IntroductionFor this assignment, I have created visual aids to be used to inform Crystal on the importance of monitoring maternal vital signs and abdominal examination in labour. Crystal is hoping for a spontaneous labour and birth with no pharmaceutical pain relief so it is key she sees these comprehensive assessments as guarding, promoting and facilitating her normal physiological process while ensuring safety by identifying complications for her and her baby 1,2. For the visual aids, I have created some affirmation displays with associated information about routine maternal checks that may be offered to Crystal during labour. These designs can be used in several ways:
I have used some of my own feminine and nature-based images that will aim to increase her sense of comfort, relaxation, and well-being. Feminine and nature images have also been shown to lower maternal heart rates, shorten labours, reduce epidural use and increase Apgar scores 3,4 that will support Crystal’s aspirations. I have used a consumer-friendly font and use non-medical language. I have used affirmations taken from the website ‘Healthline’ 5. I see the aid being used as a handout in an antenatal session with some more detailed discussion had with each page/card. The discussion can then be sustained with Crystal using the affirmations within her own home and labour setting. The maternity setting can enhance this association and the environment by using the framed versions in the labour room. Temperature
Heart/Pulse Rate
Respiration Rate
Blood Pressure
Abdominal Palpation
Contraction Palpation
Concluding remarksIt is important when talking to a woman about these clinical checks that often care settings impose time constraints which do not allow for their individual variation of spontaneous labour, but that informed consent will be acknowledged and her autonomy supported 20. To support her autonomy, midwives are required to be with the woman rather than only doing things to her to then become better attuned to her evolving situation and safety. Midwives can integrate these clinical checks into the whole dynamic of care, rather than having them be the central concern 21.
References(1) International Confederation of Midwives [ICM]. Essential Competencies for Midwifery Practice, 2019.
(2) Nursing and Midwifery Board of Australia [NMBA]. Midwife Standards for Practice, 2018. (3) Aburas, R.; Pati, D.; Casanova, R.; Adams, N. G. The Influence of Nature Stimulus in Enhancing the Birth Experience. HERD Health Environ. Res. Des. J. 2017, 10 (2), 81–100. https://doi.org/10.1177/1937586716665581. (4) Setola, N.; Naldi, E.; Cocina, G. G.; Eide, L. B.; Iannuzzi, L.; Daly, D. The Impact of the Physical Environment on Intrapartum Maternity Care: Identification of Eight Crucial Building Spaces. HERD Health Environ. Res. Des. J. 2019, 12(4), 67–98. https://doi.org/10.1177/1937586719826058. (5) Zapata, K. 20 Powerful Birth Affirmations to Encourage and Inspire You. Healthline. https://www.healthline.com/health/pregnancy/birth-affirmations#example-birth-affirmations. (6) Johnson, R.; Taylor, W.; Smith, S. de-Vitry; Bayes, S. Temperature. In Skills for Midwifery Practice Australian & New Zealand Edition; Elsevier Australia, 2022; pp 41–50. (7) National Institute for Health and Care Excellence [NICE]. Intrapartum Care for Healthy Women and Babies. 2017. (8) Safer Care Victoria [SCV]. Care during labour and birth. Safer Care Victoria. https://www.bettersafercare.vic.gov.au/clinical-guidance/maternity/care-during-labour-and-birth (accessed 2022-05-11). (9) Lavesson, T.; Källén, K.; Olofsson, P. Fetal and Maternal Temperatures during Labor and Delivery: A Prospective Descriptive Study. J. Matern. Fetal Neonatal Med. 2018, 31 (12), 1533–1541. https://doi.org/10.1080/14767058.2017.1319928. (10) Schouten, F.; Wolf, H.; Smit, B.; Bekedam, D.; de Vos, R.; Wahlen, I. Maternal Temperature during Labour. BJOG Int. J. Obstet. Gynaecol. 2008, 115 (9), 1131–1137. https://doi.org/10.1111/j.1471-0528.2008.01781.x. (11) Australian College of Midwives. National Midwifery Guidelines for Consultation and Referral, 4th ed.; ACM: Canberra, 2021. (12) Johnson, R.; Taylor, W.; Smith, S. de-Vitry; Bayes, S. Pulse. In Skills for Midwifery Practice Australian & New Zealand Edition; Elsevier Australia, 2022; pp 51–58. (13) Jackson, K.; Anderson, M.; Marshall, J. E. Physiology and Care During the First Stage of Labour. In Myles Textbook for Midwives; Elsevier Limited, 2020; pp 447–499. (14) Towers, C. V.; Trussell, J.; Heidel, R. E.; Chernicky, L.; Howard, B. C. Incidence of Maternal Tachycardia during the Second Stage of Labor: A Prospective Observational Cohort Study. J. Matern. Fetal Neonatal Med. 2019, 32 (10), 1615–1619. https://doi.org/10.1080/14767058.2017.1411476. (15) Johnson, R.; Taylor, W.; Smith, S. de-Vitry; Bayes, S. Respiration. In Skills for Midwifery Practice Australian & New Zealand Edition; Elsevier Australia, 2022; pp 59–68. (16) Blackburn, S. Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective, 5th Edition.; Elsevier Saunders: Maryland Heights, 2016. (17) Johnson, R.; Taylor, W.; Smith, S. de-Vitry; Bayes, S. Blood Pressure. In Skills for Midwifery Practice Australian & New Zealand Edition; Elsevier Australia, 2022; pp 69–90. (18) Johnson, R.; Taylor, W.; Smith, S. de-Vitry; Bayes, S. Abdominal Examination during Labour. In Skills for Midwifery Practice Australian & New Zealand Edition; Elsevier Australia, 2022; pp 309–312. (19) Weckend, M.; Davison, C.; Bayes, S. Physiological Plateaus during Normal Labor and Birth: A Scoping Review of Contemporary Concepts and Definitions. Birth 2022, birt.12607. https://doi.org/10.1111/birt.12607. (20) de Jonge, A.; Dahlen, H.; Downe, S. ‘Watchful Attendance’ during Labour and Birth. Sex. Reprod. Healthc. 2021, 28, 100617. https://doi.org/10.1016/j.srhc.2021.100617. (21) Bradfield, Z.; Hauck, Y.; Duggan, R.; Kelly, M. Midwives’ Perceptions of Being ‘with Woman’: A Phenomenological Study. BMC Pregnancy Childbirth 2019, 19 (1), 363. https://doi.org/10.1186/s12884-019-2548-4.
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