Oxford Handbook of Midwifery (54 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

BOOK: Oxford Handbook of Midwifery
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  • Antenatal care should be based on the guidelines for low-risk women. If there is any deviation from the normal, you may wish to refer to consultant care with the agreement of the pregnant woman.
    Labour
  • Ensure that all equipment for the birth is delivered to the woman’s home at 37 weeks, or as soon as possible after a decision is made, should it be later than this. Inhalational analgesia and oxygen should be stored at the home, adhering to health and safety regulations.
  • Collect resuscitation equipment from the maternity unit as soon as possible, or make arrangements to transfer the equipment in readiness for the birth. Local policies vary.
  • On receipt of a labour call, the named midwife, or midwife on call, will attend the woman. Other working colleagues and the labour ward must be informed.
  • A second midwife will be required to attend for the birth.
  • Follow the NMC and NICE guidelines for low-risk intrapartum care.
  • Adhere to guidelines for the safe administration of drugs.
  • The woman should have a bag or case packed in case urgent transfer to hospital is necessary.
  • If transfer to hospital is necessary, an emergency call for a paramedic ambulance is made. The midwife must accompany the woman in the ambulance and provide details of the woman’s labour so far to the attending hospital staff.
  • If the woman does not agree with the decision to transfer, then the supervisor of midwives must be informed.
    After delivery
  • The woman’s GP should be informed of the birth and asked to carry out the neonatal examination, unless the midwife has been trained to do this.
  • Complete and maintain all records of the birth, according to the guidelines for records and record keeping.
  • Dispose of clinical waste and sharps in a safe manner, with reference to the local trust policy. Return inhalational analgesia, oxygen, and drugs to the hospital.
  • Undertake immediate postnatal care to ensure the well-being of both
    mother and baby before leaving their home.
    Exclusion criteria for home birth
  • Parity
    : primigravida over 37 years of age, parity of five or above. Trust policies may vary regarding parity and age.
  • Stature
    : shorter than 152cm (5 feet).
  • BMI
    : under 18 or above 31.
  • Previous medical history
    :
    • Diabetes
    • Cardiac disease
    • Renal disease
    • Deep vein thrombosis
    • Pulmonary embolism
    • Hypertension
      CHAPTER 11
      Normal labour: first stage
      216
      • IV drug abuse
      • Hepatitis B antigen positive
      • HIV positive
      • Recent history of active genital herpes.
        • Previous obstetric history
          :
          • Caesarean section—dependent on the reason for the previous LSCS
          • Hysterotomy
          • Rhesus antibodies
          • Severe pregnancy-induced hypertension
          • Eclampsia
          • Previous stillbirth or neonatal death
          • Shoulder dystocia
          • Retained placenta
          • Inverted uterus
          • Primary PPH.
        • Previous gynaecological history
          :
          • Infertility
          • Major surgery
          • Myomectomy
          • Uterine anomaly (congenital or fibroids).
        • Current pregnancy
          :
          • Twins
          • Malpresentation after 36 weeks
          • Preterm rupture of membranes
          • Antepartum haemorrhage
          • Intrauterine growth retardation
          • Sustained hypertension
          • Fetal anomaly
          • Poly- or oligohydramnios
          • Abnormal glucose tolerance test
          • Anaemia below 10g/dL
          • High head at term in primigravida
          • Previous anaesthetic problems
          • Post maturity.
        • Intrapartum
          :
          • Malpresentation
          • Preterm labour
          • Poor progress in labour
          • Fetal heart rate abnormalities
          • Meconium-stained liquor
          • Maternal distress
          • Mother’s request.
            Basic equipment for planned home birth
        • Delivery pack
        • Protection and safe disposal
          :
          • Maternity pads
          • Inco pads
          • Non-sterile gloves
        HOME BIRTH
        217
    • Sterile gloves
    • Plastic aprons
    • Disposal bags
    • Clinical waste disposal bags
    • Venflon and intravenous therapy fluid (for cannulation in case of PPH)
    • Sharps disposal container.
  • Supplementary equipment
    :
    • Lubricating jelly
    • Amnihook
    • Pinard and fetal Doppler
    • Syringes and needles
    • Specimen bottles and request forms
    • Oxytocic drugs
    • Naloxone
    • Urinary catheter.
  • Equipment for mother’s comfort
    :
    • Bean bag
    • Birthing ball
    • Floor mattress
    • Hot water bottle.
  • Requirements for the baby
    :
    • Tape measure
    • Cord clamp
    • Mucus extractor
    • Name bands (only if transfer is necessary)
    • Vitamin K
    • Scales.
  • For perineal repair
    :
    • Lidocaine
    • Suture pack
    • Suture material
    • Torch.
  • Gases
    :
    • Inhalational analgesia (Entonox), two full cylinders, plus mouth and mask attachments
    • Oxygen, together with adult and neonatal masks
    • Portable suction equipment.
  • Appropriate documentation
    to include mother’s notes, baby’s notes, and birth notification.
    1. Tew M (1998).
      Safer Childbirth? A Critical History of Maternity Care
      . London: Chapman and Hall.
    2. Chamberlain G, Wraight A, Crowley P (1997).
      Home Births: The Report of the 1994 Confidential Enquiry by The National Birthday Trust Fund
      . Carnforth, Lancs: Parthenon Publishing Trust.
    3. Olsen O, Jewell M (1998). Home versus hospital birth.
      Cochrane Database of Systematic Reviews
      3
      . 1998, issue 3. Art No: CD000352. DOI:10.1002/14651858. CD000352. Available from: M http://
      www2.cochrane.org/reviews/en/ab000352.htm (accessed 22.2.11)
      CHAPTER 11
      Normal labour: first stage
      218‌‌
      Hospital birth
      A hospital is by far the most common place to give birth in the UK. This has been the result of government legislation arising from the 1970s (the Peel Report)
      1
      which advocated that all women should give birth in hos- pital where it was considered to be safer. This led to a radical change in the role of the midwife and maternity care, while increased intervention has brought a staggering rise in the of rate complications associated with pregnancy and labour and incidence of LSCS. Advanced technology and screening have contributed greatly towards better outcomes for high-risk women. However, in recent years there has been much opposition to these practices and interventions. The evidence for hospitalization of all women for birth is unfounded.
      2
      Women should be involved in deciding where to give birth following initial assessment in early pregnancy to iden- tify any risk factors to be aware of their options and be able to make an informed choice.
      Reasons for hospital birth
      • Maternal illness or pre-existing medical condition.
      • Obstetric history or present obstetric condition that warrants high-risk management.
      • Maternal choice: feels safer in hospital, request for epidural analgesia.
      • Unsupported mother: without partner, family, or friends who can provide immediate and ongoing care.
      • Social circumstances: e.g. drug misuse, poor housing /living conditions.
      • Emergency admission.
      • Concealed pregnancy.
      • Concerns over the well-being of the fetus.
        Invariably the length of stay in hospital is relatively short unless there are complications.
      • 6h stay: the woman spends the latter part of labour and delivery in hospital, followed by a short 6h-recovery period prior to being discharged home to community care.
      • 12–24h stay: this is most common for women who have had a normal birth and there are no complications.
      • 24–48h stay: very often primiparous women, or women who have had a forceps or ventouse birth, may stay a little longer.
        •
        3–4 days: mainly women who have had an LSCS or where there are
        complications.
        Admission
      • Hospital environments tend to put labour and birth into the illness mode, which equates with disease or that something is wrong.
      • The woman may be anxious about hospital admission for labour. She may not have been in hospital before and have pre-conceived ideas or had a previous bad experience.
      • Build up of tension will produce stress hormones that interfere with the normal physiology of labour, and slows the process down. Consequently the chances of intervention are increased.
      • The hospital environment may be very daunting and impersonal, care should be taken to make the woman feel comfortable and relaxed.
    HOSPITAL BIRTH
    219
    Provision of a home from home environment, with low lights, music facilities, and non-clinical furnishings should be standard.

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