Oxford Handbook of Midwifery (17 page)

1. The Nursing and Midwifery Order (2001).
   Statutory Instrument 2002/253
   .
   
2. Nursing and Midwifery Council (2008).
   Modern Supervision in Action
   . London: Nursing and Midwifery Council.
   

ROLE OF SUPERVISOR OF MIDWIVES

9‌‌

Role of supervisor of midwives

The potential SOM is nominated by peers and supervisors in their place of work and must undergo a selection process led by the LSA midwifery officer and university programme leader and which must include a user representative. The midwife must:

• Have credibility with the midwives she/he will potentially supervise and with senior midwifery management
  
• Be practising, having at least 3 years’ experience, at least one of which shall have been in the 2-year period immediately preceding the appointment
  
• Be academically able
  
• Have demonstrated ongoing professional development.
  ^1,2
  

  Having successfully completed the preparation programme, the midwife
  must then be appointed by the LSA midwifery officer as a supervisor
  

  to the LSA and to whom the SOM is responsible in that role.
  ²
  Good communication skills and an approachable manner are essential to the role. Each supervisor is responsible for supervising a maximum of 15 midwives.
  

  SOMs:
  

• Receive and process notification of intention to practise forms
  
• Provide guidance on maintenance of registration
  
• Work in partnership with mothers and midwives
  
• Create an environment that supports the midwife’s role and empowers practice through evidence-based decision making
  
• Monitor standards of midwifery practice through audit of records and assessment of clinical outcomes
  
• Are available for midwives to discuss issues relating to their practice and provide appropriate support
  
• Are available to mothers to discuss any aspects of their care
  
• Arrange regular meetings with individual midwives at least once a year, to help them evaluate their practice and identify areas of development
  
• Investigate critical incidents and identify any action required
  
• Report to the LSA midwifery officer serious cases involving professional conduct, and when it is considered that local action has failed to achieve safe practice
  
• Contribute to confidential enquiries, risk management strategies, clinical audit, and clinical governance.
  
  1. Nursing and Midwifery Council (2006).
     Standards for the Preparation and Practice of Supervisors of Midwives
     . London: NMC
     
  2. Nursing and Midwifery Council (2004).
     Midwives Rules and Standards: Rules 9–16
     . London: NMC.
     

     CHAPTER 1
     Introduction
     

     10‌‌
     

     Role of the LSA and LSA midwifery officer
     

     The LSA is a body responsible in law for ensuring that statutory supervision of midwives and midwifery practice is employed, within its boundaries, to a satisfactory standard, in order to secure appropriate care for every mother.
     ¹
     

     Each LSA appoints an LSA midwifery officer to undertake the statutory function on its behalf. This must be a suitably experienced SOM,
     ¹
     who has the skills, experience, and knowledge to provide expert advice on issues such as structures for local maternity services, human resources planning, student midwife numbers, and post-registration education opportunities.
     

     The functions of the LSA are to:
     

     • Appoint supervisors of midwives and publish a list of current supervisors
       
     • Ensure that every practising midwife has a named SOM
       
     • Determine the appropriate number of supervisors to reflect local circumstances
       
     • Receive the annual notification of intention to practise from all midwives within the LSA boundary and forward the completed forms to the NMC
       
     • Operate a system to ensure that each midwife meets the statutory requirements for practice
       
     • Provide continuing professional development and updating for all SOMs for a minimum of 15h in each registration period
       
     • Ensure that systems are in place to investigate alleged suboptimal care or possible misconduct, in an impartial and sensitive manner
       
     • Determine whether to suspend a midwife from practice
       
     • Where appropriate, proceed to suspend a midwife from practice whom it has reported to the NMC
       
     • Investigate and initiate legal action in cases of midwifery practice by unqualified persons.
       

       1
       Nursing and Midwifery Council (2004).
       Midwives Rules and Standards: Rules 9–16
       . London: NMC.
       

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       CHAPTER 1
       Introduction
       

       12‌‌
       

       Drug administration in midwifery
       

       Under the Medicines Act (1968), medicines can only be supplied and administered under the directions of a doctor. Midwives are exempt from this requirement in relation to certain specified medicines, provided they have notified their intention to practise, and the drugs are for use only within their sphere of practice. This allows midwives to supply and admin- ister these drugs without the direction of a doctor.
       

       Changes to the midwives exemptions list came into force on 1 June 2010; these changes will ensure appropriate and responsive care can be given to women safely as part of a midwife’s normal sphere of practice, and especially during emergencies.
       

       The medicines to which this exemption applies are as follows:
       

       •
       Diclofenac
       

     • Ergometrine maleate
       
     • Hydrocortisone acetate
       
     • Miconazole
       
     • Nystatin
       
     • Phytomenadione
       
     • Adrenaline
       
     • Anti-D immunoglobulin
       
     • Cyclizine hydrochloride
       
     • Diamorphine
       
     • Ergometrine maleate
       
     • Hepatitis B vaccine
       
     • Hepatitis B immunoglobulin
       
     • Lidocaine
       
     • Lidocaine hydrochloride
       
     • Morphine
       
     • Naloxone hydrochloride
       
     • Oxytocins, natural and synthetic
       
     • Pethidine hydrochloride
       
     • Phytomenadione
       
     • Prochloperazine
       
     • Carboprost
       
     • Sodium chloride 0.9%
       
     • Gelofusine
       ^®
       
     • Haemaccel
       ^®
       
     • Hartmann’s solution.
       

  Midwives can also supply and administer all non-prescription medicines, including all pharmacy and general sales list medicines, without a prescription. These medicines do not have to be in a patient group direction (PGD) for a midwife to be able to supply them.
  

  Patient group directions
  

  PGDs are detailed documents compiled by a multidisciplinary group of a local trust or hospital. They allow certain drugs to be given to particular groups of clients without a prescription to a named individual.
  

  This arrangement is very useful as it allows the midwife to give a drug listed in the PGD to a woman without having to wait for a doctor to come
  

  DRUG ADMINISTRATION IN MIDWIFERY
  

  13
  

  and prescribe it individually. The midwife is responsible for following the instructions related to dosage and contraindications provided in the PGD.
  

  Examples of drugs included in a PGD are:
  

• Dinoprostone (Prostin E2
  ^®
  gel) for induction of labour. 1mg or 2mg gel can be repeated after 6h. Give a lower dose if cervix is favourable
  
• Ranitidine 150mg tablets.
  

  It is recommended that if a drug is on the midwives exemption list it does not need to appear in a PGD. Under medicines legislation there is no provision for ‘standing orders’, therefore these have no legal basis.
  

  The NMC has published
  Standards on Medicines Management
  (2008)
  ¹
  which includes, dispensing, storage and transportation, administration, delegation, disposal, and management of adverse events and controlled drugs. Registered midwives must only supply and administer medicines for
  

  which they have received appropriate training.
  

  There is clear instruction on the role of the midwife in
  directly supervising
  

  student midwives during drug administration
  and that only a registered midwife may administer a drug which is part of PGD arrangements. Student midwives may administer any medicines that have been prescribed by a doctor (including controlled drugs), or those on the midwives exemptions list (with the exception of controlled drugs).
  

  Further reading
  

  Medicines for Human Use (Miscellaneous amendments) Order 2010. Available at: M www.opsi.
  gov.uk/si/si2010/uksi_20101136_en_1 (accessed 17.6.10).
  

  Department of Health (2010). CNO letter to SHA Directors of Nursing implementation of Medicines for Human Use (Miscellaneous Amendments) Order 2010 Midwives Exemption List. Available at: M www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/
  digitalasset/dh_116516.pdf (accessed 17.6.10).
  

  Nursing and Midwifery Council (2009). Supply and/or Administration of Medicine By Student Nurses and Student Midwives in Relation to Patient Group Directions (PGDs). Circular 5/2009. London: NMC.
  

  1
  Nursing and Midwifery Council (2008).
  Standards for Medicines Management
  . London: NMC.
  

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  Chapter 2
  

  15‌‌
  

  Pre-conception care
  

  Taking a menstrual history
  16
  

  Nutrition
  18
  

  Lifestyle
  20
  

  

  Medical conditions
  21
  

  CHAPTER 2
  Pre-conception care
  

  16‌‌
  

  Taking a menstrual history
  

  Important points to remember
  

  • A menstrual history is usually undertaken as part of the initial booking interview, ensuring privacy for the discussion.
    
  • Allow sufficient time for discussion.
    
  • Find out whether the woman has been keeping a recent diary record of her menstrual pattern or knows her normal menstrual cycle—the number of days between the first day of one menstrual period and the next.
    
  • Find out what form of contraception, if any, she has been using—most hormonal methods will influence the menstrual pattern and may take several months to return to normal after discontinuation.
    
  • An accurate menstrual history is essential to calculate the expected
    birth date, or expected date of delivery (EDD), as accurately as
    

    possible. This is a particularly important consideration where
    

    ultrasound examination to determine dates is not available or the woman makes an informed choice to decline this procedure.
    

  • An accurate calculation of the expected birth date, as near to the beginning of pregnancy as possible, will subsequently allow you to calculate gestational age accurately at any point in the pregnancy and assess fetal growth.
    
  • Abdominal assessment of uterine growth at each antenatal visit takes into account the estimated gestational age calculated from the expected birth date.
    
  • It is important that the woman understands that her baby may be born anywhere between the beginning of the 38th week and the end of the 42nd week and be at term. The calculated expected birth date is only 1 day within that time frame.
    

    Calculation of expected birth date
    

  • Conventionally undertaken using Naegele’s rule, which calculates the duration of pregnancy as 280 days.
    
  • Nine calendar months and 7 days are added to the first day of the last menstrual period (LMP).
    
  • Research by Nguyen
    et al
    .
    ¹
    into the accuracy of this method of calculation, compared with that of ultrasound measurement of fetal biparietal diameter (BPD), recommended that dating is more accurate by adding 282 days to the LMP.
    

    Naegele’s rule
    

  • To the first day of the LMP add 9 months and 7 days.
    
  • Or subtract 3 months and add 7 days (not forgetting to add a year!).
    
  • To be more accurate, as discussed above, add 9 days instead of 7.
    
  • If available, use an obstetric calendar, but add an additional 2 days.
    
  • Naegele’s rule assumes a 28-day menstrual cycle.
    

  TAKING A MENSTRUAL HISTORY
  

  17