Use Of Water In Labour Health And Social Care Essay

habituate Of wet In Labour Health And Social C are set roughA theme was promulgated in 1992 in The House of leafy vegetable regarding the provision of motherhood services it stated that all hospitals make it their form _or_ system of government to make provision wherever possible for women to choose the present which they favor for fag and stimulate with the option of a affinitying kitty where is practicable (House of Commons Health Committee 1992). Water immersion was officially certain in the UK in 1993 following the publication of the Changing Child take in report (Department of Heath 1993). This report recommended that a pond ease should be usable in all UK maternity units professional recognition came ab give away when the royal stag College of Midwives (RCM, 1994) and the United Kingdom Central Council for Nursing, Midwifery and Heath Visiting (UKCC 1994) published statements in 1994 which integrated the immersion in wet during ride into the accoucheuses rol e. Water immersion is now incorporated in the UK Midwifery Rules and Standards (2004).The current guidelines for moil in pissing in Forth Valley are that the charr should be in realized drive, determined as cervical dilatation of a minimum of 4cm, be at least 37 weeks gestation, the engrafting of the fetus should be cephalic and the fetal disembodied spirit should be at bottom normal parameters of 110 160 beats per minute, any liquor run out should be clear and no opiates should moderate been administered in the 4 bits go on entry to the consortium (Paterson Hamilton, 2009). The body of wet system temperature should be 37 grades this should be chequered hourly together with the temperature of the cleaning char charhood to ensure that she is non pyrexial (NICE, 2007). The char mustiness withal have an bumpkinly obstetric history. At present the facility to labour in piss is present in Stirling Royal hospital except there is shortly only 1 labour get on with a pool. This means that only 1 woman can labour or spend birth in peeing at a time. All woman are offered the option of a body of water birth at their booking visit however whether or not they pass on be able to labour or give birth in water will be dependant on the pool world vacant when they present in labour.The benefits of travail in water are plentiful and is recommended in the NICE Guidelines for Intrapartum Care (2007) the buoyancy afforded by water allows the work woman to adopt comfortable positions easily and the water also succeeds a reposeful environment which assists bother easement due to the vacate of inherent endorphins (Medforth et all, 2007). When a woman gets relaxed oxytocin is released which is required for successful abridgment of the uterus and progress in labour the reduction in spirits of stock will inhibit the production of adrenaline which if produced will hinder oxytocin production indeed slowing the progress of labour. Evidence suggests that the use of water in the first stage of labour empowers woman with an increase impression of control over the situation she is experiencing (Hall Holloway, 1998) it also shown that as the womens perception of wound is reduced the need for epidural analgesia is lessened (Eberhard et all, 2005) as is the need for augmentation by syntocinon (Cluett et all, 2004). Studies have shown that woman who give birth in the water have a reduced incidence of perineal trauma (Garland and Jones, 2000). This has been further back up by a clinical size up carried out in Corbar birth Centre, Baxter (2006) put that of 229 pool births 38% of woman had an intact perineum, 32% had a first peak tear, 29% sustained a sec degree tear and only 1 woman suffered a terce degree tear however this was the turn out of an accelerated second stage labour and the birth of a baby weighing in excess of 4.5 kg. The audit also showed that women who laboured in the pool except did not give birth had a reduced incidence of perineal trauma. Of the 75 woman 32% had a first degree tear, 31% had a second degree tear and again 1 woman suffered a troika degree tear however 31% did require an episiotomy. It has been suggested that it is the atmosphere achieved that results in the positive considers and military issues for the woman who choose to use the pool finished the round-the-clock one to one worry of the accoucheuse, the woman centred approach to childbirth therefrom normalising the birthing experience.The student will now reflect on her experience of a water birth using Gibbs reflective cycle. I came onto an first shift on the 27 February and my mentor and I were allocated the care of a woman in established labour who had decided to labour in water. We entered the manner where we were introduced to Sarah and her partner John. Sarah was a primigravida with an uncomplicated obstetric history and had been wellhead by means ofout her pregnancy, her body mass index of 22 was indoors normal parameters. The staff midwife we were winning over from gave a handover, detailing what had happened since Sarah had arrived in the ward Sarahs labour had commenced spontaneously at home at 41 weeks and 8 days gestation, at 2am that morning she had arrived in maternity triage for assessment at 5am she had been transferred to the labour ward, at this time she was 3cm dilated and struggling to carry on with the pain. Sarah wasnt keen to use pain relief other than entonox and the midwife providing her care had read in her maternity notes that in the past few weeks that she had been considering labouring in water, therefore she suggested Sarah could try using the pool for pain relief both the advantages and disadvantages were fully explained to Sarah and she was apprised that if her own or the fetal tick off deteriorated then she would be asked to leave the pool. Before going into the water Sarahs membranes had been ruptured unnaturally and following the proced ure she was 5cm dilated at 6am, therefore she was in active labour and suitable for labouring in water.Upon taking over Sarahs care a set of baseline observations were carried out by myself, including a kind pressure, temperature, round and urinalysis. The fetal heart was heard on a regular basis at 120 cxxx beats per minute (NICE, 2007). I also checked the water temperature which was 37 degrees. All observations were satisfactory these were noted both on the partogram as well as the labour notes. Observations of temperature and pulse were carried out hourly, the water temperature was checked regularly and Sarahs blood pressure would be checked 4 hourly. The fetal heart was auscultated intermittently using a waterproof Doppler ultrasound. Sarah was using the entonox in the pool and although she was still finding the contractions painful she was coping well. Encouragement was given(p) to Sarah during this time, assure her that she was doing fantastically and guidance on using th e entonox effectively. The atmosphere in the room was relaxed and calm, John was also giving encouragement. At around 8.30 am, 1 hour after taking over Sarahs care, she said reported that she was experiencing a zealous sensation and was feeling the urge to push. The staff midwife put a mirror into the pool and the vertex was found to be visible at this stage. As per the communications protocol (2009) Sarah was advised to push when she mat the urge but to remember not to raise her bottom out of the water. Encouragement was given to Sarah when she was button, but no direction was given as directed pushing is not recommended for birth in water (Baston Hall, 2009). The babys head was delivered approximated 20 minutes later however the babys chin had not been seen as yet. The staff midwife put a hand into the pool to ensure that the chin was bounteous and it was. A live female was delivered with the succeeding(prenominal) contraction and was guided through Sarahs legs as she was in a kneeling position and brought up to her chest.The third stage of labour, the pitch of the placenta, was carried out on a Bradbury mattress as the protocol states that the placenta cannot be delivered in the pool (Paterson Hamilton, 2009). This is due the difficulty in assessing the estimated blood loss in water. Syntometrine was administered intra muscularly by the staff midwife and the placenta was delivered by controlled heap traction approximately 30 minutes after the birth of the baby. Sarah had advised that she would like the cord to stop pulsating before it was cut and clamped therefore Sarah had remained in the water until this had occurred. Sarah had a 2nd degree tear following the delivery and although it was not actively bleeding it was sutured by the staff midwife approximated 1 hour post delivery as is recommended in the guidelines (NHS QIS, 2008).The labour and birth were a beautiful and memorable experience as although it was evident that Sarah was in pain duri ng the labour she was focused on birthing her baby. I felt very satisfied with the delivery as I felt Sarah had authoritative the support and encouragement to have the experience of birth that she had strived for. The delivery subaquatic is amazing, I felt completely overwhelmed with how natural giving birth in water is as I had never experienced a water birth first hand. When reflecting on the experience I realised that upon taking over Sarahs care I had felt slightly nervous about how hands off a water birth is. The midwife is pass judgment to basically observe both the labour and birth with the exception of carrying out the routine observations, checking and maintaining the temperature of the water and keeping the water as clear as possible with the use of a sieve. Since this experience I feel that the next time I am caring for a woman labouring or birthing in water I will feel more than confident as this is a natural and therapeutic manner which increases the focus on norma lity in childbirth.The use of hydrotherapy has been back up as a method of analgesia for many years as a natural alternative to pharmacological pain relief (Jessiman Bryer, 2000). Water exits a dual benefit, heat alleviates muscle spasm and as a result of this pain is reduced and weightlessness lessens the effects of gravity therefore relieving the try out on the pelvis. Sarah was able to adapt her position easily whilst in the pool and spent the majority of her labour in a kneeling position and then facilitating the decent of the fetus (Fraser Cooper, 2009). The NMC (20073) states that You must recognise and the respect the piece that people make to their own care and well being therefore if a woman wishes to labour and give birth in water it is the midwives duty to support her in this choice. Sarah had all the information in coiffure to make an intercommunicate choice and felt that she had contributed to the care she received thus enhancing her satisfaction with her exper ience of labour. Eckert et all (200184) concluded their randomised controlled trial with the outcome that woman who labour and give birth in water appeared more satisfied with their experience as was the case with Sarah. As a midwife advocacy is an important element of the role and it is important that midwives are advocates for the woman in their care in that they empower them with the knowledge to make informed choices regarding the care they receive (Garland, 2000).Although the use of water has been attributed to reduced perception of pain (Baxter, 2006) there is still insufficient evidence to support the use of water and studies have shown that there is no epochal difference in the distance of labour, blood loss or Apgar scores at birth (Cluett Burns, 2009). on that point have also been concerns surrounding the conditions of the neonate born in water yet as stated there has been no evidence found to support this. In fact Thoni and Moroder (200447) have stated that a water bi rth presented no risk to the adaption of the neonate to extra-uterine life. It is however vital that the woman is removed from the water should the maternal or fetal condition fashion compromised (Geissbuehler et all, 2004). There was also the question of maternal and fetal hyperthermia the hypnotism that the woman should decide the temperature of the water (Anderson, 2004) was rejected when NICE (2007) advised that the water temperature should be below 37.5 degrees. It has however been shown that entry into the pool in the potential first phase of labour can be detrimental to progress, Eriksson (1997) found that woman who entered the pool at this stage had increased augmentation of labour as well as increased requirement for epidural analgesia, hence the protocol in Forth Valley that woman should be in established labour prior to entering the pool (Paterson Hamilton, 2009).In conclusion, it appears that there is currently insufficient evidence to support the positive effects of hydrotherapy in labour and birth its use has been proven to have a relaxing effect on labouring woman who have reported feeling more satisfied with their experience. Evidence suggests that labouring in water does not make a significant difference to the length of labour however the fact that the women who choose this method of pain relief report increased fulfilment should not be over looked. Further research would provide an evidence base for best practice. At present only women with an uncomplicated obstetric history are permitted entry to a birthing pool and further research is required to enable women with a variety of obstetric backgrounds to utilise a pool confidently. The question of the environment attained through hydrotherapy has arisen do women feel increased satisfaction due to the woman centred, one to one approach to care received? It seems that this is a significant factor, and one which great emphasis should be placed upon. The role of the midwife is to be with wome n this requires the midwife to be an advocate for the women in her care, it also requires her to provide the women with information to make informed choices regarding their care and to treat every woman as an individual, with individual concerns and needs. If hydrotherapy provides a platform for a natural approach to childbirth then it is one that should be encouraged.