ADVANCING PRACTICE Reducing maternal sepsis
Midwifery Lecturer at University of Central Lancashire(September 2016)
Despite significant advances in the diagnosis and management of sepsis, sepsis in the puerperium remains an important cause of maternal death (Royal College of Obstetricians and Gynaecologists (RCOG) 2012). To ensure the best outcome for women who are septic, timely diagnosis and treatment is required, together with the appropriate management by midwives and other members of the multidisciplinary team. As the rates of maternal death due to sepsis are decreasing, midwives should be aware of how to educate women in the prevention of sepsis, using national recommendations. This article addresses the need for health care professionals to be aware of the signs and symptoms of sepsis and the importance of a prompt referral to an appropriate place to initiate treatment of the septic woman.
ADVANCING PRACTICE - Detecting fetal compromise during active labour and managing neonatal after-effects
Dawn Meredith, Clinical Midwifery Specialist at Hamad Medical Corporation, Doha, Qatar
Kevin Hugill, Director of Nursing at Hamad Medical Corporation, Doha, Qatar(July 2016)
Evaluating fetal wellbeing during the intrapartum period to detect fetal compromise and hypoxia is a topic of considerable importance to midwives. In part this is because the events during this time can have profound significance for the physical and emotional wellbeing of all those involved, including the infant, mother and midwife. This article explores the ways midwives can detect fetal compromise, what they can do to limit the effects of cerebral hypoxic-ischaemia, and reviews neonatal treatments that can optimise infant neurological outcome.
ADVANCING PRACTICE Perineal protection
Suyai Steinhauer, home birth midwife in a practice serving an Amish community in the USA(June 2016)
Perineal tearing in childbirth is common and can have a considerable impact on women. There are various hands-on techniques that midwives use routinely to protect the perineum but not all of them are evidence based. Despite this, midwives often feel that they are the determining factor in whether a woman tears or not. Furthermore, women are rarely asked permission before hands-on techniques are used. This article explores some of the techniques used to prevent perineal tears, looks at the evidence base and invites the reader to reflect on their own practice and thinking around perineal protection.
Dancing in the grey zone between normality and risk
Professor of Midwifery at Western Sydney University(June 2016)
Childbirth is mainly grey. The most straightforward of births can lead to unexpected, heart-stopping moments - and the highest risk woman can, despite our fears, birth without any of the imagined horrors being realised. As midwives we can choose to be paralysed with fear over this, or responsive to - and respectful of - such an amazing process. This paper discusses how midwives can learn to 'dance in the grey zone', while meeting their professional obligations and protecting women's human rights. Come dance the waltz, the tango and the hip-hop with me on the dance floor created by the 'triangle of wisdom'
ADVANCING PRACTICE Supporting women’s instinctive pushing behaviour during birth
Rachel Reed,programme co-ordinator and lecturer in midwifery at University of the Sunshine Coast, Queensland(June 2016)
During birth women instinctively push in the most effective and safe way for themselves and their babies. However, midwives continue to direct women’s pushing behaviours. The assumptions underpinning this practice must be examined and challenged. Midwives need to develop an evidence-based approach that acknowledges and reinforces women’s innate ability to birth.
ADVANCING PRACTICE Effective non-pharmacological birth interventions
Community and birth centre midwife in London(February 2015)
Midwifery expertise is in ‘normal’ birth. What constitutes ‘normal’ is debatable, but well embedded within ‘normal’ are the birth plans of women who aspire to give birth without using drugs. To give birth without drugs for many may seem undesirable or intolerable, especially to those whose cultural references to birth have been overwhelmingly negative, fearful or risk-obsessed. However, significant numbers of women have confidence in their innate ability to birth their babies and are rightfully concerned about the undesirable side effects of pharmacological interventions. As well as providing wider choice for women, looking for alternative ways of addressing pain and progress in labour enhances birth attendants’ knowledge and becomes a delightful journey of discovering the ancient and modern arts of midwifery. Shared here are a collection of ideas to contribute to the toolkit of knowledge about non-pharmacological interventions.