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A Midwifery Perspective

A Midwifery Perspective. Ann Rath. Ann Rath. Home of Active Management. Total No of Deliveries 2012 =8978 Total No of Babies =9142. Birth of a 1 st Baby. A PROFOUND EMOTIONAL EXPERIENCE Moulds attitude to all subsequent births If happy unlikely to have any apprehension

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A Midwifery Perspective

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  1. A Midwifery Perspective Ann Rath

  2. Ann Rath

  3. Home of Active Management Total No of Deliveries 2012 =8978 Total No of Babies =9142

  4. Birth of a 1st Baby • A PROFOUND EMOTIONAL EXPERIENCE • Moulds attitude to all subsequent births • If happy unlikely to have any apprehension • Unhappy –Requesting LSCS

  5. 1973Although childbirth has long ceased to present a serious physical challenge to healthy to women in western society –the emotional impact of labour remains a matter of common concernO’Driscoll K BMJ 1973 ;3 135-137

  6. Diagnosis of Labour The diagnosis of labour is the single most important item in the conduct of labour. If the initial diagnosis is wrong, all subsequent management is likely to be wrong too. Midwife is the only person who makes this important diagnosis in our hospital

  7. Preparation for Labour Preparation takes away the fear of the unknown. Women are familiar with terminology and labour records.

  8. Diagnosis in Practice Painful Uterine Contractions 1 : 10 Show Spontaneous Rupture of Membranes

  9. On arrival to the Labour Ward

  10. The Midwife learns this important skill while working as a Junior Midwife under the close supervision of the Midwife in charge or her deputy.

  11. Findings on Vaginal Examination Cervix uneffaced and undilated 37 weeks Gestation Contractions 1 : 20 Given an adequate explanation and allowed home

  12. Vaginal Examination 39 weeks gestation Contractions 1 : 20 Cervix Partially effaced 40 / 41 weeks Gestation Contractions 1 : 10/8 +/ - Show Home or retain in antenatal ward Retain and reassess in 1 hour

  13. Vaginal Examination Painful Uterine Contractions + / - Show or + / - SROM Cervix fully effaced In Labour and will deliver within 12 hours

  14. Vaginal Examination Cervix 2cms dilated In Labour 80% of women admitted to the labour ward have a cervical dilatation of < 3cms

  15. Diagnosis of Labour A woman who is admitted with painful uterine contractions supported by either a show or spontaneous rupture of the membranes, and on vaginal examination her cervix is fully effaced is deemed in labour, and retained in the labour ward and therefore committed to delivery which is anticipated within 12 hours.

  16. Effaced cervix is confirmation of diagnosis of labour irrespective of dilatation

  17. Diagnosis of Labour Dilatation of the cervix represents the sole conclusive evidence of labour. Effacement is the feature which serves to distinguish between the cervix which passively admits a finger tip and the cervix which is actively dilated to the extent of 1cm in labour.

  18. Clear Distinction between Nullips and Multips gl

  19. Amniotomy is performed at the diagnosis of labour • To assess the fetal condition at the start of labour • Determine which fetuses need continuous electronic monitoring • Other beneficial effects • Shortens the labour • Decreases need for oxytocin

  20. Management of Labour Latent phase Is not useful in the diagnosis and the management of labour Effacement of the cervix is the key to the diagnosis of labour and it’s graphic analysis and that is when the partogram is started Dilatation on diagnosis 80% < 3cm yes yes yes Deceleration phase Active phase Latent phase Acceleration phase

  21. Spontaneously labouring nulliparous women with a single cephalic pregnancy at 37 weeks or greater • Philosophy • A clear pattern of dilation should emerge and determined clinically within the first 3-4 hours of labour • 1 cm an hour is taken as normal progress

  22. Spontaneously labouring nulliparous single cephalic women at term 4 hours is too long to wait between examinations to make the diagnosis of inefficient uterine action Efficient uterine action and normal progress only be confirmed by doing vaginal examinations 2 hourly before oxytocin is started. Average number of vaginal examinations in total is 3.7 Epidural rate 50%. 90% of epidurals given within 4 hrs CS rate 7% and not increased significantly over the last 25 years

  23. Level of mutual confidence must be present between midwives and doctors • Clear chain of command • Mutual Respect • Co-ordinator/Midwife in charge has a vital role to play

  24. Evaluate OutcomesPatient SatisfactionPeer Review Clinical Outcomes

  25. Feedback Satisfaction Improvement Suggestions

  26. Labour Feedback Form

  27. Positive Points One to one care Communication Pain relief Antenatal classes Breastfeeding Friendly Staff Negative Points Communication Medical terms used Lack of information Pain relief issues Waiting time for epidural Ineffective pain relief Facilities Car parking Overcrowding Following Delivery

  28. Continual Audit No blame culture Continuous communication Clinical governance Risk management Quality improvement

  29. An active interest in labour Management of labour

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