Interactive engagement is a dynamic two-way relationship between midwife and woman. It’s a dialogue, spoken and unspoken, with an exchange of information and feelings between the two participants. Ideally, interactive engagement starts early in pregnancy and includes strengthening a woman’s general self-esteem, examining her awareness of her social and political position in life and exploring the challenges ahead of her with impending motherhood.
The woman needs to be actively integrated in her own care, by exploring everything that is happening or might happen. Teaching her and her partner how to perform some of the routine pregnancy tasks themselves reinforces their sense of active participation.
The woman needs to have regular and ample opportunity to explore how she feels and to express her concerns and fears. And, most importantly, her confidence in her ability to give birth needs to be nurtured and confirmed throughout. By being given credit for her instincts and her own interpretation of issues and challenges that might arise during pregnancy, the woman learns to rely on and trust herself. She realizes that she has a responsibility to explore questions for herself, by consulting books or other resources, or by speaking to people who might assist her.
In short, interactive engagement means that the woman is not just a passive recipient of instruction and, more fundamentally, that she does not assume a subservient position in the enterprise of childbirth.
With such a searching, wide-ranging dialogue in place, the midwife is able to understand the woman in her care much more thoroughly, and can tailor the engagement with her accordingly. Having gained the woman’s trust at the deepest levels, she is in a uniquely privileged position to capitalise on the benefits of interactive engagement during the impending labour, doing what midwives know best!
What has been built up through open dialogue during pregnancy, can now come to full fruition: Upright, totally supported and connected with the descending baby, the woman sits centrestage at the same level as her partner and midwife. She can establish eye contact, touch or be touched, and easily get up or sit back down unassisted. A rhythmical interplay of language and silence, engagement, trust, reassurance and self-confidence will carry her safely through the commotion of labour and enhance the reality of her birthing experience.
The midwife can give the woman her undivided attention, encourage her to remain relaxed and engage her through affirming, empathic and simple language. This creates a calm and quiet atmosphere in which the woman can feel safe and focus on her task.
As midwives, we cannot overestimate the importance of successful interactive engagement.