Fundamentals of Midwifery: A Textbook for Students (66 page)

Every interaction the midwife has with the woman must count. In other words, it is fine to body- watch, gleaning as much information about the woman from the woman without even touch- ing her, but it is totally appropriate to ensure that clinical findings concur with observation. Baseline abdominal palpation is essential, particularly if the midwife has never met the woman previously, since this will give her and the woman vital information about the position and descent of the baby. These assessments will inform decision-making regarding positions for labour and pain relief.

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Use of a pinard to auscultate the fetal heart. Source: Copyright University of Hull.

The true skills of a midwife lie in the ability to interpret findings, predict potential in the woman’s situation and to guide the suggested care; this is often viewed as instinctive midwifery. A midwife will utilise her hands, eyes, ears and nose translating those findings via her experience to inform her decision-making. She uses a pinard stethoscope to hear the fetal heart rate (Figure 7.6), undertakes maternal observations of temperature, pulse, respirations and blood pressure measurement to determine baselines and detect any changes.

Energy levels need to be maintained to enable a woman to labour efficiently. Singata et al. (2013) found inconclusive evidence and therefore no justification to restrict fluids and food intake during labour for low-risk women.

The importance of good one-to-one support in labour from a midwife cannot be over-

emphasised (DH 2007; NICE 2007). This does not mean that the midwife must be constantly at the woman’s side, unless of course that is what the woman requires, but that the midwife is available whenever the woman feels she needs that midwifery support. Communication during this time is paramount – the midwife utilising all her skills and most importantly listening to the woman for she knows herself better than anyone else. It is important for a midwife to recognise those women who have confidence in themselves and support them. This may not always be comfortable for the midwife, since the woman may wish to make choices the midwife may not agree with. Conversely the midwife must be aware of the influence she may have over a woman who has no confidence. By communicating and explaining fully, the midwife has the best opportunity to allow the woman to understand a situation and work with it.

There are many examples of procedures and examinations, which often form part of the intrapartum care and which women find uncomfortable, embarrassing or intrusive. The com- passionate midwife ensures that nothing is done without good reason and that if an interven- tion or procedure is performed, it is done with as much expertise as possible and always with informed consent.

Comfort and support to maintain maternal wellbeing and coping is overarching in the midwife’s role. Helping her to wash, encouraging oral hygiene and changing sheets if in bed, are all actions that help the woman to feel cared for. General hygiene is important, particularly necessary for women having long or complex births as they may be at higher risk of developing infection.

A philanthropic attitude underpins all the care we give regardless of whoever is involved in providing care. Women in childbirth can be seen to submit when they recognise they are vul- nerable. A woman must be allowed to submit to the most appropriate person for her – the doctor, the midwife, a lay support person or best of all herself.

Clinical consideration

When considering the options, interventions and care pathways for women in labour, think about the benefits and the risks to mother and fetus, and the alternatives.

The woman must have control over the choice of who is her birth partner, and whoever that is

must be made to feel welcome and involved. There are recognised positive outcomes from the involvement of birth partners (RCM 2011a; Dellman 2004), as long as they are well-supported and informed. The RCM (2011a; 2011b) identify the challenges in involving fathers in a system which is so woman-focused and give top tips on how to facilitate their participation in the birth and other aspects of maternity care. When this is done well then it has a positive effect on the mother, father and their relationship, parenting and breastfeeding. Fathers and other birth part- ners can have a role in assisting with relaxation techniques and act as an advocate for the woman. It is important that the birth partner wants to be there; sometimes there can be negative effects on fathers who witness traumatic births or are at the birth because they feel pressured to be there. Dellman (2004) identifies how a man being present at the birth is beneficial for most women and also identifies circumstances when they may have a negative effect on outcomes. In addition, there are women who prefer men not to be present at the birth. Hollins Martin (2008) identifies the pressures from UK society for fathers to be present at the births. She cautions making assumptions about a father’s willingness to participate at the birth. There are strategies to assist with the anxieties that fathers might have around attending the birth, which includes identifying and agreeing their role of what they do and do not want to see or participate in (Hollins Martin 2008). It is essential that the midwife is in tune to the needs of the father and other birth partners, but not to the detriment of the woman who must always be the focus of her care.

Further reading activity

Go to the link below which is listed on the Fathers Institute website, which is part of Warwick

University study on experiences of childbirth. Go to Dad’s stories and read their memories, which identify similarities and differences in each Dad’s experience. Next time you observe or participate in a birth, think about the experience from the birth partner’s perspective.

[Available online] http://www2.warwick.ac.uk/fac/arts/history/chm/outreach/hiding_in_the

_pub/memories/

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A midwife is part of an interprofessional team that works closely together to keep the woman

and her baby safe. A midwife’s role is to detect deviations from normal and call a health profes- sional who is reasonably expected to have the necessary skills and experience to assist her in the provision of care (NMC 2012). As a midwife it is important to understand the appropriate use of interventions and how sometimes midwifery expertise can assist the process of labour prior to medical assistance being required. Labour is not a black and white situation with a clear-cut pathway from low to high-risk. For example, a woman may have an epidural and perhaps an intravenous infusion of oxytocin aiming to improve uterine function and propel the passenger through the passage with more power. She may require a lot of encouragement in the pushing phase and even an episiotomy; however she may still achieve a vaginal birth with the continued care and compassion from the midwife.