THE NURSE-MIDWIFERY CHALLENGE

Bxidging the Technology Gap

May Franklin, CNM, MSN

The Journal of Nurse-Midwtfey has recently published several articles dealing with the interface of nurse- midwlfey care and technology II- 3). Jsiobson dlscussed the increased reliance on technology at the ex- pense of nontechnological assess- mentsktlts (1). Avery and DelGiudice outlined changiq practice relation- ships as a result of increased technol- ogy (2). In her introduction to the Home Study Program on Advanced Nurse-Midwifery Practice, Slnque- field stated, “Technology is a reality of our lives both in and out of mid- u&y. .” (3). Vosler and Bunt ox- amined the relationship of nurse- midwiley to medicine in the context of American gendered roles (4). In their analysis, they discussed areas of confltct such as episiotomy. intwe- “otts lines, and aticlally xuptudng membranes.

This article addresses the impact that technology has on “urse- mtdwifey care of the impoverished

wmlen many of us save. I propose that the grwih in medical technol- ogy in the last two decades has made tt ever more chaltengtng to pmvtde midwifery care and has escalated contlicts aboilt the provision of care, especially for those of us selving WI- “erable populations. The challenge

that increased technology has we- ated Is twofold: explaining technol- ogy in a way that empowers women to make intelligent decisions, and providing equal access to technol-

ogy. My practice constsb primarily of in-

ner-cy women, living in poverty, most of whom are AMcan-American. Due to ma”” factors. the women I save ge”&lly h&a low oduca- tlonal level: thts IS further com- pounded by the fact that eve” grad- u&ton from high school does not necessmily guarantee that a patticu- lar woman can read or write. For this reason, the communicatton of verbal information, augmented by the use of otcturer. is the most effective te&ht”g method. Each day, I spend a good deal of time explaining the difference between the gallbladder and the uiina~ bladder. between e

urinay kect infection and a vag&J infection, between a Pap smezu and a pelvic exam. Expk?“ationo of b&c anatomy and physlolspJ are routtno. The Increase in avatlable technology. combined with the low educational level of my panents, “lakes the pro- tees of pattent ed!4cano” I”aeaan$y difficult Many of my Patients have never heard of either the words or the concepts behind amnlownterls. cdpo+copy, or chotio”k vtlku sam- pling. It stretches all of my faculties to try and find appmpdate wrds to make the abskact concepts of antt- bodv. alpha-fetwmtet”. and antioar- dlolipin k into &dersten&ble im-

ages. For women to make truly infmd

decisions about the myriad of tezh- nologtes offered to them, they must have as complete a” understanding as possible of the rlrks, benefits, ad- vantages. dtsadvantagps. end co”se- quences of the t&“g end treahnent options that we offer them. This fs oat and oarcel of mtdwtfetv care. Hnd it is ex&tfy stated in iheACNM Standmds for the Pmaice of Nume. Midw[fee (S). Tbij pmvisionof infor- mation Is no easy task, give the time

constrabts of a clinic, but it is made

even more daunting by the rapid ex-

pansion of technology we offer

women. It is most frushattng to spend

IO minutes discussing the option of

alpha-fetoprotein testing, only to

have the woman indicate that she

has no idea what you are offering

her. Because the provision of this in-

formation is such a time-consuming

process, many women make de&

sions about their care without ade-

quate information and then are left to

suffer any consequences.

A related problem is accen to all of

this technology. FBeen years ago, I

volunteered at a Free Clinic. The

technology avatlable at this cltnlc was

not much different from that avail-

able in a private physician’s office at

the time. Both the clinic and private

offices offered birth control pills,

IUDs, and banter methods for con-

naceptton and referred patients out

for x-my, &asonogmms, and ml-

pwcopy. Today, I still volunteer at the same clinic, but now the clinic

cannot afford chlamydia cultures.

Depo-Provera. IUDs, or Norplant

system implants. It stjll does not pro-

vtde cotposqy. ukmsonograms, or

x-ray services, although these are

available at many private physictans’

offices. Tbii creates a situation where

the women using the Free Clinic for

their health care do not have BCCB

to the same services as do other

women. Even in my regular clinic.

where technology is available. it

mean* long waiting periods (some-

times up to months for a colpmopy

appointmenti, prohibitive travel and

transportation, and all of the related

sccial problems that attend traveling

to another site (lack of day care. etc. I.

It is a severe dicho!omy of expeli-

ence. In the urban outlying public

clinics away horn the hospital, poor

women do not have the same access

that private patients have to ultrasc-

nogmphy. colposcopy. cholionic ti-

lus sampling. amniocentesis, and

other outpatient procedures. Once

admitted as inpatients, however.

these women are inundated with de-

cisions to make about technology.

TIey are admitted to level III, tertiary

teaching hospitals where they are

asked to make decisions about am-

nioinfosion, scalp pH sampling, inter-

nal fetal monitoring. etc.

Many ulomen undoubtedly base

their decisions on ignorance and fear,

and they do not get enough under-

standable information so that they

can make informed decisions. For

example. it is impassible to provide

pregnant women with information. in

advance, about all of the things to

which they may be asked to agree in

labor and delivery. At the same time,

the intrapatum period is not ideal for

providing information, negot attng

choices, and asldng women to make

decisions. The tie challenge is mak-

ing technology understandable and

wailable on an equal basis. Y) that

women can make &c&ions based on

information, not on fear or igno-

rance, and so they are not dented

options duo to the inaccessibtliiy of

advanced treatments or tests This

challenge will only increase as tech-

nology expands. Whether or not

nurse-midwives participate in the

provision of high-technology inter-

ventions, we will always be responst-

ble for w&sting our patients to make

informed decisions about the accep

tance or rejection of such intewan-

ttons. As technology increases, Jo

does our responsibility and our chal-

lenge.

REFERENCES

1. Jacobson AK Are we losing the ati of mi&tely? J NUM Midunlay 1993. 3&16%9.

2. Pvery MD, DeElJldke GT. High- tech skllsm low-tech hands: issues of ad- vanced praclice and co!laboratiw man- agemert. J Nurse Midwlery 1993~38 iSuppll:9~17S.

3. SLnqueRetd G. Technolw; a real- ity and an iawe for nurse-midwwes. J Nurse Midwifery 1993,38(Suppl):lS.

4. “osler AT. Burst HV. Nurse- midwihn, as it rainforces and hansforms

the Am&an ideology of sendered r&s J Nurse Midwifery 1993;38329%300.

5. American College of Nurse- Mtdulves. Standarcs for the practice of nurse-midwifery. Washmgton. DC:

ACNM. 1987.

Jwmul of NwrMM*likrv . Vd. 39. No. 2. MmcfuA~rtt 1994 111