I agree that the need to give individualised care is vital, but like it or not,
protocols are with us, and they even serve a useful function.
If protocols are properly produced, they will take account of best
practice, and identify what local circumstances are. Ideally they will even
have ‘user’ input. It’s not a case of ‘one size fits all’. Their purpose is to
ensure that a certain minimum standard is met, and that, in particular
circumstances, practitioners act appropriately. This can mean how a
midwife deals with postpartum haemorrhage or shoulder dystocia.
It’s naïve to think that clinical practice can do without protocols. One of
the reasons why we are in this situation is that women have not always
been able to rely on practitioners reacting appropriately, particularly in
emergency situations.
We shouldn’t get too carried away with talk of protocols removing the
possibility of providing individual care: protocols are tools, not rules,
and the skill of the midwife will be in giving individualised care to each
woman. If the protocols in a unit are too deterministic, then midwives
should get involved and change them so that they reflect good
midwifery practice.
Regards
Dr. Andrew Symon
School of Nursing & Midwifery
University of Dundee
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