Birth and early Parenthood

Aims of the study:

This study aims to analyze the management and care of the women in labor and postpartum
period. This study will provide the sufficient information to facilitate parturient women and her
families.

Explanation:
1. Anatomy and physiology of labor in birth and post-partum period
The study of structure and relationship between the different body parts is anatomy and
the study of the function of the body parts is physiology.
At the parturition period i.e. a week ago the delivery date several physiological changes
occur in response to the hormones. After the pregnancy progesterone for the several
months inhibits uterine contraction but when pregnancy enter to the seventh month
progesterone level plateau and then it drops. In this period estrogen levels get rises.
Because of the rise of the estrogen to the progesterone myometrium become more
sensitive to stimuli that promote contraction of the uterine muscle. After the eight month
of the pregnancy fetal cortisol rises and it increases the formation of the estrogen
secretion and it further increases the calmness of the progesterone secretion. Some
women may feel weak and irregular at this period because of the progesterone declining.
These kinds of condition could be relieved by rest or hydration. A common sign known as
bloody show is observed at pregnancy period. A plug of mucous get accumulated at the
cervical canal blocking the path of the uterus. In about 1 or 2 days plug loosen and get
expel out with the small amount of blood. And posterior pituitary boost the secretion of
the oxytocin which stimulate the contraction of labor. At this stage sensitivity of
myometrium increases by the production of oxytocin which further stimulate more
painful uterine contraction. After that secretion of prostoglands and oxytocin increases
whose combination are known as Pitocin. Finally myometrium and cervix stretches by
the full fetus in vertex. These labor get increases in this period and labor is attributed as
myometrial hypoxia during the uterine contraction. Uterus is the organ where fetus
develops and grow. Placenta provides the all the necessary nutrients needed for the
development and growth of the fetus. As the fetus grows the size of the uterus get
increases. When the labor starts uterus contract and relaxes to give the birth to the baby.
The fetus remains at the uterus and develop, and at the time of labor fetus moves down to
the vagina from the front door of the uterus. Labor begin after the dilation of the cervix.
After the birth of the child the size of the placenta decreases to the size of melon. This
helps placenta to detach from the wall of the uterus and delivered after the birth of the
baby.
2. Analyze psychological and sociological aspects which influence progress and
outcome during the intra period for the woman, baby and her family.
Woman and baby must be give a key priority at the intra period of the women. At this
stage woman may not be able to do the needed physical work so family member must
take care of the baby and the mother. Woman and baby both needs a healthy and balanced
diet food for the promotion of the physical and social health. The year after the birth is
the significant transition period. As she get enter into the motherhood role, she undergo
through the different psychological and sociological changes. She have to work to meets
the emotional and physical needs of the infants and other family members. In the intra
period woman are more vulnerable to the health related diseases. In global context, about
136 million of women suffer from the excessive bleeding after the birth of the child.
Large number of death news could be observed at this due to various health related
problems. So family must provide the effective care at this stage.
These duties may compromised to maintain her self-care and unhealthy behavior such as
smoking, sedentary life style is developed in this phase. We observe people not giving
much attention to the care of the woman at post-partum period. Family member also give
more priority to the infants than the woman which may affect the psychological and
sociological well-being of the woman. Those woman must be provided with the
advocacy, empathy and constant emotional support. They must be encouraged and
assurance must be given to maintain the psychological and sociological wellbeing of both
mother and the infant. The social needs of the woman could be divided into two
categories. Woman at post-partum period must not be allowed to remain alone and
frequently health care professional must be visited. Family could encourage doctors,
nurse or midwife to visit the infants and mother at the home. Regular checkup of both
infants and mother must be done to determine the infant and mother health state.

3. Analyze the issues surrounding the maintenance of safe environment both in

hospital and community.
A level of compassion and vigilance is reflected in maintaining a safe environment for
patient welfare which is one of the most important aspect of health care. This cause
policymakers, researcher to intensify their effort to maintain the safe environment in the
process of health care systems as they are directly related to the safety of the patients.
Infants and mother are at most vulnerable that they may affected by the various health
related problems. Sanitation must be given key priority to maintain the good health of the
infants and mother. As there are large number of patients in the hospital pregnant woman
may not get a favorable environment needed for them. And community also may not be
able to provide the favorable environment needed for the pregnant woman. Hospital must
 give priority and must establish effective provision to maintain the prompt health of the
pregnant woman. Community also must give priority to maintain the environment
favorable to the pregnant woman who are vulnerable to different health related problems.
Hence, new medical hospitals should be made in much quieter area, provide patients with
views of nature and other positive distraction, improve lighting and focus should be given
on natural lighting and improve ventilation system by the use of improved filter for
maintaining the safe environment.

4. PROVIDE SUPPORT TO A WOMAN AND HER FAMILY IN LABOR/POST-

PARTUM CARE
In some cases, skill attendant are present in home when some women gave birth to the
child while most of them doesnt have a skilled attendant present. There are some women
who need to spend time there following the childbirth. According to World Health
Organization (WHO), women should not be discharged before 24 hours of birth. Hence,
irrespective of the place of birth women should be accompanied by someone for the first
24 hours to respond to any changes on mother and baby. Also, women should be
recommended to eat more and healthier foods along with plenty of clean, safe water. The
rest and sleep is equally important in this period and hard labor should be avoided.
Postpartum bleeding is common and when bleeding exceeds what is normal, they should
seek care urgently. It is also equally important to provide them the home environment for
the quick recovery of the mother and health of the baby.
It is the beginning of new opportunity for both mother and baby and other family
members to start finding new way of relating to each other in the postpartum period while
incorporating the newly born baby into their mindset. In such case, partner should be
involve much and spend more time together as much as he can. They should be
continuously aware and encourage to visit and should be concerned about the new family
situation. It is also possible in the case of few maternity hospital that husband can be stay
in the postpartum period despite working in day. This family-centred care encourage the
mother to early discharge from the hospital which give mother and baby to care in their
home soon after the delivery. The general rule is what mother chooses for herself rather
what hospital prescribes is considered as the best arrangement. The system of care can be
 whatever but it is important requirement that the system should support the new family to
grow and prosperous together when it comes to caring the mother and baby.

5. Demonstrate the skills required to care for woman and her baby during labor and early
post-partum
Skills required during the labor
It is important to have the proper skills for safe and clean delivery of the baby. When
women is admitted to the labor ward of the hospital, maternity records including the birth
plan should be reviewed along with abdominal palpation, monitoring of the fear and
diagnosis of the labor. The person who is responsible for the care of the mother should be
aware of the cultural and religious beliefs of the women. In normal labor, blood pressure
should be frequently checked and minimum of half-hourly heart rate recording should be
made in the first stage of labor. Prior to the vaginal examination, abdominal palpation
should be undertaken and in every few hours vaginal examination should be undertaken
in normal labor or more frequently. The reason for the rupturing the membrane should be
clearly documented while noting the color of the liquor. Light diet should be given the
clients who were on low risk while only water should be offered for high risk client. As
per the choice of the client, pain relief should be regularly reviewed and the position in
labor should be discussed with the mother and her choice must be accommodated as far
as possible.
Skills required during the early post-partum
During post-partum, encourage should be given to the women to ask the question during
the examination and listening skills should be developed to reflect and clarify what client
is saying. The rest and sleep routine of the women should be properly taken care of and
should help her to avoid hard physical labor. Personal hygiene of the mother should be
maintained and infant feeding and breast care should be discussed. Only prescribed
medicines should be given when breastfeeding. Some women, when unsure and hesitant,
voice their concern in an indirect manner instead of directly voicing their issue. Hence, it
is essential skill to understand the body language and verbal sign women is showing. At
 the end, it is important to remind her that she can ask any question regarding the post-
partum care and make sure she feels supported.

6. Demonstrate the skills of neonatal and maternal resuscitation

Neonatal is the care of new born infants require special medical care duet low various
reason such as low birth weight, prematurity, congenital malformation, pulmonary
hypoplasia, sepsis or birth asphyxias. There are some new born babies who do not
breathe spontaneously hence should be stimulated by rubbing the back 2-3 times by
initiating positive pressure ventilation and clamping the cord. Suction should be not be
given the newborns who can breathe on their own and medical professionals should avoid
using routine nasal, intrapartum suction, tracheal suctioning etc on newly born babies.
Cord clamping should be performed just after one to three minutes of birth and early cord
clamping should not be done. The newly born baby should be make skin-to-skin contact
with the mother during the first hour in order to prevent hypothermia. Vitamin K
prophylaxis should be given as neonates requires surgical procedures as they have high
risk of bleeding.
Key intervention is necessary in maternal resuscitation. The airway should be secure first
since pregnant women is prone to build hypoxemia due to increased oxygen intake and
reduced functional residual capacity and if the caregiver found uterus above the
umbilicus, the uterus should be displaced laterally to the left. Caregiver should start
cardiopulmonary resuscitation (CPR) with chest compression by the help of pregnancy
modification. Without the cause of cardiac arrest it is difficult to treat the patient hence
the possible cause of cardiac arrest should be considered first to ease the problem. The
gestation age of the fetus should be estimated. When the uterus fundus is greater or equal
to 4 fingerbreadths above the umbilicus, perimortem cesarean delivery should be begin at
the fourth minute and by the fifth minute delivery should be completed following the
cardiac arrest. The direct cardiac massage should be performed when resuscitation remain
unsuccessful at the fifteenth minute when appropriate caregivers and resource are
available.
7. Safely manage, administer, record and monitor effects of common medicines used in
midwifery care
Midewifery are accountable for all the action and while administering medication
midwife should think through the issue and should apply their professional judgment and
expertise for the best interest of patients. They should be aware of the interrelationship
with the multidisciplinary administration team. The patient plan of care should be taken
care of and the therapeutic use of medicine including the side effects, normal dose,
contradiction and precaution. The clear procedure should be followed to ensure the right
person receiving right drug in right time, in the right dose. The prescription written on
medicine dispensed must be checked and when uncertainty arise about the prescription, it
must be clearly clarified before administering the medication. The identity of the patient
to whom the medicine is administered must be made certain and also the expiry date of
the medicine should be administered. The second practitioner should be appointed where
complex calculation is required in order to ensure the correct quantity of medication
which helps to minimize the risk of error. The clear, immediate and accurate record of all
medicine must be administered which is refused by the patient ensuring the legitimity of
the signature. All the medicines should be stored in accordance with the patient
information and label on the instruction must be strictly followed. Nurse in Charge
working in the clinical area must kept the drug refrigerators, medicine trolley and keys of
the medicine in line with local policy. The drug keys should be returned to the nurse in
charge at the end of each shift. Midwife should be aware of the legislation which exists in
relation to controlled drugs namely ketamine and morphine and should be familiar with
the local trust policy regarding collection, storage, administration and ordering of
controlled drugs. The epidural or intravenous medication must be avoid unless midwife
hasnt documented competence assessment and additional training in accordance with the
trust policy. When there is no direct supervision, midwife must have the skill and
knowledge for effective and safe practice. Local trust policy need to be followed when
administering oral liquid medication and must use enteral syringes if it is available.
Unless appropriate training has not been received, midwife should avoid taking part in
the collection, prescription, administration and storage of the cytotoxic agents. Further,
midwife who havent receive appropriate training and certified must avoid checking
 intrathecal chemotherapy drugs prior to administration. For the management of patients
own medicine, local Trust guidance should be followed. Finally, no attempt should be
made to disguise medication and in case if it is asked to do, midwife should refuse and
immediately report the case to senior nurse.

8. Equipped with the knowledge and skills to support breastfeeding

According to WHO, breastfeeding protects against the infant morbidity and death apart
from unquestioned nutritional superiority. The newly born child are less likely to suffer
from respiratory infection and diarrhea compare to the babies who are not breastfeed.
WHO also stated that at least 97% of the mothers are capable of breastfeeding the child
successfully but there are large numbers of mothers who gave up breastfeed after few
weeks. First of all, midwife should make them understand that all women should able to
product milk unless they have retained placenta and size of breast and nipple is not
important for the success of breastfeeding. Midwife should encourage women to talk
about the expectation and concern about the breastfeeding. They should pay special
attention in case of women who are young and single and had difficulty in breastfeeding
previously and encourage them to trust their own body. The midwife should be able to
make women feel that she is the one who control the pregnancy and parenting. This
control should be taken away from them. Sometimes excessive monitoring of health
pregnancy make women feel unsure about her abilities and herself. This negatively affect
her breastfeeding approach. For creating the breastfeeding experience, women should be
explained the importance of first hour following delivery. The mechanism of how
breastfeed works should be explained to the women in brief and simple terms by
emphasizing on baby-led and good attachment feeding. As 99% of breastfeeding issues
can be resolved, confidence should be create among the women that there is no risk in
breastfeeding.

9. Communicate effectively and participate in the multi-disciplinary team including referral

to appropriate agencies and family members
When professionals from wide range of disciplines work together with different
complementary skills, experience and knowledge works to deliver comprehensive
healthcare for providing greatest possible outcome for the psychological and physical
needs of the people. The need of the patient change with time and the composition of
team should work towards meeting the changing demand and there is a need of strong
culture in multidisciplinary caret to improve the primary health care facilities as it
provides a diverse range of experience and skills compare to single health professionals.
The more comprehensive approach is enable by multidisciplinary teams to meet the
comprehensive needs of individual patients. The women and families are cared by quality
maternity care which is in turn depends upon the effective contribution of all the member
in multidisciplinary team. Midwives works alongside with other member of the
interdisciplinary team are the key members as coordinators of care. Womens general
medical care is the responsibility of general practitioner but midwives plays a crucial role
as the first point of contact as evidence suggest pregnant women benefit as early as
possible from accessing the maternity service from midwives. For providing maternity
care for women, midwives works with obstetric and also with social care colleagues,
specialist workers, public health practitioners and maternal care assistant so that they are
able to respond to social needs and complex health problems of women along with their
families. Partnership are not the only option for achieving success but timely and
effective communication are equally important for creating success. The underlying cause
of substandard care are the poor and ineffective team working which further leads to
failure of sharing important information between professionals includes maternity team,
social service and general practitioner (GP). The fundamental of multidisciplinary is the
good communication and each member working in multidisciplinary team should take
personal professional accountability in order to ensure the clear and effective
communication.