health within the socio-cultural and economic
context of how individuals live their everyday lives’. Providing antenatal care
to woman and fetus demonstrates a unique opportunity to enhance holistic health
through advice, guidance, support and social networks where the woman can be
offered further specialised care if needed. This assignment has discussed the
concept of health and health promotion. Beattie’s and health care model was
used to show the importance that a supportive environment is created in which
people can challenge ideas and question beliefs. Beattie’s model is adaptable
and could be applied to many scenarios; the model shows knowledge of awareness
of adult education by provoking a deep understanding of processes and problem
solving, and therefore the quality of teaching and the learning process. There
are many ethical issues involved in parent education. Participants need to be
listened to carefully and their questions answered truthfully, which gives a positive
effect on the woman and leads to the skills and confidence to take more control
over their health. The Midwife woman partnership is a complex relationship that
balances on understanding and acceptance factoring in the beliefs, rituals,
lifestyle, ethnic values and the risks associated  of the woman or mother to be in order to
achieve both a positive and empowering labour, as well as a favourable and
healthy outcome for all involved. This understanding makes it essential for
Midwives to be aware of all the cultural differences apparent and possess
knowledge pertaining to the cultural expectations and lifestyles of all
cultural groups. It is important for Midwives to continually undertake further
training and education, to maintain their professional development, as well as
broadening their existing knowledge and skills. Good health is not just the
physical wellbeing of an individual, but the social, emotional, cultural
wellbeing of the whole community in which everyone is able to achieve their
full potential as a human being thereby bringing about the total wellbeing of
their community.