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Description of Care

Discuss about the Midwife Practice for Knowledge and Skills.

The midwifery skills require appropriate knowledge and skills to maintain the patient’s quality of life. This assignment is related to demonstrate the incident and personal experience related to the incident. There comes many occasions when midwives have to go through ethical and moral problems as well as have to recognize the importance of the role of the midwife. This reflective essay is based on the case study of a patient named as X. She is a 28 years old women with gravida para 1. Leaking liquor was noticed in her urine. The patient starts to feel increased leaking sensations and contraction pain. Once the fetal head was delivered it got recoiled in the perineum and “turtle necking” occur. This kind of situation is very difficult for the healthcare professional, and if the baby is not delivered within 5 minutes then chances of brain damage in child increases. Such difficult situations challenge the role of midwives and can also prepare them to for future challenges. Through this reflective essay I will attempt to evaluate the experience as a midwives student and how such experience can be helpful for future practice.

The patient X involved in this case is a 28 years old pregnant woman, who has been experiencing liquor leaking and pain. During the acute pain and delivery process, the head of the baby recoils against the perineum of mother. The turtle sign is identified, when the head of the baby suddenly retracts back, while it was emerging through vagina. This means that the cheeks of the baby bulges out, which resembles to the turtle pulling its head back into its shell. However, the delivery of the baby was done through McRoberts maneuver. This time is very difficult for the healthcare professionals and mainly for the midwife, who is committed to provide personal support and assistance to the women before and during delivery (Adams, 2015).  

Delivery of the baby is not easy and professionals as well as the mother have to face many challenges during the process of delivery (Aune, Amundsen, & Aas, 2014). In the given case study turtle necking occur, which calls for the immediate professional care and quality interventions otherwise the life of the baby be in danger. The major danger is to face shoulder dystocia during turtle necking. This is the situation, where shoulder of the baby stuck in the pelvis or symphysis pubis (the pubic bone) of mother. Understanding the variations of shoulder dystocia is very important for the midwives.

Acknowledgment of Feelings and Thoughts

The role of midwife is to work in coordination with other professionals. During this case in Patient X’s situation, I felt very terrified, as the life of baby is very important. I concentrated on the skills and knowledge that I gained from my midwifery degree. This knowledge encourages midwives to consider patient safety and understand the variations and types of shoulder dystocia. The learning resources for midwives help to focus on the problems and how to solve them. I believe that role of midwife is to save the life by taking accurate action for problem solving. During the delivery of baby I felt terrified on the first place, it is because the life of baby was in danger and any delay in the appropriate intervention can result in severe brain and physical injuries in child.

 However, women are amazing and they are capable of delivering their babies with difficult challenges as well. Thus, later I felt that I am very lucky that I got a chance to take part in such delivery and all my fear was gone when I concentrated on knowledge I have gained, which says that there are many bizarre birth positions, delivery situations and movements, but still instinctive pelvic movements can result in riskless deliveries. Baby need some time to come in comfortable position and appropriate knowledge and skills of the midwives can reduce the risk (Code of ethics for midwives in Australia, 2008). Thus, I felt happy to participate in this challenging delivery. Shoulder dystocia is a very unpredictable situation and healthcare professionals have to be prepared for such unpredictable situations. The role of professional communication and working in coordination is also important. This delivery experience helped me to enhance my nursing skills and supporting patients.

Midwife is the person, who is recognized as being accountable and responsible professionals, who works in partnership with other women, who require care, support and advice during their period of pregnancy, labour, delivery, conducting birth of babies, postpartum period, and offering appropriate care to the new born. The role of midwife is to apply preventive measures and promote the birth of baby through normal delivery, detecting any kind of complications if appear, accessing appropriate assistance from other healthcare professionals and carrying emergency measures.  

The incident that took place was very challenging or me. My duty was to identify the problem and inform the professionals to seek their assistance. As, the turtle necking occurred, it was important to understand that such problem has occurred and require appropriate measure. It is appropriate to monitor each and every change in the condition of woman and baby. As the baby’s head appeared with puffed cheeks, it was obvious that turtle necking has occurred, which can result in shoulder dystocia (Politi et al, 2010). This case was beneficial to display the importance of team work and leadership. By seeing the problem, the whole team was activated and all the nursing professionals displayed good communication and effective team work. Thus, it was beneficial to take part in such case and enhance the skills and knowledge for future practice. However, this experience could have been detrimental, if I would have not focused on the patient’s and child’s safety. But, good and effective team work was a very beneficial factor in resolving the problem of Shoulder dystocia.

Evaluation of Care

Shoulder dystocia can be a very serious and significant cause of neonatal and maternal injury. “This kind of situation is characterized as a severe obstetrical emergency that complicates between 0.2% and 4.0% of vaginal births in the United States” (Robins, 2012). Shoulder dystocia is the problem that occurs, when shoulder of the baby is failed to be delivered spontaneously. And from this situation I learnt that role of midwife is very important and additional maneuvers by the midwives in order to facilitate safe delivery for the child.  The main risk associated with this kind of delivery is of substantial neonatal injuries and morbidities. This kind of problem requires working effectively and in coordination with team.

According to Smith et al, (2013), there is limited research available on the topic about the factors that make women vulnerable to the risk of such delivery, and mainly such incidents occur in women, who do not display any signs of such problem. Thus, such cases are very beneficial for getting practical knowledge. The delivery done in this case was through McRoberts maneuver. It is important for the safe birth. Before that I learnt that it is important to give significant time to the child to adjust the shoulder (Simic, 2014).

Sometime within five minutes child can take the necessary position and can come out easily, but if in five minutes it does not come in normal position then necessary professional assistance is required. I learnt that in such cases midwives should take immediate action. Not to make the bad situation worse, it is important to remember that baby’s shoulder should not be pulled. It is because pulling is the most common mistake that midwives do because they panic. Also continuous communication with the patient is very important. I learnt that continuous communication with the patient may reduce their stress and provide the support during difficult time.

According to Robins (2012) “Midwives and physicians are entrusted as gatekeepers for the safety and wellbeing of the mother and infant during the birth process”. When there are any kind of adverse outcomes of mortality or morbidity in the patient or the fetus, such situation can be very distressing for the healthcare professionals as well (Schneider, & Whitehead, 2013). Thus, taking appropriate care and applying the knowledge and skills in the correct way are important to fulfill the duty of care (Borrelli, 2014). Midwives also have the role of educating people and counseling them (Code of professional conduct for midwives in Australia, 2008), thus I learn that communication with patient, as well as inter-professional communication is necessary for working in accordance to provide quality care and support (Yznaga, 2013).

Analysis

For the future action plan I would concentrate on patient and child’s safety. I would concentrate on changing condition of patient, with regular communication and monitoring condition (Thelin, Lundgren, & Hermansson, 2014). According the Code of professional conduct for the Midwives in Australia (2008), “Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman”. Thus, my focus will also on the health and safety of patient and will consider her expectation and dignity while practicing.

Conclusion

The role of midwife is very important in nursing and healthcare practice. This role is mainly dedicated to the pregnant mother, postpartum care and fetus safety. This role also includes attaining unsurpassed skills and experience. The case presented in this reflective essay helped me to gain great experience regarding complex deliveries. I learnt to appropriately demonstrate the duties of the midwife and gained experience and knowledge for future practices. I discussed the points that were beneficial to be learnt through this case and how complications can occur due to ignorance or getting panic. I would be able to practice in safe and competent manner in future.

References

Adams, M. C. (2015). A documentation standard for the maternal and child health nurse in Victoria.

Aune, I., Amundsen, H. H., & Aas, L. C. S. (2014). Is a midwife's continuous presence during

childbirth a matter of course? Midwives' experiences and thoughts about factors that may influence their continuous support of women during labour. Midwifery, 30(1), 89-95.

Borrelli, S. E. (2014). What is a good midwife? Insights from the literature.Midwifery, 30(1), 3-10.

Code of professional conduct for midwives in Australia. (2008). Nursing and Midwifery Board of Australia. Retrieved From: file:///C:/Users/Master/Downloads/Nursing-and-Midwifery-Board---Codes-and-Guidelines---Code-of-professional-conduct-for-midwives---August-2008.PDF

Code of ethics for midwives in Australia. (2008). Nursing and Midwifery Board of Australia.

Retrieved From: file:///C:/Users/Master/Downloads/Nursing-and-Midwifery-Board---Codes-and-Guidelines---Code-of-ethics-for-midwives---August-2008.PDF

Politi, S., D?Emidio, L., Cignini, P., Giorlandino, M., & Giorlandino, C. (2010). Shoulder dystocia: an Evidence-Based approach. Journal of prenatal medicine, 4(3), 35.

Robins, K. (2012). Psychological trauma of nurse-midwives following shoulder dystocia complicated by neonatal morbidity or mortality.

Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.

Smith, L. A., Price, N., Simonite, V., & Burns, E. E. (2013). Incidence of and risk factors for perineal trauma: a prospective observational study. BMC pregnancy and childbirth, 13(1), 1.

Simic, L. (2014). Birth Story. Performance Research, 19(4), 24-30.

Thelin, I. L., Lundgren, I., & Hermansson, E. (2014). Midwives' lived experience of caring during childbirth–a phenomenological study. Sexual & Reproductive Healthcare, 5(3), 113-118.

Yznaga, E. (2013). Interprofessional Roles Shoulder Dystocia: Maximizing Safety in Community Hospitals.

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