11.1 Intrapartum emergency situation and role of a midwife.

Intrapartum emergency implies emergency occurring during the act of childbirth.

A midwife is a healthcare person who is trained to take care of the mother and the child
during and post pregnancy. A midwife plays an important role during intrapartum situations
and emergencies.

There have been increased death rate all over the world referring to intrapartum
complications of which neonatal asphyxia being most common followed by rise and drop in
heart rate. Involvements of midwives have substantially shown a great fall in the foetal and
maternal death rate. This involvement includes Emotional, Physical and Mental support at the
time of parturition including encouragement and mental support, monitoring the mother’s and
child’s heart rate and sign, help reliving pain and suggesting strategies for safe and
uncomplicated child birth, get a proper medical assistance and help if needed. Other than all
this support, a midwife is expected to check the mother’s health status [haemoglobin and
haematocrit value], fetal well-being by USG, fetal heart rate (FHR) monitoring, periods of
marked FHR variability, fetal pulse oximetry, intermittent auscultation, etc. Presence of a
midwife provides a positive childbirth experience and positive outcomes. (Forster et al, 2016)

This labour support provided by a midwife assures the woman and her partner the
continuous support and guidance and emotional support and ways to ease out with pain and
to express the woman her wishes and needs during parturition. With the child’s distress, the
midwife continuously monitors its heart rate and other outcomes along with handling the
mother’s stress and insufficiency in context to the maternal and child’s needs, providing
accurate emotional as well as medical support and care. Along with a midwife there are
certainly less chances of any complication as they are skilful and equipped with all amenities
for a proper stress free delivery experience along with avoidance of intra and postpartum
emergencies and complications of both the mother and the child. (Hildingsson et al, 2019)

11.2 Importance and process of intrapartum risk assessment

The time of birth is critical for both the mother and the child as there are increased chances of
complications at the time of parturition. It’s critical at the beginning and throughout the
labour.
The best way to assess the risks during parturition is to see what works and what doesn’t in
the whole situation where there are chances of any risks. The mid wife is a skilful trained
health care provider who works as an ease providing medium for the woman during and post
pregnancy to avoid all kinds of complications and risks. So a good communication between
the mother and the mid wife or any healthcare personnel present is of utmost importance. It
helps the mother to express all kinds of needs and discomfort and the mid wife being trained
monitors the rest to avoid any risk or to manage and assess them successfully if any of it
arises. In case of any risk emergence, to tackle it needs awareness to the mother and the
health care person\midwife, knowledge and skill. Need of identification of requirements
including proper active interaction, active up skilling, clinical expertise, experience.
( Talaulikar et al, 2014)

Partnership and co-operation between the mid wife and the mother. Requirement of proper
following of rules, regulations and protocols and referrals if necessary to higher authorities.
Next phase requires immediate monitoring and problem solving skills and amenities,
evaluation and proper feedback to avoid any further future risks. It is definitely important to
manage and assess these risks to avoid the biggest complication of mortality of the new born
or the mother. Thus, other complications can be avoided too with awareness and certain
actions taken during the risk management. Risk assessment not only provides freedom from
certain complications but also helps to plan the further treatment, needs and extensive care
that are to be incorporated for the better well-being of the mother and the child. The overall
experience gives a positive outcome and feedback towards a successful intrapartum process
and a postpartum experience. (Healy et al, 2016)

11.3 Midwife during labour preparation

Midwives play a major role during labour times providing for a healthy labour and parturition
experience for the woman. It also becomes a midwife’s duty and responsibility to carry out a
risk and hassle free labour experience along with avoidance of any complication during the
whole labour phase. It all starts with establishing the trust with the very first contact and
maintaining it throughout the woman’s stay. (Gibson, 2014)

Then communication is the key, where the midwife must listen to all the psychological and
physical needs of the woman and help her feel eased and comfortable at every stage of the
labour, along with providing continuous emotional and physical support. Also, the woman
must follow the guidance and knowledge required for the procedure provided by the midwife
throughout. Midwives must keep the woman updated with the knowledge and the events that
will occur during labour including the phases of labour and how can a mother contribute for
the betterment of herself and the child accompanying explanations of all the decisions being
taken reassuring the woman with utmost safety and privacy. (Levett et al, 20116)

The aims and intentions of the midwife must be made clear to the woman for a better bond
between them to avoid any miscommunication and complication factor. The aims of midwife
should be a healthy child delivery with minimal physical or psychological maternal trauma.
Early detection of any risk or abnormality accompanied with labour must be discussed with
the woman and her family and they must be reassured for the best outcome. Reassuring with
emotional support and all the necessary steps required for labour like checking and
maintaining vitals of the mother and fetal heart sound, assessing uterine contractions,
maintenance of proper hygiene during the complete procedure and encouraging the mother
for increased fluid intake, explaining positions for a normal birth procedure and relaxation
techniques. (Sarah et al, 2018)

21.1 Role of Nursing and Midwifery council

The Nursing and Midwifery council (NMC) principally and fundamentally regulates, support
and influence the midwives and their roles at every stage.

The nursing and midwifery council have midwifery unit which provides all kinds of accurate
advice and guidance at all stages of their work. The most important being safe, effective and
kind midwifery practice for the better health and wellbeing of the woman and the child. In the
allusion of the intrapartum period, the nursing and midwifery council supports through
creating resources and guidance, helping them to deliver the best of their services. Proper
regulation helps a proper influence towards health and social care. Intrapartum period is
susceptible to higher risk chances and risk management is firmly fixed with the norms and
guidance of the NMC. (Bedwel, McGowan, Lavender, 2015)

A midwife supports the woman and the family through a care model, the care model being
promoting the woman’s right to inform choice, decision choice, regardless of the advice
given clinically or the midwife’s own personal view. This fear free approach prioritising the
woman’s and her family decisions at such a delicate situation is supported by the NMC and
definitely promotes trust and values in the procedure towards the midwife from the patient.
This helps in practicing effectively with the mother and child being kept above all along with
values, ethics and confidentiality. ( Lewis, 2014)

There are certain programmes conducted in NMC by their units to fully skill and keep the
midwives updated to manage all sorts of risks that arise during their practice especially for
the intrapartum period requiring a lot of decision making and working promptly skills and
knowledge. NMC also provides awareness of social needs, providing personalised care to the
woman along with organisational expectations. Making decisions promptly and acting
efficiently in time of emergencies shows leadership and this leadership quality is indirectly
influenced and supported by the NMC in various ways to maintain an overall healthy
midwife and patient relationship by taking the charge and providing all the support even with
the involvement of other medical help and the organisation associated. (Peat, & Hamilton,
2014)

21.2 Implications of The Code in intrapartum care

It is necessary that the midwives and nurses must follow The Code and act in line to provide
care with skills and knowledge to the patients. Although, all the strategies and actions taken
by the midwife during any event is under the code of conduct yet the code exists to protect
and serve the public. The principles and values present in the code can be applied to diverse
situations and practices but they are not at all flexible or do not show any discrimination.
(Warwick, 2016)

The Code consists of professional standards and behaviour for midwives and other health
practitioners associated with it. That is why all the work done by a mid-wife along with other
co-workers is under strict professional practice. During the intrapartum care, the midwife
work accordingly as per the conduct of the code which says to plan and enact the entire care
provided. (Hughes & Hughes, 2016)

It all begins with the trust and communication developed since the beginning with the patient.
During intrapartum period it’s important to develop a god bond with the patient with
complete confidence in each other and the complete team present to have a smooth
experience overall. The confidence to work efficiently with good decision making in the
benefit of the patient and prioritising the patient at every situation is a strength provided by
the code which clearly states the patients will and wish is prioritised at every cost. The
confidentiality and respect of the patient is maintained. Preservation of the safety of the
patient and the child with the team work is assured with risk assessment and skilful actions of
the midwife and the team. Acting without any delay in case of emergencies and risk is backed
up by the NMC regulated by The Code. This helps in reducing all kinds of harm and issues
arising post and during the procedure. (Rajan & Mitchell, 2020)

21.3 Role of supervisors in labour

Supervisors of the midwives, as the name suggests, supervises the midwives at every stage.
The supervisors are highly trained healthcare providers with additional skills and knowledge.
They are also practicing midwives with experience. (Freemantle, 2013)

The supervisors give guidance to the midwives and the patient and its family. Supervisors are
free of any employer and work as self-employed yet under the NMC and work in teams. They
make sure that all the care and knowledge provided to the patient by the midwife is right in
all senses including the organisation, patient and the midwife itself. The midwife ensures all
the comfort of the patient and all the actions taken by the midwife are reassured by their
supervisor. They also support the midwives in their work and practice at every stage.
(Roseghini and Olson, 2015)

Though all the events in labour are very feeble and there’s a very narrow bridge in a normal
healthy experience turning into a mishap during labour. Many women experience trauma
during labour and thus midwives and their supervisors play a major role in psychological,
emotional and physical support of the patient. There are high chances of developing post-
traumatic stress disorder followed by traumatic labour. The patient is let free to express the
emotions and discomfort initially. The emotion of communication and console with patient is
to relieve the patient’s concern and trauma to the best extent. Patient’s wish and decisions are
prime concerns and their decisions for further procedures are followed. Anything against
patients will disturbs them psychologically and lifts all the trust and connection with midwife
and team, which is to be avoided at every cost. Along with the guidance, knowledge, skill,
and support of the supervisor, the team works in progress of the patient’s and child’s well-
being. With the emotional support, the physical vital status is also monitored from time to
time. All the amenities and provisions are skilfully used to relieve the trauma and stress to the
most extent. Most of the cases are resolved successfully with the supervisor, midwife and
team. (Barimani, Jonas, & Zwedberg, 2019)
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