1. MATERNITY Brenda Rees and Colin Rees Chapter 18

2. Introduction This presentation will test your knowledge of maternal care as provided by a midwife and the policies, values and philosophy on which that care is based. You will be encouraged to explore your understanding of the material covered in the printed chapter. Part 1 - The Focus of Maternity Care Part 2 – Changes in Maternity Care Part 3 – Pregnancy Part 4 – Birth Part 5 – The Postnatal Period

3. The slides will ask you to write a list, or chose from a number of alternatives. The answer will be given after each question. Questions in this format are designed for discussion within a student learning group. If you want to work on your own, you may also like to try the chapter MCQs.

4. ‘Birth is a life-changing event and the care given to women during labour has the potential to affect them both physically and emotionally in the short and longer run’. NICE (2007)

5. PART 1: The Focus of Maternity Care

6. Q. List some of the ways that the term ‘pregnancy’ differs from the term ‘illness’ in other health care settings.

7. Answers You may have included the following: Pregnancy is not an illness Women can be regarded as healthy although pregnant Pregnancy is a normal physical state Pregnancy is not something you catch It is not necessarily an undesirable physical condition

8. PART 2: Changes in Maternity Care

9. Q. What do you think have been the implications of declining homebirths on the: skills of the midwife? kind of birth that women experience? expectations women now have about birth?

10. Answers Homebirths required a wide range of midwifery clinical skills. The move to hospitals initially led to a reduced level of skill for midwives. The kind of births experienced have been more medically influenced, with a greater range of technology available. Women’s expectations have been for a birth to take place in a hospital setting with a potentially high level of technical intervention.

11. PART 3: Pregnancy

12. Q. List 4 of the early signs of pregnancy

13. Answers Include any of the following: Missed periods Nausea and vomiting Abdominal pains A metallic taste in the mouth Changes to the breasts including tenderness, increase in size, ‘heaviness’, sensation of tingling Feeling tired Increased frequency of micturition Constipation Increased vaginal discharge Heightened sense of smell in relation to food Changes in the taste of certain food May go off foods May start to crave unusual foods or unusual combinations of food (pica)

14. Q. Which of these define the 3 trimesters of pregnancy: a) First 0-15 weeks, Second 16-32 weeks, Third 33-42 weeks b) First 0-11 weeks, Second 12-28 weeks, Third 29-37 weeks c) First 0-13 weeks, Second 14-26 weeks, Third 27-40 weeks d) First 0-14 weeks, Second 15-30 weeks, Third 31-42 weeks

15. Answer The correct answer is: c) First 0-13 weeks, Second 14-26 weeks, Third 27-40 weeks

16. Q. Fill in the blanks below: At about 22 weeks the developing fetus is covered in very fine soft hair called ‘******’. Later, it is covered in white, greasy ‘******’. Both disappear before birth.

17. Answer You should have agreed the following: At about 22 weeks the developing fetus is covered in very fine soft hair called ‘lanugo’. Later, it is covered in white, greasy ‘vernix’. Both disappear before birth.

18. Q. There are a number of maternal risk factors, apart from BMI. In your groups, identify at least 4 other maternal risk factors.

19. Answer You could have included any of the following: Hypertension Renal disease Respiratory disease Cardiac disease Haemoglobinopathy Psychiatric conditions Infections (e.g. varicella) Drug misuse Extremes of age Maternal diabetes

20. Q. There are a number of psychological and social factors that a midwife should be alert to in pregnancy. Work together in your learning groups to identify at least 4 of them.

21. Answers could include the following: Issues surrounding whether the pregnancy was planned/wanted Changing body image Frequent feelings of being unwell Relationship issues with partner/parents Fears of miscarriage Anxiety regarding the transition to parenthood Career/employment issues Housing/environmental issues Financial issues Altered lifestyle issues (including reducing or stopping smoking, alcohol, drug use) Religious/cultural issues concerning the baby Anxiety regarding screening and fetal well-being Answers

22. Q. Name one of the clinical complications that may occur in pregnancy

23. Answers The main clinical complications of pregnancy include: Pre-eclampsia Placenta praevia Fetal growth restriction

24. PART 4: Birth

25. Birth in the UK About 600,000 women give birth in England and Wales each year, of whom about 40% are having their first baby. Most of these women are healthy and have a straightforward pregnancy. Almost 90% of women will give birth to a single baby after 37 weeks of pregnancy with the baby presenting head first. Most women (about two thirds) go into labour spontaneously (p.5). NICE (2007)

26. Q. According to Lavender and Kingdon (2006) throughout labour, the midwife constantly assesses progress and does everything possible to ensure that the labour and birth remain normal. List at least 3 of the ways of optimising this.

27. Answers Creating a positive atmosphere and environment Presence, comfort and encouragement Assessment of labour Assessment of the heath of the fetus Mobility and encouraging suitable positions for labour and birth Helping women to cope with the pain of labour (Lavender and Kingdon 2006 p.336)

28. Q. How would you define the third stage of labour?

29. Answer The third stage of labour follows the birth of the baby, and involves the uterus contracting and reducing in size. The placenta is also expelled in this stage.

30. Q. The physical condition of the baby is assessed at 1 and 5 minutes using the ‘apgar’ scoring system. What do the letters A-P-G-A-R stand for?

31. Answer ‘Apgar’ stands for: Appearance (colour) Pulse (heart rate) Grimace (response to stimuli) Active (muscle tone) Respirations

32. PART 5: The Postnatal Period

33. Q. List at least 3 of the priorities for the midwife involved in care of the mother in the postnatal period.

34. Answers Carry out full examination of the baby within 72 hours of birth Monitor any health indicators showing deviations for mother and baby Support with feeding Help in adapting to parenting roles Carry out neonatal screening between 7- 10 days including PKU, and hypothyroidism Health education, including contraceptive advice (NICE 2006)