Childbearing - Support Measures during Labour - Case Study Example

Childbearing women case Institutional affiliation Name Introduction Except for women in the developing countries, majority of women enter into labour with a low or no risk for complications or any other related problem. In the U.S. for example, according to the Healthy People 2020, 85% of childbearing women experience complication-free labour ("Needs of Healthy Childbearing Women", 2011). Assuming Susan is from the developed countries and the fact that she received antenatal care throughout her pregnancy, it is correct to deduce that she is entering into labour with a very low risk for childbirth complications (ANMC, 2006).Although her medical needs may be limited as a result, she can benefit from support care prior to, during and shortly after delivery of her baby. Most often, prim gravid women are anxious about what the experience will be like. The level of anxiety will affect her perception of the labour pain (Christenson, M. H. 2013). Childbirth experience is phenomenal in that one can’t really understand it fully unless one personally experiences it. Nevertheless, this anxiety can be reduced by getting information and other support. The support needs for a woman in labour have generally been categorized into four dimensions, physical support, emotional support, informational support and advocacy. This support has proved to be positively impacting on the perception of the delivering mother towards her labour experience if effectively provided (Campbell, 2006). It is worth noting that medical staffs in the labour wards follow routines and as a result many women are subjected to the same routine; there is lack of individualization of care. Therefore specific needs of a client may not be comprehensively met. This is where a birth assistant comes in.The birth assistant may be a relative to the mother in labour or one who is not from her social network also known as a Doula. Hodnett and colleagues (2011) suggested that the labour support is even more effective when the birth assistant is not from the woman’s social networks. Roles of the partner and mother during the first stage Childbirth can be a very stressful experience to the mother if she lacks the support she needs. Mothers who do not receive continuous support during delivery are less likely to deliver spontaneously ("Having a Doula | American Pregnancy Association", 2014). This is mostly because of prolongation of labour which is a risk factor to many other complications of childbirth. During the first stage of labour of which Susan is already, the partner assisted by the mother can help her meet the support needs by undertaking a variety of support measures. Firstly, the pain that Susan is experiencing during this stage as a result of the contractions needs to be top on the priority table. Support measures that can help her to cope with the contractions are hereby discussed. Some of these support measures can be done even when they are still in the house (Christenson, 2013). Rhythmic deep breathing and moaning is the commonly applied technic. While the woman in this case Susan is trying to breath in rhythm with the contractions, the partner/Jake may support her by moaning with her or murmuring comforting phrases accompanied by stroking (Pilliteri, 2010).Murmurs such as “that’s the way”, “perfect” or “you are doing great” offer emotional support to her and this comforts her that she is not alone. It is sometimes possible for the partner to feel unappreciated by the woman, for example, she may tell him to stop because whatever he is doing is not helpful. The mother (Karen) should thus encourage the partner to take such comments positively and do what is helpful (Simkin P. 2013). Another way of reducing pain and improving comfort during the contractions experienced in the first stage of labour is by movement and positioning (Iliadou, M). Movements help to facilitate quicker descent of the foetal presenting part and thus ensuring that labour progresses quickly. This prevents complications such as prolonged labour. The partner and the mother can help by suggesting position changes since has been attending childbirth classes. They should also support her when changing to new positions. For instance, holding her hands and providing support when she is squatting. The partner can also support her in a hugging-like position when she is in a leaning forward position (Simkin P. 2004). Advocacy as a support measure may come in when the two assistants feel that they can use warm and moist measures (e.g. a warm towel on her abdomen) by asking the hospital staff whether they can go ahead. Here the partner or the mother is expected to support the towel or cold/hot gel pack on the patients abdomen (Weydt, 2010). Apply double hip squeeze if needed which is done when the woman is on fours and then pressing both sides of her buttocks with the palms. The partner can also experiment o where this becomes helpful through trial and error. The partner can also help to support her as they dance slowly. Other measures which have proved to be helpful in the first stage of labour include rocking, massaging etc (Larkin P, Begley, 2009) as full dilatation approaches, the mother may be overwhelmed by the increased duration and frequency of the contractions and hence a take charge routine becomes important. In such a time, the birth assistant should stay calm and confident, encourage the mother in labour to look at him/her and follow the instructions given. Informational support by the two assistants may be limited due to the less scientific knowledge of the experience they have but then they should be the advocate for the delivering mother. They should consult the medical staff for explanations of events as they follow. This reassures the woman hence relieving anxiety. The supportive measures for the medical staff in the hospital during the first stage are mainly providing information promptly and reassuring the woman by giving correct explanation of the process. Teaching or reminding the woman what is expected of them during the second stage for example where to hold when pushing, bowing down etc. is done as the cervical fully dilatation nears. Another support measure done by the hospital medical staffs but only when necessary is the administration of analgesics in case the contraction pains become unbearable. Otherwise, they should explain why the pain is important to the assessment of labour progress. In addition, the hospital should offer an environment conducive enough for the provision of labour support services by the loved ones (Klaus, M. H., Kennell, J. H., & Klaus, P. H.1993). During actual delivery or the second stage, the birth assistants are mostly involved in giving emotional support social support which includes encouraging the mother to push during contractions and relax when the contractions fade (Qureshi, 2012) Most of the measures done during the delivery of the baby are the standard/routine medical and nursing procedures. In the event of any emergency, the nurse and other medical staff extend their informative roles by explaining to the family members on any issues that may need to be handled. After the baby is born and the placenta, the nurse ensures that the woman is in a comfortable environment, that is, a clean bed, offering something warm to take for example porridge or warm milk. The nurse then should give a summary of the birth process to woman and the family members. Was the labour and delivery within the normal range in terms of duration and blood loss? They should provide information to the postpartum mother concerning the signs of postpartum haemorrhage and how to prevent it. Such preventive measures include emptying the bladder regularly and massaging the uterus after every 15 minutes. The midwife should encourage the assistants to report any signs of excessive bleeding promptly - another advocacy role by the loved ones Lavender T, Kingdon, et al.(2006) The postpartum mother and family should feel the caring nature of the hospital staff. The mother (birth assistant) should then promote bonding as soon as possible by initiating breastfeeding for Susan. She should demonstrate to her the procedure of effective breastfeeding including the correct way to remove her nipple from the mouth of the baby without causing tension on its jaw bones (Hotelling, B., Amis, D., & Green, J. 2004, et al.). Impacts of support measures Support measures during labour and delivery have many positive impacts to the woman. Hodnett and colleagues (2011) showed that comprehensive emotional, social, physical, psychological and informational support reduces the likelihood of having analgesics administered to the woman in labour. There is also reduction of complications associated with childbirth. Complications which may lead to caesarean section due to prolonged labour are reduced. According to ANMF (2013), supportive measures also increase the Apgar score rating of the infants. Conclusion Continuous support during labour has numerous benefits as shown herein and it is a challenge to midwifery facilities to formulate and/or effectively implement policies that encourage the application of these support measures. If undertaken effectively, support measures will positively impact on childbearing experiences. The child’s mother should be well taken care of and given all the health facilities that are required during the entire stages. References ANMC (2006). National Competency Standards for the Registered Nurse. Retrieve from: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#competencystandards ANMF (2013) Nursing and Midwifery Education: Continuing Professional Development. Retrieve from: http://anmf.org.au/documents/policies/P_Nursing_midwifery_education_CPD.pdf Campbell, D. A., (2006). A randomized control trial of continuous support in labour. Philadelphia, PA: Lippincott Williams and Wilkins Christenson, M. H. (2013).Perception, Expression and Management of the Pain of Childbirth. Harvard Common Press Hotelling, B., Amis, D., & Green, J. (2004).Care practices that promote normal birth:Harvard Common Press: Hodnett, E., Gates, S., Hofmeyr, G., & Sakala, C. (2005). Continuous Support For Women During Childbirth. Birth, 32(1), 72-72. Iliadou, M. (2012). Supporting women in labour. Health Science Journal,6(3),385-391. Klaus, M. H., Kennell, J. H., & Klaus, P. H. (1993). Mothering the mother: Reading, Mass.: Addison-Wesley. Pilliteri, A. (2010). Maternal and child health nursing (6th ed.) (pp. 398-399) . Philadelphia, PA: Lippincott Williams and Wilkins Qureshi, R. I. (2012). Continuous support for women during childbirth. International Journal of Evidence-based Healthcare, 10(3), 227-228. Simkin, P. (2008). The birth partner: Boston, Mass.: Harvard Common Press. Larkin P, Begley C (2009) Women’s Experiences of labour and birth: London: Rutledge Lavender T, Kingdon, C (2006) Keeping birth normal. Cambridge Publication. New York City Weydt, A. (2010) Developing Delegation Skills.The American Nurses Association, 15; 2. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No2May2010/Delegation-Skills.html Read More