Antenatal and Intrapartum Competencies - Essay Example

Antenatal and Intrapartum Competencies INTRAPARTUM PERIOD Initial assessment of the woman who may be in labor at or near term: This entails the caregivers establishing communication with the pregnant mother, through greeting the woman with a smile and establishing her language needs (NHS, 2007 p16). This is followed by the caregivers introducing themselves and explaining their role in assisting the pregnant mother. Then, the caregiver asks the pregnant woman about her wants and expectations, which then is the information that should be applied in guiding the woman throughout the labor period (NHS, 2007 p16). Initial assessment (observation, history taken, physical examination, social, cultural and emotional assessment) using a systematic and logical approach, using appropriate terminology: Entails reviewing the patient’s health record, then, testing the blood pressure, temperature, pulse rate and undertaking urinalysis tests (NHS, 2013 n.p.). Enquire about the social, cultural and emotional facts of the patient, to establish how such factors will influence how the patient is treated. Ask the patient about vaginal contractions, and then undertake vaginal examination, as well as palpating the abdomen. Finally, observe the fetal heart rate, while avoiding using cardiotocography, where the pregnancy is in the low-risk category (NHS, 2013 n.p.). Outline a variety of methods of assessing maternal and foetal well being: Ultrasonography: A method applied to produce visible images of the foetus in the amniotic cavity, to assess its positioning, and observing the organs formation, which can start from 6 weeks, running up to 28 weeks (NICE, 2007 p28). Amniocentesis: a process of assessing whether the amniotic fluid is adequate, as well as determining the maturity level of the foetus, through passing a needle in the mother’s lower abdomen (NMC, 2009 p24). Record Keeping: Traces are named with the mother’s name, hospital number and date (NICE, 2007 p43). Any intrapartum events, such as vaginal examination are recorded in the patient’s record, with corresponding date and time. Any opinion regarding patients trace is recorded by the staff, with corresponding, time, date and signature of the staff (NMC, 2009, p63). INTRAPARTUM PERIOD in Labour Systematic and logical approach on how to observe, participate and provide midwifery care: Provision of midwifery care involves assessment of the social, emotional, spiritual and psychological state of the patient, to determine how it can affect the physiology of the pregnant mother, and applying the appropriate interpersonal skills to assist the mother overcome these adverse effects (NMC, 2009 p4). Applying physiological, obstetric and neonatal skills to assist the mother address any emergencies and assisting the mother at birth centres and at home, throughout their pregnancy, labour, birth and postnatal period (NMC, 2009 p4). Factors which contribute to normal progress in labour The position of the baby, the freedom of movement and the ability to change positions frequently contributes to the normal progress in labour, through ensuring that the mother and the foetus are both physiologically, emotionally and psychologically fit (NHS, 2013 n.p.). Reviewing birth plan in partnership with the woman Reviewing birth plan entails first seeking the wishes of the woman regarding the birth plan, which is then reduced into written instructions or, if the woman already has a birth plan, discuss it with her to establish whether she has full understanding of coping with different birth plans (NICE, 2007 p17). Monitoring the maternal/foetal well-being and progress of labour by appropriate clinical and technical means: This monitoring entails assessing the maternal vital signs, most especially maternal pulse and blood pressure, while monitoring the foetal heart rate, using a Pinard stethoscope (NMC, 2009 p48). Further monitoring includes examining the labour progress, behaviour and abdominal characteristics. Support woman who chose to have pharmacological methods of pain relief and become aware of the effects on labour of various drugs: Ensure the access of Entonox and opioids to the woman, while explaining their side effects to the pregnancy, such as drowsiness, nausea, while also explaining that opioids may interfere with mother’s breastfeeding, and thus provide the mother with antiemetic, to alleviate the effects of opioids (NICE, 2007 p20). Record keeping Any monitoring and assessment done to the woman or the foetus should be recorded, alongside date and time. The position of the child as noted, the quantity of amniotic fluid and the abdomen characteristics should also be recorded. Finally, any medication offered to the mother should be recorded, with details of the prescriptions (NHS, 2013 n.p.). INTRAPARTUM PERIOD in Labour Prepare equipment and the environment to ensure safe birth: Ensuring a safe birthplace requires granting women a choice of where they would like to deliver, whether at home, in an obstetric unit or in a midwife-led unit (NICE, 2007 p15). In case of existence of a health condition, the mother should be advised to go for the obstetric unit. The place of birth should be well equipped with adequate anaesthetic, obstetric and neonatal expertise, with the provision of the necessary tools and equipment (NICE, 2007 p15). Factors during first and second stage of labour which impact on the baby and what action may be taken: The Factors during first and second stage of labour which impact on the baby, include the Foetal Heart Rate, the Pulse Rate and the Contractions; during the first stage, and the blood pressure, in addition to all the other First stage factors ,in the second stage (NICE, 2007 p58). The actions that may be taken include checking the Foetal heart Rate every 15 minutes using either Pinard stethoscope or Doppler ultrasound (NMC, 2009 p24). Checking and documenting the frequency of contractions every 30 minutes, in addition to temperature and blood pressure being monitored every 4 hours (NICE, 2007 p59). The assessment of the mothers emotional and psychological conditions and needs, as well as monitoring the frequency of emptying the bladder are necessary interventions to enhance the wellbeing of the baby and that of the mother (NICE, 2007 p58). The foetal position and the progress of cervix dilation should be consistently monitored. Assessing the mother’s ability and the urge to push , while discouraging her from lying supine, and also assessing her pain relief and change of position needs to ensure the necessary assistance and encouragement is granted (NMC, 2009 p25). INTRAPARTUM PERIOD In labour Provision of safe midwifery care throughout the birth: Provision of safe midwifery care throughout the birth entails monitoring the physical health of the mother during birth, and offering either active or physiological support to the mother. Active support includes palpating the uterus, pulling the placenta and early cord clamping, where the health of the mother is not perfect, while physiological support entails not pulling the placenta or palpating the uterus (NICE, 2007 p33). Active management is offered where the mother has high haemorrhage during birth, or fails to deliver the placenta within half an hour (NICE, 2007 p33). Outline factors which contribute to normal progress in the second stage of labour: The positioning of the foetus, the frequent change of position of the mother, the systematic dilation of the cervix and the high frequency of emptying the bladder are the factors which contribute to normal progress in the second stage of labour (NHS, 2013 n.p.). Rapid changes which can occur in the second stage of labour: Rapid changes which can occur in the second stage of labour includes the active dilation of the cervix, the baby becomes visible, while the expulsive contractions increases (NICE, 2007 p29). Further, the mother is observed to unconsciously apply maternal effort to push the baby. How optimal positioning can influence the outcome of labour: Optimal positioning of the mother allows the baby to choose optimal positioning, through the application of gravity to push the baby in a downward movement (NHS, 2013 n.p.). Effects of pharmacological methods of pain relief on the second stage of labour: Pharmacological methods of pain relief on the second stage of labour may help the woman relief pain (NICE, 2007 p20). However, they may cause drowsiness, nausea and affected milk processing, while causing short term respiratory depression and long-term back-ache (NICE, 2007 p21). INTRAPARTUM PERIOD Third stage of labour Factors during first and second stage of labour which impact on third stage: The factors during first and second stage of labour which impact on third stage, include the application of the pharmacological methods of pain relief in the second stage, which may delay the completion of the third labour stage from the expected 30 minutes to 60 minutes, while also increasing the chances of back-aches (NHS, 2013 n.p.). Additionally, the women’s positioning during the first and second labour stage influences the time taken to complete the third stage labour. Risks inherent in the third stage of labour: The risks inherent in the third stage of labour include prolonged duration of labour, risk of maternal haemorrhage, delayed delivery of the placenta and the general weakness and poor physical health of the mother (NICE, 2007 p34). Differences between active and expectant management of the third stage management: Active management include the administration of oxytocin, followed by the control of the cord traction and the early clamping of the cord, as well as palpating the uterus and pulling the placenta (NICE, 2007 p33). Expectant management entails delivery by maternal effort, without pulling the placenta, or palpating the uterus. Additionally, no oxytocin is administered in expectant management (NICE, 2007 p34). Factors which influence the estimation of blood loss: The factors include vaginal bleeding, maternal Haemorrhage, maternal collapse or retained placenta (NMC, 2009 p27). This necessitates the estimation of blood, to determine the emergency measures necessary. Placenta checking: Meant to determine the completeness of the placenta, its structure, general condition and completeness of blood vessels (NICE, 2007 p36). How the perineum is checked following delivery First confirming that the analgesia is in place, followed by visual assessment of perennial trauma and finally the rectal assessment (NICE, 2007 p37). EXAMINATION OF THE BABY Difference between the immediate assessment and the first Apgar score is assigned: The immediate crying of the baby, is the normal initial evaluation of the new born baby to ensure that its organs are functioning appropriately, especially the lungs which determines the ability of the baby to breath outside of the mothers uterus (NHS, 2013 n.p.). On the other hand, Apgar assessment entails the assessment of the breathing problem of the baby, when the baby is noticed to be in poor condition, after the initial assessment. Immediate initial assessment of the baby and explain how vital signs can be confirmed: This entails placing be baby in a warm radiant unit, through assessing its ability to cry within the first 30 seconds to 1 minute of life by rubbing the baby gently on the back or on its feet, in addition to measuring the temperature f the baby. The observation of the baby’s colour forms part of the immediate assessment (NHS, 2013 n.p.). How are Apgar Scores assigned and link the Apgar score to the physical appearance and behaviour of the baby? The Apgar Scores are assigned to the baby at one and five minutes of birth, which entails giving a score of between 1 to 10, in five vital areas of the baby’s functioning, which include respiration, muscle tone, response to stimulation, colour and heart rate (NHS, 2013 n.p.). First physical examination of the baby This entails observing the baby’s colour and the ability to breathe and cry. Adaption of the baby to extra uterine life: It is assessed through the full functioning of the heart, muscles, lungs and respiratory system as well as the reflex system (NHS, 2013 n.p.). What signs in the baby would give cause for concern and what action would be taken: The inability of the baby to cry, abnormal heart and pulse rates, poor respiratory ability, abnormal body colour, and inability to respond to reflex stimulants forms the signs (NHS, 2013 n.p.). The action taken is to call upon the neonatal resuscitative providers to take over the management of the child, to give the baby the required emergency measures. INTRAPARTUM PERIOD-AT RISK Care for women with a range of complications: The care for women with a range of complication entails transferring the mother with risk signs to an obstetric unit, where she can be accorded specialized care (NHS, 2013 n.p.). Other care for such women entails carrying out a caesarean section, to avoid further complications as a result of the pain, pressure and struggle efforts related with vaginal birth. How labour will be affected by the particular conditions Therefore, complications affect labour by shortening the labour period, mainly through induced labour (NMC, 2009 p50). Additional means there are for monitoring maternal and foetal well-being where there are complications: Electronic foetal monitoring (EFM) assess complications such as abnormal foetal heart rate for the foetus, as well as complicated perineal trauma and retained placenta for the mother (NEC, 2007 p16). Support woman whose birth plan changes because of complications: Women whose birth plan changes because of complications should be supported through assessing their emotional, psychological and mental needs, and offering them the necessary support, while also according them the necessary emergency measures, to prevent them from suffering adverse health, while also applying expertise to save the life of the mother and the baby, through various procedures such as caesarean section (NHS, 2013 n.p.). Detail a few specific complications that can arise in particular high risk conditions and discuss how they would be dealt with: Placental abruption: The placenta detaches from the uterus. It can be addressed though undertaking a caesarean section (NHS, 2013 n.p.). Antepartum haemorrhage: Associated with excessive bleeding, and can be addressed through uterine massage, uterotonics and introduction of intravenous fluids (NEC, 2007 p55). Importance of record keeping and complexity where many members of the multidisciplinary team are involved: Medical records help to guide the treatment of the complication, while also acting as a source of reference. BABY AT RISK Specific complications for the baby that can arise in particular high risk conditions and how to deal with the situations Respiratory failure: The baby can suffer from respiratory problems, arising from high-risk complications. This can be addressed through resuscitation and aiding breathing through oxygen (NHS, 2013 n.p.). High blood pressure, pulse and heart rate: A baby can suffer from the complications in case of a high risk pregnancy. This can be addressed through aiding breathing using oxygen, intravenous fluids feeding, and treating the baby for heart conditions and blood pressure (NHS, 2013 n.p.). Sensitivity when communicating about concerns to parents about the condition of their baby: Caregivers should address the mothers affected with high-risk conditions with sensitivity, through assessing their emotional, psychological and mental needs, and addressing them, while encouraging the mothers and giving them courage to pull through (NHS, 2013 n.p.). Smiling and confident look is essential for the care givers to display to such mothers, at all times. Preparation and resuscitate a baby where necessary Preparations entail the planning for adequate ventilation, as well as emergency referral pathways in the delivery settings, for the baby to access oxygen units if need be (NICE, 2007 p51). The healthcare professionals should attend resuscitation courses, to be able to address neonatal resuscitation needs when it arises (NICE, 2007 p51). Basic resuscitation for the neonatal should be initiated with air. Examples of when mother and baby may need separate care following birth and how to involve parental involvement: The mother may be separated from the baby for a while during the initial normal assessment of the baby. However, this can be extended when the health of the baby is poor and they need attention, or when the mother has suffered from genital and Perineal injury, requiring immediate treatment, especially where it involves injuries to the anal sphincter (NICE, 2007 p36). PREGNANCY LOSS Describe sensitivity to mother and family: Perinatal loss affects a family in a great way and requires that such parents, especially the mother should be accorded comfort, and emotional and psychological support (NMC, 2009 p28). Therefore offering psychological counselling while addressing physical needs of the mother with a lot of love and sensitivity is essential, to enable the mother pulls through the grieving moment by seeking to understand the psychological, emotional and mental state, as well as comforting the mother and offering physical help they may need in order to recover. Most importantly, the mother should be addressed with tenderness, love and care (NMC, 2009 p29). Define pregnancy loss: Pregnancy loss is the unexpected loss of a baby that is not born. Support for a woman just informed that her baby has died: The care givers should engage with the bereaved mothers both emotionally and physically, through being there for them and supporting them, while offering them a shoulder to cry on (NHS, 2013 n.p.). The care givers should avoid distancing themselves from the bereaved mother, while completely refraining from blaming her for any of the occurrences leading to the loss of her pregnancy (NHS, 2013 n.p.). Describe specific care required in the postnatal period: The mother should be granted adequate access to foods and drinks, so that they are highly hydrated, while also ensuring that the required maternal nutrition is available to the mother (NICE, 2007 p59). Another care required for the mother is privacy and adequate rest, to help the mother recover from the physical trauma, as well as the emotional and psychological assistance that will enable the mother to be holistically healthy (NICE, 2007 p60). Guidance on practical issues such as care for baby, documentation: The mother should be granted sufficient guidance on how to handle the baby, most significantly being on how to breastfeed, bathe, cloth and disinfect the baby’s clamped cord (NHS, 2013 n.p.). Documentation of the baby’s and mother’s progress should be kept, to assist the care givers and medical practitioners make references, in case of need. Ongoing care for family and support groups Perpetual support should be granted to the family and the support groups, on issues regarding how to handle and raise the baby, while preparing them to meet the material needs of the newborn (NHS, 2013 n.p.). Support stuff Community pharmacists should stock vitamin supplements, to supply mothers who may not have adequate supply. References National Health Service (NHS). (2013). Newborn and Infant Physical Examination - Standards and Competencies. Retrieved November 25, 2013 http://newbornphysical.screening.nhs.uk/competencies National institute for health and clinical excellence (NICE). (September, 2007). Intrapartum care: Care of healthy women and their babies during childbirth. National collaboration centre for women’s and Children’s Health, 1-65. Nursing and midwifery council (NMC). (2009). Standards for pre-registration midwifery education. Nursing and midwifery council. Read More