More than cultural awareness, women seek specific information about pregnancy and birth. It is suggested in the United States of America, that a third of women seek information from popular childbirth education books. Information however is variable, with inaccuracies in the presentation of scientific evidence and recommendations (Powell et al. 2009). Women may attend classes in the antenatal period wanting the opportunity to understand the process of childbirth and develop confidence in becoming a parent. Part of that process can be learning how to communicate with caregivers to make the choices and decisions discussed earlier, rather than them merely conforming to practitioner preferences and prescriptive policy guidance.
Such learning could enhance that empowerment and personal control within the childbearing domain for women, their families and the wider community.
Birth preparation and the traditionally known ‘Parent Education’ classes have been part of UK maternity service provision for some time. During the 1960s and 1970s, a focus on active birth developed and aimed to give women information about labour that included birthing positions and breathing techniques (Walsh 2012). Such classes are provided through NHS midwifery services, and private and charitable organisations across the country, the National Childbirth Trust (NCT) being the largest non-NHS organisation that is paid for by individuals. Research has predominantly focused on birth outcomes, such as mode of birth or use of analgesia, as a measure of the effectiveness of antenatal classes, finding their merits to be consistently incon-clusive (Gagnon and Sandall 2011). There is some evidence that women’s experience of birth and parenting may be improved if they attend participant-led classes compared with more traditional classes (NICE 2008). Nolan (2009) also highlights that studies have universally failed to take into account the quality of the education provided. Recent research on the provision of birth preparation classes identifies consensus across stakeholders, that current provision is seri-ously inadequate and that midwives are inadequately prepared and supported in this role; also identifying that an expanded focus is needed on relationships and the transition to parenthood (Barlow et al. 2009).
The ‘Birth and Beyond’ package developed by McMillan et al. (2009) provides practitioners with a framework and content for delivering a quality programme of learning to women and families. However, this work did not explain how facilitators were meant to deliver it. Midwives are expected to deliver classes within their clinical role (NMC 2012) and traditionally within their working hours, despite their increased pressures and reduction in staffing levels more recently.
Provision of birth preparation/parent education classes can therefore be a challenge for NHS Trusts. Midwives or health visitors receive little or no training on how best to facilitate them and there is no obvious quality assurance on the content and delivery of the sessions. Robust facili-tation by experts trained in adult education, more than just curriculum planning, along with satisfaction evaluation would demonstrate quality and urgently needs to be developed nationally.
Human rights in childbirth (http://www.birthrights.org.uk/) is a UK organisation dedicated to improving women’s experiences of pregnancy and childbirth.
Further reading activity
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Activity 6.4
•
Write a birth plan for a woman who is pregnant for the first time, has experienced a normal pregnancy and is intending to give birth in a hospital labour ward staffed by midwives and obstetricians.•
Write a birth plan for a woman for the second time after an instrumentally assisted first birth, who intends to have a baby at home with a community midwife attending.Think about the differences each woman will have. What might influence each of these women and who might have the greatest risk of a medically assisted outcome?
Key points
•
Women should be offered a choice for their birth place.•
Screening and surveillance of the mother and fetus monitors for abnormalities.•
Good midwife–woman relationships and education assists a woman in her decision making.•
Care must always be woman-centred and individualised.Barlow et al. (2009) conducted research into the provision of birth preparation classes; at the time of the review an outgoing NHS Primary Care Trust (PCT) in a Northern city in England was becoming an example of an organisation looking to do things differently. The PCT con-tracted out these services to be delivered outside the conventional midwifery concon-tracted time (Reports to the PCT 2010–13) by a small social enterprise organisation rooted in midwifery to pioneer and develop the service. Social enterprise business models are able to sit within the NHS framework working alongside other providers (DH 2008; DH 2010). Ethically and morally, not for profit organisations complement the NHS promoting organisational autonomy and staff engagement (Addicott 2011). This commissioned service in the North of England, was highly successful in improving parent attendance and quality of class provision. However, the venture was not re-commissioned despite excellent satisfaction scores from attendees. The state of antenatal education provision is therefore, somewhat precarious and subject to market forces.
Conclusion
This chapter highlights how pregnancy can be a normal process for women to enjoy and cel-ebrate. National policy guides the journey for women in relation to choices about where to give birth and utilising information for the wellbeing of herself and her baby. Midwifery care is at the heart of service provision, supporting and educating women throughout the antenatal period. This ensures the woman is both physically and psychologically prepared for giving birth and becoming a mother. However, variables and complexities of pregnancy do exist and a good midwife–mother relationship, based on individualised woman-centred care, will ensure best outcomes and satisfaction.
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End of chapter activities
Crossword
1 2
3 4
5 6
7 8
9
10 11
12
13
14
7. Infection from animal faeces 9. Care without Doctor involvement 12. To observe for
13. Having not yet given birth to any viable infants
14. One of the three periods of pregnancy Across
Down
1. Leading to the opening of the uterus 2. Reflects the evidence base and
recom-mends practice
3. The presenting part descending into the pelvis 4. Before labour
5. Recommends women should be offered choice of place of birth
6. Caused by hormonal influence on the bowels
8. Extracts blood
10. Screening questions for mental health issues
11. A deviation from the normal
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Find out more
Below is a list of things you can find out about to enhance your knowledge of the issues and topics covered in this chapter. Make notes using the chapter content, the references and further reading identified, local policies and guidelines and discussions with colleagues.
1. Read the Antenatal Care Guidelines: Routine care for the healthy pregnant woman (NICE 2008; 2010).
2. Read the Hospital Trust Guideline/Policy which identifies reasons for pregnant women needing additional care and referral to consultant-led care.
3. Read the Hospital Trust Guideline/Policy which identifies reasons for referral to the paediatrician.
4. Make a list of some of the commonly used abbreviations in antenatal care and find out the meanings.
Glossary of terms
AFP (alpha fetoprotein) Protein that is produced by the yolk sac and liver during fetal development.
Body Mass Index The weight of a person (in kilograms) divided by the square of their height (in metres), the units are therefore kg/m2.
Carpal tunnel syndrome A combination of parasthesia (pins and needles), numbness, and pain in the fingers and hands. Often worse at night. Caused by pressure on the median nerve as it passes through the wrist.
Cervix Relating to the ‘neck’ of the uterus. The area below and inclusive of the cervical OS.
Chorionic villus sampling (CVS) An invasive procedure in which a sample of placental tissue is aspirated through the cervix or abdomen under ultrasound visualization.
Chromosomal disorders Problems within the structure of the cell nucleus that carries the genetic information.
Down syndrome A condition resulting from a chromosomal abnormality most commonly due to the presence of three copies of chromosome 21; most likely to occur with advanced maternal age.
Fracture Breakage of a bone.
Fundus The part furthest from the opening of an organ.
Gamete intrafallopian transfer (GIFT) A procedure for assisting conception, suitable only for women with healthy Fallopian tubes.
Gestation The period during which a fertilized egg cell develops into a baby that is ready to be delivered; averages 266 days in humans.
Haemolysis The destruction of red blood cells.
Haemorrhoid Enlargement of the normal spongy blood-filled cushions in the wall of the anus.
hCG (human chorionic gonadotrophin) A hormone produced by the placenta during preg-nancy. Maintains the secretion of progesterone by the corpus luteum of the ovary.
Hepatitis B or C Inflammation of the liver caused by viruses, toxic substances or immunological abnormalities.
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HIV Human immunodeficiency virus.
Immunisation The production of immunity by artificial means through administration of a vaccine.
Intracytoplasmic sperm injection (ICSI) A technique of assisted conception. Spermatazoa are extracted and injected into the cytosplasm of the egg and implanted into the uterus.
Intrauterine insemination (IUI) Carefully washed spermatozoa are injected into the uterus through the vagina at the time of ovulation.
Iso-immunisation The development of antibodies within an individual against antigens form another individual of the same species.
Listeria Bacteria that are parasites of warm-blooded animals. Affecting many domestic and wild animals. Can be transmitted to humans by eating infected animals or their products.
Macrocytic Larger than normal cells.
Microcytic Smaller than normal cells.
Micturition Act of passing urine.
Nuchal translucency scanning Ultrasound screening test to measure the maximum thickness of the translucency between the skin and the soft tissue overlying the cervical (neck) region of the spine of the fetus.
Nulliparous (woman) Having not yet given birth to any viable infants.
Oedema Excessive accumulation of fluid in the body tissues. It can be local because of injury or inflammation, or more general, as in heart or kidney failure which can include pre-eclampsia in pregnancy.
Os Cervical opening (internal: to the uterus/ external: to the vagina).
PAPP-A Pregnancy-associated plasma protein A: a marker for Down syndrome.
Placental Relating to the placenta. An organ within the uterus by which the embryo is attached to the wall of the uterus. It links between the fetal and maternal blood systems to transfer nutrients and waste products.
Prophylaxis Any means taken to prevent disease.
Rhesus (Rh) factor Antigens that may or may not be present on the surface of red blood cells;
people who lack the factor are Rh negative. Incompatibility between Rh negative and positive is the cause of haemolytic disease of the newborn.
Rubella German Measles – a mild highly contagious viral infection, mainly of childhood. It can cause malformations in the fetus in early pregnancy.
Sickle cell anaemia A hereditary blood disease. Production of an abnormal type of haemoglobin (red blood cells) leading to episodes of anaemia and jaundice and has no cure only able to treat symptoms.
Symphysis pubis Joint between the pubic bones of the pelvis.
Syphilis Sexually transmitted disease caused by bacteria entering the body through mucous membranes during sexual intercourse, resulting in the formation of lesions throughout the body.
Thalassaemia A hereditary blood disease. Red blood cells cannot function normally leading to anaemia and enlargement of the spleen and abnormalities of the bone marrow.
139 Toxoplasmosis A disease in mammals and birds caused by a protozoan. Transmitted to humans
through ingesting undercooked meat or contaminated by faeces of infected cats.
Urinary tract The entire system of ducts and channels that conduct urine from the kidneys to the exterior. It can be susceptible to infections in pregnancy.
Varicose veins Veins that are distended, lengthened and tortuous. Superficial veins in the legs are most commonly affected.
Venous thrombo-embolic (VTE) The formation of a blood clot in a vein, which may become detached and lodged else-where. In pregnancy the risk of VTE is more common and can result in death.
Zygote intrafallopian transfer (ZIFT) Following in-vitro fertilisation the zygote is introduced into the fallopian tube. Commonly used when tubes block the normal binding of the sperm and egg.
(Adapted from Martin 2010.)
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Chapter 7
Intrapartum midwifery care
Julie Flint Sue Townend
Calderdale and Huddersfield NHS Foundation Trust, West Yorkshire, UK University of Hull, Hull, UK
By the end of this chapter the reader will be able to:
•
explain parameters of normality in labour•
discuss some of the challenges that midwives and women face in reducing the medicalisation of labour and birth•
monitor the wellbeing of mothers and their unborn children in normal labour•
determine when deviations from the norm may occur in the intrapartum period•
provide evidence based care in the intrapartum setting.Learning outcomes
Introduction
The emphasis of the midwife’s role in the provision of maternity care continues to lie within the boundaries of normal childbirth. The increasing rates of intervention in childbirth cause a great deal of debate, and the current medical model for childbirth is much criticised. It is paramount that student midwives base their knowledge and skills within the context of women centred care when pregnancy and birth are physiologically normal. Equally, as all women deserve the best care, all aspects of compassionate and competent care need to be applied to complex situ-ations to give all women and their babies the best start to family life.
This chapter will focus on normal labour and birth and the role and responsibilities of the midwife, highlighting how an understanding of anatomy and physiology informs care provision and ensures a woman-centred approach. Place of birth and the influence of birth preparation education as a way to empower women are also included.
Fundamentals of Midwifery: A Textbook for Students, First Edition. Edited by Louise Lewis.
© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.
Companion website: www.wileyfundamentalseries.com/midwifery
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