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A birthing environment which claimed and reduces stress supports physiologic birth. During labour lower levels of stress hormones promotes neonatal wellbeing and uterine blood flow, whereas a greater stressed condition can extend the labour process and thwart the transition of the neonatal. Women with a lower risk of obstetric complications, and carrying out the delivery process in a home-like environment are approaching less use of analgesics, fetal abnormalities and operative delivery (Neiman et al, 2020). That’s why the birthing environment is very important to carry out a satisfied delivery process.
Depending on the condition of the mother how the process of delivery will be attempted decided. Normally child delivery options are natural birth, assisted childbirth and C-section. The location of delivery is also included in making a perfect birth environment in-home or in any birth centre.
According to the case study, Kehinde has become very anxious and as per the previous note, she is in a higher stress level. As she decided to go through a normal delivery process and she can feel intermittent pain and labour it does not appear in this condition at that time a good observation on the appearance of contraction is needed. As it is known that contraction in this situation is a very frequent incident but if contraction starts to come in each 5 min intervals then this notify the high time (Bohren, et al, 2019). The midwife also needs to make her calm down and also advise her to stay at home until and unless she feels the frequent contraction.
Starting of labour
As described previously the preliminary sign of labour is the occurrence of frequent contraction, muscles are plugged in the cervix. Starts to come out of pinkish slimy mucus from the vagina. Losing more blood signifies a serious situation. The next sign is the water breaking the liquid in the womb or amniotic sac which breaks in this stage and the fluid came out of the vagina in this stage, the midwife needs to observe if the water has a particular smell or losing blood. This depicts urgency and attention. If labour doesn't start after breaking water then there is left sometimes for observation (Mosteanu et al, 2020). The midwife has the responsibility if the baby does not move or move less in the womb if the temperature gets increased more than 37.5 degrees C.
In this scenario, the midwife needs to share important information with the parents, encourage them and also need to support them emotionally, monitor the progress and strategies that need to be described for labour, monitoring the baby’s different health signs such as heartbeat, movement and so on. Arrange a doctor to administrate this situation.
Acceleration
Induction of labour and acceleration of labour is two different processes because it is self-starting labour and that’s why labour is different for every woman. It is important to know why labour sometimes needs to be accelerated. This process is only recommended when the woman feels contractions frequently but her cervix is not opening or dilating or the baby is not moving down in the deeper pelvis (Janjua, et al, 2018). As observed in the case of Kehinde who can feel the contraction and also pain but labour does not appear.
This process is aimed to accelerate the labour and increase the strength, frequency and length of contractions, and also shorten the labour length by helping to get progress at a faster length.
To accelerate the labour the midwife needs to carry out some processes with the permission of doctors and also the parents. Two processes are needed to be carried out to accelerate the labour process one is breaking the water and syntocinon infusion. This first requires the examination of the diameter of the cervix. The second thing is the administration of oxytocin through drip when labour is very slowly progressed and that can increase the contraction strength, length and frequency.
Monitoring labour is an important task for each midwife. This can be done by carryout several responsibilities. In this process, several factors need to be monitored as monitoring the baby’s heartbeat by electronic foetal monitoring. If the mother is healthy then this needs intermediate monitoring where the frequency of contraction is measured in the first stage this happened every fifteen minutes the labour stages need gaps of a total of 1 minute (Outhwaite, et al, 2019). The continuous monitoring of the heartbeat of the baby is monitored through a cardiogram. Other than that a midwife needs to monitor the mother’s condition and support her in labouring, mobility and positioning, contraction management, breathing practices and so on.
Intervention in labour
In several ways, intervention can occur. The most common way is to assist the delivery process by the vacuum cup or forceps or in any induced labour (Cluett et al, 2018). The intervention is needed in the case of Kehinde as it was pretty clear that she becomes unable to give birth without assistance and that can cause the occurrence of intervention to make the birth process quick.
The main four stages signify that it is high time to go to the hospital and in those stages midwife has some responsibilities. Steps are cervix dilation and delivery of baby, after birth pushing out the placenta and the last stage is a recovery (Edqvist et al, 2022).
Figure 3: Responsibilities of the midwife in labour
(Source: https://www.sciencedirect.com/science)
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Responsibilities of the midwife in labour |
Description |
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Supporting during labour helps to lower the anxiety of parent(s) and can make this process short and safe. Giving physical, psychological, or emotional support. |
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Reducing the worry and anxiety for mother and keeping rude people away from her. Her partner and supporting friends need to interfere in the labour process. To reduce the distraction of the birthing process people need to be out of the room and people should allow in the room according to her choice. Guarding labour means protecting the process from several interferences. |
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This is mainly focused on how she feels comfortable giving birth in some processes encouragement is needed for the mother to try different positions. As it is known changing positions can help the cervix to open. |
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Many women become very tired during a b contraction period. They feel anxious if they become failed to push the baby out. That’s why midwives need to take care of her rest in between contractions. She needs to make her body relaxed, take a deep breath and sit or lie down as she wants. |
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Breathing can make a b effect on labour. Taking long and slow breaths and breathing out by making a kiss with a lip and slow and long breaths out practice or breathing out by making a “hee” sound. |
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This was needed to prevent her body from dehydration. And that can be water, juice, or any higher calorie fluid. If she becomes dehydrated this can cause a long and hard way of delivery and also feel exhausted. |
Table 1: Responsibilities of the midwife in the birthing process
(Source: Self-made)
In this case, Kehinde needs the help of a midwife as she facing problems in her labour process. Moreover, she expects a normal vaginal delivery and in her situation, it is complicated to go through a normal delivery as she feels pain but cannot proceed with the normal delivery process. In this process, she needs to be calm and eliminate her anxiety to give birth in a satisfying process.
3.1 Assistance of the midwife in taking care of the baby in the immediate postnatal period
Immediate care of the baby after birth is another important task for the midwife. She helps to breastfeed, how breathe the baby and administration how to relieve pain, carry out routine health assessments, and carry out some routine health tests for the baby. In a home birth midwife check regularly the baby and also the mother. This includes the essential care for newborn babies within the delivery room by professionals including drying and stimulating, breathing access, and in the core, caretaking care of skin, initial breastfeeding, vitamin K supplements, place of weighing, and identification band (Negussie et al, 2018). The essential care of new babies is aimed to protect the babies against mortality and morbidity by applying thermal care, clean cord care, and wrapping new-borns immediately after a successful delivery.
3.2 Midwife assists the parent (s) after birth
The midwife does support new parents to take care of their children. How a mother can breastfeed the baby, settle the baby, change nappies to give them a safe bath in all aspects midwife support parents. There are many challenges that can be mitigated with the help and assistance of a midwife (Ueda et al, 2019). In the whole procedure of pre-delivery care and post-delivery care also how parents can take care of children is also demonstrated by the midwife. If the birthing procedure occurs in the home then it can be advantageous for the midwife but there can be a shortage of technology occur. If the birth venue is a hospital or any kind of healthcare organization this can make more open access for the doctors and the midwife. A midwife can provide physical support to the new mother and also psychological support to the parent(s) and family.
Journals
Neiman, E., Austin, E., Tan, A., Anderson, C.M. and Chipps, E., 2020. Outcomes of waterbirth in a US hospital?based midwifery practice: a retrospective cohort study of water immersion during labor and birth. Journal of midwifery & women's health, 65(2), pp.216-223.
Bohren, M.A., Berger, B.O., Munthe?Kaas, H. and Tunçalp, Ö., 2019. Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews, (3).
Mosteanu, N.R., 2020. Finance digitalization and its impact on labour market. Technium Soc. Sci. J., 8, p.598.
Janjua, M., Waheed, K., Iqbal, T. and Ejaz, S., 2018. Efficacy of phlorogucinol in comparison to drotaverine hydrochloride in reducing duration of active phase of 1st stage of labour in primigravidae at term. Journal of The Society of Obstetricians and Gynaecologists of Pakistan, 8(1), pp.36-40.
Outhwaite, O. and Martin-Ortega, O., 2019. Worker-driven monitoring–Redefining supply chain monitoring to improve labour rights in global supply chains. Competition & change, 23(4), pp.378-396.
Cluett, E.R., Burns, E. and Cuthbert, A., 2018. Immersion in water during labour and birth. Cochrane Database of Systematic Reviews, (5).
Edqvist, M., Dahlen, H.G., Häggsgård, C., Tern, H., Ängeby, K., Teleman, P., Ajne, G. and Rubertsson, C., 2022. The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden. The Lancet, 399(10331), pp.1242-1253.
Edqvist, M., Dahlen, H.G., Häggsgård, C., Tern, H., Ängeby, K., Teleman, P., Ajne, G. and Rubertsson, C., 2022. The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden. The Lancet, 399(10331), pp.1242-1253.
Negussie, B.B., Hailu, F.B. and Megenta, A.D., 2018. Knowledge and practice of essential newborn care and associated factors among nurses and midwives working at health centers in Jimma Zone, Ethiopia, 2016. J Nurs Care, 7(446), pp.2167-8.
Ueda, S., 2019. Spiritual midwifery, empty chair meditation, and prenatal memories: Helping clients navigate pregnancy, birth, lifelong stress, and communication. Journal of Prenatal and Perinatal Psychology and Health, 34(2), pp.55-165.
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