Introduction

            Mourning is the entire process precipitated by the loss of a family member or a loved one through death. During childbirth, the loss of a newly born baby is a profound loss to new mothers, prompting the need to introduce bereavement handling as part of mandatory training for midwives. Training midwives on the management of bereavement especially for mothers who lose their newly born babies will significantly improve midwifery service delivery and help the bereaved parents to grieve their babies(Stephen & Macduff, 2012).Parents find it difficult to come to terms with the sad news of the loss of a baby since most parents try to envision the life of their baby even before they are born, thus building expectations over the time of pregnancy with the climax when the mother goes into labor. During this time both the father and the mother are highly expectant of a live child who will live their entire lifetime and achieve milestones. However, despite all the expectation, one thing that the expectant parents do not consider is the death of their newly born infants at birth(Canadian-Peadriatric-Society, 2001).

Bereavement is an important consideration that ought to be considered as an essential part of midwifery training to equipmidwives with necessary skills to guide parents who have unfortunately lost their infants during birth. According to Fenwick and colleagues, the current midwifery training does not provide the essential skills and psychological techniques for managing bereavement during pregnancy or childbirth (Fenwick, Jennings, Downie, Butt, & Okanaga, 2007).

Much of the research in perinatal loss is profoundly focused on the psychology aspect of midwifery which particular emphasis on psychometric evaluation of specific components including components of care such as naming newly born babies and naming babies (Allott, 1996). Hughes described the dramatic changes which have been experienced in this field for more than 20 years and credits the positive changes so far experienced to the initial interest in the clinical benefit in the experience during a perinatal loss(Hughes & Goodall, 2013).

Learning outcome 1: organizational structure and policy influence

More recently, there has been a shift in the focus on how perinatal bereavement care is provided in healthcare facilities(Hughes & Goodall, 2013). However, the care provided to women who have suffered the unfortunate perinatal bereavement has not been strengthened and optimized to achieve positive care outcomes calling for an urgent assessment of the guidelines for perinatal care. In the evaluation, news aspects for improving perinatal loss care such as the introduction of holistic care, woman-centered care, and evidence-based care should be recommended. Moreover, there is a need to revise the perinatal loss care policies appropriately.Along with the changes above that can be used as the basis for improving perinatal bereavement care, further research in the area of perinatal bereavement should be encouraged.

The existence of structures in healthcare organizations as well as government policies that establish perinatal bereavement care does reflect good care for bereaved mothers and their families. The quality of care provided by midwives to the bereaved families is gradually diminishing in the United Kingdom, following poor training of midwives. Non-inclusion of the bereavement aspect in training curriculum used in training of midwives is thus a significant drawback in the journey to realize a holistic and mother-centered perinatal bereavement care.Widening the scope of the scope of midwifery training by including the aspect of bereavement will be a significant milestone and will boost the journey towards realizing quality care and acknowledging prenatal bereavement in both healthcare organizations and the society(Schott & Henley, 2007).

Organizational structures and government policies have a significant impact on midwifery professional practice. The quality of services rendered to mothers who have lost their infant babies is significantly determined by the existing organizational structures in health care facilities as well as the government policies in place. In the UK, the perinatal loss has been associated with an interplay of complex risk factors such as maternal age, smoking, and obesity. Majority of the risk factors contributing to perinatal bereavement can be addressed through formulation and putting in place simple policies such as health education policies. This policy will require that all pregnant women are registered in healthcare facilities and are educated about pregnancy by qualified midwives. Besides, all pregnant women must be monitored throughout their pregnancy as a policy. High rates of perinatal bereavement have been reported among minority ethnic and socio-economic groups suggesting that the policies must be strengthened to ensure that all pregnant mothers from minority groups are monitored throughout their pregnancy. Strengthening government policies on perinatal bereavement is particularly crucial since the currently existing systems have not been followed carefully(Mukherjee & Bandyopadhyay, 2016).

Learning outcome 2: management and leadership influence

            Management and leadership theories are frameworks/models that define different types of leadership approaches. Leadership is the reflects one’s ability to convince other people to willingly behave differently while on the other hand management is more or less making things happen(Armstrong, 2016).Leadership theories are anchored on the different behaviors and traits exemplified by leaders in various fields. These the different traits led to the different leadership styles such as transformative and transactional leadership, authoritarian leader, democratic leaders, and Laissez-faire leader. Every leadership approach influences the outcome and achievement of the organization’s primary objectives differently. For instance, transformative leaders base their leadership approach on the need to transform the organization from the current state to a better status that at the end of his/her tenure, the organization will be proud of him/her.

In line with the introduction of bereavement as an essential aspect of midwife training, this paper delves into the influences of leadership/management theories on team building, prioritization, motivation and change management. The proposed change in midwifery practice focusses on creating an enabling environment for the enhancement of midwifery training to optimize their practice outcomes. The proposed changes will ensure that parents who have suffered perinatal bereavement receive holistic, care, woman-centered care, and evidence-based care. These proposed changes will partly be achieved through a revision of the existing policies. However, to make these recommendations, there is a need to involve different groups of people including voluntary organizations, head of midwifery, bereavement midwife and matron. It is evident that the participates in the practice change introduction are drawn from different backgrounds creating the need to put in place good leadership to ensure cohesion and team building within the diverse group.

There are many leadership theories to choose from; however, the primary objective is to the leadership approach selected for this task will maximize team building, motivating group members, prioritization and managing change. Example of the leadership theories that can be applied in this context includes transformative, authoritarian leader, democratic leaders, and Laissez-faire leader. Transformative leadership approach, for instance, is concerned with the ability of leaders to inspire followers to achieve great things. Transformational leaders are regarded as agents of change and their primary objective is to change the organization positively.In view of introducing change in the midwifery practice, transformational leadership approach is the best approach as it promotes team building, motivated the group members, and provided capacity for managing change(Aga, Noorderhaven, & Vallejo, 2016).

Leaders and managers are the determinants of organizational performance. Organizational leaders play the primary role in ensuring that a conducive environment and culture that promote employee performance exist in their organizations(Mathew, Esowe, Udo, & Ajagbe, 2016).Employee motivation and productivity are closely related in the sense that motivated employees are likely to be more productive as compared to un-motivated employees. According to Alghazo, the management and leadership theory adopted in organizations significantly influences team building, change management and motivation(Alghazo & Al-anazi, 2016). Some of the leadership approaches such as transformative, democratic and Laissez-faire leadership are known to promote team building, motivation and managing change whereas authoritarian leadership hinders team limits team building, motivation and change management.

Learning outcome 3: build a case for change

            The proposed change in practice is the introduction of bereavement as a mandatory component of the midwifery training curriculum. The introduction of this practice change is aimed at optimizing perinatal loss care that women receive following the death of their newly born infants. Perinatal bereavement is a long standing problem in the UK triggering the UK government to formulate policies that will work towards the reduction of these cases. In the year 2014, an estimated 3, 245 stillbirths and 2,689 infant deaths were reported in England and Wales(Office of National Statistics, 2014).The loss of a child during or immediately after birth is a traumatic experience that the mother and relatives go through. Based on the quality of care victims of perinatal loss receive afterward, the events may leave a long-lasting impact on the family(Montacute & Bunn, 2016).

Based on the above evidence, it is of primary importance to establish strategies that can facilitate practice change on how the victims of perinatal bereavement are treated and the quality of care they receive. This paper proposes a practice change in which a component of bereavement is introduced into the midwifery teaching curriculum. The practice change will entail expanding the scope of the curriculum to include pre and post-bereavement care techniques(Mitchell, 2005). By equipping bereavement midwives with such skills is an important priority which will not only promote good care for the mothers who experience perinatal bereavement but also accelerate their recovery from the traumatic experience and resume their healthy lives.

The model for the proposed practice change will involve process enhancement and capacity building with the target of equipping bereavement midwifes with skills necessary for optimizing perinatal bereavement care. Thus, the primary objective of the practice change is to introduce bereavement techniques and handling psychosocial impact on bereaved parents. Training optimization is the major component of the practice change which has two major outcomes. The first outcome is the optimization of perinatal loss victim’s care and the second outcome is the building capacity for transformative leadership among bereavement midwifes. The optimization of care provided to bereaved parents will be realized through various approaches such as the provision of holistic care, evidence-based care, and policy formulation. Transformative leadership among bereavement midwives is encouraged partly due to its effectiveness and partly due to its association with change.

Most importantly, transformative leadership encourages team building; hence it will ensure that all the grief midwives in the UK collaborate and work as a team to attain the primary objective of care optimization. Another desirable aspect of transformative leadership is the motivation aspect implying that the transformative leader will motivate followers and foster for the implementation of the proposed change.Transformative leaders have the necessary skills and techniques for managing changes suggesting that once trained on transformative leadership; bereavement midwives will be able to effectively manage the change process eventually attaining all the set objectives.

Voluntary community-based organizations will be in recruited to facilitate the change process by reaching out to community health care workers and bereavement midwives stationed in rural areas. The head of midwifery for all the hospitals that will participate in the change process will also be recruited to help educate and lead all the midwives through the change process. Finally, but most importantly, the bereavement midwives and matrons will be involved in the change process as the primary target as they will be educated and empowered to facilitate bereavement care optimization.

Learning outcome 4: Importance of quality

Quality of care provided to bereaved parents determines how fast the bereaved parents recover from the traumatic ordeal of losing a newly born baby. Good quality care including before and after delivery events will ensure that the parent safely delivers the baby hence reducing the cases perinatal bereavement. In my opinion, good quality care is the purpose for which midwifery as a profession exists, thus all midwives should be ready to go out of their way to help pregnant mothers to deliver their infants safely. It is also important to note that quality determines the purpose for which professional midwives exist and as such, there is need to ensure that midwives receive quality education including the component of bereavement handling to optimize their service delivery.It is also a common practice to build a good brand and win the trust of the patients in the health care industry. To win the trust of patients, it is necessary to ensure that the quality of services is at the heart of the care provided. Good quality is an indicator of patient satisfaction and must be maintained to ensure that patients are satisfied. I believe that the joy of every pregnant woman is to hold in their hands live new born infants. Midwives are the facilitators of this joy by providing quality are which reflects the professional practice of midwifery(Shorey, André, & Lopez, 2017).

References

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