Oxford Handbook of Midwifery (53 page)

Principles

possible use of complementary therapies to help with coping strategies.

1. Royal College of Midwives (2005).
   Evidence-based Guidelines for Midwifery-led Care in Labour
   . London: RCM.
   
2. Enkin M, Kierse M, Neilson J,
   et al
   . (2000).
   A Guide to Effective Care in Pregnancy and Childbirth
   . Oxford: Oxford University Press.
   
3. Lavender T, Alfrevic Z, Walkinshaw S (2006). Effects of different partogram action lines on birth outcomes: a randomized controlled trial.
   Obstetrics and Gynaecology
   108
   (2), 295–302.
   

   CHAPTER 11
   Normal labour: first stage
   

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   Principles of care in the first stage of labour
   

   The first stage of labour is primarily a stage of preparation, both physically and emotionally. The cervix has to undergo radical anatomical changes in order for birth to be possible, and the mother has to quickly adjust to the demands of labour. As it is the longest stage of labour, this may place a great deal of strain on the woman and therefore be challenging in terms of care. It is always important to give individualized care, based on the woman’s choices and her progress in labour.
   

   It is important when taking over care from a colleague, admitting a woman in labour, or visiting for a home birth that you familiarize yourself with all the necessary information about the woman.
   

   • Be aware of previous medical or obstetric history that is relevant to the labour and birth.
     
   • Be aware of any risk factors or possible problems that may necessitate potential referral to consultant care.
     
   • Essential information that should be available:
     
     • Blood group and haemoglobin result
       
     • Allergies and drug reactions
       
     • The ultrasound report confirming the location of the placenta. Also double check the woman’s gestation.
       
   • Familiarize yourself with the birth plan and discuss any preferences the woman may have.
     
   • Check any information about the history of the labour so far—whether membranes are intact, onset of contractions, loss per vagina, and so on. Then carry out an assessment of the woman’s physical condition, degree of comfort/pain, and how she is coping emotionally with the labour so far. This will involve observation, abdominal palpation, recording vital signs,
     

     direct questioning, and possibly a vaginal examination, only if indicated.
     

     Discuss with the woman what her options of care are. You may need to raise questions such as:
     

   • How far advanced in labour is the woman?
     
   • Does she want to mobilize?
     
   • Does she want a bath or analgesia?
     
   • What about food and drink?
     

     •
     Is the environment satisfactory?
     

     Assess the woman’s progress regularly, while also being flexible in responding to her individual needs.
     

   • If the woman is not in established labour, give her a realistic and reassuring explanation of early labour, and that this could last for several hours and sometimes days before established labour begins in earnest.
     
   • Encourage and assist with positions of comfort and hygiene. A shower or bath in early labour is often relaxing and refreshing.
     
   • Encourage her to adopt upright positions and mobilization, to assist progress. These measures are known to result in shorter labours, less demand for analgesia and epidural anaesthesia, and less need for augmentation of labour.
     

PRINCIPLES OF CARE IN THE FIRST STAGE OF LABOUR

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In their excitement, women, particularly primigravidae, often overestimate their progress. You will need to provide a realistic picture while acknowledging their excitement as well as their fears.

to her needs.

CHAPTER 11
Normal labour: first stage

214‌‌

Home birth

When pregnancy is straightforward, there is no evidence to suggest any difference in mortality or morbidity between a hospital or home birth.
¹
Studies have highlighted that, in low-risk women, there are: fewer cae- sarean births; fewer assisted births; fewer inductions; fewer episiotomies and severe tears; fewer low Apgar scores; less fetal distress; fewer neo- natal respiratory problems; less birth trauma; and less PPH.
²
There was no difference in perinatal mortality rates, often cited as the reason for going into hospital to give birth.
³
Where women had given birth at home, they were very satisfied with their experience and care.

In order for women to make an informed choice as to where they would like to give birth, they require unbiased and realistic information about their choices. In some areas there may be the option for low-risk women to give birth in a midwife-led ‘birth centre’ or these women may feel more comfortable giving birth at home.

Planning and preparation

• During the first contact with the pregnant woman, discuss where she would like to give birth. Women should not feel pressurized to go into hospital.
  
• Discuss the risk factors thoroughly with the woman (see below) and, if she is deemed to be high-risk, advise her to consider giving birth in a consultant unit.
  
• The woman needs plenty of time to think over her options, therefore the decision to opt for a home birth can be taken at any time during pregnancy, or even delayed until the commencement of labour, provided this has been discussed and appropriate plans made for a home birth.
  
• Inform the supervisor of midwives when a home booking is made.
  
• Assess the home environment for suitability for a home birth. This includes:
  
  • The location of the home and ease of access in case an ambulance needs to be called
    
  • Heating and hot and cold water supply.
    
  • A hygienic environment for the birth, with adequate towels, blankets, and clothing for the baby
    

    • Adequate telephone communication.
    

• The woman’s family and birth partner need to be supportive.
  
• Care of any other children should be considered, with preferably an adult to look after them.
  
• You (the named midwife) should ensure that your working colleagues are informed of a planned home birth and the relevant information, should they be on duty to assist or conduct the birth. Ideally colleagues who may be involved in the woman’s care should be introduced to her in the antenatal period.
  
• A birth plan is advisable, outlining the woman’s care options. Emphasize that if there are concerns antenatally or in labour regarding the welfare of the mother or the fetus, you will discuss the situation with your superiors and, if necessary, transfer to hospital care.
  

  HOME BIRTH
  

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