Case study of Midwifery in hospitals

Midwifery is a profession which provides the pregnant women their needed care and treatment (Jean and John, 1986). The main approach for the achievement of the chief indicators for MDGs IV and V on the maternal and child health is by the use of multi professional approaches (Lancet Maternal Survival Series Steering Group, 2006). When different professionals work together in combination, the partnership assures the sharing of knowledge, excellence, respect, trust and willingness to contribute to the mother child health care system (Bhutta, 2005). Access to the professional experts before and during the child birth is very crucial for the well being of babies and mothers. The nations which have paid attention in this issue and taken necessary steps to improve the child and mother health, have achieved drop in new born mortality rates (WHO, 2005). In the cycle of life an individual depends upon the availability of health care professionals not only to save the life but also to improve the physical and mental conditions of the human beings particularly (International Federation of Gynecology & Obstetrics). When taken in the context of mother child care systems these professions range from nurses to experts. They have majorly focused upon the availability of multi professional experts at the time of delivery at the hospitals (Simpson et al, 2006; Mann and Pratt, 2006; Nielsen et al, 2007; Williams 2008). These professionals majorly are nurses, midwives, physicians, obstetricians, neonatologists, anesthesiologists (Physician trained in anesthesia) (ABA, 2009) and pharmacists and the pediatricians who can examine the child right after birth for any kind of disease or life threatening condition (International Federation of Gynecology & Obstetrics). The approach to females with assumed preterm labor has altered slightly in the past 3 decades. The main element to that method is the slowdown of complete inhibition of contractions (Simhan, 2007; Caritis,et al, 1979) but to use such methods only professional team could work.

Health care professionals and managers require a very strong and integrated system of care at both the local and the national level (Princeton University, 2007). These are particular in case of deliveries and C-sections. If the system of this multi professionalism is integrated at the hospitals at every level particularly in the gynecological departments millions of deaths and disabilities can be avoided as complications in the delivery can cause severe mental or physical retardations (Lane, 1987; Stockham and Alice, 1891)

The major issue in his view point is also the lack of experience during the critical conditions and non availability of multi professionals at the time of need particularly in critical or unexpected conditions like C-sections (Ramondt, 1990). The midwifery in separate is not recommended but when the midwives join the complete health care professional team they should be given the status of a special professional (Golden, 2002; Bailey, 1998). This should be taken into account by the fact that they provide quality care and support to the mother during the child bearing and right after birth. This helps the mother to establish a loveable and comfortable relationship with the baby right after birth. They also help the mother to feed the baby immediately after birth which is a difficult task as the new born is a bit tricky to feed (Harper, 2006). To explain all these facts in detail and to establish the importance of multi professionalism in the field of gynecological departments with particular reference to the child delivery case, a special clinical case is discussed below.

Case Study

In this case study we will see the inter relationship of various people and professionals in the child birth procedure. The scenario in the case is that pregnant women with gravid 1 plus 0 primp arrived into the hospital. This means that the woman was having her first pregnancy or she had been pregnant before but had not given birth i.e. she might have had an abortion or miscarriage earlier. She was admitted to the labor ward of the hospital. The overall condition looked alright initially

When the history of the women was taken it was noticed that she was known to the social services for the misuse of the substances like heroin and some other drugs. This substance misuse is a very critical factor in the pregnancies as such drugs could have an adverse effect on the fetus and special precautionary measures for some particular drugs might be required so as to avoid any harmful impact. The family history was normal like there have been no prevalence of diabetes in her family. Smoking history has also been observed and it is a general possibility that smoking is not good for fetuses. However the smoking was a general habit of the woman but during her pregnancy period she stopped it so as to prevent her baby from the side effects. The smear tests were normal with no apparent malignancies of neoplasias. Before pregnancy she had a normal menstrual cycle of 28 days. The blood group was B+.

She was physically examined by the routine doctor and she was found out to be on 36 weeks gestation. The initial thorough examination of the abdomen was performed. No scars or pigmentation were seen. After the complete antenatal examination the woman was found to be in the first stage of the labor. There was 9cm dilation in the cervix. The contractions were observed to be 4 times in 10 minutes with strong contractions in the membranes. The water bags had spontaneously ruptured when she was at her home an hour earlier. After about one hour the woman was in her 2nd stage of labour. She was encouraged to push continuously. After almost an hour the decent of the fetal head was not seen. The woman was exhausted. The heart rate was found to be low on recording using a sonic aid followed by pinard. Because of this the CTG commenced. Cardiotocography (CTG) in medicine (obstetrics) is specifically used as a means of examining and recording the contractions in the uterine area and the heart beat of the fetus (Wikianswers.com). This was started in trimester of the pregnancy (Alfirevic et al, 2006). The FHR base line was determined by the approximate mean FHR to an increment of five beats in one minute in the window of ten minute time period (Macones et al, 2008). In this case fetal compromise was anticipated due to low cardiac activity (bradycardia) and due to head compression and there is no recovery after the contractions as observed by the CTG. All these observations were noted down in the documents.

Based on the critical condition of the fetus the senior midwife, registrar, pediatric specialist and anesthesia doctor and ascribe was called to the delivery room. After the detailed reexamination by the senior doctor it was decided to deliver the fetus. The 36 week/40 week neonate was delivered by using a ventouse because the forceps failed and there was fetal emergency the mother was exhausted. It is a very technical vacuum device, designed for the delivery purpose. It helps to deliver the baby when adequate progression in the delivery was not apparent (e medicine). The apgars observed were of 4 at 1 minutes time and 8 at 10 minutes. The apgar shows:

Activity of the neonate

Pulse of the neonate

Grimace of the neonate

Appearance (physical) of the neonate

Respiration of the neonate

It was generally taken two times after delivery (Rebecca, 2000). The first one after 1 minute of delivery and the second after 5 minutes of birth. If baby is critical the 3rd apgar may also be taken. The doctors usually add the scores of the five conditions to calculate the total score. The score ranges from 0 to 10 with 10 being the best and zero the worst.

There was some damage to the head of the baby due to the mode of delivery. After the delivery the baby was handed over to the peadiatrition as the baby needed to go to the special care for head injuries preterm, and possible substance misuse withdrawal symptoms. 

In keeping with the Driscoll’s (2000) reflection model we can assess the situation via “what?” “so what?” and “now what?” constructs. It has been seen that there are a number of professionals involved in the delivery procedure i.e. the nurses, midwives, doctors, neonatal nurses and peadiatritions. These all make an effective team and ensure the delivery of even a very critical baby with care and safety. All these are not available in the home midwifery procedure. Even if the situation become worse and there is no way to deliver the baby normally like sometime the umbilical cord winds around the baby’s neck and it is impossible to deliver the baby through the normal route the cesarean operation is performed (Chu et al, 2007; Wagner 2009). This requires specified equipment and the surgeon doctors with nurses and anesthesia doctor so as to perform a proper procedure. If the above mentioned case is not performed in the strict conditions and in the presence of specialized professionals there could have been a serious threat to the health and even life of the mother and the baby. Like the history of the mother lead the nurses to decide some special conditions, the senior midwife and doctor decided for the delivery and the peadiatrition decided about the type of treatment to be given to the baby after he had some injuries at the head because of delivery procedure. Neonatal and mother health is a very important department of the hospital (Selga, 2006). The nursing of neonates is a 28 day provision of care to the baby after birth (Harper, 2006). It is an important part of the care team for the babies and nurses are specially trained for this purpose (Whitfield et al, 2004). There are 3 levels of neonatal nursing activity (Neonatal Nurse). ll the above mentioned professionals must be present at the time of the delivery. Only their presence ensures safe birth and health of the neonate and mother.