The Midwife's Labour and Birth Handbook

Vicky Chapman, Cathy Charles, Vicky Chapman, Cathy Charles

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9781119235118
• eBook ISBN: 9781119235095
• Edition: 4
• Topic: Medicine
• Subtopic: Nursing

Praise for the previous edition:

"…An outstanding handbook. It will be a familiar volume on most midwifery bookshelves, providing an excellent guide to midwifery focused care of both woman and child in the birthing setting."
- Nursing Times Online

Providing a practical and comprehensive guide to midwifery care, The Midwife's Labour and Birth Handbook continues to promote best practice and a safe, satisfying birthing experience with a focus on women-centred care.

Covering all aspects of care during labour and birth, from obstetric emergencies to the practicalities of perineal repair (including left-hand suturing), the fourth edition has been fully revised and updated to include:

• Full colour photographs of kneeling extended breech and footling breech births
• New water birth and breech water birth photographs
• Female genital mutilation
• Sepsis
• Group B streptococcus
• Care of the woman with diabetes /Neonatal hypoglycaemia
• Mental health
• Seeding/microbirthing

It also addresses important issues such as:

• Why are the numbers of UK women giving birth in stirrups RISING rather than falling?
• Why are so few preterm babies given bedside resuscitation with the cord intact?
• Would the creation of midwife breech practitioners/specialists enable more women to choose vaginal breech birth and is breech water birth safe?
• What is the legal position for women who choose to free birth – and their birth partners?
• Why are midwives challenging the OASI care bundle?

Incorporating research, evidence and anecdotal observations, The Midwife's Labour and Birth Handbook remains an essential resource for both student midwives and experienced practising midwives.

1
Labour and normal birth

Cathy Charles

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1. The birth environment
2. Signs that precede labour
3. First stage of labour
4. Analgesia
5. Regional anaesthesia
6. Mobility and positions
7. Transition
8. Second stage of labour
9. Pushing
10. The birth
11. Third stage of labour
12. After the birth
13. Mental health/safeguarding
14. Early discharge home
15. Appendix 1.1: Group B Streptococcus

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Introduction

Undisturbed birth … is the balance and involvement of an exquisitely complex and finely tuned orchestra of hormones.

(Buckley, 2004a)

The most exciting activity of a midwife is assisting a woman in labour. The care and support of a midwife may well have a direct result on a woman’s ability to labour and birth her baby. Every woman and each birthing experience is unique.

Many midwives manage excessive workloads and, particularly in hospitals, may be pressured by colleagues and policies into offering medicalised care. Yet the midwifery philosophy of helping women to work with their amazing bodies enables many women to have a safe pleasurable birth. Most good midwives find ways to provide good care, whatever the environment, and their example will be passed on to the colleagues and students with whom they work.

Some labours are inherently harder than others, despite all the best efforts of woman and midwife. A midwife should be flexible and adaptable, accepting that it may be neither the midwife’s nor the mother’s fault if things do not go to plan. The aim is a healthy happy outcome, whatever the means.

This chapter aims to give an overview of the process of labour, but it is recognised that labour does not simplistically divide into distinct stages. It is a complex phenomenon of interdependent physical, hormonal and emotional changes, which can vary enormously between individual women. The limitation of the medical model undermines the importance of the midwife’s observation and interpretation of a woman’s behaviour.

Facts and recommendations for care

• Women should have as normal a labour and birth as possible, and medical intervention should be used only when beneficial to mother and/or baby (DoH, 2007; NICE, 2016).
• Midwife‐led care gives the best outcomes worldwide: more spontaneous births, fewer episiotomies and epidurals, better breastfeeding rates. Women report that they feel more in control of their labour (Sandall et al., 2016).
• Although 88% of women give birth in an obstetric unit many would not choose to: low‐risk women (i.e. around 60%) should also be offered the choice of birth either at home or in a midwife‐led unit; a woman has a right to choose her place of birth (DoH, 2007; NICE, 2014; NHS England, 2016).
• Women should be offered one‐to‐one care in labour (NICE, 2014). The presence of a caring and supportive caregiver has been proved to shorten labour, reduce intervention and improve maternal and neonatal outcomes (Green et al., 2000; Hodnett et al., 2013).
• The UK birth rate continues to rise, while England alone is short of 3500 midwives (RCM, 2016).
• 1–2% of mothers develop birth‐related post‐traumatic stress disorder (Andersen et al. 2012) and midwives can too (Sheen et al., 2015).
• The attitude of the caregiver seems to be the most powerful influence on women’s satisfaction in labour (NICE, 2014).
• 89% of fathers attend the birth (Redshaw and Heikkila, 2010); other relationships, e.g. same‐sex couples, have been less closely studied.
• The birth rate for women aged >40 rose above that for women <20 for the first time since 1947 (ONS, 2016).
• 27.5% of births in England and Wales are to women born overseas (ONS, 2016).
• 20% of pregnant women in England are clinically obese (Health and Social Care Information Centre, 2016), increasing the risk of complications.

Mode of delivery

• The UK normal birth rate is around 60% (ONS, 2016; NHSD, 2017).
• The instrumental delivery rate is around 10–15% (ONS, 2016; NHSD, 2017).
• The episiotomy rate for England is around 20% (see Chapter 4).
• The caesarean section (CS) rate is around 26% (NHSD, 2017).

The birth environment

In what kind of surroundings do people like to make love? A brightly lit bare room with a high metal bed in the centre? Lots of background noise, with a series of strangers popping in and out to see how things are going? The answers to these questions may seem obvious. If we accept that oxytocin levels for sexual intercourse are directly affected by mood and environment, why is it that women in labour receive less consideration? The intensely complex relationship between birth and sexuality is an increasing source of study and reflection by birth writers.

Once women gave birth where and when they chose, adopting the position they wanted, using their instinctive knowledge to help themselves and each other. Recently birth has become more medicalised, and the place of birth often restricted. No one would deny that appropriate intervention saves lives. For some women an obstetric unit is the safest choice, and for others it feels like the safest, so that makes them feel happier. But does it have to be the choice for everyone?

The clinical environment and increased medicalisation of many birth settings directly affect a woman’s privacy and sense of control (Walsh, 2010a). Home‐like birthing rooms (‘alternative settings’), even within an obstetric unit, increase the likelihood of spontaneous vaginal birth, labour/birth without analgesia/...

Table of contents

• Cover
• Title Page
• Table of Contents
• Preface
• Contributors
• 1 Labour and normal birth
• 2 Vaginal examinations and amniotomy
• 3 Fetal heart rate monitoring in labour
• 4 Perineal trauma and suturing
• 5 Examination of the newborn baby at birth
• 6 Home birth
• 7 Water for labour and birth
• 8 Malpositions and malpresentations in Labour
• 9 Slow progress in labour
• 10 Assisted birth: ventouse and forceps
• 11 Caesarean section
• 12 Vaginal birth after caesarean section
• 13 Preterm birth
• 14 Breech birth
• 15 Twins and higher order births
• 16 Obstetric haemorrhage
• 17 Emergencies in labour and birth
• 18 Neonatal and maternal resuscitation
• 19 Induction of labour
• 20 Pre‐eclampsia and diabetes
• 21 Stillbirth and neonatal death
• 22 Risk management, litigation and complaints
• 23 Intrapartum blood tests
• 24 Medicines and the midwife
• Appendix A: Blood reference ranges and tests for specific conditions
• Index
• End User License Agreement