Unit 14: The Role of the Midwife in Postnatal Care PDF

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Unit 14: The Role of the Midwife in Postnatal Care
Midwifery Access Course...

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The Role of a Midwife in Postnatal Care In this essay I will be discussing the role of the midwife in caring for the mother and baby during the postnatal period, including both immediate and ongoing postnatal care. Supporting breastfeeding, the assessment of postnatal depression, and the important role of the Nursing and Midwifery Council (NMC) in regulating midwifery practice during the postnatal period (Stearns, Assignment). The NMC states the roles of a midwife during the postnatal period as “Responsible for providing an evidence-based, minimum high standard of care for the woman and baby, until transfer of care to the health visitor. It is the midwife's responsibility to formalise an individualised plan of care in partnership with the woman and her family and to liaise with members of the multidisciplinary team as required. This care may take place in a hospital and/or community-based setting.” (Nursing and Midwifery Council, 2012). After an emergency caesarean the midwife will encourage skin to skin, to maintain baby's body temperature and stop hypothermia, giving mother and baby a stronger emotional bond. Midwife offers support and assistance regarding breastfeeding if needed. The Department of Health advocates breastfeeding within 30-60minutes after birth. Straight after birth, midwife assess the baby’s vital signs and responsiveness using the Apgar score. Developed in 1952 by Virginia Apgar, assessment of the baby’s condition at one minute and again at five minutes after the birth. Baby is scored in each category and added up to decide the Apgar score. Factors examined are 1 activity and muscle tone, 2 Heart rate, Breathing, 4 Colour, 5 Grimace reflex response. Identify baby with a wrist band, Cover mother and baby with a dry towel / blanket. The midwife will go through the woman's care plan, normally done during the antenatal period, including pertinent factors from all stages of pregnancy, healthcare professionals’ details involved with mother and baby, postnatal plans, includes how mother intended on feeding neonate. Home or hospital birth, midwife monitors the physical condition of both mother and baby closely monitored. This includes checking mother’s vital signs, lochia (known for bleeding after a caesarean), uterine tone and fundal height, pain levels, bladder function (check for urine retention after epidural). A physical condition examination of the baby is done within 72 hours via midwife, doctor or HV. The screening programme is part of the Newborn and Infant Physical Examination (NIPE), Includes measurements, eyes, hips, heart and testicles and weight. All interactions should be recorded in mother maternity records and the midwife will sort out the discharge of both mother and baby (if in hospital) (Streans, page 1.1). Postnatal depression (PND) is a type of depression affecting 1 in 10 women within a year of giving birth and can cause major health consequences. Midwives acknowledge and support mothers in the postnatal period. ND can start for no apparent reason. Midwives must look out for warning signs like depression during pregnancy, women who have experienced mental health problems, and have a previous history of PND following a birth. The midwife must support and put in place treatment if needed, record any concerns about the mother’s health in the maternity records, including treatment given and support. (NICE) 2015 guidelines recommend that all women should have a mental health assessment before final discharge from the midwife's care and an appropriate referral if needed like therapy or medical.

Edinburgh Postnatal Depression Scale (EPDS) identifies women who have postnatal depression. EPDS can be used up to 8 weeks after birth. Midwives’ routine involves detailed record of women's medical history (family mental health history also) this can indicate increased depression vulnerability. Midwifes develops trust with the woman and encourages her to talk about their birth experience, emotional changes, mood, or behaviour pattern. The risk assessment is done by the midwife and concludes of 10 questions, its purpose is to assess various clinical depression symptoms, like sleep disturbance, energy levels, feeling guilty or suicide. The risk assessment impacts the physical and emotional health of mother and baby, symptoms recognised early so treatment can be put in place (Stearns, page 1.2)

The postnatal period is about healing and recuperating. The midwife monitors the mother’s physical health, including her diet, appetite, energy levels and sleeping pattern while also providing advice about exercise, rest, sleep, and good nutrition. An examine of the mother’s uterus, lochia, perineum, and breasts is done to evaluate the physical recovery of the mother after childbirth. Physical needs of baby such as breast or bottle feeding, establishing a routine, weight monitoring and the baby’s physical care. Immunisation’s information such as Bacillus-Calmette-Guerin (BCG). The midwife and other healthcare professionals must be able to notice the signs and symptoms of the women's mental health problems.10 to 14 days after birth the woman should be asked about the baby blue symptoms. Postnatal depression occurs within weeks to months of giving birth. The midwife provides strategies to copy day to day, adapting to motherhood and having another child. Encourage the woman to look after their mental health. Providing psychological help and emotional support by encouraging the woman and her family members to talk about their feelings and make referrals if specialist is required, if the woman is suffering from postnatal depression. Recommended support groups to help reassure and encourage women who are depressed or suffering with postnatal depression, breast feeding, and parenthood (Stearns, page 1.3).

Breastfeeding is the most beneficial way to feed babies, giving them the best possible start in life.1991 UNICEF Baby Friendly Initiative has been promoting breastfeeding benefits. Advantages include a strong bond between mother and baby, protects the neonate from infections like gastroenteritis and reduces sudden infant death syndrome (SIDS). UNICEF offers a checklist to assess how well breastfeeding is progressing. In addition to a midwife, maternity support workers, health visitors and other healthcare professionals can support a mother with breastfeeding. NICE use an evaluated and structured program. A supportive environment for breastfeeding, the healthcare professionals support the mother in starting to breastfeed successfully via establishing a comfortable position for mother and for the baby to lack on and suck efficiently and help form effective feeding and prevent sore nipples especially for women who had a caesarean section. They provide encouragement and information about, physiological process of breastfeeding, let-

down reflex and lactation and eating a nutritious balanced diet and getting adequate sleep. A health visitor will begin visiting the mother and baby in their own home from 10 days post birth and make provisions with a local facility for breastfeeding mothers and support groups and how to store and express breast milk, to encourage other family members to bond with the baby. And discuss any concerns the mother may have like breast engorgement and mastitis (Stearns, page 1.4). It’s a legal requirement for all health professionals including nurses and midwives to register within the Nursing and Midwifery council (NMC 2014). NMC is the regulator for nursing and midwifery professions in the UK and are the statutory body for regulation of the profession from 2002 and protects the wellbeing and health of the publican has standard regulations such as education, conduct, performance, and fitness to practice. Midwives must have knowledge and understanding of care including monitoring the physical health, emotional wellbeing of the mother and the examination of both mother and neonate. They provide guidance and reassurance to new mothers about infant breastfeeding and other topics. Postnatal record keeping and the legal responsibilities relating to report and record information regarding the health of the mother and neonate, postnatal depression, and abnormal symptoms. conduct and performance of midwives, relates to the care of the mother and neonate for ten days minimum after birth, handover to the health visitor Midwives Rules and Standards (2012) set duty of practice to follow, woman and baby’s needs are the focus. They work with the woman and her family providing first class care, help ease the woman physically and emotionally through the postpartum period. Fit to practice requires midwives to have the skills, knowledge, health, and character to do their job safely and successfully. Midwives must uphold to be registered to practise in the UK. If allegations are made an investigation will take place to see if the midwife is fit to practice (Stearns, page 2.1).

The code includes prioritising people, practise effectively, preserve safety and promote professionalism and trust. Midwife must prioritise the care and safety of women and their families. Implications are, providing inadequate information to the women for them to make informed choices, listening and respecting the women's dignity. Midwives take part in continuous professional development training (CPD) to provide the best standard of postnatal care. Midwives communicate effectively with women and their families, a range of verbal and non-verbal communication methods, like visual aids about infant feeding, baby’s umbilical cord for English speaking individuals. Midwives keep clear, accurate records, include documents of all interactions with mother during the postnatal period, and record any problems that arise. All postpartum records, paper-based or electronic, must be clear, dated, and timed, and securely stored. A midwife must preserve safety to ensure that the public is protected. Assessment of a mother’s physical and mental wellbeing during the postnatal period; egg postnatal depression, midwife will do a referral for medical intervention. Midwives understand the legal requirements about reporting and sharing information if the mother or baby is at risk of harm like domestic abuse, fairly treating without discriminating, bullying, or harassing a woman or her family, due to religious, culture, disability, or same-sex partnerships. All forms of communication

must be documented. Midwives are responsible for taking part in regular learning activities in order to develop their competence and improve their professional performance (Streans, page 2.2). Supervision of midwives (SOMs) dates to Midwives Act 1902. SOMs means the motivation of quality in midwifery by supporting midwives to practice in confidence. Their purpose is to protect women and their babies by ensuring safe standards of midwifery practice. SOMs work within a team and job role is different to the midwifery manager.20 major failures from 2004 to 2013 at Furness General Hospital. The deaths of eleven babies and one mother at FGH were avoidable and a result of a 'lethal mix' of failings. Amongst the findings were that the maternity unit had been 'dysfunctional', with 'substandard care' provided by staff 'deficient in skills and knowledge'(BBC News, 2015). This led to SOMs being separated from regulation, due to the unclear relationship between NMC and supervisors. The statutory midwifery supervision had an indistinct relationship with the regulatory function of the NMC affecting systems of sound clinical governance. The removal will mean employers and providers of midwifery services need to ensure they have processes to measure and improve quality and offer choice and support women through the postnatal paronym’s Midwives rules and standards 2012, new supervision system covers the full midwifery role(gov.uk,2016). SOM’s may review the midwife’s practice via assessments of the mental and emotional wellbeing, physical health of the mother and baby. Advising on infant feeding, ensuring the mother takes care of her own health, and is aware of any symptoms that may need discussing, like postnatal depression (Stearns, page 2.3) Conclusion Midwifery has changed over the years, to meet society needs. Midwives today do more than just deliver babies, they embrace and advocate for women and advise them many things throughout the postnatal period, including postnatal depression and breastfeeding support. And help them make informed choices and prepare for parenthood. Recommendations A lot of labour went into researching this assignment. It was time consuming. In future I will allocate more time to research more information. I have a better understanding of The Role of the Midwife in the Postnatal period. Processing the information more acceptable through a video, rather than reading, I dealt with this by allocating myself more time to understand in depth before continuing...