Care for pregnant women with leg cramps 51 Care for pregnant women with nausea and vomiting 52. Care for pregnant women with round ligament pain 55 Care for pregnant women with varicose veins 57.
Disclaimer
Consultation, collaboration and referral with other members of the health care team as needed to provide optimal health care. We affirm that obstetric care encompasses these qualities and that the healthcare needs of women are well covered by obstetric care.
Women First
Each midwife is repeatedly called upon to make critical decisions and act upon them in a manner appropriate to the environment in which she practises, but she must show respect and honor for the uniqueness of each woman and family in her care.
How to Use This Book
Documentation skills allow midwives or other women's health professionals to review care provided at a later date. We must consider each woman as an individual who exists, not in our practical settings, but in her own corner of the world.
The Purpose of Clinical Practice Guidelines
Collaborative practice connects midwives with additional health professionals who provide ongoing or specialty care that is not within the midwife's scope of practice. Every client who comes to a midwife for care has the right to information regarding the midwife's scope of practice, usual practice location(s), and provision for access to medical or obstetric care should it become necessary.
Documenting Midwifery Care
Each individual midwife must define her or his scope of practice based on philosophy of midwifery practice, educational preparation, experience, skill level and the individual practice setting. A midwife's scope of practice may vary from one practice location to another and may change throughout her career.
Developing a Collaborative Practice Network
We have discussed possible treatments, and she is interested in exploring endometrial ablation to treat her menorrhagia.” In this case, the client has a problem that requires evaluation and treatment that is not within your scope of practice. The expectation is that the customer will return to you for care once the problem is resolved or treated.
Health Care As a Continuum
Women may come from settings where there is very limited access or availability of health care and accept whatever care is offered. Midwifery care is traditionally based on providing care that starts from non-interventional care and includes intervention only as needed or as indicated.
Cultural Diversity
Developmental Considerations
Individual assessment is necessary to determine the client's developmental level and provide developmentally appropriate services. Nonjudgment provides the optimal opportunity to determine how best to identify each individual's unique needs and provide or direct women to services that can best meet those needs.
Risk Management
Each midwife must manage individual occupational risks by continually assessing the scope of her or his midwifery practice and whether it meets the needs of the midwife and the community. Standards of practice define the expected knowledge and behavior of a midwife based on her education, certification status, and licensure.
Summary
Some may prefer to work in settings where there is a physician available at all times, while others may practice in isolated settings where the nearest physician is miles away.
If midwives truly provide woman-centred care with a focus on excellence in the processes of providing care and attention to outcomes, this should be clearly reflected in each client's record. Thoughtful documentation can demonstrate inherent differences between midwifery and medical models of providing women's health care.
Standards for Documentation
Documentation as a reflection of the midwifery model of care; whether and how events are recorded accurately reflects the philosophy and standards of midwifery practice.
Documentation as Communication
Skills and Techniques
Components of the history included in the client interview should be documented, including, where relevant, the client's attitude, affect or emotional state. Many practices use duplicate forms to document client education with a copy of the form in the client's record.
Evaluation and Management Criteria
When evaluating the client personally, the consultant is responsible for documenting the care provided.
Documentation as Risk Management
The follow-up file is a convenient way to track clients with problems that require future care. The practice risk management plan should describe the follow-up process and indicate the procedure for using the follow-up system.
Documenting Culturally Competent Care
Using fill-in-the-blank forms can be a useful way to quickly record essential information, especially during busy work hours or in an emergency. The follow-up file allows tracking of whether clients return for recommended care and physician notification when clients are noncompliant.
Informed Consent
Although not part of the client's medical record per se, it forms an important part of the midwife's risk management plan. Refusal of treatment may be an indication that further discussion is needed to gain insight into the client's beliefs and understanding about the nature of the problem and recommendations for care (University of Washington, School of Medicine, 2005).
Components of Common Medical Records
This applies to GPs and members of the office staff who contribute to the record. The client's main complaint or purpose of the visit is clear • The client's main complaint or the purpose of the visit is.
Diagnosis of Pregnancy
The provision of prenatal care varies greatly from practice to practice, based on the type of women's health care professional(s) in practice, the practice setting, and the expected location of labor and birth. Maternal participation in prenatal care encourages self-determination and can foster the woman's determination to surrender to the forces of labor and birth.
Initial Evaluation of the Pregnant Woman
Evaluation of Health Risks in the Pregnant Woman
Ongoing Care of the Pregnant Woman
Care of the Pregnant Woman with Backache
Care of the Pregnant Woman with Constipation
Care of the Pregnant Woman with Dyspnea
Care of the Pregnant Woman with Edema
Care of the Pregnant Woman with Epistaxis
Care of the Pregnant Woman with Heartburn
Care of the Pregnant Woman with Hemorrhoids
Care of the Pregnant Woman with Insomnia
However, a woman with significant sleep deprivation may have a significantly reduced ability to function on a daily basis.
Care of the Pregnant Woman with Leg Cramps
Care of the Pregnant Woman with Nausea and Vomiting
Care of the Pregnant Woman with Pica
Care of the Pregnant Woman with Round Ligament Pain
Care of the Pregnant Woman with Varicose Veins
Emerging infectious diseases. http://www.cdc.gov/ncidod/EID/vol9no8/03-0033.htm Centers for Disease Control and Prevention [CDC]. Use of water immersion for the treatment of massive labial edema during pregnancy. emedicine.com/emerg/topic479.htm. Retrieved July 1, 2005, from http://lpi.oregonstate.edu/infocenter/vitamins/. 2003).Practice Guidelines for Obstetrics and Gynecology.
Bibliography
During optimal evaluation of potential or developing problems, the midwife actively engages the mother in decision-making regarding options for care for herself and her unborn child. While the mother may not have control over the development of problems during pregnancy and may feel threatened by their development, the midwife can offer her a sense of control by presenting options in the areas where the client's choice is possible. The recommendations are based on the midwife's assessment of what is the best care for mother and fetus in light of the current problem.
Occasionally, the midwife's recommendations may conflict with the mother's preferences or the hospital's standard expectations for obstetric care.
Care of the Pregnant Woman with Iron Deficiency Anemia
Midwifery care for problems in pregnancy forms a continuum from the least intervention to the greatest intervention.
Care of the Pregnant Woman with Fetal Demise
Care of the Pregnant Woman Exposed to Fifth’s Disease
It is common for women who are school teachers to find that their students have fifth's disease. Fortunately, most women contract Fifth's disease as children and are not at risk for primary infection during pregnancy (Division of Maternal-Fetal Medicine Newsletter, 1997).
Care of the Pregnant Woman with Gestational Diabetes
Care of the Pregnant Woman with Hepatitis
Care of the Pregnant Woman with Herpes Simplex Virus
Care of the Pregnant Woman Who Is HIV Positive
Inadequate Weight Gain
Hypertensive Disorders in Pregnancy
Decreased renal function (elevated BUN, 2. Diastolic ≥110 mm/hg decreased urinary output, serum creatinine 3. 2 readings ≥6 hours apart.
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
Care of the Woman Who Is Rh Negative
Size–Date Discrepancy
Determine the volume of fetal blood in the mother's system and the dosage of Rh IG to give the mother.
Toxoplasmosis
Urinary Tract Infection in Pregnancy
First Trimester Vaginal Bleeding
Recommendations for the prevention and control of iron deficiency in the United States. Morbidity and Mortality Weekly Report, 47, 1–25. Expectations and standards for midwifery care vary geographically in the United States as well as by location of birth. Nowhere in a woman's life is individual care more important than during labor and delivery.
Negotiating midwifery care in the world of obstetrics presents unique challenges.
Initial Midwifery Evaluation of the Laboring Woman
Midwives should explore the options and pathways available to them to overcome these challenges in order to continue being with the woman. Diplomacy and tact are essential midwifery skills, as is a comprehensive knowledge of local and state rules and regulations that affect a midwife's ability to independently care for her clients. The practice of midwifery is different from the practice of obstetrics, and midwives working in technologically advanced environments are more likely to be forced to practice obstetrics than midwifery.
Care of the Woman in First-Stage Labor
Care of the Woman in Second-Stage Labor
Care of the Woman in Third-Stage Labor
Amnioinfusion
Assisting with Cesarean Section
Caring for the Woman Undergoing Cesarean Birth
Caring for the Woman with Umbilical Cord Prolapse
Document as soon as possible after childbirth Caring for the woman with umbilical cord prolapse 129.
Care of the Woman with Failure to Progress in Labor
Care of the Woman with Group B Strep
Care of the Woman Undergoing Induction or Augmentation of Labor
Care of the Woman with Meconium- Stained Amniotic Fluid
Caring for the Woman with Multiple Pregnancy
NRP: American Heart Association and American Academy of Pediatrics Neonatal Resuscitation Program Recommendations from the Neonatal Resuscitation Textbook (2000).
Caring for the Woman with a Nonvertex Presentation
Caring for the Woman with Postpartum Hemorrhage
Postterm Pregnancy
ACOG recommends starting fetal surveillance at 42 weeks, although many practices begin surveillance before 42 weeks' gestation (ACOG, 2004b). There are no firm guidelines on what is a reasonable time frame for starting fetal monitoring in post-dated pregnancies. Induction may be indicated for maternal or fetal indications, but not limited to 42 weeks' gestation.
Recent literature review shows a slight increase in perinatal mortality beginning at 43 weeks of gestation (Hart, 2002).
Caring for the Woman with Pregnancy- Induced Hypertension in Labor
Care of the Woman with Preterm Labor
Care of the Woman with Prolonged Latent Phase Labor
Care of the Woman with Premature Rupture of the Membranes
Care of the Woman with Shoulder Dystocia
Care of the Woman Undergoing Vacuum-Assisted Birth
Care of the Woman During Vaginal Birth After Cesarean
Developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists. The pressure on evidence: Managing the second phase. Journal of Midwifery & Women's Health, 47, 2–15. Liver chamber management of the apparently powerful meconium. colored neonate: Results of the multicenter, international collaborative trial. Pediatrics, 105, 1–7.
Ongoing supportive care allows mother and baby to focus on each other as they adjust to their respective changes, under the watchful eye of the expert midwife.
Postpartum Care, Week 1
The birth of the baby marks a time of tremendous transition in which both mother and child are particularly vulnerable to disruption. For the midwife working in a multicultural environment, it offers a wonderful opportunity to explore care in its many forms. Changes in intimate relationships are common, as the baby takes up time and both physical and emotional energy.
Concerns about fertility are resurfacing, presenting a new opportunity to examine women's health within the context of individual women's lives.
Postpartum Care, Weeks 1–6
Women who are having difficulty adjusting to postpartum may benefit from referrals to local resources, such as parenting groups or classes, breastfeeding groups, play groups, and other support services.
Postpartum Depression
