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Preface xiii Contributors xv 1 Labour and normal birth ??? Cathy Charles 1 Introduction 1 The birth environment 3 Signs that precede labour 5 First stage of labour 6 Second stage of labour 18 Pushing 20 The birth 22 Third stage of labour 25 After the birth 30 Summary 31 Useful contacts and information 32 References 32 2 Vaginal examinations and artificial rupture of the membranes ??? Vicky Chapman 39 Vaginal examinations 39 Accuracy and timing of VEs 40 Consent or compliance? 41 Performing a VE 42 Some common problems 45 Artificial rupture of the membranes 47 Summary 49 References 49 3 Fetal heart rate monitoring in labour ??? Bryony Read 52 Introduction 52 Intermittent auscultation 52 Electronic fetal monitoring 54 Fetal scalp electrode 56 Classification of fetal heart rate features 56 Positive and negative aspects of EFM 59 Summary 60 References 61 Appendix: Continuous EFM algorithm (NICE, 2007) 63 4 Perineal trauma and suturing ??? Vicky Chapman 64 Introduction 64 Reducing perineal trauma 65 Assessment of perineal trauma 66 First and second degree tears: to suture or not to suture? 67 Suturing procedure 69 Summary 82 Recommended reading 82 References 82 5 Examination of the newborn baby at birth ??? Caroline Rutter 86 Introduction 86 The midwife???s assessment of the baby at birth 87 Measurements of the newborn 89 Vitamin K prophylaxis 90 Top–to–toe check 91 Neonatal infection 96 Giving upsetting news to parents 98 Useful contacts 99 References 99 6 Home birth ??? Janet Gwillim and Cathy Charles 102 Introduction 102 Benefits of home birth 103 Issues to consider before choosing home birth 104 Preparing for a home birth 106 Care in labour 108 Possible transfer to hospital 112 Summary 115 Useful contacts 115 References 115 7 Water for labour and birth ??? Cathy Charles 117 Introduction 117 Benefits of warm water immersion 118 Possible risks of warm water immersion 119 Criteria for labouring in water 120 Relative contraindications 120 Preparation 121 Labour care 123 Possible problems 125 Summary 127 Useful contacts 128 Recommended reading 128 References 128 8 Malpositions and malpresentations in labour ??? Vicky Chapman 130 Introduction 130 Definitions 130 Occipitoposterior position 133 Face presentation 140 Brow presentation 141 Transverse lie (shoulder presentation) 142 Summary 143 References 144 9 Slow progress in labour ??? Vicky Chapman 146 Introduction 146 Prolonged labour 147 Causes of a prolonged labour 148 Prolonged latent phase 149 Prolonged active first stage 150 Prolonged second stage 153 Summary 155 Recommended reading 156 References 156 10 Assisted birth: ventouse and forceps ??? Cathy Charles 160 Introduction 160 Avoiding an instrumental delivery 161 Indications for an instrumental delivery 161 Types of instrument 162 Choice of instrument 162 Care of a woman undergoing instrumental delivery 163 Assisting at an instrumental delivery 166 Midwife instrumental delivery 167 Post–birth discussion and care 172 Summary 174 References 174 Appendix 10.1 Midwife ventouse practitioner log book record 177 Appendix 10.2 Decision to decline midwife ventouse delivery 178 11 Caesarean section ??? Cathy Charles 179 Introduction 179 Risks and benefits of CS 180 Stemming the flow 182 Indications for elective CS 183 The experience of CS 183 Elective CS birth plan 184 Midwifery care for CS 184 Summary 189 Support groups for women following CS 190 Further reading 190 References 190 12 Vaginal birth after caesarean section ??? Vicky Chapman 193 Introduction 193 The influence and opinions of professionals 194 VBAC or elective CS 194 What improves the success rate in VBAC? 196 Induction of labour for VBAC 196 Midwifery care for VBAC labour 197 Summary 201 References 201 13 Preterm birth ??? Charlise Adams 204 Introduction 204 Incidence and facts 205 Causes and associated factors of preterm birth 206 Place of delivery 206 Preterm prelabour rupture of membranes (PPROM) 206 Corticosteroids for threatened preterm birth 208 Tocolysis in threatened preterm labour 208 Monitoring the fetal heart in preterm labour 209 Midwifery care 209 Mode of delivery 210 Care immediately after birth 211 Skin–to–skin contact 212 Resuscitation 213 Care related to specific types of preterm labour 214 Postnatal care 215 Summary 216 Useful contacts 217 References 217 14 Breech birth ??? Lesley Shuttler 220 Introduction 220 Types of breech presentation 221 Women???s options and the provision of care 223 Concerns and possible complications with a breech birth 225 Labour and birth 226 Summary 236 Useful contacts 236 Recommended reading 236 References 236 15 Twins and higher–order births ??? Jo Coggins 240 Introduction 240 Place of delivery 241 Mode of delivery 241 Care in labour 243 Third stage of labour 246 Care after the birth 248 Summary 249 Useful contacts 249 References 249 16 Haemorrhage ??? Sheila Miskelly 252 Introduction 252 Placenta praevia 253 Vasa praevia 255 Placental abruption 255 Postpartum haemorrhage 260 The 4Ts: Tone, Tissue, Trauma, Thrombophilias 261 Retained placenta 265 Summary 267 References 268 17 Emergencies in labour and birth ??? Sheila Miskelly 271 Introduction 271 Snapped cord 272 Cord prolapse and cord presentation 272 Amniotic fluid embolism 274 Uterine rupture 276 Shoulder dystocia 278 Inverted uterus 284 Maternal collapse/shock 286 Summary 287 References 288 18 Neonatal and maternal resuscitation ??? Nick Castle 292 Introduction 292 Risk management: anticipation 293 Basic neonatal resuscitation 293 Ongoing neonatal resuscitation/complications 297 Maternal resuscitation 301 Summary 304 References 304 19 Induction of labour ??? Mary–Lou Elliott 306 Introduction 306 Risks and side effects 307 Information giving and informed consent 308 Determining expected date of delivery (EDD) 308 IOL for social reasons 309 Induction for post–term pregnancy 309 IOL versus expectant management for PROM at term 309 Assessing the cervix 310 Methods of induction 310 Care of a woman during IOL 313 Summary 315 Recommended reading 316 References 316 20 Pre–eclampsia ??? Annette Briley 318 Introduction 318 Signs and symptoms 321 Care during labour 323 Monitoring the maternal and fetal condition in moderate/severe pre–eclampsia 324 Drugs used in the treatment of severe hypertension 326 Management of eclampsia 327 Care during/following an eclamptic fit 328 HELLP syndrome 330 Summary 332 Useful resources 333 References 333 21 Stillbirth and neonatal death ??? Barbara Kavanagh and Cathy Charles 336 Introduction 336 Definition 337 Incidence and facts 337 Causes and predisposing factors for perinatal death 337 Diagnosing fetal death and decision making 338 Midwifery care in labour following intrauterine death 341 Neonatal death and unexpected death at/after birth 342 Immediate care following stillbirth/NND: precious moments with the baby 343 Ongoing postnatal care 345 Supporting staff 349 Summary 350 Useful contacts 350 References 350 Appendix: Checklist following a pregnancy loss after 24 weeks 353 22 Risk management, litigation and complaints ??? Cathy Charles 355 Introduction 355 Clinical risk management: learning from adverse events 356 Litigation 357 Vicarious liability of employer 358 Clinical risk management organisations 359 Records 359 Complaints 360 Writing a statement 360 Caring for the mother or father following an adverse event 361 Conclusion 361 Summary 362 Useful contacts 362 References 362 23 Intrapartum blood tests ??? Vicky Chapman and Julie Davis 364 Blood tests 364 Haematology and coagulopathy 370 Blood bank (immunohaematology) 373 Blood tests for specific conditions and blood pictures 374 Fetal blood tests 376 References 379 24 Medicines and the midwife ??? Vicky Chapman 381 Introduction 381 Midwife exemption orders 382 Standing orders 385 Patient group directions (PGDs) 385 Documentation and drug errors 385 Common abbreviations 387 Useful contacts 388 References 388 Index 389