Midwifery

This booklet is a learning resource provided at the National Educational Conference on female genital mutilation (FGM) organised in Exeter in February 2011 and is relevant to the learning of a wide range of healthcare professionals, including medical students, doctors and midwives. It aims to provide key summary points, both from the lectures on the day and guidelines published to date, in order to aid recognition and management of cases of female genital mutilation.  

Women having a straightforward pregnancy "should be encouraged to give birth in a midwife-led unit", official advice for England and Wales says.  

Louise Silverton and Maureen Treadwell discuss draft guidelines that suggest healthy women should be encouraged to give birth in a midwife-led unit or at home.  

The Nursing and Midwifery Council urges patients to have their say as it drafts a new version of its code for nurses and midwives.  

The most dangerous journey needs a helping hand. 6min 2009. Directed by Emma Lazenby Produced by Sally Arthur Funded by 4mations, South West Screen and the U...  

Thousands of NHS workers, including nurses, midwives and ambulance staff, are taking part in a four-hour strike in a row over pay.  

Nurses, pharmacists, dentists and midwives could face language skills checks to make sure they are fluent in English, under plans being put out to consultation.  

The UK's highest court will hear legal argument on whether midwives have a right to refuse to take any part in abortion procedures on moral grounds.  

“Most women, in every country across the world, would prefer to give birth as physiologically as possible. For most women and babies, this is also the safest way to give birth, and to be born, wherever the birth setting. If routine interventions are eliminated for healthy women and babies, resources will be freed up for the extra staff, treatments and interventions that are needed when a laboring woman and her baby actually need help. This will ensure optimal outcomes for all women and babies, and sustainable maternity care provision overall.” (Professor Soo Downe, Professor in Midwifery Studies, 2014)  

Taking inspiration from UK drama Call the Midwife, a new TV series is trying to break the taboo of childbirth in Bangladesh.  

It is not uncommon to see babies in clinic who have been referred because they are persistently tachypnoeic. Sometimes this has been noticed by the parents, but more often, especially if it is the parents’ first baby, they do not realise anything is amiss, and it is the midwife, health visitor or general practitioner who brings it to their attention. Occasionally it has been noted as early as the postnatal ward. This article outlines a management approach to a term baby with tachypnoea in an outpatient setting, and is not focusing on acutely unwell infants (figure 1). It is taken from the perspective of a referral to a general paediatric clinic, although these babies are also often referred straight to a respiratory clinic.  

Terri Coates explains why it’s difficult to show the reality of birth of screen, and why she gets a hard time from admissions tutors on midwifery courses  

I'm not sure why I like to quote lines from films on this blog. I mean, I really haven't seen enough of them to make myself out to be some sort of hotshot film geek. I'm hoping this is the last (probably inappropriate) quote I use for a while, so here goes... 'Give me a word, any word, and I show you that the root of that word is Greek.' Courtesy of Gus Portokalos, the funniest character in the My Big Fat Greek Wedding. Sometimes I feel like medics tend to do that, we have a habit of making absolutely any conversation about Medicine. It seems to give us a bit of a bad rep, but surely it's understandable? I mean, it's what we do. It's what we've 'always wanted to do' i.e. since leaving the womb*. It's what we're always going to do. Right? Even so, it's surely human nature to relate everyday conversation to something you think that you know a lot about. Let's take a look at real-life example, cue the Blue Peter quip 'here's one I made earlier': I know nothing about football. Well, I know a bit more than some and a lot less than your average football fan so I guess I know VERY little about football. I do, however, know a thing or two about Hillsborough Stadium in Sheffield. Why, you ask? Well, the Hillsborough Disaster in 1985 saw the deaths of 96 Liverpool fans during an FA cup semi-final. A pivotal case emerged from this disaster which affected medical decision-making at the end of life, that of Anthony Bland. Bland was left brain damaged and in a 'persistent vegetative state' (a disorder of consciousness) after the disaster. In 1993, he finally won his battle to have the treatment that was keeping him alive withdrawn. This was a landmark case in both medical ethics and law. Don't say you heard it hear first, look it up: it's relevant. It would be dishonest to say, 'Give me a word, any word, and I'll show you that it's somehow linked to Medicine. But just ask me what I know about football, just once and I might just surprise you. *After writing this entry, I realised that it might be unfair to presume that there isn't at least one person who knew that they wanted to be a doctor just seconds after taking their first gasp of air and crying their eyes out in the midwife's arms. My sincere apologies if this applies to you. (To have a look at more of my entries, visit: http://contemplationsofamedic.blogspot.co.uk/)  

Shattered. Third consecutive day of on-calls at the birth centre. I’m afraid I have little to show for it. The logbook hangs limply at my side, the pages where my name is printed await signatures; surrogate markers of new found skills. Half asleep I slump against the wall and cast my mind back to the peripheral attachment from which I have not long returned. The old-school consultant’s mutterings are still fresh: “Medical education was different back then you see....you are dealt a tough hand nowadays.” I quite agree, it is Saturday. Might it be said the clinical apprenticeship we know today is a shadow of its former self? Medical school was more a way of life, students lived in the hospital, they even had their laundry done for them. Incredulous, I could scarcely restrain a chuckle at the consultant’s stories of delivering babies while merely a student and how the dishing out of “character building” grillings by their seniors was de rigeur. Seldom am I plied with any such questions. Teaching is a rare commodity at times. Hours on a busy ward can bear little return. Frequently do I hear students barely a rotation into their clinical years, bemoan a woeful lack of attention. All recollection of the starry-eyed second year, romanced by anything remotely clinical, has evaporated like the morning dew. “Make way, make way!...” cries a thin voice from the far reaches of the centre. A squeal of bed wheels. The newly crowned obs & gynae reg drives past the midwife station executing an impressive Tokyo drift into the corridor where I stand. Through the theatre doors opposite me he vanishes. I follow. Major postpartum haemorrhage. A bevy of scrubs flit across the room in a live performance of the RCOG guidelines for obstetric haemorrhage. They resuscitate the women on the table, her clammy body flat across the carmine blotched sheets. ABC, intravenous access and a rapid two litres of Hartmann’s later, the bleeding can not be arrested by rubbing up contraction. Pharmacological measures: syntocinon and ergometrine preparations do not staunch the flow. Blood pressure still falling, I watch the consciousness slowly ebb from the woman’s eyes. Then in a tone of voice, seemingly beyond his years, the reversely gowned anaesthetist clocks my badge and says, “Fetch me the carboprost.” I could feel an exercise in futility sprout as I gave an empty but ingratiating nod. “It’s hemabate....in the fridge” he continues. In the anaesthetic room I find the fridge and rummage blindly through. Thirty seconds later having discovered nothing but my general inadequacy, I crawl back into theatre. I was as good as useless though to my surprise the anaesthetist disappeared and returned with a vial. Handing me both it and a prepped syringe, he instructs me to inject intramuscularly into the woman’s thigh. The most common cause of postpartum haemorrhage is uterine atony. Prostaglandin analogues like carboprost promote coordinated contractions of the body of the pregnant uterus. Constriction of the vessels by myometrial fibres within the uterine walls achieves postpartum haemostasis. This textbook definition does not quite echo my thoughts as I gingerly approach the operating table. Alarmingly I am unaware that aside from the usual side effects of the drug in my syringe; the nausea and vomiting, should the needle stray into a nearby vessel and its contents escape into the circulation, cardiovascular collapse might be the unfortunate result. Suddenly the anaesthetist’s dour expression as I inject now assumes some meaning. What a relief to see the woman’s vitals begin to stabilise. As we wheel her into the recovery bay, the anaesthetist unleashes an onslaught of questions. Keen to redeem some lost pride, I can to varying degrees, resurrect long buried preclinical knowledge: basic pharmacology, transfusion-related complications, the importance of fresh frozen plasma. Although, the final threat of drawing the clotting cascade from memory is a challenge too far. Before long I am already being demonstrated the techniques of regional analgesia, why you should always aspirate before injecting lidocaine and thrust headlong into managing the most common adverse effects of epidurals. To have thought I had been ready to retire home early on this Saturday morning had serendipity not played its part. A little persistence would have been just as effective. It’s the quality so easily overlooked in these apparently austere times of medical education. And not a single logbook signature gained. Oh the shame! This blog post is a reproduction of an article published in the Medical Student Newspaper, February 2014 issue.  

Guidance has been published to support paediatricians, midwives and GPs in detecting whether a newborn baby has a cleft palate.  

Midwifery, health visiting and school nursing services play an essential role in ensuring the health and wellbeing of children from conception to adulthood, yet there are many issues affecting...  

Changing the labor and delivery care system decreases cesarean deliveryIn a study to be presented on Feb. 5 in an oral plenary session at 8 a.m.  

Meet the midwifery team from the Nebraska Medicine Olson Center for Women's Health.  

midwivesonline.com is the UK's leading unique midwifery led web site for midwives, health care professionals and expectant and new parents  

The author of this book has a vast experience of teaching Medical and Midwifery students both in Tanzania and abroad. He has also worked as a Consultant Obstetrician and Gynaecologist in public hospitals both in Tanzania and abroad. This book is a testimony of the vast experience of the author. This book describes the management of a woman during pregnancy, childbirth and postpartum as well as care of the newborn. The book gives useful guidelines in the management of normal as well as 'High risk' women during this critical period of their lives. The book has been written in a style which makes it easy to read and understand. It is a book that medical/midwifery students and the practitioners working in health centres will find useful.