Fundamentals of Midwifery: A Textbook for Students (53 page)

Discuss and offer maternal and fetal screening and begin baseline monitoring to assess wellbeing

Maternal baseline observations – Temperature, pulse, respirations, blood pressure, body mass index, urinalysis and screening for asymptomatic bacteriuria

Assess previous history, general health and lifestyle issues. Offer haematologic screening

Determine risk factors

Advise on nutritional supplements vitamin D and folic acid Routine enquiry – For domestic abuse

Whooley questions – To assess perinatal mental health status

Antenatal appointments 25–34 weeks, second trimester

Physical and psychological assessment; consider both history and current findings

Discuss and offer maternal and fetal screening and monitor for deviations in the wellbeing of mother and baby

Maternal observations – At each antenatal appointment, blood pressure measurement and urinalysis for protein, to screen for pre-eclampsia

At each antenatal appointment, woman to be informed of the need to seek immediate advice from a healthcare professional if she experiences symptoms of pre-eclampsia

At each antenatal appointment, raise awareness of fetal wellbeing by discussing fetal movements

At each antenatal appointment, from 25 weeks – Symphysis fundal height should be measured and recorded

At 28 weeks – Offer repeat full blood count, blood group and antibodies

It is recommended that routine antenatal anti-D prophylaxis is offered to pregnant women who are rhesus D-negative.

Antenatal appointments 34–42 weeks third trimester

Physical and psychological assessment; consider both history and current findings

Discuss and offer maternal and fetal screening and monitor for deviations in the wellbeing of mother and baby

Prepare for birth and motherhood

Maternal observations – Screening and monitoring (indicated above) at each antenatal appointment, including review of the screening undertaken at 28 weeks

Plan impending birth – parental education

From 36 weeks, check presentation and position of the fetus, engagement in the pelvis of the presenting part

Discuss care of the newborn and the postnatal period

From 38 weeks – Discuss management of prolonged pregnancy From 41 weeks – Support woman’s decisions for induction of labour

Serial measurement of symphysis–fundal height and plotting on customised growth charts is recommended (Royal College of Obstetricians and Obstetricians [RCOG] 2013). There has been a recent drive to train midwives to ensure consistency in this skill.‌‌

Changes in anatomy and physiology occur, and the nurturing of the fetus begins (Figure 6.1).

129

Activity 6.3

From your own clinical practice placements; discuss with colleagues and or clinical mentors

some of the common changes of pregnancy you have observed in women for whom you have cared for during the first, second and third trimesters of pregnancy.

Seek to understand the causes and reasons for the anatomical and physiological changes by further reading. Read: Section 3, Pregnancy, in: (eds) Marshall, J., Raynor, M. (2014)

, 16th edn. Edinburgh: Elsevier.

Antenatal surveillance aims to detect deviations from normality such as pre-

eclampsia, Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, and previ- ously unknown medical conditions (see Chapter 16: ‘Emergencies in midwifery’ where pregnancy-related conditions are discussed in greater depth). Whilst the previous content reflects care for women who fall within the parameters of normality, demographics are chang- ing in relation to the number of women in that category. Increasing maternal age and increasing levels of obesity are now major contributing factors that impact on the perception of wellbeing and parameters of normality (Bonar 2013). These issues can impact on the medicalisation of pregnancy and the opportunity to adequately monitor the pregnancy along with the woman’s ability to give birth.

The midwife must be able to recognise physiological and psychological deviations through- out the pregnancy; refer to an obstetrician and provide seamless care, still aiming to normalise aspects despite variables to level of normality. The woman should feel in control of her situation and able to make informed decisions and choices to empower her sense of wellbeing and respecting her emotional perspective.

The concept of wellbeing is about a mind–body-health relationship. Stacey (2011) describes

how in the 1970s, science identified the link between the brain and immune system. In 1985 the discovery of signalling neuropeptides triggered the discipline of psychoneuroimmunology (PNI). Although acknowledging that the biomedical approach to health still dominates, explor- ing the PNI influences for childbirth can highlight the potential health impact and possible effect on the birth process. An emotional feeling will trigger the limbic system in the brain (thalamus, hypothalamus, hippocampus and amygdala) and transforms that feeling into the

Antenatal midwifery care

(a)

TirednessEmotional considerations:

Potential depression and anxiety or ambivalence - particularly if the pregnancy was not planned.Change of lifestyle considerations :

Career

Social lifestyle - smoking/alcohol/exerciseBreasts:

Lactogenesis 1 begins - Stimulating Infant feeding decisionsGastro-intestinal changes:

Increased appetite

Nausea and Vomiting

Constipation

Heartburn

Haemorrhoid development

(c)