What have I learnt about how to interact with women and their families.

The Inner Consultation, Roger Neighbour



Chris, my husband gave me this book to read. It is aimed at GP`s in practice and looking at how they interact and consult with their patients, so you may wonder why he should suggest a midiwfe should read it and I must admit to being skeptical. I did wonder what on earth I could get from a book which is set in a medical context? Chris did reason with me, that as a practitioner in a primary care setting that I may be able to adapt some of the philosophies of which the author describes.

I have to admit that after reading the first section, he is right. So often as midwives we are taught in our training about the practicalities of the job and we are left to our own devices to develop our own intuative style of connecting with women. I`m left to reflect, is there more that could have been done during my training which would have helped?



In the begining

It is important for us to look at and examine how we are taught our consultation style. Often we have learnt our style from our mentors with whom we have worked during our training. These were women who at times could seem infalible, with the huge amount of what seemed infinate knowledge they had and some of us held them in high regard.

Models of consultation can also be looked at to make the skills of connecting seem easier. I like the description he uses for `keeping it simple` and `the consultation as a journey` because I often see the midwife/woman relationship as a `journey` through pregnancy, birth and with her new baby. It is often when considering this `journey` we can look at the models that are used.



The `role model`

In his book, Neighbour describes this model of the patient entering the `sick role` and they hand over partial or complete responsibility for their well-being to the doctor. I liked this role model to the one of the pregnant woman going to see the obstetrician for a consultation regarding her pregnancy. She may assume the role of `sickness` because she has only ever associated the doctor with being sick and during that consultation she begins to partially or completely handover control to the obstetrician and although she had every intention of having a normal labour and birth she ends up before she knows it booked for an elective c/s. I enjoyed reading about the `role signals` which may lead a woman to assume this role. How often have we seen the obstetrician in his clinic, enthroned behind a desk in a white coat with what Neighbour describes as `access rituals`, such as receptionists, appointment systems and the women having to present their urine specimens as gifts to secure the obstetricians attention.



The doctor-centred or patient centred consultations

I was left to reflect how often I have over heard the `midwife-led` consultation, the woman is bombarded by information which must be covered so that a box can be ticked in the box of the careplan with a total disregard for anything that the woman may have wished to discuss and a disregard for whether she has heard it all before or if she has found it out herself. The midwife is happy at the end of the visit having accomplished her agenda. Or on the other hand the `woman centred` consultation whereby none of the essential information is covered at all and the woman is in charge of the visit.



The Task orientated model

This is very much similar to the above model whereby the visit is dominated by tasks that have to be completed and the success of the visit is set with the accomplishment of these tasks.



The Health Belief Model

This is the model that most interested me, especially in the climate which I have worked. In this model he discusses that the beliefs and motivations which the patient (woman in midwifery world) brings into the visit influence the understandings and intentions she takes away with her and passes on to her family. With this model it is useful to consider the ideas, concerns and expectations the woman has with regard to her pregnancy, birth and with her new baby. These aspects I believe, will influence her choices and the information she looks to the midwife to provide during the pregnancy. Then depending on what she has heard and absorbed her health beliefs will influence how she transmits that information to her family and friends.



Talking with two heads

After reading this chapter I was left reflecting how often I use two heads during an antenatal assessment. In his book, Neighbour names these heads as the Organiser and the Responder and he takes us through a couple of examples and I have been left trying to construct a midwifery example in my head. The organiser head is the intellectual part of the brain, is very logical, task orientated, is calculating, likes to anticipate and stay one jump ahead of the game. It sets your goals and `wants` certain things to happen. It deals with the checking of urine, Bp`s, palpation and the documentation of the visit and the checking of the careplan. The responder is the spontaneous head, naive and intuitive and picks up on not only verbal communication but non verbal communication. Have you ever wondered why you connect with some women better than others? Thats because your responder head has been busy reading all the non verbal cues which may be suggesting that the woman isn`t connecting with you, such as lack of eye contact, fidgeting, hesitancy of speech.

The responder head and the organiser head may alternate during a visit with one or the other whispering in your ear as you talk.

One exercise which I found useful is to recall some visits which you have done recently and see if you can remember some of your internal dialogue and then jotting your thoughts down.



Continuing with the two heads theme I was left to reflect on the midwife/obstetrician relationship in the book he says, "Two heads are better than one just as long as they are each working towards the same goal, and each respects the strengths and weaknesses of the other." I was left thinking of the recent signing of a memo by the College of Obstetricians and the College of Midwives to each share the aspiration to work towards the health of the mother and baby and wondered if that would ever be possible if we don`t respect each others strengths and weaknesses.

I look forward to reading the second part of the book and picking out the information which may improve how I connect with women or having the reasons for the times that I don`t.