Introduction

Do midwives have a defined role and responsibility in the provision of care for women with a high-risk diagnosis such as renal disease in pregnancy? And if they do have a distinct role, then what is it? All women need a midwife, some will need doctors too, and this has been highlighted as a guiding principle for modern maternity services in the recently published Maternity Matters. The role of the midwife has its traditions in care for women and infants experiencing normal pregnancy and birth and detecting deviations from this; however, the role of the midwife is increasingly changing and adapting to new ways of working. No matter how complicated or high risk a pregnancy is deemed to be, the distinct and unique contribution that midwifery can make to the care of these women in the childbirth continuum cannot be overestimated.

This chapter focuses on midwifery issues in caring for women with renal disease in pregnancy and includes topics on perceptions and definitions of risk, defining ‘normal’, continuity of care, women's and midwives' experiences, and the distinct role that midwifery has. A brief case study will also be used to examine the midwifery role. Many of the discussions in this chapter are not only relevant to care of women with renal disease in pregnancy but may extend to care of all women experiencing high-risk pregnancies.