A Midwifery Perspective
Ann Rath
Ann Rath
Home of Active Management
Total No of Deliveries 2012 =8978
Total No of Babies =9142
Birth of a
•
•
•
•
st
1
Baby
A PROFOUND EMOTIONAL EXPERIENCE
Moulds attitude to all subsequent births
If happy unlikely to have any apprehension
Unhappy –Requesting LSCS
1973
Although childbirth has long ceased to present a
serious physical challenge to healthy to women in
western society –the emotional impact of labour
remains a matter of common concern
O’Driscoll K BMJ 1973 ;3 135-137
Diagnosis of Labour
The diagnosis of labour is the single most important
item in the conduct of labour.
If the initial diagnosis is wrong, all subsequent
management is likely to be wrong too.
Midwife is the only person who makes this
important diagnosis in our hospital
Preparation for Labour
Preparation
takes away
the fear of the
unknown.
Women are
familiar with
terminology and
labour records.
Diagnosis in Practice
Painful Uterine
Contractions 1 : 10
Show
Spontaneous
Rupture of
Membranes
On arrival to the Labour Ward
The Midwife learns this important skill while
working as a Junior Midwife under the close
supervision of the Midwife in charge or her deputy.
Findings on Vaginal
Examination
Cervix
uneffaced
and
undilated
37 weeks
Gestation
Contractions
1 : 20
Given an adequate explanation and allowed home
Vaginal Examination
39 weeks
gestation
Cervix
Partially
effaced
Contractions
1 : 20
40 / 41 weeks
Gestation
Contractions
1 : 10/8
+/ - Show
Home or
retain in
antenatal
ward
Retain and reassess in 1 hour
Vaginal Examination
Cervix fully
effaced
Painful Uterine
Contractions
+ / - Show or
+ / - SROM
In Labour and will deliver within 12 hours
Vaginal Examination
Cervix
2cms
dilated
In Labour
80% of women admitted to the labour ward
have a cervical dilatation of < 3cms
Diagnosis of Labour
A woman who is admitted with painful uterine
contractions supported by either a show or
spontaneous rupture of the membranes, and on
vaginal examination her cervix is fully effaced is
deemed in labour, and retained in the labour
ward and therefore committed to delivery which
is anticipated within 12 hours.
Effaced cervix is
confirmation of
diagnosis of labour
irrespective of
dilatation
Diagnosis of Labour
Dilatation of the cervix represents the sole
conclusive evidence of labour.
Effacement is the feature which serves to
distinguish between the cervix which passively
admits a finger tip and the cervix which is
actively dilated to the extent of 1cm in labour.
gl
Clear Distinction between
Nullips and Multips
Amniotomy is performed at the diagnosis of labour

To assess the fetal condition at the start of labour

Determine which fetuses need continuous electronic monitoring

Other beneficial effects
 Shortens the labour
 Decreases need for oxytocin
yes
yes
Management of
Labour
yes
Deceleration phase
Latent phase
Active
phase
Latent phase
Acceleration
phase
Is not useful in the
diagnosis and the
management of labour
Effacement
of the cervix is the key to
the diagnosis of labour
and it’s graphic analysis
and that is when the
partogram is started
Dilatation on diagnosis
80% < 3cm
Spontaneously labouring
nulliparous women with a
single cephalic pregnancy
at 37 weeks or greater
Philosophy
A clear pattern of dilation
should emerge and
determined clinically
within the first 3-4 hours
of labour
1 cm an hour is taken as
normal progress
Spontaneously labouring
nulliparous single cephalic
women at term
4 hours is too long to wait between
examinations to make the diagnosis
of inefficient uterine action
Efficient uterine action and normal
progress only be confirmed by
doing vaginal examinations 2 hourly
before oxytocin is started.
Average number of vaginal
examinations in total is 3.7
Epidural rate 50%.
90% of epidurals given within 4 hrs
CS rate 7% and not increased
significantly over the last 25 years
• Level of mutual confidence must be
present between midwives and doctors
• Clear chain of command
• Mutual Respect
• Co-ordinator/Midwife in charge has a
vital role to play
Evaluate Outcomes
Patient Satisfaction
Peer Review
Clinical Outcomes
Satisfaction
Improvement
Suggestions
Feedback
PLEASE PLACE
PATIENT STICKER
HERE
THANK YOU
EVALUATION FORM
DELIVERY WARD
DATE OF DELIVERY
PARITY
We would be grateful if you would spare the time to offer your views in response to the following
questions.
The information gained from these forms is analysed and used to improve our care. We value your
comments and anything written will be treated seriously and in complete confidence.
1.What do you think was good about your labour and the care you received?
2. What aspect of your care could have been improved?
3a Did you attend antenatal classes? Yes /No If Yes where did you attend classes
3b..How could you have been better prepared for your labour?
4.Any other comments.
Thank you for taking the time to complete this form, if you feel you would like to
discuss your labour further, please tick the box and we will contact you.
As part of our wish to continually to improve the service we sometimes need to
contact women after delivery. Please indicate if you would be prepared to be included
in further questionnaires
YES / NO
Labour
Feedback
Form
Following Delivery
Positive Points
Negative Points
•
•
•
•
•
•
• Communication
– Medical terms used
– Lack of information
• Pain relief issues
– Waiting time for epidural
– Ineffective pain relief
• Facilities
– Car parking
– Overcrowding
One to one care
Communication
Pain relief
Antenatal classes
Breastfeeding
Friendly Staff
Continual Audit
No blame culture
Continuous communication
Clinical governance
Risk management
Quality improvement
Management
of labour
An active
interest in
labour