The community midwife is returning for a second visit at a home assessment for a woman having a homebirth. The woman has experienced intermittent, contractions for the last 24 hours with no evidence of a spontaneous rupture of membranes.
Questions
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a) What would the assessment include?
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Correct answer:
- Antenatal examination including vital signs and urinalysis.
- Abdominal palpation - in particular consider the engagement and descent of the presenting part.
- Assessment of the frequency, strength and duration of contractions.
- Fetal assessment - fetal heart auscultation and ask about fetal movements.
- Spend time listening to the woman and observing her coping ability, considering her recollection of events.
- Perform a vaginal examination to determine:
- position, effacement and dilatation of the cervix;
- application of cervix to presenting part;
- the descent, position and attitude of the presenting part;
- any moulding or caput present on the fetal head.
- Bladder care and assessment.
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b) What potential advice might be given?
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Correct answer:
Advice would depend on the stage and progress of labour, balanced with the woman's coping abilities, dependant on the well-being of the woman and fetus.
A woman is labouring well in a birth pool and the care has just being taken over by another midwife.
Questions
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a) What observations will need to be assessed and recorded throughout the woman's labour?
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Correct answer:
- General wellbeing of the woman.
- Vital signs, including temperature, pulse, respirations, blood pressure and urinalysis.
- Pool temperature.
- Timely progress reviews including abdominal palpation to determine engagement and descent of presenting part.
- Vaginal examinations as per NICE guidance to determine:
- position, effacement and dilatation of the cervix;
- application of cervix to presenting part;
- the descent, position and attitude of the presenting part;
- any moulding or caput present on the fetal head.
- Assessment of the frequency, strength and duration of contractions.
- Fetal assessment - Fetal heart auscultation and ask about fetal movements.
- Bladder care and assessment.
A healthy woman in her second pregnancy has progressed in normal labour without analgesia or any medical intervention. She is pushing spontaneously in the second stage and the midwife needs to prepare for the impending birth.
Questions
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a) What are the considerations and potential actions of the midwife throughout and after the birth?
Show Answer
Correct answer:
- The plan for third stage management of labour has been discussed and the woman has made an informed choice about physiological or active management of the third stage.
- Continue to assess fetal wellbeing throughout the pushing phase, using pinard and hand-held Doppler as recommended by NICE.
- Assess the woman's general wellbeing throughout the pushing phase.
- Ensure the environment is appropriate, e.g. warm and private.
- Ensure equipment is ready.
- Standard precautions are being applied.
- Consider the need for potential neonatal resuscitation in all births.
- Consider the woman's position for birth encouraging instinctive movement.
- Be mindful of the timeframe for active pushing in relation to fetal wellbeing.
- Assess the condition of the baby at birth. Dry the baby, give tactile stimulation, and provide the opportunity for skin-to-skin contact if appropriate.
- Initiate breastfeeding; use the opportunity to encourage breastfeeding if decision not yet made.
- Cord blood is tested to determine blood group and rhesus status if mother is rhesus negative.
- Involve the partner and encourage bonding with mother and partner.
- Assess maternal wellbeing post birth, including trauma to the perineum and need for suturing.
- Measure and record vital signs and assess general wellbeing of the mother.
- Record keeping, documenting all aspects of care.
