This paper will discuss and describes the process of engagement in communication skills including different stages of interaction. Also, the impact on the different stages of interaction will be identified. To demonstrate and understand these stages, an individual counselling process session will be used and will be related to midwifery.

The first stage of the counselling process is the preparation stage. It involves health professionals being aware of their personal beliefs and feelings as well as receiving and reviewing referral information (Geldard & Geldard. 2012). Prior the first meeting with women, midwives have to make sure that their practices is safe meaning they have thought on their own values but also their own attitudes and beliefs. They have to ensure there are no disparity (Phiri, Dietsch , Bonner, 2010). Midwives are more likely to be confronted with women with various social determinants of health. For that reason, the stage of preparing to meet these women are extremely essential. To give an example, when midwives meet women who have unsafe comportments such as alcohol consumption or smoking, they need to have positive attitudes towards them. That means, midwives need to be constructive and encouraging. Through beneficial and favourable interactions midwives have the potential to elaborate long term outcomes for the future mum and baby. This is true as pregnancy is recognizing to be a very teachable moment (Pairman et al.2015). Sometimes, midwives have to contact women throughout their pregnancy to gather more information or simply discuss their history or their wellbeing. To do so, this process of communication should be done via telephone or even in person as other kind of contact such as text messaging are not reliable or can be confused or misunderstand (Pairman et al. 2015). When a midwife has received all necessary information, referrals, medical history or charts, the time for both of them to meet and build a relationship has arrived. This is the second stage of the counselling process.
This stage is the joining process and refer to the initial stage when the midwife meets the woman and attempts to put the woman at ease and try to establish a trusting relationship. The midwife role is to listen and invite the woman to talk and help her to express her problems and feelings to gain a better understanding (Counselling skills, 2015). At this point, minimum questions are required however it would be good to check how the woman is feeling by asking her. It could be a simple question like " how are you feeling right now?" Such questions are good as it immediately focused on the woman and make her more comfortable to talk and express herself. Again, the midwife's role at this point is the build a relationship and trust between both of them. It is important for the midwife to listen and keep minimum questions. This is where the active listening comes in place.
During the stage of active listening, the midwife will depend most of the time on paraphrasing, reflection of feelings and also summarising. As stated above, although few questions may be essential like one or two, it is more suitable to keep them as a minimum. By doing this, the woman will feel more comfortable and can gain assurance and moreover, she can feel valued. The stage of active listening is an important skill of this process as indicated above. It allows positives and healthy interaction with the woman but also improve overall communication.

The next step in the process of engagement in communication skill is emphasis on emotions. As the relationship develops between the woman and the midwife, the midwife will use reflection of feelings in order to help the woman to get in touch with her own emotions (Geldard & Geldard, 2012). With this in mind, the midwife has to make sure she is using paraphrasing and summarising. It is important to realise, that the midwife will probably experience feelings herself by listening to the woman and she has to be aware of it. It is crucial for the midwife to continuing to be empathic as it can have a big impact on the relationship. If this happen, the focus will not be on the pregnant woman but on the midwife as the woman will be concern about the midwife feelings. This is not useful in this process as the priority is the woman. The midwife needs to take time to help the woman and she has to do it sensitively as the woman may have difficult time to express herself and going through her emotions. Clearly, the midwife needs to be able to manage her own emotions.
Following this stage, the midwife needs to be able to ask further questions, this is where the emphasis on thoughts especially clarifying the problem comes in place. To move forwards in addition to identify the issue, specific questions need to be asked. Further in the process, the midwife requires additional skills that are useful in promoting changes by helping the woman to think differently. These skills are normalising, reframing, challenging self-destructives beliefs, exploring polarities and facilitated the woman to use her own strengths (Geldard, K.,2008). Normalising is a powerful skill and useful if used correctly. For example, it can be used to reduce a woman anxiety if the woman recognise that her emotional state response is normal.
Time to time, pregnant women can be scared and may feel overwhelmed by emotions and it is the midwife responsibility to ensure that she use the normalising stage. Letting the woman knows that is perfectly normal to responses to an emotion. In fact, normalising is to be used for emotional states and normal change of behaviours, roles and relationship due to developmental crisis.
Reframing stage is a method used by the midwife to help to change the wat the woman sees evens or situations by reframing the picture the woman can see. The purpose of the reframing is to help the woman to see the picture in another way they can see it, it doesn’t mean that the way they see the situation is wrong but it helps to look at the picture differently, expended the view of the picture.
Challenging self-destructive beliefs is the following stage in these skills listed above. What we think and believe about ourselves, the world, and our lives has a powerful impact on our life, and this is true for pregnant women. It affects our everyday existence. Unfortunately, some beliefs can be destructives to the process of a successful life. This is where the midwife role come in place. She needs to identify these sabotaging thoughts that affect the woman and work on them and banish them for good (Personal Development Wisdom, 2013). Given this points, the goal is to replace negative, irrational thoughts with more positives and realistic ones. The midwife has to help the woman in the realisation of her negatives thoughts and help her to let them go for a better wellbeing and life. Finally, the last stage is exploring polarities. Human being have polarities or we can call them opposites side in their personality. Usually, we try to show the more acceptable side of us but sometimes the opposite side of us emerged. This is also true for pregnant women as they are in stage where they are very emotional, sensitive due to the pregnancy. The midwife role is to help the woman to accept this unrevealed part of herself so she can be able to deal with them and increase her strengths from the opposites side (Geldard, K.,2008).
The last stage of the process of engagement in communication is emphasis on behaviour. At this point, the woman is clearly able to exploring different options or discuss different dilemma. She is also able to plan for the future. All these processes have been assisted with the midwife in regard on a relationship that both of them have built during all this phase. The woman doesn’t feel any pressure and may feel confident to speak p and to express her feelings. It is crucial to encourage the woman to make her own decisions for the future. The woman is more and more independent by making choices and be optimistic for the future.
Finally, the closure is the last process in the communication. To close the session, it is crucial for the midwife to summarise all the important points that have been discussed in accordance with the woman. As stated above, the woman is more likely to be independent on her own choices but also feel more comfortable to move forward. This is where the woman and the midwife agreed to terminate the session and this is as just important as the initial phase of joining. This process of termination can involve emotional for the woman. Before leaving the session, the midwife has to be sure that the woman is feeling much better and ready for the future. She can also provide all the information necessary for the woman in regards of any kind of help. This can include referrals, associations around the woman area. To achieve

The process of engagement in communication skill in this paper describes that midwives need to have micro skills to conduct communication with pregnant women. These skills are necessary in order to achieve to goals implemented with both parties, woman and midwives. The process of communication is a long journey and it can’t be achieving in one time, it needs time to build a relationship.

References

Phiri J, Dietsch E, Bonner A. (2010). Cultural safety and its importance for Australian midwifery practice. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21046963 Persona lDevelopment Wisdom. (2013). Self Destructive Beliefs. Retrieved from http://personaldevelopmentwisdom.com/self-destructive-beliefs.html |

Geldard, K. (2008). Promoting change through the use of an integrating approach. Personal Counseling Skills: An Integrative Approach, 141. Retrieved from https://books.google.com.au
Pairman, S., Tracy, S., Thorogood, C., & Pincombe, J. (2010). Midwifery: Preparation for Practice (2nd ed.). Chatswood, NSW, Australia: Libby Houston -
ACS Distance Education. (2015). Counselling Skills II. Retrieved October 15, 2015, from http://www.acseduonline.com/courses/psychology-counselling-behaviour-8/counselling-skills-ii-bps110-159.aspx
Geldard, D. & Geldard, K. (2012) Basic Personal Counselling: a training manual for counsellors. 7th ed. Pearson Australia.
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