Childbirth and Midwife
Midwives are autonomous professionals who are responsible for delivering high quality and holistic care for women during the antenatal, intrapartum and postnatal period’s . This involves working in close partnership with women to enable the provision of all necessary support, care and guidance (ICM, 2011). The midwife also has the important task of providing woman -centred care whilst always striving to promote normal birth (midwifery 20 20).
The royal college of midwives (RCM, 2010a) describes normal childbirth as one where a woman begins, continues and completes labour physiologically at term without intervention. However it must be recognised that normality is a hazy subject in health care and there are many different theories making it difficult to define. This essay will discuss the role of the midwife in the provision of normal midwifery care during the intrapartum period, specifically in relation to up-right positioning and mobility during labour and birth.
Childbirth and Midwife Essay Example
It will analyse the essential skills a midwife must acquire to allow the provision of normal midwifery care, the main components include; becoming an advocate for the woman, empowering the woman to make informed choices by providing evidence based information and the importance of continuous support and effective communication. The importance of mobility will also be examined and the role of the midwife in enabling mothers achieve effective mobility during labour will be discussed.
There are also numerous different positions that women can adopt during the intrapartum period , there are various advantages for different positions therefore the role of the midwife in helping mother’s to accomplish these positions will also be considered. An imperative role that midwife must adopt in the promotion of mobility during labour and birth, is the role of an educator (Dunkley, Bent, 2012 Mayes book ref). It is important that the woman has been provided with all of the relevant information regarding mobility and positioning.
Antenatal classes can be very beneficial and discuss labour in great detail. However not every woman will attend these classes and it is therefore the role of the attending). midwife to educate the woman of the benefits and ensure that the woman understands all of the information, enabling her to make an informed decision. Any information must derive from evidence based practice as stipulated by the Nursing and Midwifery Council (NMC, 2011 In order for a midwife to be able to inform her practice it is essential that she keeps up to date with the latest research, guidance, policy changes and statutory training.
This is why midwives are described as lifelong learners (Mayes PG 47). The (RCM, 2005) emphasises the importance of a midwife’s knowlegde of anatomy in the understanding of how adapting different positions in labour can aid the physiological processes. One of the benefits that the mother should be made aware of is that remaining mobile during labour can aid the descent of the fetus (Midirs, 2008). Despite more women being educated on the benefits of mobility and positioning, the majority of women in the United Kingdom continue to labour and give birth lying down on a bed.
A survey carried out by the (RCM, 2010b) concluded that a massive sixty three per cent of the women surveyed gave birth in a recumbent position. It is ultimately the mother’s decision to decide what position she may want to adapt during labour and birth however the midwife has a duty of care to ensure that she possess the adequate knowledge to make an informed choice (NMC, 2011). It is important that the midwife develops a quick rapport with a woman in her care if the woman is to actively listen and take in any information that is being offered.
According to (Midirs, 2006) a qualitative study in the Netherlands concluded that the dominating factor in influencing the women’s choice of birthing positions was the advice she had been given by her midwife. A Cochrane review carried out by(Hodnett et al 2011) also mirrors these findings and suggests that the length of time in labour may even be reduced and there may also be fewer interventions if a supportive care giver (the midwife in this case) is present.
To be able to build an effective and trusting relationship, one to one care is essential, furthermore the National Institute for Clinical Excellence (Nice, 2007) guidelines state that all women should be provided with one to one care while in labour. This care should ideally take place in a warm and welcoming environment The birthing environment plays an integral role in the provision of women-centred care. It is therefore the responsibility of the midwife to ensure the environment is safe, hazard free and suitable for mobilisation in the aim to provide normal midwifery care (Midwifery matters, 2010 ref 5).
In the hospital setting, the bed tends to be the central feature in the delivery room , the midwife should consider moving the bed to the side prior to the woman’s arrival and maybe provide a comfortable chair( The Practising Midwife, 2003 REF 9). The (RCM, 2010a) campaign for normal birth also recommends the use of low lighting, removing any unnecessary equipment and minimising interruptions. Midwives should also be sensitive to the importance of respecting a woman’s privacy and helping to maintain her dignity at all times.
Suggests that women are encouraged to adjust the environment to meet their own individual needs during labour and delivery, this helps to empower women and give them a sense of self-control. The midwife is obliged to facilitate the woman’s needs to the best of her ability and could maybe suggest bringing in some aids such as bean bags or a birthing ball that can enhance a woman’s comfort while also promoting mobility and upright positioning ( The Practising Midwife, 2003 REF 9).
Mobility is especially important in early stages of labour as this can aid the descent of the fetus through the pelvis (British Journal of Midwifery, 2010 REF 18). The first stage of labour, in particular the Latent phase can be a particularly confusing and worrying time for women as they often believe themselves to be in established labour. How the woman’s care is managed at this stage is vitally important and can have implications for the remainder of the birthing experience.
The midwife has a huge part to play in supporting the mother through this stage by listening to her, remaining positive and providing constant reassurance (RMC, 2010a). A recent Cochrane review found that offering continuous support to a woman during labour can reduce the use of pharmacological analgesia, shorten labour, and increase the likelihood of a natural birth while enhancing the woman’s birthing experience (Hodnett et al, 2011).
Supporting a woman in labour can be both mentally and physically demanding for a midwife, therefore involving the birthing partner can be beneficial to both the midwife and the woman and can improve the overall quality of care (TB page 10). During this early stage the midwife should encourage the woman to be as mobile as possible and maybe suggest that she walks up and down stairs as this can maximise the pelvic outlet allowing the fetus to descend into the birth canal.
A Cochrane review from (Lawrence et al, 2009) found that remaining mobile and adopting upright position can shorten the first stage of labour by about one hour. It is also well recognised that adapting up-right positions during labour and birth have many other advantages for both woman and fetus. The fetus is more inclined to have a better alignment and contractions tend to be more effective help to reduce the risk of; episiotomy, assisted delivery, fetal distress and less severe pain (Gupta and Hoffney, 2006).
Women who choose to labour in an up-right position also have a reduced risk of aorto-caval compression , which is when the aorta is constricted and can cause hypotension and loss of consciousness in the Woman (Midirs, 2008 final report). However a review carried out by (Lawrence et al, 2009) implied that there is a link between upright positions and increased blood loss, but a reason for this could be the fact that the woman is in an upright position could the loss more obvious.
However research suggests that Giving birth in a recumbent or flat position can have the potential to be more harmful to the fetus and carries a higher risk of an instrumental delivery or a caesarean section (RCM 2010b). It is the role of the midwife to ensure that the woman is aware of all of the evidence on both the benefits and potential risks of labouring and giving birth in an up-right position. She must also confirm the woman’s understanding of the information given.