Midwifery Focused Option - Essay Example

?Midwifery Focused Option Introduction Child birth is a cultural and social event and associated with change in roles and responsibilities. For a woman, child birth is a major transition in her life and implies several changes in the social and personal identity of the woman in a major way (McCourt, 2006). There is enough evidence to suggest that average crisis scores are higher in women than in men after birth during the transition period and women experience more decline in marital satisfaction after the birth of their infant. This is also the period when parents divide the roles based on their gender leading to frustration of the woman (MCCourt, 2006). In this essay, the role of midwives in facilitating women centered care will be discussed through case analysis of a woman in labour through review of appropriate literature. Review of prenatal care On admission, the midwife taking care of Karen must review her prenatal history and antenatal care provided. Prenatal care is very important in any pregnancy. According to NICE guidelines (2003), all pregnant women who seek prenatal care must be given evidence-based information and allowed to take informed decisions about their care. Issues like "who will take care of the pregnant woman" and "where will the delivery be conducted" should be based on the pregnant woman's choice and after receiving enough information about various options available. Blood tests which merit importance are diabetes screening, serological tests for rubella, cytomegalovirus, toxoplasmosis, herpes, syphilis, hepatitis B and humman immunodeficiency virus, hemoglobin and thyroid function tests. During the antenatal check ups, drugs taken by the patient must be reviewed and in case the mother is consuming alcohol or is smoking, she must be motivated to refrain from them. Infact, these and other issues must be addressed much before the conception of the fetus and it is known as preconception care. One of the important strategies of preconception care is to take folic acid supplements to prevent neural tube defects in the baby (Atrash et al, 2006). Labour Karen is a primigravida mother with term gestation. Karen awaited onset of labour at home. The midwife gave her adequate information as to when to contact the midwife. When Karen was in early labour, she was assessed away from the delivery unit. There is evidence that such a practice results in less number of interventions during active phase of labour (McNiven et al, 1998). The midwife must discuss the plan of birth with Karen and make her comfortable. After Karen gets admitted in the hospital, unnecessary digital examination must be avoided to prevent infection (Hannah et al 1996). Fetal heart must be monitored using a sonicaid. The descent of the presenting part, color and quality of the liquor and various other maternal observations must be assessed and recorded. There are four dimensions of support which women need to be given in labour and they are informational support, emotional support, physical support and advocacy (Hodnett, 1996). There is enough evidence to point that provision of continuous support in labour shortens the course of labour, decreases the use of pharmacological analgesia and decreases the use of forceps during delivery (Hodnett, 1996). The midwife must help Karen in choosing nonpharmacological methods of pain relief because they are safe for both mother and baby (Watson, 1994). The most commonly used nonpharmacological method of pain relief is exercise therapy which must be taught in antenatal classes. The requirements of pain medications are less in those who are prepared well in antenatal classes (Watson, 1994). Karens's progression of labour must be monitored through vaginal examination. Progression of labour involves moving of cervix from posterior position to anterior position, ripening or softening of cervix, effacement of cervix, dilatation of cervix, rotation, flexing and moulding of head and descent of fetus (Simkin & Ancheta, 2000). Vaginal examinations are painful and a source of distress (Simkin & Ancheta, 2000). Hence, the midwife must consider emotional and psychosexual aspects of vaginal examination while performing examination of Karen. During active labour, Karen must be shifted to the labour room where she is assisted in positioning. Karen must be helped to adopt a comfortable position suitable for labour. Though upright position has several advantages, lying down position is the most preferred position (NICE, 2003). Karen must be given confidence in following her own urge to push. She must be encouraged to push in upright position because it is associated with better outcomes. She must be given episiotomy if needed to prevent tear of pelvic floor muscles (NICE, 2003). The midwife taking care of Karen must be well trained and know when to refer to tertiary care center. The care deliverers have a responsibility to to select women who are not at high risk of complications and to establish an infrastructure for safe obstetric interventions (NICE, 2003). The midwives must also allow access to hospital facilities in the rise of serious complications which need the immediate attention of expertise care. Hence, there should be good coordination between the primary care health personnel and the obstetrician (NICE, 2003). Eating and drinking during labour Karen must be allowed to eat and drink with no restriction during labour. Eating and drinking during labor is a controversial topic with different types of practice by different practitioners (O'Sullivan et al, 2009). According to WHO (cited in Sharts-Hopko, 2010), during labor, women's drinking and eating should not be interfered by health care providers, especially when there are no definite risk factors. Postpartum In the postpartum period, Karen must be monitored closely by the midwife. Care in the postnatal period includes monitoring of vitals signs, especially fever, assessment of lochia, assessment of the extent of damage in the perineum, evaluation of fundal height, bowel and urinary output, care of breasts, observation of legs, evaluation of psychosocial well being and education of the needs of the mother and the baby (Gilmour and Twining, 2002). According to Gilmour and Twining (2002), it is easier to provide individualized care where there has been continuity of care with a midwife who is known. Postpartum or newborn blues Karen can appear depressed and disinterested after delivery. She can become anxious and emotional. This may be a source of anxiety to the partner. The midwife must tell him that it would settle down with lots of psychological and emotional support. The most common mental disturbance after childbirth is 'newborn blues' (Murray and Cooper, 1997). This mental illness lasts for a short duration of time and improves without treatment. Sometimes this illness can last longer than usual and it is known as postpartum depression. Postnatal depression can have serious consequences on the mother, her child and the family too (Murray and Cooper, 1997). It is a risk factor for suicide (Murray and Cooper, 1997). It can contribute to depression in the partner and also lead to infanticide (qtd. in Morrel et al, 2009). It can lead to child abuse. Nurses are one of the first persons to identify child abuse (Higgins et al, 2009, O'Donnell et al, 2009; Naysa, 2004). Mothers may not understand the reason for crying in the babies and can feel disgusted. According to McPherson and Thorne (2000), "in expressing their needs and wishes, infants and children are influenced by their experience in the world, by their immature physical bodies, and by a culture that has particular expectations of children. Psychological support is a more preferred mode of treatment by women and anti-depressants have their own side effects. In the UK, there is plenty of promotion for management of postnatal depression by health visitors inclusing midwives (Morrel et al, 2009). I Breast feeding Karen must be motivated to breast feed the baby. The midwife must help the mother in positioning and latching while breast feeding. Breastfeeding is undisputedly the optimum source of nutrition for infants in the early months of life. It also has health advantages for mothers (Brttion et al, 2007; Lumbigannon et al., 2007; Henderson and Scobbie, n.d.). Studies have demonstrated numerous benefits of breast milk and breastfeeding for this vulnerable population including ease of digestion, increased immunological status, protection from infection and necrotising enterocolitis, increased tolerance to procedural pain, improved brainstem maturation and cognitive development, and enhanced visual development (Brttion et al., 2007; Lumbigannon et al., 2007; Oddy, 2002; Spatz, 2005; Karen, 2005, Fitzparick and Downing, 2007). For mothers’ health, breastfeeding results in reducing risk of breast and ovarian cancers and enhancing maternal infant attachment, more rapid uterine involution, less postpartum depression and weight reduction (Peters et al, 2005). Moreover, breastfeeding has cost-benefit. The World Health Organisation (1998) strongly recommends that all infants are exclusively breastfed for the first six months of their life. During the postpartum period in a hospital, most mothers initiate breastfeeding in a hospital under the supervisions of health care professionals like midwives (Pugh et al, 2002). Therefore, midwives are required to provide postpartum care in the hospital and community, including breastfeeding education and support to reduce the risk factors of premature weaning as nurses have a prime position to be available to new mothers as experts in breast-feeding during postpartum hospitalization and provide them with factual information (Pugh et al., 2002). Conclusion Having a baby is a huge physical, social and emotional upheaval .for the woman. The arrival of new baby makes the mother elated and delighted and creates feelings of tender and protectiveness towards the baby. At the same time, mothers may also develop feelings of frustration, anger, guilt and fear of not able to be in control of their own lives. They may shred the new responsibilities which are shouldered on them. 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