Midwifery Skills at a Glance

Patricia Lindsay, Carmel Bagness, Ian Peate, Patricia Lindsay, Carmel Bagness, Ian Peate

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781119233916
• eBook ISBN: 9781119235125
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Being an effective midwife requires a range of knowledge and skills, all of which are essential to provide competent and safe care to childbearing women and their infants. Midwifery Skills at a Glance offers an invaluable, straightforward guide for students and practitioners – offering readable, easily digestible information, supported with illustrations throughout to enhance application to practice.

Clear and concise throughout, Midwifery Skills at a Glance covers a wide range of skills – exploring issues such as infection control, personal hygiene care, and safeguarding; assessment, examination and screening skills; how to care for the woman and neonate with complex needs; drug administration and pain relief. 

• A comprehensive, highly visual guide to the skills essential for safe, effective, and compassionate midwifery practice
• Written by experts in their field
• Briefly describes each skill and provides clear illustrations — making it an ideal companion in clinical practice
• Offers instruction on the safe use of a wide range of essential skills required to deliver safe, evidence-based maternity care
• Includes service user viewpoints and key points to help consolidate learning and reflect on the experience of receiving care 

Written with the student midwife in mind, Midwifery Skills at a Glance is equally invaluable for all others providing care, including Maternity Support Workers, mentors, registered midwives and medical students. 

 

Part 1
The basics of care

Chapters

Infection control

1. 1 Infection prevention and control
2. 2 Hand hygiene
3. 3 Infectious diseases in pregnancy
4. 4 Modes of transmission
5. 5 Asepsis and sepsis

Health and safety at work

1. 6 Moving and handling
2. 7 The control of substances hazardous to health
3. 8 Safety in the working environment
4. 9 Sharps injuries
5. 10 Working safely in the community

Personal hygiene care

1. 11 Personal hygiene care for women
2. 12 Perineal and vulval hygiene; use of bedpans and commodes
3. 13 Pressure area care

Quality and patient safety in maternity care

1. 14 Risk management, liability and avoidable harm
2. 15 Types of incident, incident reporting, record keeping and duty of candour
3. 16 Audit and quality assurance in maternity care

Safeguarding

1. 17 Safeguarding vulnerable women
2. 18 Safeguarding of children: key issues
3. 19 Female genital mutilation

1
Infection prevention and control

The prevention of infection is a core element of safe and effective midwifery practice. Midwives and other healthcare professionals should consider the development of infection as an ‘adverse’ event, and monitor and investigate all infections as part of their organisation’s patient safety systems and learning culture. Box 1.1 indicates how infections may occur.

As knowledge of microbiology and the epidemiology of multiresistant organisms has increased, prevention now also includes the avoidance of colonisation of bacteria of clinical importance including (but not limited to):

• Staphylococcus aureus (including PVL strains)
• Meticillin-resistant Staphylococcus aureus (MRSA)
• Pseudomonas aeruginosa
• Multidrug-resistant Gram-negative bacteria (MDR GNB) such as Klebsiella pneumonia and Escherichia coli (E. coli)
• Mycobacterium tuberculosis
• Fungi and yeasts.

Viruses can also be problematic, in particular blood-borne viruses (hepatitis B and C, HIV) and chickenpox.

Box 1.2 provides examples of common infections associated with pregnant and postnatal women.

A number of different practice interventions are described supporting the midwife to prevent or interrupt the development of infection or colonisation, which may lead to risks specifically in-patient care setting. They are:

• The use of standard precautions (see Chapter 4)
• Knowledge and compliance of organisational infection prevention and control policies and guidance
• Active laboratory surveillance and reporting of cases of infection
• Screening of women/babies
• Vaccination of staff, women and babies
• High standards of cleanliness
• Education and information on hygiene, infection and prevention methods.

Many women and babies who develop an infection recover well; a small proportion go on to develop sepsis, a potentially life-threatening condition (Chapter 5). The importance of sepsis as a cause of maternal death has been recognised in reports such as MBRRACE UK.

Sepsis cannot be transmitted from person to person. It is a condition that occurs due to overwhelming infection, resulting in an immune cascade leading to septic shock. It can affect both mothers and neonates. Information on neonatal sepsis is detailed below. See Chapter 5 for the management of sepsis in adults.

Isolation: Physical (source) isolation has traditionally been used to separate people receiving hospital care from others due to a risk of spread of infection. In midwifery and neonatal care, isolation may be through the provision of single room accommodation (for mother or mother and baby) or an incubator/cot in the neonatal setting.

The route of transmission for the infection must always be known; this identifies which specific practice precautions are required. Box 1.3 indicates the requirements when source isolation is used.

Identifying neonatal infection, and preventing and managing neonatal sepsis

Midwives are uniquely placed to identify deviations from the normal in the newborn they care for as part of holistic family-centred care. There are some factors that can predispose to a higher risk of early-onset neonatal sepsis. The neonate may be exposed to organisms from the mother during pregnancy as well as vaginal delivery and in many cases of early-onset neonatal sepsis there have been intrapartum complications identified. Identifying these babies and providing the appropriate management will save lives.

Assessment of the neonate

NICE (2014a) recommends that all infants born to women who had prelabour rupture of the membranes at term are closely observed for the first 12 hours of life (at 1, 2, 6 and 12 hours).

The assessments recommended are:

• Temperature
• Heart rate
• Respiratory rate
• Presence of respiratory grunting
• Significant subcostal recession
• Presence of nasal flare
• Presence of central cyanosis, confirmed by pulse oximetry if available
• Skin perfusion assessed by capillary refill
• Floppiness, general wellbeing and feeding.

If any of the above are present, a neonatologist assesses the baby and advises the family of any need for transfer to appropriate neonatal services if required. In the absence of a neonatal assessment (e.g. non-hospital settings) an urgent referral or transfer to a hospital will be required.

Neonatal sepsis can present with subtle and non-specific symptoms. By the time sepsis is considered the infant may already be very ill. NICE recommendations (2014b) include the use of the red flag to support clinical decision making and British Association of Perinatal Medicine (BAPM) have developed a Newborn Early Warning Trigger and Track (NEWTT) framework to alert midwives to babies who need further help. The framework provides a visual prompt, aiding the identification of abnormal parameters by using a colour code.

Signs and symptoms of sepsis are provided in Box 1.4.

The diagnosis of shock does not require that a neonate be hypotensive. This is a late finding in septic shock and when it occurs confirms progression towards decompensated shock (Robinson et al. 2008). A tense or bulging anterior fontanelle is suggestive of meningitis, common in late-onset sepsis. The assessment of the infant’s fontanelles should be made with the infant held and supported in an upright position.

Temperature ins...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• Foreword
• Preface
• Part 1 The basics of care
• Part 2 Assessment, examination, screening and care of the woman and baby
• Part 3 The woman or neonate with different needs
• Part 4 Drug administration in midwifery
• Glossary
• Index
• EULA