Rapid Midwifery

Sarah Snow, Kate Taylor, Jane Carpenter

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781119023364
• eBook ISBN: 9781119023388
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

RAPID Midwifery

The Rapids are a series of reference and revision pocket books that cover key facts in a simple and memorable way. Each book contains the common conditions that students and newly qualified nurses encounter on the wards, in the community, and on placements. Only the basic core relevant facts are provided to ensure that these books are perfect and concise 'rapid refreshers'. To see all the titles in the series, go to: www.wiley.com/go/rapids

Rapid Midwifery is an essential read for all midwifery students and newly qualified staff. Designed for quick reference, it explores a broad range of midwifery topics which are mapped against the 6Cs to illustrate the fundamental importance of compassionate midwifery care. Each section is structured around the key criteria used in midwifery examinations, with bite-sized information supported by the latest evidence base, making it the perfect revision tool for OSCEs and written examinations. Every chapter includes key points, essentials of midwifery care, key physiology, professional accountability, and links to further resources.

Covering all the key topics in midwifery, for both hospital and community settings, this concise and easy-to-read title is the perfect quick reference book.

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Part I

Antenatal Care

Antenatal Health Assessment

The main objective of antenatal care is to support the woman through pregnancy and to monitor the health and well-being of the woman and fetus. Although pre-conceptual care is advised (see Section 1.10), antenatal care generally commences at booking. The National Institute for Health and Care Excellence (NICE) provides a framework and recommended schedules for routine antenatal care (NICE 2014c); however, timely referral is required if the woman or fetus is at increased risk. All care should be evidence based and woman centred, enabling her to make informed choices about her care.

Key Points

• The first antenatal contact with the woman requires comprehensive history taking, including relevant obstetric, medical and personal details. Determining risk, offering an early ultrasound scan for gestational age, together with health screening checks and tests should be discussed (NICE 2014b).
• Blood pressure monitoring, urinalysis and abdominal examination are all essential components of antenatal care; however, other physical and emotional issues need to be considered.
• Breast examination: This is not routinely recommended (NICE 2014b); however, the woman may find information about breast changes to be reassuring. Breast tenderness and tingling often occur early in pregnancy and an early increase in size often occurs. Colostrum leakage is common.
• Blood pressure: A number of factors can influence blood pressure measurements, including time of day, size of cuff, maternal position and variations in technique. Midwives must fully understand the principal mechanisms that control blood pressure and other factors that can influence systolic and diastolic pressures, blood pressure phases and Korotkoff sounds.
• Urinalysis: Observation of the volume, colour, smell, deposits and specific gravity of urine offers a unique insight into the physiological workings of many body systems (Blows 2012).
  • Colour: This is dependent on concentration and varies from pale straw (normal) to amber. Diet, drugs, bilirubinuria and haematuria affect the colour of urine. Haematuria is not normal and may be indicative of infection or trauma.
  • Clarity: Urine should be clear. Cloudy or foamy urine can be caused by protein; cloudy and thick urine may be indicative of the presence of bacteria (Blows 2012). Routine midstream urine (MSU) screening for asymptomatic bacteriuria early in pregnancy to exclude asymptomatic pyelonephritis is currently recommended by NICE (2014b).
  • Odour: The odour of urine can be influenced by food. However, a smell of pear-drops or nail-polish remover indicates the presence of ketones which may be due to fasting, vomiting or uncontrolled diabetes mellitus. Infection may cause the urine to smell offensive and, when accompanied by the presence of nitrates and/or leucocytes on test strips, further laboratory culture is required.
  • Specific gravity is affected by both the water concentration and solute concentration in a urine sample and reflects the kidney's ability to concentrate or dilute urine.
  • pH reflects the acidity or alkalinity of urine and a low pH may predispose to the formation of calculi (stones) in the kidneys or bladder (Waugh and Grant 2014).
• Altered renal tubular function can increase renal excretion of glucose and protein. This needs to be considered when analysing urine.
• Abdominal examination is carried out from 24 weeks and is achieved by inspection, palpation and auscultation.
  • Inspection: The uterus should be ovoid in shape, being longer than it is broad. The size and shape of the abdomen can give clues to the size and position of the fetus as pregnancy progresses. However, a full bladder, distended colon and obesity can make the assessment of fetal size difficult. Skin changes, such as linea nigra and striae gravidarum and scars from previous surgery, self-harm or domestic violence may be evident on abdominal inspection. Fetal movements may be reported from around 20 weeks (Bharj and Henshaw 2011).
  • Fundal palpation determines the presence of a head or breech in the fundus. The head is hard and round and much more distinctive in outline than the breech.
  • Symphysis–fundal height (SFH) should be measured (in centimetres) and recorded at each antenatal appointment from 24 weeks (NICE 2014b). Measurements should be plotted on a customised chart. Further investigation is required if a single measurement plots below the 10th centile or serial measurements show slow growth by crossing centiles (RCOG 2013).
  • Lateral palpation determines the position of the fetal back. This feels like a smooth continuous line of resistance, while fetal limbs feel like small irregular shapes on the opposite side. The fetal back cannot be felt if the fetus is in the occipito-posterior position (see Section 2.1.2), although fetal limbs can be felt on both sides of the midline (Bharj and Henshaw 2011).
  • Pelvic palpation determines the presentation of the fetus, the attitude and degree of engagement. This is best carried out using a two-hand approach. If the head is above the pelvic brim then the head is not engaged. Once engaged, if the fingers of one hand slide further into the pelvis than the other, then the head is flexed. NICE (2014b) recommends that presentation should not be assessed by abdominal palpation prior to 36 weeks.
• Auscultation of the fetal heart is best heard at a point over the fetal shoulder, hence lateral palpation to identify the fetal back is useful. When the fetus is in the occipito-posterior position, the fetal heart can be heard at the midline or lateral borders. NICE (2014b) does not recommend antenatal auscultation or electronic fetal heart rate monitoring in women with uncomplicated pregnancies.
• Vaginal discharge often increases in pregnancy. It is usually white, non-offensive and non-irritant. If the discharge is associated with pain on micturition, soreness, itching or an offensive smell, then further investigations are required (see Section 1.7).
• Oedema should not be present at the initial assessment. However, it may occur as pregnancy progresses due to physiological changes. Oedema that is visible in the woman's face and hands and becomes increasingly pitted in the lower limbs may be indicative of hypertension, especially if other markers are present.
• Varicosities are common in pregnancy owing to the effect of progesterone on the smooth muscles of blood vessel walls. Redness and tenderness/pain and areas that appear white may be indicative of deep vein thrombosis and require medical referral.
• Maternal weight and height should be measured at the first contact with the pregnant woman. Routine weighing during pregnancy is not recommended unless clinical management can be influenced or if nutrition is a concern (NICE 2014b). Women who have a body mass index (BMI) of <18 or ≥30 kg/m² need referral to a consultant and other health professionals working in nutrition and weight management (NICE 2010) (see Section 4.3).

Essentials of Midwifery Care

NICE (2014b) offers comprehensive guidance for the provision of antenatal care, a summary of which is provided below to aid revision.

• Management of care will depend on the individual needs of the woman. A holistic woman-centred approach is paramount and observations of physical characteristics are important, as these may give clues to current problems or problems that may arise.
• When women are assessed an...

Table of contents

• Cover
• Title Page
• Copyright
• Table of Contents
• Preface
• Acknowledgement
• Part I: Antenatal Care
• Part II: Labour and Birth
• Part III: Postnatal Care
• Part IV: Hot Topics
• Conclusion: Top Tips for Examination Success
• Index
• End User License Agreement