Antenatal Care Notes PDF

Explore the aim and considerations of antenatal care Identify models of antenatal care Explore the supporting guidelines for antenatal care provision Review the importance of antenatal history taking Identify screening tests and their place in antenatal care Discu...

Explore the aim and considerations of antenatal care Identify models of antenatal care Explore the supporting guidelines for antenatal care provision Review the importance of antenatal history taking Identify screening tests and their place in antenatal care Discuss the role of the midwife in antenatal care Ascertain components of antenatal education Discuss models of antenatal education Antenatal Care Overview 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. 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 Models of 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. Australian Pregnancy Care Guidelines (2023) Maternity and Neonatal Clinical Guidelines: Developed by the Australian Living Evidence Collaboration. Midwife Standards for Practice (NMBA, 2018) 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, rhesus factor, FBC, syphilis, hepatitis B and C, rubella antibodies, HIV, 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, 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. However there is a document that you will learn about called the partogram and this is a one page visualisation of everything that is happening while the woman is in labour. It is usual to commence the partogram when the woman is in the active phase of labour. The partogram is essentially an observation tool and will only be as good as what is put on it. As a minimum it should record: o fetal heart rate every 15 to 30 minutes (after a contraction for 60 secs) o half hourly assessment of contractions: length, strength and frequency o 4 hourly blood pressure, temperature and vaginal examination offered o Frequency of bladder emptying o Ongoing consideration of woman’s emotional and psychological need 1. Non-Invasive Prenatal Testing (NIPT): Guideline: Recommended as a screening option for all pregnant women. It is highly accurate for detecting trisomies 21, 18, and 13. Normal Result: Low risk for chromosomal abnormalities. Reference: Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines. 2. Combined First-Trimester Screening: Guideline: Recommended for all pregnant women between 11-13+6 weeks of gestation. Components: o Nuchal Translucency (NT) Ultrasound: § Normal Result: NT measurement less than 3.5 mm. o Blood Tests: § PAPP-A and Free β-hCG: Levels within the normal range for gestational age. Normal Result: Low risk for chromosomal abnormalities when combining NT measurement and blood test results. Reference: RANZCOG and Australian Government Department of Health. 3. Nuchal Translucency (NT) Ultrasound: Guideline: Part of the combined first-trimester screening. Normal Result: NT measurement less than 3.5 mm. Reference: RANZCOG guidelines. 4. Second-Trimester Maternal Serum Screening (Quad Screen): Guideline: Offered as an alternative if first-trimester screening is missed. Components: o AFP, hCG, uE3, and Inhibin A: Levels within the expected range for gestational age. Normal Result: Low risk for neural tube defects, Down syndrome, and trisomy 18. Reference: Australian Government Department of Health guidelines. 5. Anatomy Scan (18-20 Weeks Ultrasound): Guideline: Recommended for all pregnant women between 18-20 weeks of gestation. Normal Result: No structural abnormalities detected. Reference: Australian Society for Ultrasound in Medicine (ASUM) guidelines. 6. Glucose Tolerance Test (24-28 Weeks): Guideline: Recommended for all pregnant women between 24-28 weeks of gestation to screen for gestational diabetes. Normal Results: o Fasting Blood Glucose: Less than 5.1 mmol/L (92 mg/dL). o 1-Hour Blood Glucose: Less than 10.0 mmol/L (180 mg/dL). o 2-Hour Blood Glucose: Less than 8.5 mmol/L (153 mg/dL). Reference: Australasian Diabetes in Pregnancy Society (ADIPS) guidelines. 7. Group B Streptococcus (GBS) Screening (35-37 Weeks): Guideline: Recommended for all pregnant women between 35-37 weeks of gestation. Normal Result: Negative for GBS colonization. Reference: Australian Government Department of Health guidelines Midwifery and Obstetrics Key Concepts Midwife: Formed in Middle English 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 (General):  Spontaneous onset, low risk at the start and throughout labor. Infant born spontaneously in vertex position between 37-42 weeks. Mother and infant in good condition after birth. Interventions should only occur if there is a valid reason. Queensland Health Definition: Includes spontaneous onset, progression, and birth in vertex position. Allows for artificial rupture of membranes, nitrous oxide, opioids, intermittent fetal auscultation, and third stage management (physiological or active). Excludes induction, augmentation with oxytocin, epidural, spinal or general anesthesia, forceps, ventouse, caesarean section, and episiotomy. Cascade of Intervention Example: G1P0 with normal pregnancy in spontaneous labor. o Cervix dilates from 4 to 6 cm in four hours, ARM performed. o Pain increases, variable fetal heart decelerations heard. o CTG monitoring initiated, mobility limited. o Epidural administered, contractions weaken, oxytocin infusion commenced. o Epidural interferes with pushing mechanism, vacuum extraction required. Cesarean Section (CS) Rate in Australia: 32%. Indications: Clinically indicated reasons, lifesaving. Risks: o Intraoperative: Infections, organ injury, anaesthesia o Subsequent pregnancies: IUGR, preterm delivery, spontaneous abortion, ectopic pregnancy, stillbirth, uterine rupture, infertility, placenta praevia/accreta/percreta. Supporting Normal Birth Principles: Language, expectation, evidence, practice. Women-Centered Language: Avoid terms like "delivery," "catch," "confine," "trial of scar." Use terms like "birth," "vaginal birth after cesarean." Contractions and Pain: Contractions: Onset of painful contractions to full dilation. o Latent phase: 0-4 to 6 cm, may stop and start.  o Active phase: 4-6 cm, labor accelerates. o Transition phase. Pain: Subjective experience, influenced by psychological and cultural factors. Suffering: Includes fear and anxiety, differs from pain. Supporting Women: Nonpharmacological methods: Presence, massage, water immersion, mobility, sterile water injections, heat and cold packs, distraction. Monitoring: Vaginal exams, abdominal palpation, maternal behaviors, changes in contraction pattern, purple line. Stages of Labor First Stage: Onset of painful contractions to full dilation. o Latent phase: 0-4 to 6 cm, irregular contractions. o Active phase: Labor accelerates, 4-6 cm. o Transition phase. Second Stage: From full dilation to birth of infant. o Latent phase. o Active phase: Expulsive reflex increases, fetal descent. Third Stage: Birth of infant to birth of placenta. o Active management: Oxytocin, cord traction. o Physiological management: Wait for uterine cramps, maternal effort. Key Concepts in Labor and Birth Midwifery Practice: o Know when to intervene and when to wait. o Consider benefits, risks, alternatives, intuition, and doing nothing. Pain and Suffering: o Pain: Sensation associated with tissue damage. o Suffering: Subjective sensations like fear and anxiety. Nonpharmacological Support: o Presence and support, massage, water immersion, mobility, sterile water injections, heat and cold packs, distraction. Monitoring Progress: o Vaginal exams, abdominal palpation, maternal behaviors, contraction patterns, purple line. Summary of Contraction Phases Latent Phase: Mild-moderate contractions, localized pain, presenting part 3-4/5, uterus irritable. Support: Reassurance, home care, alternate rest and activity. Active Phase: Stronger, longer contractions, presenting part descends, woman becomes more centered. Support: Comfort measures, position changes, relaxation, verbal encouragement. Transition: Intense, frequent contractions, presenting part descends, woman may feel hot and restless. Support: Verbal support, position changes, space and calm environment. Second Stage (Latent and Active): Contractions slow, expulsive reflex increases, presenting part visible. Support: Celebrate progress, position changes, stay positive and encouraging. Third Stage: Signs of placental separation: Cord lengthening, separation bleed. Support: Active or physiological management, breastfeeding helps Mechanisms of Labour Fetal Movements: The fetus negotiates the curved birth canal formed by the bony maternal pelvis, turning slightly to take advantage of the widest part of each plane of the pelvis. Pelvic Planes: o Inlet: Widest in the transverse diameter. Fetus enters pelvis in the transverse diameter. o Outlet: Widest in the anteroposterior diameter. Fetal head seeks this diameter at birth. Importance: Knowledge of mechanisms of labour and diameters of the fetal skull and maternal pelvis helps midwives facilitate birth with minimal trauma to mother and fetus. Stages of Labour Stage 1: Onset of regular contractions to full dilation of the cervix (Cx). Divided into latent, active, and transitional phases. Stage 2: Full dilation of the cervix to complete expulsion of the fetus. Stage 3: Expulsion of the fetus to expulsion of the placenta and membranes, with controlled bleeding. Pre-Birth History Taking Questions to Ask: o Gestation? Number? o Number of previous babies? o Time since last baby? o Duration of previous labour? Uterine Segments at Term Upper Segment: Bulk of muscle, contracts and shortens, pushing fetus downward. Lower Segment: Thins and elongates as cervix effaces, dilates, and retracts upward. Effacement & Dilatation Process by which the cervix prepares for delivery, becoming thinner (effacement) and opening wider (dilatation). Factors Affecting Labour and Birth (5 P's) 1. Passenger: Fetus and placenta. 2. Passageway: Birth canal. 3. Powers: Contractions. 4. Position: Mother's position during labour. 5. Psychological Response: Mother's psychological state. Fetal Positioning and Movements Determined by Abdominal Palpation: o Lie o Attitude o Presentation o Position Fetal Skull: o Comprised of parietal, temporal, frontal, and occipital bones. o United by membranous sutures (sagittal, lambdoidal, coronal, frontal) and fontanelles. o Flexibility due to sutures and fontanelles allows molding during labour. Presentations Cephalic (96% of births): Head first. Breech (3%): Buttocks or feet first. Shoulder (1%): Shoulder first. Fetal Lie Longitudinal Lie: Either cephalic or breech presentation. Transverse Lie: Cannot birth vaginally. Oblique Lie: Converts to longitudinal or transverse during labour. Fetal Attitude Normal Attitude: General flexion (rounded back, chin flexed on chest, arms crossed over thorax). Diameters of Fetal Skull Flexed Attitude: Presents smallest diameters (suboccipitobregmatic, occipitofrontal, occipitomental) at maternal pelvic brim. Denominators and Stations Denominator: Point on presenting part of fetus indicating its position in relation to maternal pelvis. Stations: Measure of fetal descent through birth canal. o 0 Station: Level of ischial spines. o Negative Stations (-1, -2, etc.): Above spines. o Positive Stations (+1, +2, etc.): Below spines. o Imminent Birth: +4 to +5. Birth Canal Composed of: Bony pelvis and soft tissues of cervix and vagina. Pelvic Brim: Separates false pelvis (above, no role in birth) and true pelvis (below, involved in birth). Cardinal Movements of Labour 1. Descent: Fetal head enters pelvis. 2. Flexion: Head flexes to present smallest diameter. 3. Internal Rotation: Head rotates to align with pelvic outlet. 4. Extension: Head extends as it passes through birth canal. 5. Restitution: Head untwists after passing through pelvis. 6. Internal Rotation of Shoulders: Shoulders rotate to align with pelvic outlet. 7. Lateral Flexion: Shoulders and body follow head through birth canal. Third Stage of Labour Separation and Expulsion of Placenta: o Active Management: Prophylactic oxytocic drug and controlled cord traction. o Physiological Management: Hands-off approach, waiting for signs of placental separation (cord lengthening, fresh blood loss). Care of Neonate: o Place baby on mother's chest. o Keep mother and baby warm. o Encourage breastfeeding to stimulate natural oxytocin release. o Clamp and cut the umbilical cord as directed. o Monitor maternal blood loss. Professional and Ethical Behaviour Language: Use empowering, non-paternalistic language.  Protection: Birth is a vulnerable time; focus should be on the woman. Intra Partum Care Assessment: o Fetal heart rate (FHR) auscultation. o Progress of labour via maternal behaviour and vaginal examinations. o Maintain a care pathway through intra partum records. Key Points Mechanisms of Labour: Essential for recognizing and facilitating normal birth processes. Midwife's Role: Utilize knowledge of pelvic diameters and fetal positioning to minimize trauma. Labour Progression: Regular monitoring and appropriate interventions based on the 5 P's. Ethical Care: Focus on woman-centered language and care, ensuring empowerment and partnership The Postnatal Period Mostly a time of joy and excitement. Involves both physical and psychological changes. Care for Women Includes Physical Emotional Cultural Individualized and Woman-Centered Key Points for Midwives First education from midwives is crucial. Develop rapport and trust by listening. Provide reassurance and be sympathetic. Use appropriate language. Focus on normalcy. Listen attentively. Physical and Emotional Needs Head: Address emotional needs. Breasts: Include feeding support. Uterus Lochia Perineum  Elimination Legs Comfort: Ensure hygiene, mobility, nutrition. Observations: Monitor vital signs based on the woman's condition. Cultural Needs Hygiene Nutrition Infant Feeding Examples: Japan: No showering or washing hair until 7 days after birth; mothers rest for a month. Afghanistan: New mothers relax, eat nutritious food, and stay home for 40 days. Cambodia: New mothers must be kept warm and not shower for three days; wear a headscarf and socks. Maternal Wellbeing Normal Emotions: o Baby blues (days 3-10): teary, irritable, mood changes. o Baby blues are not the same as postnatal depression and usually resolve within a few days with support. o Persistent feelings beyond a few weeks may indicate depression or anxiety. Infant Wellbeing Parental mental wellbeing is crucial for the infant's emotional and physical development. Important for infants to form secure relationships with parents and explore their environment. Partner Wellbeing Partners play a vital role in the baby's development from pregnancy. Involve partners in baby care and teach them to support breastfeeding. Provide praise and encouragement. Midwives can facilitate partner involvement in care. Maternal Postnatal Physiological Changes Breasts: The Mammary Gland Undergoes significant changes from birth to pregnancy, lactation, and involution. Major structures: skin (including nipple and areola), subcutaneous tissue, and corpus mammae. Functional Anatomy Corpus Mammae: Mammary gland. Parenchyma: Ducts, lobes, and alveolar structures.  Stroma: Connective tissue, adipose tissue, blood vessels, lymphatics, and nerves. Hormonal Reflex Sensory nerve stimulation releases prolactin and oxytocin. Sympathetic mammary stimulation (suckling) contracts myoepithelial cells of the areola and nipple. Human Lactation - Morphogenesis Embryogenesis: Fetal bud develops at 18-19 weeks. Mammogenesis: Mammary growth during puberty, pregnancy. Lactogenesis: Initiation of milk secretion in two stages. o Stage I: Secretory differentiation, colostrum produced at 16 weeks. o Stage II: Onset of copious milk production after birth. o Stage III: Maintenance of established lactation (galactopoiesis). Uterus and Lochia Uterus Involution: o Check fundus every 15-30 minutes post-birth. o Uterus descends 1 cm/day, back to normal size within 6 weeks. o If "boggy," rub up the fundus. Lochia: o Rubra (bright red) for the first few days. o Serosa (light watery discharge) for a few weeks. o Alba (yellow-white discharge) for 6-8 weeks. o 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 Exam Notes: 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: o Devised by Virginia Apgar in the 1950s. o Low scores linked to long-term perinatal morbidity and mortality. Skin-to-Skin Contact: o Stabilizes cardiovascular system, increases thermoregulation, higher BGLs, earlier and improved breastfeeding initiation and bonding. o Maintain warmth, ensure baby is dried and in direct contact, continue observation of respiration rate, tone, temperature, and color. Managing Heat Loss: o Infants lose heat quickly; cold stress can lead to hypoglycemia and respiratory distress.  o 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: o Length: Top of head to heel. o Head Circumference: Above ears. o Temperature: Axilla. o Heart Rate: Stethoscope. o Respirations: Abdomen/chest. o Weight: Monitored for expected gain. o Output: Urination and defecation patterns. Weight and Output Expected Weight Gain: o Day 3: May lose up to 10% of birth weight. o 1 week: 20-30 grams/day. o 2 weeks: Back to birth weight. o 3 weeks to 5 months: 150 grams/week. o 5-6 months: 70-100 grams/week. Output: o Day 1: 1+ wet nappy, 1+ meconium (black). o Day 2: 2+ wet nappies, 1+ meconium (black). o Day 3: 3+ wet nappies, 1+ poo (black/brown/green). o Day 4: 4+ wet nappies, 1+ poo (brown/green/yellow). o Day 5: 5+ wet nappies, 1+ poo (brown/yellow). o Day 6: 6+ wet nappies, 1+ poo (yellow). 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: o Unconjugated: Fat-soluble, can cross the blood-brain barrier, potentially causing kernicterus. o 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. What is a Midwife? International Confederation of Midwives (ICM) Definition: The International definition of the Midwife: A midwife is a person who has successfully completed a midwifery education program that is recognized in the country where it is located 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 Origin of the Word 'Midwife': The word 'midwife' comes from the Middle English words "mid" meaning "with" and "wife" meaning "woman," thus, "with woman." Definitions: Webster Dictionary (2013): A person who assists women in childbirth. French: 'Sage-femme' meaning a wise woman providing continuity of care. Swahili: 'Mkunga' meaning midwife. History of Childbirth Ancient Egypt to Aristotle: Women being with mothers in childbirth depicted in art. Middle Ages: Epistemology of Midwifery (pseudo-Aristotle). Association with witchcraft. 17th Century: Medicalization of midwifery. Last 100 Years: Modern movement of midwifery. Woman-focused midwifery training. Being a Midwife Philosophy of Midwifery: Midwifery is often seen not just as a job but as a passion and a calling. Difference Between a Midwife and an OB/GYN: Midwives provide woman-centered care, focusing on natural childbirth and minimizing interventions, while OB/GYNs are trained to handle more complex pregnancies and perform surgeries. Woman-Centered Care (WCC) WCC Themes and Sub-Themes (Brady et al., 2019): Defining characteristics of woman-centered care. The role of the midwife in woman-centered care. Woman-centered care and systems of care. Woman-centered care in education and research. Consensus on Woman-Centered Care (Brady, Bogossian, & Gibbons, 2023): Care should be holistic and tailored to the individual woman rather than routine. Systems of maternity care should support this approach. Concept Analysis of Woman-Centered Care (Brady, Bogossian, & Gibbons, 2024): Education, models of care, and midwife characteristics are antecedents. Attributes include choice, control, empowerment, and relationships. Consequences involve shared decision-making and improved health outcomes. Responsibilities of a Midwife Provide care during pregnancy, birth, and postnatal periods, including care of the newborn. Midwifery encompasses antenatal, intrapartum, and postnatal care. Characteristics of a Good Midwife Perceptions from Nearly Graduated Students in the Netherlands (Feijen-de Jong, Kool, Peters, & Jansen, 2017): Good midwives possess specific personal characteristics, organizational competencies, and promote physiological reproductive processes. Five Themes Identified (Halldorsdottir & Karlsdottir, 2011): Professional caring: Empowering and understanding the needs of women and their families. Professional wisdom: Adhering to guidelines and showing passion for the profession. Personal and professional development: Staying updated and self-evaluation. Interpersonal competence: Building trust and providing empathetic care. Professional competence: Skilled in medical situations and mentoring students. Sustainability in Midwifery Midwifery is a rewarding but demanding profession.  Key principles for sustainability include enjoying the work, good work-life balance, autonomy over working life, and good working relationships. Standards and Guidelines Midwife Standards for Practice (NMBA, 2018): Guidelines to support and guide midwifery practice. Code of Conduct for Midwives (NMBA, 2018): International Code of Ethics for Midwives (2014) covering midwifery relationships, practice, professional responsibilities, and advancement of knowledge. Additional Considerations Being mindful of terminology (e.g., "failure to progress," "woman-centered care" vs. "patient-centered care"). Supporting women through understanding and sensitive communication. Example Glossary Terms Gravida: Number of times a woman has been pregnant. Parity: Number of babies a woman has had past 20 weeks or weighing more than 400 grams. Conclusion Midwifery involves collaboration, communication, and continuous reflection. The role is defined by both what midwives do and how they do it, with a strong emphasis on providing holistic, woman-centered care.