Oxford Handbook of Midwifery (54 page)

Labour

After delivery

mother and baby before leaving their home.

Exclusion criteria for home birth

• Diabetes
  
• Cardiac disease
  
• Renal disease
  
• Deep vein thrombosis
  
• Pulmonary embolism
  
• Hypertension
  

  CHAPTER 11
  Normal labour: first stage
  

  216
  

  • IV drug abuse
    
  • Hepatitis B antigen positive
    
  • HIV positive
    
  • Recent history of active genital herpes.
    
    • Previous obstetric history
      :
      
      • Caesarean section—dependent on the reason for the previous LSCS
        
      • Hysterotomy
        
      • Rhesus antibodies
        
      • Severe pregnancy-induced hypertension
        
      • Eclampsia
        
      • Previous stillbirth or neonatal death
        
      • Shoulder dystocia
        
      • Retained placenta
        
      • Inverted uterus
        
      • Primary PPH.
        
    • Previous gynaecological history
      :
      
      • Infertility
        
      • Major surgery
        
      • Myomectomy
        
      • Uterine anomaly (congenital or fibroids).
        
    • Current pregnancy
      :
      
      • Twins
        
      • Malpresentation after 36 weeks
        
      • Preterm rupture of membranes
        
      • Antepartum haemorrhage
        
      • Intrauterine growth retardation
        
      • Sustained hypertension
        
      • Fetal anomaly
        
      • Poly- or oligohydramnios
        
      • Abnormal glucose tolerance test
        
      • Anaemia below 10g/dL
        
      • High head at term in primigravida
        
      • Previous anaesthetic problems
        
      • Post maturity.
        
    • Intrapartum
      :
      • Malpresentation
      
      • Preterm labour
        
      • Poor progress in labour
        
      • Fetal heart rate abnormalities
        
      • Meconium-stained liquor
        
      • Maternal distress
        
      • Mother’s request.
        

        Basic equipment for planned home birth
        

    • Delivery pack
      
    • Protection and safe disposal
      :
      
      • Maternity pads
        
      • Inco pads
        
      • Non-sterile gloves
        

    HOME BIRTH
    

    217
    

• Sterile gloves
  
• Plastic aprons
  
• Disposal bags
  
• Clinical waste disposal bags
  
• Venflon and intravenous therapy fluid (for cannulation in case of PPH)
  
• Sharps disposal container.
  

• Lubricating jelly
  
• Amnihook
  
• Pinard and fetal Doppler
  
• Syringes and needles
  
• Specimen bottles and request forms
  
• Oxytocic drugs
  
• Naloxone
  
• Urinary catheter.
  

• Bean bag
  
• Birthing ball
  
• Floor mattress
  
• Hot water bottle.
  

• Tape measure
  
• Cord clamp
  
• Mucus extractor
  
• Name bands (only if transfer is necessary)
  
• Vitamin K
  
• Scales.
  

• Lidocaine
  
• Suture pack
  
• Suture material
  
• Torch.
  

• Inhalational analgesia (Entonox), two full cylinders, plus mouth and mask attachments
  
• Oxygen, together with adult and neonatal masks
  
• Portable suction equipment.
  

1. Tew M (1998).
   Safer Childbirth? A Critical History of Maternity Care
   . London: Chapman and Hall.
   
2. Chamberlain G, Wraight A, Crowley P (1997).
   Home Births: The Report of the 1994 Confidential Enquiry by The National Birthday Trust Fund
   . Carnforth, Lancs: Parthenon Publishing Trust.
   
3. Olsen O, Jewell M (1998). Home versus hospital birth.
   Cochrane Database of Systematic Reviews
   3
   . 1998, issue 3. Art No: CD000352. DOI:10.1002/14651858. CD000352. Available from: M http://
   www2.cochrane.org/reviews/en/ab000352.htm (accessed 22.2.11)
   

   CHAPTER 11
   Normal labour: first stage
   

   218‌‌
   

   Hospital birth
   

   A hospital is by far the most common place to give birth in the UK. This has been the result of government legislation arising from the 1970s (the Peel Report)
   ¹
   which advocated that all women should give birth in hos- pital where it was considered to be safer. This led to a radical change in the role of the midwife and maternity care, while increased intervention has brought a staggering rise in the of rate complications associated with pregnancy and labour and incidence of LSCS. Advanced technology and screening have contributed greatly towards better outcomes for high-risk women. However, in recent years there has been much opposition to these practices and interventions. The evidence for hospitalization of all women for birth is unfounded.
   ²
   Women should be involved in deciding where to give birth following initial assessment in early pregnancy to iden- tify any risk factors to be aware of their options and be able to make an informed choice.
   

   Reasons for hospital birth
   

   • Maternal illness or pre-existing medical condition.
     
   • Obstetric history or present obstetric condition that warrants high-risk management.
     
   • Maternal choice: feels safer in hospital, request for epidural analgesia.
     
   • Unsupported mother: without partner, family, or friends who can provide immediate and ongoing care.
     
   • Social circumstances: e.g. drug misuse, poor housing /living conditions.
     
   • Emergency admission.
     
   • Concealed pregnancy.
     
   • Concerns over the well-being of the fetus.
     

     Invariably the length of stay in hospital is relatively short unless there are complications.
     

   • 6h stay: the woman spends the latter part of labour and delivery in hospital, followed by a short 6h-recovery period prior to being discharged home to community care.
     
   • 12–24h stay: this is most common for women who have had a normal birth and there are no complications.
     
   • 24–48h stay: very often primiparous women, or women who have had a forceps or ventouse birth, may stay a little longer.
     

     •
     3–4 days: mainly women who have had an LSCS or where there are
     

     complications.
     

     Admission
     

   • Hospital environments tend to put labour and birth into the illness mode, which equates with disease or that something is wrong.
     
   • The woman may be anxious about hospital admission for labour. She may not have been in hospital before and have pre-conceived ideas or had a previous bad experience.
     
   • Build up of tension will produce stress hormones that interfere with the normal physiology of labour, and slows the process down. Consequently the chances of intervention are increased.
     
   • The hospital environment may be very daunting and impersonal, care should be taken to make the woman feel comfortable and relaxed.
     

HOSPITAL BIRTH

219

Provision of a home from home environment, with low lights, music facilities, and non-clinical furnishings should be standard.