Figure 7.9 depicts a nurturing and enclosing womb, demonstrating the best way to assist the decision-making process for birth, that is, to formulate a rationale based on the best evidence and guidance available. This is done while working through the experiential knowledge and intuitive views of both the woman and the midwife; discussing the benefits risks and alterna-tives and making collective decisions based on the woman’s needs.
Being aware of the instinctive, innate, deeply emotional information the woman shows in her behaviour, such as being talkative, dependant, tearful, excited or fearful, will help to inform a midwife’s decision-making. The midwife will consider how the environment is impacting on the hormonal balance and how these are linked with factors such as nourishment, fluids, position and movement in labour. Also assessing any impact of pharmacological and non-pharmacological pain management support e.g. water immersion, coupled with how the cognitive, knowledge-able aspects are helping or hindering progress. Together, women and carers can formulate a rationale that includes the expertise of the professional. Only then can the woman’s decisions about her needs and birth experience be informed.
Key points
•
Set a woman up with confidence in her capability to birth through providing compassionate woman-centred care.•
Support her by managing the environment to prevent unnecessary stimulation and anxiety for her, and encourage the optimal hormonal balance.•
Always palpate the abdomen to determine descent of the fetal head in determining progress of labour; do not rely on what can be seen at the vulva during slow pushing.•
Know what deviations may occur and be that watchful guardian, yet being adequately proactive when necessary.•
Watch, listen and feel the progress of a woman’s labour, and your craftsmanship as a midwife will develop rapidly.Conclusion
Caring for a birthing woman brings many midwives immense pleasure in their professional role.
It is an emotive time, laced with hard work, assessing risks and monitoring signs of wellbeing.
Within the parameters of normality a midwife has a great opportunity to minimise unnecessary interventions and protect the birthing environment. Observing birthing behaviour through its phases as well as the bio-physical observations ensures that compassionate, woman-centred
160
Figure 7.9 Concept map guideline for decision-making in normal labour.
Behaviour Environment Physiological Psychological Formulate rationale
Talkative, Descriptive, Dependant, Tearful, Excited, Tired, Movement, Unsure, Happy
Talkative, Descriptive, Dependant, Tearful, Excited, Tired, Movement, Unsure, Happy
Un-stimulating, dim lights, use of complementary therapies, quiet, music, feeling safe, nesting Endorphins/Oxytocin/Adrenaline Un-stimulating, dim lights, use of complementary therapies, quiet, music, feeling safe, nesting Endorphins/Oxytocin/Adrenaline Breathing and relaxation, one to one support, nourishment and fluids, position and movement, massage, birthing ball, Pharmacological/Non-pharmacological pain management
Breathing and relaxation, one to one support, nourishment and fluids, position and movement, massage, birthing ball, Pharmacological/Non-pharmacological pain management
Perception, fear, beliefs, emotions, expectations, coping strategies, relationships and interpersonal dynamics Perception, fear, beliefs, emotions, expectations, coping strategies, relationships and interpersonal dynamics Evidence based practice/Experiential knowledge of woman and Midwife/Women’s intuitive view/Midwives (professionals) Impression/Benefits, Risks and Alternatives -Collective understanding
Evidence based practice/Experiential knowledge of woman and Midwife/Women’s intuitive view/Midwives (professionals) Impression/Benefits, Risks and Alternatives -Collective understanding
161 care is provided, leading to a better potential for women to feel they have had some control. A midwife, therefore, can help the woman to achieve an optimal hormonal balance, even when medical intervention is needed to assist the birthing process, ensuring the best outcomes for mother and baby and satisfaction with the experience.
End of chapter activities
Crossword
1 2
3
4
5 6
7 8
9
10 11 12
13 14
15
16
Across
1. Stage of labour when the cervix is fully dilated until the birth of the baby
3. Biofeedback mechanism
4. Chemicals which have roles in the central nervous system and sympathetic nervous system
5. Hormone which stimulates the sympa-thetic nervous system
8. Describing the phases between the stages of labour
12. Person in control during labour and birth
162
14. Stage of labour involving delivery of the placenta and membranes
15. Electronic monitoring of the fetal heart
16. Surgical incision to widen the vaginal orifice
Down
2. Surgical operation where the baby is deliv-ered via an incision in the abdomen 6. The phase when the cervix is effacing in the
presence of the hormone prostaglandin 7. The arrest of bleeding involving blood
coagulation and contraction of blood vessels
9. Includes a graphical record of progress of labour
10. What midwives should be facilitating and maintaining
11. Artificial rupture of the amniotic sac 13. A regional anaesthetic
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 Hospital Trust guideline/policy for midwifery-led care in labour.
2. Read the Royal College of Midwives (2012) Evidence-based guidelines for midwifery-led care in labour.
3. Find out what resources are available to facilitate an active birth in the area you are working.
4. Find out about the local provision for birth preparation for pregnant women and birth partners.
Glossary of terms
Acupuncture Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body. It is a complementary therapy.
Adrenaline Hormone secreted by adrenal gland, which stimulates the sympathetic nervous system.
Amniotomy Artificial rupture of the amniotic sac.
Caesarean section Surgical operation where the baby is delivered via an incision in the abdomen.
Cardiotocograph Electronic monitoring of the fetal heart.
Catecholamines Chemicals which have roles in the central nervous system and sympathetic nervous system.
Craftmanship A person who is skilled.
Effacement The cervix softening, shortening and becoming thin.
163 Endorphin Natural pain relieving chemicals.
Epidural anaesthesia A local anaesthetic is injected into the epidural space, which suppresses sensation in the lower part of the body.
Episiotomy A surgical incision to widen the vaginal orifice.
Ferguson reflex Bio feedback mechanism, caused by an increase in oxytocin due to stimulation of the cervix and lower vagina, leading to increased uterine contractions.
Haemostasis Process which stops haemorrhage.
Hormone A chemical substance which is has a specific effect on particular cells or organs, they travel around the body to the target cells or organs.
Instrumental delivery When the birth is assisted with the use of forceps or ventouse.
Latent phase The time when the cervix is effacing in the presence of the hormone prostaglandin.
Local anaesthetic A reduction or removal of sensation in a particular area of the body.
Mechanism of labour Manoeuvres which the fetus undertakes in order to move through the birth canal.
Meconium The first stools of a newborn baby, which are sticky and dark green, composed of cellular debris, mucus and bile pigments.
Mortality Death.
Oxytocin A hormone released by the posterior pituitary gland, which causes uterine contraction and stimulates milk flow.
Partogram A graphical record of the progress of labour.
Philanthropic Benevolent, humane.
Purple line A purple line, seen from the anal margin and extending between the buttocks.
Skin‑to‑skin Baby being placed naked, skin-to-skin on mother or father immediately after birth.
Transitional phase Moving between one phase of labour to another.
Uterotonic Drugs that cause contraction of the uterine muscle.
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Chapter 8
Postnatal midwifery care
Louise Lewis Lisa Lachanudis
Women and Children’s Hospital, Hull, UK University of Hull, Hull, UK
By the end of this chapter the reader will be able to:
•
understand the roles and responsibilities of the midwife in assessing, monitoring and evaluating the care of the mother and baby in the postnatal period•
explain the basic anatomy and physiology of the puerperium•
provide evidence-based information to promote health and well-being of the mother and baby•
explain the provision, organisation and content of postnatal care•
support involvement of fathers in the postnatal period•
understand the responsibilities of the midwife in safeguarding vulnerable adults and children.Learning outcomes
Introduction
The postnatal period marks an important time of adaptation, encompassing many physical, emotional, socioeconomic and life changing experiences for the mother and partner. The Nursing and Midwifery Council (NMC) of the United Kingdom, in ‘Midwives Rules and Standards’
(2012, p. 6) define the postnatal period:
. . . as the period after the end of labour during which the attendance of a midwife upon a woman and baby is required, being not less than ten days and for such longer period as the midwife considers necessary . . .
The National Institute for Health and Care Excellence (NICE) (2013) suggest the postnatal period lasts six to eight weeks after the birth, concluding with a postnatal examination of mother and baby by an appropriately qualified practitioner, marking the end of the maternity care provision.
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
167 The aim of postnatal care is to facilitate a smooth transition to parenthood, promote a bio-psycho-social recovery in the mother, monitor the wellbeing of the newborn and provide evidence-based information to the parents. For many women and babies the postnatal period is uncomplicated; this chapter will provide an overview of the key aspects of midwifery care aiming to address the needs of the normal postnatal recovery of the healthy mother whilst offering an insight into recognition of deviations from the normal and the appropriate manage-ment (see Chapter 9: ‘Care of the newborn’, where the needs of the neonate are explored in more depth).