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Questions and Answers
What are the aims of antenatal care according to the NICE Guidelines? (Select all that apply)
What is the purpose of the partogram?
To visually track important aspects of labor progress
Non-Invasive Prenatal Testing (NIPT) is recommended for all pregnant women.
True
Combined First-Trimester Screening involves Nuchal Translucency (NT) Ultrasound and ________ tests.
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Match the screening test with the recommended gestational age at which it should be conducted:
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What are the key components of the mammary gland?
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Fetal circulation involves the ductus venosus shunting deoxygenated blood away from the liver.
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What is the purpose of the Foramen Ovale in fetal circulation?
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_______ ______ is the mechanism that involves heat loss when a liquid converts to vapor.
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Match the following postnatal care needs with their categories:
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What does the acronym SIDS stand for?
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What are some common risk factors associated with Neonatal Jaundice? (Select all that apply)
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Midwives are generally known for focusing on natural childbirth and minimizing interventions. (True/False)
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Match the following with their definitions:
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What are the aims of antenatal care as per the NICE Guidelines 2017?
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Which of the following is a model of antenatal care mentioned in the content?
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Routine screenings in antenatal care may include blood tests, urinalysis, and ultrasounds.
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Gestational Diabetes Screening is typically conducted between ____ to ____ weeks of pregnancy.
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Match the following screening tests with their appropriate timings:
- Glucose Tolerance Test
- Group B Streptococcus (GBS) Screening
- Anatomy Scan (18-20 Weeks Ultrasound)
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What is the purpose of placing cribs away from windows in relation to radiation?
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What is the expected weight gain per day for a newborn at 1 week of age?
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Midwives provide care during pregnancy, birth, and postnatal periods, excluding care of the newborn. Is this statement true or false?
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____ and defecation patterns are monitored in newborns for health assessment.
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What are the signs of placental separation?
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What are the three stages of labor?
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What is the purpose of effacement and dilatation in labor?
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Match the following fetal presentations with their descriptions:
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What are the 5 P's that affect labor and birth?
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What are the aims of antenatal care according to NICE Guidelines, 2017?
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What is the importance of antenatal history taking?
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According to Australian Pregnancy Care Guidelines (2023), midwife standards for practice were developed by the Australian _____ Collaboration.
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The partogram is primarily used for diagnostic purposes during pregnancy.
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Match the following prenatal screening tests with their components:
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What is the definition of Sudden Infant Death Syndrome (SIDS)?
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What is the origin of the word 'midwife'?
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Midwives are typically focused on natural childbirth and minimizing interventions.
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Healthy newborns sleep approximately __ hours per day.
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Match the following terms with their meanings:
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What are the 5 P's that can affect labor and birth?
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Which fetal lie allows the baby to be birthed vaginally?
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Flexed attitude of the fetal skull presents the smallest diameters for birth.
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____ Station indicates the level of ischial spines during labor.
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Match the following stages of labor with their descriptions:
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What are key points to consider for postnatal care in the postnatal period?
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What are the 5 P's that affect labor and birth?
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What are the three main presentations during birth?
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Uterine involution refers to the uterus descending about ______ cm/day after birth.
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Match the following structures of the human lactation process with their functions:
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Skin-to-skin contact immediately following birth can help stabilize the cardiovascular system of the newborn.
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What is the primary prevention method for Hyperbilirubinemia?
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Sudden Infant Death Syndrome (SIDS) is explained easily after investigation.
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What is the definition of a Midwife according to the International Confederation of Midwives (ICM)?
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Midwifery is seen not just as a job but as a __________ and a calling.
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Match the following terms with their definitions:
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What are the aims of antenatal care according to the NICE Guidelines, 2017?
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What is the purpose of the partogram?
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Is Non-Invasive Prenatal Testing (NIPT) recommended for all pregnant women?
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Fetal heart rate should be monitored every __ to __ minutes on the partogram, typically after a contraction lasting __ seconds.
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Match the following antenatal screening tests with the recommended timing:
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Study Notes
Antenatal Care Overview
- Aims of Antenatal Care (NICE Guidelines, 2017):
- Optimize maternal and fetal health
- Offer maternal and fetal screening
- Provide medical or social interventions
- Improve pregnancy and birth experiences
- Prepare women for motherhood regardless of risk status
- Phases: Pre-conception and pregnancy
- Relationships: Building partnerships with respect for each other's knowledge
- Cultural Safety: Consideration of cultural safety and addressing power imbalances
- Promotion of Wellness: Supporting wellness and normality
Models of Antenatal Care
- Public Hospital Clinic Care: General antenatal care with midwives, specific clinics for refugees, young women, Indigenous women
- Obstetric Care in Public Hospital: Includes specialist services such as maternal fetal medicine
- Public Hospital Midwifery Care: Predominantly midwife-led, with some consultations with doctors
- Team Midwifery: Small teams providing comprehensive care throughout pregnancy and birth
- Birth Centre Care: Midwife-led care in a separate hospital section
- GP Shared Maternity Care: Collaboration between public hospitals and local practitioners
- Caseload Midwifery Care: Ongoing care by the same midwife
- Planned Homebirths: Midwife-led care at home with hospital transfer if needed
- Private Maternity Care: Care by private obstetricians or GPs
- Private Midwifery Care (MyMidwives): Private midwives providing hospital births
Importance of Antenatal History Taking
- Systematic History Taking: Essential for effective antenatal care
- Psychological History: Screening for mental health issues
- Routine Screenings: Includes blood tests, urinalysis, and ultrasounds
Screening Tests in Antenatal Care
- Initial Tests:
- Blood group and rhesus factor
- FBC and urinalysis
- Syphilis, hepatitis B and C, and rubella antibodies
- HIV and asymptomatic bacteriuria
- Gestational Diabetes Screening: 24 to 28 weeks
- Mental Health Screening: Using the Edinburgh Postnatal Depression Scale (EPDS)
- Ultrasound and Serum Testing: For fetal growth, gestational age, and anomalies
Role of the Midwife in Antenatal Care
- Health Promotion: Educating about nutrition, exercise, and smoking cessation
- Emotional Support: Addressing mental health and domestic violence
- Screening and Diagnostics: Performing and interpreting screening tests
- Referral: Referring to specialists when necessary
- Education: Providing antenatal education and facilitating informed choices
Components of Antenatal Education
- Passive Education: During antenatal visits, through brochures and media
- Active Education: Classes covering various topics including labour, birth, and postpartum care
Models of Antenatal Education
- General Classes: Covering pregnancy, labour, and birth
- Specialized Classes: For fathers, Indigenous parents, non-English speakers, multiple births, caesarean births
- Alternative Methods: Hypnobirthing, Lamaze, active birth, antenatal yoga
- Types of Antenatal Classes:
- Pre-conception Classes: For those planning pregnancy
- Early Pregnancy Classes: Covering the first trimester
- Third Trimester Classes: More comprehensive, usually spanning 4-6 weeks
- Refresher Classes: For those who have had previous pregnancies
- Online Classes: Accessible option for those unable to attend in person
Additional Education Topics
-
Postpartum Care: Breastfeeding, baby care, managing lifestyle changes
-
Support Resources: Community support, stress reduction, and relaxation techniques### Lactogenesis
-
Lactogenesis is the initiation of milk secretion in two stages:
- Stage I: Secretory differentiation, colostrum produced at 16 weeks
- Stage II: Onset of copious milk production after birth
- Stage III: Maintenance of established lactation (galactopoiesis)
Uterus and Lochia
- Uterus involution:
- Check fundus every 15-30 minutes post-birth
- Uterus descends 1 cm/day, back to normal size within 6 weeks
- If "boggy," rub up the fundus
- Lochia:
- Rubra (bright red) for the first few days
- Serosa (light watery discharge) for a few weeks
- Alba (yellow-white discharge) for 6-8 weeks
- Monitor for signs of infection
Perineum and Wound Care
- Regular pad changing, showering, and side-lying inspections
- Ice packs for 10-20 minutes intervals in the first 24-72 hours
- Avoid constipation with urinary alkalisers and stool softeners
Caesarean Section (LSCS)
- Inspect wound each shift, protect during movement, and check for infection
- Mobilize to avoid pressure areas and ensure suture line remains clean
- Monitor for signs of infection and provide appropriate care
Bladder and Bowel Care
- Expect voiding within 6 hours post-birth
- Normal bowel function can vary; stool softeners may be needed
- Treat perineal discomfort and monitor for urinary tract infections (UTIs)
Legs: Venous Thromboembolism (VTE)
- Pregnancy increases VTE risk due to hypercoagulability, reduced blood flow, and vessel wall damage
- Risk factors include previous thromboembolism, thrombophilia, and various obstetric and lifestyle factors
- Prevention includes smoking cessation, weight reduction, hydration, mobilization, anticoagulation therapy, and compression stockings
Vital Signs
- Monitor temperature, pulse, respiratory rate, and blood pressure after birth
- Assess fluid loss, signs of anemia, and overall condition
Breastfeeding
- Support the decision to breastfeed with education and practical guidance
- Address common issues like nipple pain and trauma with evidence-based tips
- Monitor infant feeding cues and ensure proper latch and positioning
- Teach mothers to recognize effective sucking and swallowing
Safe Sleep Environment
- Ensure safe sleep practices for the infant
Transition to Extrauterine Life
- Fetal circulation:
- Oxygenation and Nutrition: Provided via the placenta
- Ductus Venosus: Shunts oxygenated blood from the placenta away from the liver into the inferior vena cava and then into the right atrium
- Foramen Ovale: Allows oxygenated blood from the right atrium to shunt across to the left atrium, entering systemic circulation via the aorta, bypassing pulmonary circulation
- Ductus Arteriosus: Shunts deoxygenated blood from the pulmonary artery into the aorta, facilitating the entry of oxygenated blood into systemic circulation, bypassing the lungs
Midwifery Assessment Immediately Following Birth
- APGAR Score:
- Devised by Virginia Apgar in the 1950s
- Low scores linked to long-term perinatal morbidity and mortality
- Skin-to-Skin Contact:
- Stabilizes cardiovascular system, increases thermoregulation, higher BGLs, and earlier and improved breastfeeding initiation and bonding
- Maintain warmth, ensure baby is dried and in direct contact, continue observation of respiration rate, tone, temperature, and color
- Managing Heat Loss:
- Infants lose heat quickly; cold stress can lead to hypoglycemia and respiratory distress
- High surface area to volume ratio; cannot shiver, rely on brown adipose tissue for heat
- Four Mechanisms of Heat Transfer:
- Convection: Heat loss to cooler ambient air
- Radiation: Heat loss to a cooler solid surface nearby
- Evaporation: Heat loss when a liquid converts to vapor
- Conduction: Heat loss to cooler surfaces in direct contact
- Preventing Heat Loss:
- Convection: Keep birthing suite at ~24°C
- Radiation: Place cribs away from windows
- Evaporation: Dry newborns immediately after birth or bath
- Conduction: Use warm blankets or skin-to-skin contact if temperature is low
Examination of the Newborn
- Initial Assessment:
- Length: Top of head to heel
- Head Circumference: Above ears
- Temperature: Axilla
- Heart Rate: Stethoscope
- Respirations: Abdomen/chest
- Weight: Monitored for expected gain
- Output: Urination and defecation patterns
- Weight and Output:
- Expected Weight Gain:
- Day 3: May lose up to 10% of birth weight
- 1 week: 20-30 grams/day
- 2 weeks: Back to birth weight
- 3 weeks to 5 months: 150 grams/week
- 5-6 months: 70-100 grams/week
- Output:
- Day 1: 1+ wet nappy, 1+ meconium (black)
- Day 2: 2+ wet nappies, 1+ meconium (black)
- Day 3: 3+ wet nappies, 1+ poo (black/brown/green)
- Day 4: 4+ wet nappies, 1+ poo (brown/green/yellow)
- Day 5: 5+ wet nappies, 1+ poo (brown/yellow)
- Day 6: 6+ wet nappies, 1+ poo (yellow)
- Expected Weight Gain:
Examinations by Medical Officers
- Developmental Dysplasia of the Hips: Checked for abnormalities
- Red Eye Reflex: Confirms lens clarity, checks for congenital cataracts
- Palpation of Internal Organs: Check for abnormalities
- Femoral Pulses: Check for cardiovascular anomalies
Neonatal Jaundice
- Definition: Accumulation of bilirubin causing yellow discoloration
- Physiological Jaundice: Common, occurs around day 3-5, often harmless but may require management
- Risk Factors: Poor feeding, low birth weight, prematurity, birth trauma
- Types of Bilirubin:
- Unconjugated: Fat-soluble, can cross the blood-brain barrier, potentially causing kernicterus
- Conjugated: Water-soluble, excreted in feces and urine
- Recognition and Management of Jaundice:
- Early Detection: Jaundice first appears in the sclera
- Progression: Starts from the face, progresses to the trunk and extremities
- Kramer's Rule: Depth of jaundice indicates bilirubin levels
- Phototherapy: Treatment involves exposure to light; breastfeeding should continue
Prevention of Hyperbilirubinemia
- Primary Prevention: Early and frequent breastfeeding, monitoring for jaundice
- Monitoring: Especially important for infants discharged before 72 hours of age
Healthy Hearing Test
- Offered to Every Baby: Free, early identification of hearing deficits to prevent speech and developmental delays
Sudden Infant Death Syndrome (SIDS)
- Definition: Sudden and unexpected death of an infant under 1 year during sleep, unexplained after investigation
- Hypothesis: Caused by multiple stressors like prone sleeping, maternal smoking, and prematurity
Neurological Development (Birth to 6 Weeks)
- Vision: Sensitive to bright lights, focus at 15-20 cm, prefer human faces
- Hearing: React to localized sounds, high-pitched sounds cause blinking/startle
- Smell, Touch, and Taste: Respond to mother's milk, prefer sweet tastes, mimic facial expressions
- Sleep/Wake Cycles: Newborns sleep 16-20 hours/day, wake primarily for hunger
Thriving Baby Indicators
- Signs of Good Health: Regular wet nappies, clear and bright eyes, calm breathing, good tone, and regular weight gain
Antenatal Care Overview
- Aims of Antenatal Care (NICE Guidelines, 2017):
- Optimize maternal and fetal health
- Offer maternal and fetal screening
- Provide medical or social interventions
- Improve pregnancy and birth experiences
- Prepare women for motherhood regardless of risk status
- Phases: Pre-conception and pregnancy
- Relationships: Building partnerships with respect for each other's knowledge
- Cultural Safety: Consideration of cultural safety and addressing power imbalances
- Promotion of Wellness: Supporting wellness and normality
Models of Antenatal Care
- Public Hospital Clinic Care: General antenatal care with midwives, specific clinics for refugees, young women, Indigenous women
- Obstetric Care in Public Hospital: Includes specialist services such as maternal fetal medicine
- Public Hospital Midwifery Care: Predominantly midwife-led, with some consultations with doctors
- Team Midwifery: Small teams providing comprehensive care throughout pregnancy and birth
- Birth Centre Care: Midwife-led care in a separate hospital section
- GP Shared Maternity Care: Collaboration between public hospitals and local practitioners
- Caseload Midwifery Care: Ongoing care by the same midwife
- Planned Homebirths: Midwife-led care at home with hospital transfer if needed
- Private Maternity Care: Care by private obstetricians or GPs
- Private Midwifery Care (MyMidwives): Private midwives providing hospital births
Importance of Antenatal History Taking
- Systematic History Taking: Essential for effective antenatal care
- Psychological History: Screening for mental health issues
- Routine Screenings: Includes blood tests, urinalysis, and ultrasounds
Screening Tests in Antenatal Care
- Initial Tests:
- Blood group and rhesus factor
- FBC and urinalysis
- Syphilis, hepatitis B and C, and rubella antibodies
- HIV and asymptomatic bacteriuria
- Gestational Diabetes Screening: 24 to 28 weeks
- Mental Health Screening: Using the Edinburgh Postnatal Depression Scale (EPDS)
- Ultrasound and Serum Testing: For fetal growth, gestational age, and anomalies
Role of the Midwife in Antenatal Care
- Health Promotion: Educating about nutrition, exercise, and smoking cessation
- Emotional Support: Addressing mental health and domestic violence
- Screening and Diagnostics: Performing and interpreting screening tests
- Referral: Referring to specialists when necessary
- Education: Providing antenatal education and facilitating informed choices
Components of Antenatal Education
- Passive Education: During antenatal visits, through brochures and media
- Active Education: Classes covering various topics including labour, birth, and postpartum care
Models of Antenatal Education
- General Classes: Covering pregnancy, labour, and birth
- Specialized Classes: For fathers, Indigenous parents, non-English speakers, multiple births, caesarean births
- Alternative Methods: Hypnobirthing, Lamaze, active birth, antenatal yoga
- Types of Antenatal Classes:
- Pre-conception Classes: For those planning pregnancy
- Early Pregnancy Classes: Covering the first trimester
- Third Trimester Classes: More comprehensive, usually spanning 4-6 weeks
- Refresher Classes: For those who have had previous pregnancies
- Online Classes: Accessible option for those unable to attend in person
Additional Education Topics
-
Postpartum Care: Breastfeeding, baby care, managing lifestyle changes
-
Support Resources: Community support, stress reduction, and relaxation techniques### Lactogenesis
-
Lactogenesis is the initiation of milk secretion in two stages:
- Stage I: Secretory differentiation, colostrum produced at 16 weeks
- Stage II: Onset of copious milk production after birth
- Stage III: Maintenance of established lactation (galactopoiesis)
Uterus and Lochia
- Uterus involution:
- Check fundus every 15-30 minutes post-birth
- Uterus descends 1 cm/day, back to normal size within 6 weeks
- If "boggy," rub up the fundus
- Lochia:
- Rubra (bright red) for the first few days
- Serosa (light watery discharge) for a few weeks
- Alba (yellow-white discharge) for 6-8 weeks
- Monitor for signs of infection
Perineum and Wound Care
- Regular pad changing, showering, and side-lying inspections
- Ice packs for 10-20 minutes intervals in the first 24-72 hours
- Avoid constipation with urinary alkalisers and stool softeners
Caesarean Section (LSCS)
- Inspect wound each shift, protect during movement, and check for infection
- Mobilize to avoid pressure areas and ensure suture line remains clean
- Monitor for signs of infection and provide appropriate care
Bladder and Bowel Care
- Expect voiding within 6 hours post-birth
- Normal bowel function can vary; stool softeners may be needed
- Treat perineal discomfort and monitor for urinary tract infections (UTIs)
Legs: Venous Thromboembolism (VTE)
- Pregnancy increases VTE risk due to hypercoagulability, reduced blood flow, and vessel wall damage
- Risk factors include previous thromboembolism, thrombophilia, and various obstetric and lifestyle factors
- Prevention includes smoking cessation, weight reduction, hydration, mobilization, anticoagulation therapy, and compression stockings
Vital Signs
- Monitor temperature, pulse, respiratory rate, and blood pressure after birth
- Assess fluid loss, signs of anemia, and overall condition
Breastfeeding
- Support the decision to breastfeed with education and practical guidance
- Address common issues like nipple pain and trauma with evidence-based tips
- Monitor infant feeding cues and ensure proper latch and positioning
- Teach mothers to recognize effective sucking and swallowing
Safe Sleep Environment
- Ensure safe sleep practices for the infant
Transition to Extrauterine Life
- Fetal circulation:
- Oxygenation and Nutrition: Provided via the placenta
- Ductus Venosus: Shunts oxygenated blood from the placenta away from the liver into the inferior vena cava and then into the right atrium
- Foramen Ovale: Allows oxygenated blood from the right atrium to shunt across to the left atrium, entering systemic circulation via the aorta, bypassing pulmonary circulation
- Ductus Arteriosus: Shunts deoxygenated blood from the pulmonary artery into the aorta, facilitating the entry of oxygenated blood into systemic circulation, bypassing the lungs
Midwifery Assessment Immediately Following Birth
- APGAR Score:
- Devised by Virginia Apgar in the 1950s
- Low scores linked to long-term perinatal morbidity and mortality
- Skin-to-Skin Contact:
- Stabilizes cardiovascular system, increases thermoregulation, higher BGLs, and earlier and improved breastfeeding initiation and bonding
- Maintain warmth, ensure baby is dried and in direct contact, continue observation of respiration rate, tone, temperature, and color
- Managing Heat Loss:
- Infants lose heat quickly; cold stress can lead to hypoglycemia and respiratory distress
- High surface area to volume ratio; cannot shiver, rely on brown adipose tissue for heat
- Four Mechanisms of Heat Transfer:
- Convection: Heat loss to cooler ambient air
- Radiation: Heat loss to a cooler solid surface nearby
- Evaporation: Heat loss when a liquid converts to vapor
- Conduction: Heat loss to cooler surfaces in direct contact
- Preventing Heat Loss:
- Convection: Keep birthing suite at ~24°C
- Radiation: Place cribs away from windows
- Evaporation: Dry newborns immediately after birth or bath
- Conduction: Use warm blankets or skin-to-skin contact if temperature is low
Examination of the Newborn
- Initial Assessment:
- Length: Top of head to heel
- Head Circumference: Above ears
- Temperature: Axilla
- Heart Rate: Stethoscope
- Respirations: Abdomen/chest
- Weight: Monitored for expected gain
- Output: Urination and defecation patterns
- Weight and Output:
- Expected Weight Gain:
- Day 3: May lose up to 10% of birth weight
- 1 week: 20-30 grams/day
- 2 weeks: Back to birth weight
- 3 weeks to 5 months: 150 grams/week
- 5-6 months: 70-100 grams/week
- Output:
- Day 1: 1+ wet nappy, 1+ meconium (black)
- Day 2: 2+ wet nappies, 1+ meconium (black)
- Day 3: 3+ wet nappies, 1+ poo (black/brown/green)
- Day 4: 4+ wet nappies, 1+ poo (brown/green/yellow)
- Day 5: 5+ wet nappies, 1+ poo (brown/yellow)
- Day 6: 6+ wet nappies, 1+ poo (yellow)
- Expected Weight Gain:
Examinations by Medical Officers
- Developmental Dysplasia of the Hips: Checked for abnormalities
- Red Eye Reflex: Confirms lens clarity, checks for congenital cataracts
- Palpation of Internal Organs: Check for abnormalities
- Femoral Pulses: Check for cardiovascular anomalies
Neonatal Jaundice
- Definition: Accumulation of bilirubin causing yellow discoloration
- Physiological Jaundice: Common, occurs around day 3-5, often harmless but may require management
- Risk Factors: Poor feeding, low birth weight, prematurity, birth trauma
- Types of Bilirubin:
- Unconjugated: Fat-soluble, can cross the blood-brain barrier, potentially causing kernicterus
- Conjugated: Water-soluble, excreted in feces and urine
- Recognition and Management of Jaundice:
- Early Detection: Jaundice first appears in the sclera
- Progression: Starts from the face, progresses to the trunk and extremities
- Kramer's Rule: Depth of jaundice indicates bilirubin levels
- Phototherapy: Treatment involves exposure to light; breastfeeding should continue
Prevention of Hyperbilirubinemia
- Primary Prevention: Early and frequent breastfeeding, monitoring for jaundice
- Monitoring: Especially important for infants discharged before 72 hours of age
Healthy Hearing Test
- Offered to Every Baby: Free, early identification of hearing deficits to prevent speech and developmental delays
Sudden Infant Death Syndrome (SIDS)
- Definition: Sudden and unexpected death of an infant under 1 year during sleep, unexplained after investigation
- Hypothesis: Caused by multiple stressors like prone sleeping, maternal smoking, and prematurity
Neurological Development (Birth to 6 Weeks)
- Vision: Sensitive to bright lights, focus at 15-20 cm, prefer human faces
- Hearing: React to localized sounds, high-pitched sounds cause blinking/startle
- Smell, Touch, and Taste: Respond to mother's milk, prefer sweet tastes, mimic facial expressions
- Sleep/Wake Cycles: Newborns sleep 16-20 hours/day, wake primarily for hunger
Thriving Baby Indicators
- Signs of Good Health: Regular wet nappies, clear and bright eyes, calm breathing, good tone, and regular weight gain
Antenatal Care Overview
- Antenatal care involves two phases: pre-conception and pregnancy
- Building partnerships with respect for each other's knowledge and considering cultural safety are essential
- Promoting wellness and normality is a key aim of antenatal care
Models of Care
- Public hospital clinic care: general antenatal care with midwives, specific clinics for refugees, young women, and Indigenous women
- Obstetric care in public hospitals: includes specialist services such as maternal fetal medicine
- Public hospital midwifery care: predominantly midwife-led, with some consultations with doctors
- Team midwifery: small teams providing comprehensive care throughout pregnancy and birth
- Birth centre care: midwife-led care in a separate hospital section
- GP shared maternity care: collaboration between public hospitals and local practitioners
- Caseload midwifery care: ongoing care by the same midwife
- Planned homebirths: midwife-led care at home with hospital transfer if needed
- Private maternity care: care by private obstetricians or GPs
- Private midwifery care: private midwives providing hospital births
Australian Pregnancy Care Guidelines
- Maternity and neonatal clinical guidelines: developed by the Australian Living Evidence Collaboration
- Midwife standards for practice: established by the Nursing and Midwifery Board of Australia (NMBA)
Importance of Antenatal History Taking
- Systematic history taking is essential for effective antenatal care
- Psychological history: screening for mental health issues
- Routine screenings: includes blood tests, urinalysis, and ultrasounds
Screening Tests in Antenatal Care
- Initial tests: blood group, rhesus factor, FBC, syphilis, hepatitis B and C, rubella antibodies, HIV, and asymptomatic bacteriuria
- Gestational diabetes screening: 24-28 weeks
- Mental health screening: using the Edinburgh Postnatal Depression Scale (EPDS)
- Ultrasound and serum testing: for fetal growth, gestational age, and anomalies
Role of the Midwife in Antenatal Care
- Health promotion: educating about nutrition, exercise, and smoking cessation
- Emotional support: addressing mental health and domestic violence
- Screening and diagnostics: performing and interpreting screening tests
- Referral: referring to specialists when necessary
- Education: providing antenatal education and facilitating informed choices
Components of Antenatal Education
- Passive education: during antenatal visits, through brochures and media
- Active education: classes covering various topics including labour, birth, and postpartum care
Models of Antenatal Education
- General classes: covering pregnancy, labour, and birth
- Specialized classes: for fathers, Indigenous parents, non-English speakers, multiple births, and caesarean births
- Alternative methods: hypnobirthing, Lamaze, active birth, and antenatal yoga
Types of Antenatal Classes
- Pre-conception classes: for those planning pregnancy
- Early pregnancy classes: covering the first trimester
- Third trimester classes: more comprehensive, usually spanning 4-6 weeks
- Refresher classes: for those who have had previous pregnancies
- Online classes: accessible option for those unable to attend in person
Additional Education Topics
- Postpartum care: breastfeeding, baby care, and managing lifestyle changes
- Support resources: community support, stress reduction, and relaxation techniques
Midwifery and Obstetrics Key Concepts
- Midwife: formed from "mid" (together with) and "wife" (woman), meaning "with woman"
- Obstetric: derived from "obst" (to stand in front of) and the feminine suffix "trics," meaning "to stand in front of the baby as it is being born"
Definitions of Normal Birth
- Normal birth: spontaneous onset, low-risk at the start and throughout labor, infant born spontaneously in vertex position between 37-42 weeks, and mother and infant in good condition after birth
- Queensland Health definition: includes spontaneous onset, progression, and birth in vertex position, with some medical interventions allowed
Cascade of Intervention
- Example: G1P0 with normal pregnancy in spontaneous labor, with a series of interventions leading to a cesarean section
Cesarean Section
- Rate in Australia: 32%
- Indications: clinically indicated reasons, lifesaving
- Risks: intraoperative and subsequent pregnancies
Supporting Normal Birth
- Principles: language, expectation, evidence, and practice
- Women-centered language: avoiding terms like "delivery" and "catch"
- Contractions and pain: understanding the subjective experience of pain and suffering
Stages of Labor
- First stage: onset of regular contractions to full dilation of the cervix
- Second stage: full dilation of the cervix to complete expulsion of the fetus
- Third stage: expulsion of the fetus to expulsion of the placenta and membranes
Mechanisms of Labour
- Fetal movements: the fetus negotiates the curved birth canal
- Pelvic planes: inlet, outlet, and midpelvis
- Importance: knowledge of mechanisms of labour and diameters of the fetal skull and maternal pelvis helps midwives facilitate birth with minimal trauma
Importance of Mechanisms of Labour
- Understanding fetal positioning and movements
- Knowledge of pelvic diameters and maternal pelvis
Fetal Positioning and Movements
- Determined by abdominal palpation
- Fetal lie: longitudinal, transverse, or oblique
- Fetal attitude: normal or abnormal
- Fetal presentation: cephalic, breech, or shoulder
Pelvic Diameters
- Outlet: widest in the anteroposterior diameter
- Inlet: widest in the transverse diameter
- Importance: knowledge of pelvic diameters helps midwives facilitate birth with minimal trauma
Cardinal Movements of Labour
- Descent: fetal head enters pelvis
- Flexion: head flexes to present smallest diameter
- Internal rotation: head rotates to align with pelvic outlet
- Extension: head extends as it passes through birth canal
- Restitution: head untwists after passing through pelvis
- Internal rotation of shoulders: shoulders rotate to align with pelvic outlet
- Lateral flexion: shoulders and body follow head through birth canal
Third Stage of Labour
- Separation and expulsion of placenta
- Active management: prophylactic oxytocic drug and controlled cord traction
- Physiological management: hands-off approach, waiting for signs of placental separation
Care of Neonate
- Place baby on mother's chest
- Keep mother and baby warm
- Encourage breastfeeding
- Clamp and cut the umbilical cord as directed
- Monitor maternal blood loss
Professional and Ethical Behaviour
- Language: using empowering, non-paternalistic language
- Protection: birth is a vulnerable time; focus should be on the woman
- Intra-partum care: assessment, prevention, and management of complications
Postnatal Period
- Physical and psychological changes
- Care for women: physical, emotional, cultural, and individualized
- Key points for midwives: first education, rapport, and trust
Maternal Wellbeing
- Normal emotions: baby blues and postnatal depression
- Infant wellbeing: parental mental wellbeing and secure relationships
Partner Wellbeing
- Partners play a vital role in the baby's development
- Involve partners in baby care and teach them to support breastfeeding
Maternal Postnatal Physiological Changes
- Breasts: undergo significant changes from birth to pregnancy, lactation, and involution
- Uterus and lochia: uterine involution and lochia changes
- Perineum and wound care: regular pad changing, showering, and side-lying inspections
- Legs: venous thromboembolism prevention
Bladder and Bowel Care
- Expect voiding within 6 hours post-birth
- Normal bowel function can vary
- Treat perineal discomfort and monitor for urinary tract infections
Legs: Venous Thromboembolism
- Pregnancy increases VTE risk
- Risk factors: previous thromboembolism, thrombophilia, and various obstetric and lifestyle factors
- Prevention: smoking cessation, weight reduction, hydration, mobilization, anticoagulation therapy, and compression stockings### Vital Signs and Newborn Care
- Monitor temperature, pulse, respiratory rate, and blood pressure after birth to assess overall condition and fluid loss.
- Support breastfeeding with education and practical guidance to address common issues like nipple pain and trauma.
- Ensure proper latch and positioning, and teach mothers to recognize effective sucking and swallowing.
- Create a safe sleep environment for the infant.
Fetal Circulation and Transition to Extrauterine Life
- Fetal circulation involves oxygenation and nutrition via the placenta.
- Ductus venosus shunts oxygenated blood from the placenta away from the liver into the inferior vena cava and then into the right atrium.
- Foramen ovale allows oxygenated blood from the right atrium to shunt across to the left atrium, entering systemic circulation via the aorta, bypassing pulmonary circulation.
- Ductus arteriosus shunts deoxygenated blood from the pulmonary artery into the aorta, facilitating the entry of oxygenated blood into systemic circulation, bypassing the lungs.
Midwifery Assessment Immediately Following Birth
- APGAR score assesses newborn health and well-being, with low scores linked to long-term perinatal morbidity and mortality.
- Skin-to-skin contact stabilizes cardiovascular system, increases thermoregulation, and promotes earlier and improved breastfeeding initiation and bonding.
Managing Heat Loss in Newborns
- Infants lose heat quickly due to high surface area to volume ratio and inability to shiver, relying on brown adipose tissue for heat.
- Four mechanisms of heat transfer: convection, radiation, evaporation, and conduction.
- Prevent heat loss by keeping the birthing suite at ~24°C, placing cribs away from windows, drying newborns immediately after birth or bath, and using warm blankets or skin-to-skin contact.
Examination of the Newborn
- Initial assessment includes length, head circumference, temperature, heart rate, respirations, weight, and output.
- Monitor weight gain, expected to lose up to 10% of birth weight on day 3, and return to birth weight by 2 weeks.
- Assess output, including urination and defecation patterns.
Neonatal Jaundice
- Definition: Accumulation of bilirubin causing yellow discoloration.
- Physiological jaundice is common, occurring around day 3-5, and often harmless but may require management.
- Risk factors: Poor feeding, low birth weight, prematurity, and birth trauma.
- Types of bilirubin: unconjugated (fat-soluble) and conjugated (water-soluble).
- Recognize and manage jaundice by early detection, monitoring bilirubin levels, and phototherapy treatment.
Sudden Infant Death Syndrome (SIDS)
- Definition: Sudden and unexpected death of an infant under 1 year during sleep, unexplained after investigation.
- Hypothesis: Caused by multiple stressors like prone sleeping, maternal smoking, and prematurity.
Midwifery Philosophy and Definition
- The International Confederation of Midwives (ICM) definition: A midwife is a person who has successfully completed a midwifery education program and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
- Australian College of Midwives (ACM) definition: A midwife is a person recognized by their country's midwifery regulatory authority as a qualified practitioner who provides care to women during pregnancy, birth, and the postnatal period.
- Midwifery philosophy: Focus on natural childbirth, minimizing interventions, and providing woman-centered care.
History of Midwifery
- Ancient Egypt to Aristotle: Women being with mothers in childbirth depicted in art.
- Middle Ages: Epistemology of midwifery (pseudo-Aristotle) and association with witchcraft.
- 17th Century: Medicalization of midwifery.
- Last 100 Years: Modern movement of midwifery, woman-focused midwifery training, and being a midwife as a passion and calling.
Woman-Centered Care (WCC)
- WCC themes and sub-themes: Defining characteristics of woman-centered care, the role of the midwife, and woman-centered care in education and research.
- Consensus on woman-centered care: Care should be holistic and tailored to the individual woman, rather than routine.
- Concept analysis of woman-centered care: Education, models of care, and midwife characteristics are antecedents, attributes include choice, control, empowerment, and relationships, and consequences involve shared decision-making and improved health outcomes.
Responsibilities and Characteristics of a Midwife
- Provide care during pregnancy, birth, and postnatal periods, including care of the newborn.
- Midwifery encompasses antenatal, intrapartum, and postnatal care.
- Good midwives possess specific personal characteristics, organizational competencies, and promote physiological reproductive processes.
- Five themes identified: Professional caring, professional wisdom, personal and professional development, interpersonal competence, and professional competence.
Antenatal Care Overview
- Antenatal care involves two phases: pre-conception and pregnancy
- Building partnerships with respect for each other's knowledge and considering cultural safety are essential
- Promoting wellness and normality is a key aim of antenatal care
Models of Care
- Public hospital clinic care: general antenatal care with midwives, specific clinics for refugees, young women, and Indigenous women
- Obstetric care in public hospitals: includes specialist services such as maternal fetal medicine
- Public hospital midwifery care: predominantly midwife-led, with some consultations with doctors
- Team midwifery: small teams providing comprehensive care throughout pregnancy and birth
- Birth centre care: midwife-led care in a separate hospital section
- GP shared maternity care: collaboration between public hospitals and local practitioners
- Caseload midwifery care: ongoing care by the same midwife
- Planned homebirths: midwife-led care at home with hospital transfer if needed
- Private maternity care: care by private obstetricians or GPs
- Private midwifery care: private midwives providing hospital births
Australian Pregnancy Care Guidelines
- Maternity and neonatal clinical guidelines: developed by the Australian Living Evidence Collaboration
- Midwife standards for practice: established by the Nursing and Midwifery Board of Australia (NMBA)
Importance of Antenatal History Taking
- Systematic history taking is essential for effective antenatal care
- Psychological history: screening for mental health issues
- Routine screenings: includes blood tests, urinalysis, and ultrasounds
Screening Tests in Antenatal Care
- Initial tests: blood group, rhesus factor, FBC, syphilis, hepatitis B and C, rubella antibodies, HIV, and asymptomatic bacteriuria
- Gestational diabetes screening: 24-28 weeks
- Mental health screening: using the Edinburgh Postnatal Depression Scale (EPDS)
- Ultrasound and serum testing: for fetal growth, gestational age, and anomalies
Role of the Midwife in Antenatal Care
- Health promotion: educating about nutrition, exercise, and smoking cessation
- Emotional support: addressing mental health and domestic violence
- Screening and diagnostics: performing and interpreting screening tests
- Referral: referring to specialists when necessary
- Education: providing antenatal education and facilitating informed choices
Components of Antenatal Education
- Passive education: during antenatal visits, through brochures and media
- Active education: classes covering various topics including labour, birth, and postpartum care
Models of Antenatal Education
- General classes: covering pregnancy, labour, and birth
- Specialized classes: for fathers, Indigenous parents, non-English speakers, multiple births, and caesarean births
- Alternative methods: hypnobirthing, Lamaze, active birth, and antenatal yoga
Types of Antenatal Classes
- Pre-conception classes: for those planning pregnancy
- Early pregnancy classes: covering the first trimester
- Third trimester classes: more comprehensive, usually spanning 4-6 weeks
- Refresher classes: for those who have had previous pregnancies
- Online classes: accessible option for those unable to attend in person
Additional Education Topics
- Postpartum care: breastfeeding, baby care, and managing lifestyle changes
- Support resources: community support, stress reduction, and relaxation techniques
Midwifery and Obstetrics Key Concepts
- Midwife: formed from "mid" (together with) and "wife" (woman), meaning "with woman"
- Obstetric: derived from "obst" (to stand in front of) and the feminine suffix "trics," meaning "to stand in front of the baby as it is being born"
Definitions of Normal Birth
- Normal birth: spontaneous onset, low-risk at the start and throughout labor, infant born spontaneously in vertex position between 37-42 weeks, and mother and infant in good condition after birth
- Queensland Health definition: includes spontaneous onset, progression, and birth in vertex position, with some medical interventions allowed
Cascade of Intervention
- Example: G1P0 with normal pregnancy in spontaneous labor, with a series of interventions leading to a cesarean section
Cesarean Section
- Rate in Australia: 32%
- Indications: clinically indicated reasons, lifesaving
- Risks: intraoperative and subsequent pregnancies
Supporting Normal Birth
- Principles: language, expectation, evidence, and practice
- Women-centered language: avoiding terms like "delivery" and "catch"
- Contractions and pain: understanding the subjective experience of pain and suffering
Stages of Labor
- First stage: onset of regular contractions to full dilation of the cervix
- Second stage: full dilation of the cervix to complete expulsion of the fetus
- Third stage: expulsion of the fetus to expulsion of the placenta and membranes
Mechanisms of Labour
- Fetal movements: the fetus negotiates the curved birth canal
- Pelvic planes: inlet, outlet, and midpelvis
- Importance: knowledge of mechanisms of labour and diameters of the fetal skull and maternal pelvis helps midwives facilitate birth with minimal trauma
Importance of Mechanisms of Labour
- Understanding fetal positioning and movements
- Knowledge of pelvic diameters and maternal pelvis
Fetal Positioning and Movements
- Determined by abdominal palpation
- Fetal lie: longitudinal, transverse, or oblique
- Fetal attitude: normal or abnormal
- Fetal presentation: cephalic, breech, or shoulder
Pelvic Diameters
- Outlet: widest in the anteroposterior diameter
- Inlet: widest in the transverse diameter
- Importance: knowledge of pelvic diameters helps midwives facilitate birth with minimal trauma
Cardinal Movements of Labour
- Descent: fetal head enters pelvis
- Flexion: head flexes to present smallest diameter
- Internal rotation: head rotates to align with pelvic outlet
- Extension: head extends as it passes through birth canal
- Restitution: head untwists after passing through pelvis
- Internal rotation of shoulders: shoulders rotate to align with pelvic outlet
- Lateral flexion: shoulders and body follow head through birth canal
Third Stage of Labour
- Separation and expulsion of placenta
- Active management: prophylactic oxytocic drug and controlled cord traction
- Physiological management: hands-off approach, waiting for signs of placental separation
Care of Neonate
- Place baby on mother's chest
- Keep mother and baby warm
- Encourage breastfeeding
- Clamp and cut the umbilical cord as directed
- Monitor maternal blood loss
Professional and Ethical Behaviour
- Language: using empowering, non-paternalistic language
- Protection: birth is a vulnerable time; focus should be on the woman
- Intra-partum care: assessment, prevention, and management of complications
Postnatal Period
- Physical and psychological changes
- Care for women: physical, emotional, cultural, and individualized
- Key points for midwives: first education, rapport, and trust
Maternal Wellbeing
- Normal emotions: baby blues and postnatal depression
- Infant wellbeing: parental mental wellbeing and secure relationships
Partner Wellbeing
- Partners play a vital role in the baby's development
- Involve partners in baby care and teach them to support breastfeeding
Maternal Postnatal Physiological Changes
- Breasts: undergo significant changes from birth to pregnancy, lactation, and involution
- Uterus and lochia: uterine involution and lochia changes
- Perineum and wound care: regular pad changing, showering, and side-lying inspections
- Legs: venous thromboembolism prevention
Bladder and Bowel Care
- Expect voiding within 6 hours post-birth
- Normal bowel function can vary
- Treat perineal discomfort and monitor for urinary tract infections
Legs: Venous Thromboembolism
- Pregnancy increases VTE risk
- Risk factors: previous thromboembolism, thrombophilia, and various obstetric and lifestyle factors
- Prevention: smoking cessation, weight reduction, hydration, mobilization, anticoagulation therapy, and compression stockings### Vital Signs and Newborn Care
- Monitor temperature, pulse, respiratory rate, and blood pressure after birth to assess overall condition and fluid loss.
- Support breastfeeding with education and practical guidance to address common issues like nipple pain and trauma.
- Ensure proper latch and positioning, and teach mothers to recognize effective sucking and swallowing.
- Create a safe sleep environment for the infant.
Fetal Circulation and Transition to Extrauterine Life
- Fetal circulation involves oxygenation and nutrition via the placenta.
- Ductus venosus shunts oxygenated blood from the placenta away from the liver into the inferior vena cava and then into the right atrium.
- Foramen ovale allows oxygenated blood from the right atrium to shunt across to the left atrium, entering systemic circulation via the aorta, bypassing pulmonary circulation.
- Ductus arteriosus shunts deoxygenated blood from the pulmonary artery into the aorta, facilitating the entry of oxygenated blood into systemic circulation, bypassing the lungs.
Midwifery Assessment Immediately Following Birth
- APGAR score assesses newborn health and well-being, with low scores linked to long-term perinatal morbidity and mortality.
- Skin-to-skin contact stabilizes cardiovascular system, increases thermoregulation, and promotes earlier and improved breastfeeding initiation and bonding.
Managing Heat Loss in Newborns
- Infants lose heat quickly due to high surface area to volume ratio and inability to shiver, relying on brown adipose tissue for heat.
- Four mechanisms of heat transfer: convection, radiation, evaporation, and conduction.
- Prevent heat loss by keeping the birthing suite at ~24°C, placing cribs away from windows, drying newborns immediately after birth or bath, and using warm blankets or skin-to-skin contact.
Examination of the Newborn
- Initial assessment includes length, head circumference, temperature, heart rate, respirations, weight, and output.
- Monitor weight gain, expected to lose up to 10% of birth weight on day 3, and return to birth weight by 2 weeks.
- Assess output, including urination and defecation patterns.
Neonatal Jaundice
- Definition: Accumulation of bilirubin causing yellow discoloration.
- Physiological jaundice is common, occurring around day 3-5, and often harmless but may require management.
- Risk factors: Poor feeding, low birth weight, prematurity, and birth trauma.
- Types of bilirubin: unconjugated (fat-soluble) and conjugated (water-soluble).
- Recognize and manage jaundice by early detection, monitoring bilirubin levels, and phototherapy treatment.
Sudden Infant Death Syndrome (SIDS)
- Definition: Sudden and unexpected death of an infant under 1 year during sleep, unexplained after investigation.
- Hypothesis: Caused by multiple stressors like prone sleeping, maternal smoking, and prematurity.
Midwifery Philosophy and Definition
- The International Confederation of Midwives (ICM) definition: A midwife is a person who has successfully completed a midwifery education program and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
- Australian College of Midwives (ACM) definition: A midwife is a person recognized by their country's midwifery regulatory authority as a qualified practitioner who provides care to women during pregnancy, birth, and the postnatal period.
- Midwifery philosophy: Focus on natural childbirth, minimizing interventions, and providing woman-centered care.
History of Midwifery
- Ancient Egypt to Aristotle: Women being with mothers in childbirth depicted in art.
- Middle Ages: Epistemology of midwifery (pseudo-Aristotle) and association with witchcraft.
- 17th Century: Medicalization of midwifery.
- Last 100 Years: Modern movement of midwifery, woman-focused midwifery training, and being a midwife as a passion and calling.
Woman-Centered Care (WCC)
- WCC themes and sub-themes: Defining characteristics of woman-centered care, the role of the midwife, and woman-centered care in education and research.
- Consensus on woman-centered care: Care should be holistic and tailored to the individual woman, rather than routine.
- Concept analysis of woman-centered care: Education, models of care, and midwife characteristics are antecedents, attributes include choice, control, empowerment, and relationships, and consequences involve shared decision-making and improved health outcomes.
Responsibilities and Characteristics of a Midwife
- Provide care during pregnancy, birth, and postnatal periods, including care of the newborn.
- Midwifery encompasses antenatal, intrapartum, and postnatal care.
- Good midwives possess specific personal characteristics, organizational competencies, and promote physiological reproductive processes.
- Five themes identified: Professional caring, professional wisdom, personal and professional development, interpersonal competence, and professional competence.
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Explore the importance of antenatal care, including models of care, guidelines, and education. Discuss the role of midwives and screening tests in antenatal care.
