Midwifery Skills at a Glance

Patricia Lindsay RN, RM, MSc, PGCEA, DHC Registered Midwife. Carmel Bagness MA, RN, RM, ADM, PGCEA Professional Lead for Midwifery & Women’s Health Royal College of Nursing London, UK. Ian Peate OBE FRCN, EN(G), RGN, DipN (Lond), RNT, BEd (Hons), MA (Lond) LLM Editor in Chief British Journal of Nursing Visiting Professor of Nursing St George’s University of London and Kingston University London Head of School School of Health Studies Gibraltar.

Contributors viii

Foreword xi

Preface xii

Part 1 The basics of care 1

Chapter 1: Infection control

1 Infection prevention and control 2

2 Hand hygiene 4

3 Infectious diseases in pregnancy 6

4 Modes of transmission 8

5 Asepsis and sepsis 10

Chapter 2: Health and safety at work

6 Moving and handling 12

7 The control of substances hazardous to health 14

8 Safety in the working environment 16

9 Sharps injuries 18

10 Working safely in the community 20

Chapter 3: Personal hygiene care

11 Personal hygiene care for women 22

12 Perineal and vulval hygiene; use of bedpans and commodes 24

13 Pressure area care 26

Chapter 4: Quality and patient safety in maternity care

14 Risk management, liability and avoidable harm 28

15 Types of incident, incident reporting, record keeping and duty of candour 30

16 Audit and quality assurance in maternity care 32

Chapter 5: Safeguarding

17 Safeguarding vulnerable women 34

18 Safeguarding of children: key issues 36

19 Female genital mutilation 38

Part 2 Assessment, examination, screening and care of the woman and baby 41

Chapter 6: Assessment of the woman

20 ‘Booking’: the initial consultation with the midwife 42

21 The antenatal appointment: physical and psychological assessment of the woman in pregnancy 44

22 Abdominal examination in pregnancy 46

23 Physical and emotional assessment after birth 48

Chapter 7: Care of the woman in labour

24 Assessing the woman in labour 50

25 Abdominal examination in labour 52

26 Vaginal examinations in labour 54

27 Positions in labour and birth 56

28 Supporting and caring for women in labour 58

29 Supporting and caring for the partner 60

30 Care of the perineum in labour including episiotomy and suturing 62

31 Examination of the placenta and membranes 64

32 Urinary catheterisation 66

Chapter 8: The fetus in pregnancy and labour

33 Assessing fetal wellbeing in pregnancy and labour 68

34 Monitoring the fetal heart in pregnancy and labour 70

Chapter 9: Assessment and examination of the neonate

35 The Apgar score 72

36 The midwife’s examination of the baby at birth including identification of the neonate 74

37 Appearance and characteristics of the well term neonate 76

38 Overall daily assessment of the term neonate including vital signs and bladder and bowel function 78

39 Newborn and infant physical examination 80

40 The term, preterm and growth-restricted baby 82

Chapter 10: Caring for the newborn

41 Providing daily hygiene for the neonate including changing a nappy 84

42 Bathing the newborn 86

43 Breastfeeding 88

44 Formula feeding 90

45 Other feeding methods 92

46 Neonatal blood screening (‘heel prick’) 94

Chapter 11: Blood sampling and cannulation

47 Maternal venepuncture, including glucose tolerance testing 96

48 Cord blood and neonatal capillary blood sampling 98

49 Venous cannulation of the woman 100

Chapter 12: Taking and testing other body samples

50 Urinalysis 102

51 Specimen collection – stool specimen 104

52 Taking a wound swab 106

53 Use of a vaginal speculum and taking a vaginal swab 108

Part 3 The woman or neonate with different needs 111

Chapter 13: Induction/stimulation of labour

54 Membrane sweep 112

55 Insertion of vaginal prostaglandin E2 114

56 Artificial rupture of membranes 116

Chapter 14: Care skills for the woman with complex needs

57 Recognising the deteriorating woman 118

58 CVP, Spo2 and ECGs 120

59 Fluid balance monitoring 122

60 Peak flow measurement in the woman 124

61 MEOWS, AVPU, GCS and SBAR 126

62 Care of the deceased 128

Chapter 15: Care skills for the baby with complex needs

63 Recognising deterioration in the neonate 130

64 Neonatal jaundice 132

65 Hypoglycaemia 134

66 Hypothermia 136

Chapter 16: Wound care

67 Wound assessment 138

68 Wound dressings and drains 140

69 Wound closures 142

Chapter 17: Prevention of venous thromboembolism

70 Assessment of venous thromboembolism risk and prevention of deep vein thrombosis in childbirth 144

71 Application and use of compression stockings 146

Part 4 Drug administration in midwifery 149

Chapter 18: Routes of administration

72 Drug administration, handling and storage 150

73 Administration by injection to the woman 152

74 Intravenous administration of drugs 154

75 Medicine administration by oral, rectal, vaginal, topical and inhalation routes 156

76 Neonatal drug administration 158

77 Immunisation 160

Chapter 19:Pain relief

78 Regional analgesia 162

79 Non-pharmacological methods of pain relief 164

80 Transfusion of blood and blood products 166

81 Anti-D: preventing rhesus isoimmunisation 168

Appendices 170

Key references and further reading 172

Glossary 182

Index 184