Midwife's role when caring for the mother where labor is being induced

1. Midwife's role when caring for the mother where labor is being induced

2. The midwife's responsibilities regarding IOL include care during the antenatal and intrapartum period.

3. It is important for the woman and her partner to understand that induction may be delayed if the labor suite is busy

4. Time should be allowed for discussion with the midwife or obstetrician and it must be remembered that consent to a treatment can be withdrawn at any time and this decision by the woman must be respected

5. The midwife or doctor should record any discussion that takes place. • During the induction process all maternal and fetal observations will be recorded in the maternity notes. • When labor is established ,the partogram is commenced

6. the partogram it is important • The frequency and type of monitoring of the mother and fetus will depend on the reason for and method of induction.

7. It is important when monitoring the wellbeing of the mother and fetus during the induction process that the midwife understands the possible risks associated with each method of induction ,able to recognize and respond to any deviations from normal.

8. When labor is induced the sudden onset of strong painful contractions occurring every three to four minutes can be quite overwhelming and result in an early request for pain relief

10. Continuity of caregiver in labour is important in developing a rapport with the woman and her partner and in being able to make an assessment of her progress based on physical observations of abdominal examination and VE as well as less tangible observations of body language and behaviour

11. the midwife able to advise the woman of her progress to help her in her decision • IOL does not have to be a negative experience and the midwife is in a key position to use her ‘art’ to enable the woman to have a positive birthing experience, whatever the outcome.

12. It must be remembered that each woman's labor, whether it is spontaneous onset or induced, is their own individual experience, and what they wish for their labour

13. the midwife provides, valid consent must be obtained before any examination or intervention, • When a woman is experiencing painful contractions in labor the information about any examinations or procedures that the midwife or doctor may wish to perform should be given between contractions.

14. Alternative approaches to initiating labour • some women avoidance of any surgical or pharmacological intervention in an otherwise low-risk pregnancy is extremely important and they might seek advice from the midwife.

15. Alternative approaches include : • the ingestion of castor oil • nipple stimulation • sexual intercourse • acupuncture • the use of homeopathic methods.

17. One alternative approach with more positive findings is that of stimulation of the breast. • stimulation of the breast either by massage or nipple stimulation ‘appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates’.

18. It appears to be less effective where the cervix is not ripe. • Stimulation of the breast or more specifically the nipple appears to cause the release of endogenous oxytocin, the effect being to initiate a uterine response.

19. Failure to progress and prolonged labor • Effective labor with effective uterine contractions and cervical changes leading to progressive effacement and dilatation of the cervix, rotation of the fetus and descent of the presenting part, the birth of the baby, and expulsion of the placenta and membranes and the control of bleeding.

20. The psychology of labor need a safe and stress-free environment • has trust in those caring for her • the process of labor starts spontaneously and continues that way without the need to intercede.

22. ‘failure to progress’, ‘prolonged labor’ and ‘dystocia’ have been used when labor is perceived not to be following a pre-determined line of progress, • the rate of cervical dilatation/hour or if the labor is considered to have exceeded a set number of hours. • a change in progress in the first or second stage of labor as ‘suspected delay’

23. Prolonged labor is not easily defined, normal time limit for labor either in the latent or active part of the first stage or the passive or active part of the second stage.

24. When labor is slow to progress or prolonged there is an increased risk of chorioamnionitis if there has been prolonged rupture of membranes, and an increased risk of postpartum haemorrhage as a result of an atonic uterus.

25. the interventions used to correct a dystocia, such as amniotomy, oxytocin infusion and instrumental or operative birth, are not risk-free

26. Delay in the latent phase of labour • In the first stage of labour, the latent phase is the period when structural changes occur in the cervix and it becomes softer and shorter (from 3 cm to less than 0.5 cm), its position is more central in relation to the presenting part and there are painful contractions

27. the dilatation of the cervix at this time is up to 4 cm. During this period the woman needs support and encouragement from those caring for her. • The perceived result of painful contractions may be disappointing when hearing the cervix is 3 cm dilated after several hours. • If progress in this phase of labour is considered to be slow the emphasis is on conservative management rather than intervention

28. The midwife must ensure the woman knows to keep eating and drinking if she feels able to as this will not only help maintain her energy levels but can also bring a sense of normality and comfort. • It is important for the woman to rest at this time and not to feel that if she tries to sleep the contractions will cease.

29. Advice on how to relieve pain might include simple back massage, changes of position, a warm bath or some simple analgesia; • Any intervention such as an ARM at this stage can interfere with the action of amniotic prostaglandin on the cervix and be counterproductive

30. Delay in the active first stage of labour • refers to the established first stage of labour rather than the active phase, and define this as the period when the uterine contractions are regular and painful and the cervix dilates progressively from 4 cm. • the active phase begins between 3 and 5 cm when there are regular uterine contractions. • For nulliparous women delay is suspected if their progress, in terms of cervical dilatation, is less than 2 cm in 4 hours.

31. For parous women it is the same, or there is considered to be a ‘slowing in progress’ • This suggests the rate of cervical dilatation and duration of labor is measurable and such measurements can be applied to all nulliparous or multiparous women. • wide range of variables in terms of maternal age, maternal size, fetal position etc.

32. when caring for women in labor midwives do need some parameters to work within in order to better understand what is considered acceptable in terms of progress

33. the active phase of labour suggest a rate of 0.5 cm/h. • Although they suggest that consideration should also be given to the rotation, descent and station of the presenting part, these observations do not appear to merit the same importance as cervical dilatation.

34. suggest that for low-risk, nulliparous women, with spontaneous onset of labour ‘contemporary expectations of active labor are overly stringent’.

35. When there is ‘suspected delay’ the midwife needs to discuss with the woman how the situation might be best managed . • with appropriate consideration of all the facts in the context of that particular woman.

36. Alleviating anxiety by ensuring there is continuous support in labour, changing maternal position, alleviating pain using non-pharmacological means are some of the ways in which the midwife can help the woman at this time.

37. Medical interventions to correct this include ARM or oxytocin or a combination of both, • 50% of nulliparous women receiving an oxytocin infusion in labour

38. When failed , an instrumental or operative birth may be the only course of action depending on the stage of labor reached. • C.s due to failure to progress or prolonged labor.

39. The partogram or partograph is a graphical representation of the maternal and fetal condition in established labor and the dilatation of the cervix against time.

41. a record of observations in labor on one sheet of paper might for example make for easier reading for anyone taking over care of a woman in labor,.

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