Module 1: Setting the Stage Flashcards
Compare outcomes for hospital, birth center and home birth, including perinatal mortality and obstetrical interventions.
Two studies were released.
1) One in Canada showed no difference in home vs OOH birth in regards to maternal and fetal mortality, but did find a slightly increased risk in fetal seizures.
2) In America a much smaller retrospective study showed a threefold increase in maternal and fetal mortality.
The American study did not differentiate by risk, provider type, etc., but the Candian study compares low-risk patients in and out of the hospital with the same providers. The Canadian study followed over 10,000 cases.
Understand the importance of integrating out of hospital birth into the maternity system in maximizing safety.
Canada and other countries have more integrated OOH births that likely lead to safer OOH births. There is a better system set up for patients who “risk out” of delivery OOH.
America has more unlicensed providers and little to no integration of in and OOH maternity care.
Compare and contrast the “pain relief” paradigm and the “working with pain” paradigm as described by Leap.
This is discussed in the Evidence Based Birth podcast “Overview of pain management during labor.”
“Pain relief”- this is the belief that pain in labor is unnecessary and the benefits of pain outweigh the risk.
“Working with the pain”- this is the belief that pain is a normal part of labor and necessary because it encourages you to change positions to help the labor process. This releases natural pain relief hormones.
Discuss the relationship between pain and suffering.
This is discussed in the Evidence Based Birth podcast “Overview of pain management during labor.”
Pain and suffering do not always go together. Patients can have pain in labor but are coping well and are, therefore, not suffering. Some people may be pain-free and still be suffering. For example, someone with an epidural can be suffering from fear, discomfort because they cannot feel their body, etc.
Understand the “coping with labor” algorithm.
This is a new algorithm to help with assessing pain in labor since pain is an expected part of labor, and patients may not want to use medical pain relief. This focuses on assessing patients for signs that they are or are not coping with the pain. They can observe the patient or ask, “how are you coping”. If the patient is coping, nothing needs to be done. If the patient is not coping, the provider should assess what techniques could best assist the patient. For example, emotional support (discuss fears she may have and how to best help her), physical supprt (change the lighting, music, positioning, fragrance), Asistance with the physiological process (pain medication, water therapy, position changes, breathing coaching)
Know what Albers means by the “over-treatment of normal childbirth.”
Albers study showed a significant difference in rates of use in regards to oxytocin, epidural, continuous EFM, episiotomy, and vaginal birth rate for patients delivered by a “traditional” model vs. collaborative care. Patients included were low risk. This showed a medical focus within birth instead of a physiological focus.
Identify the 3 primary hormonal systems involved in the hormonal physiology of childbirth.
oxytocin, stress hormones (epinephrine and norepinephrine) and beta endorphins
How does oxytocin benefit the labor and delivery process and how can it be disrupted?
Oxytocin helps ripen the cervix (with prostaglandins), give effective contractions, assists with pushing, promote breast feeding, and reduce postpartum bleeding, promote bonding. Pre-labour oxytocin is neuroprotective.
Epidurals lower the maternal level of oxytocin, prolonged IV oxytocin may desensitize the receptors and ^ risk of PPH, breastfeeding problems, attachment problems
How do stress hormones (epinephrine and norepinephrine) and beta-endorphins benefit the labor and delivery process, and how can they be disrupted?
Stress hormones protect against labor hypoxia, have neuroprotective effects, and promote PP fetal breathing, energy, glucose production and heat regulation. The hormones drop steeply in mom and baby post delivery and promote uterine contractions. These hormones can be affected if the mother does not feel safe. Epidurals drop epinephrine and may contribute to hypotension and tachysystole.
Beta-endorphins have stress relieving and analgesic effects, helps with labor progression, is neuroprotective, and facilitates maternal euphoria/imprinting with infant, reinforces breastfeeding with rewarding effect. It is also passed through colostrum. Excessive stress increase beta-endorphins and prolong labor, low beta-endorphins can cause increased pain levels.
What is the Midwifery Management Process? List and describe the steps?
The midwifery management process is the mental process midwives use to make accurate diagnoses and appropriate plans.
Data Collection (Subjective and Objective)
Making and Assessment (Differentiate between the normal and abnormal)
Developing a Plan of Care (Shared decision making and consultations as needed)
Implementing the Plan
Evaluating Outcomes (Successfulness of plan, consider alternatives)
List and describe the steps of the Clinical Reasoning Cycle
Consider the patient’s situation
Collect cues/information
Process Information
Identify problems/issues
Establish goals
Take action
Evaluate outcomes
Reflect on process and new learning
Define Shared Decision Making.
an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences
List and describe the steps of the Shared Decision Making process
Formulate diagnosis or condition
Name and explain diagnosis or condition
Name care options
Discuss pros and cons of care options
If appropriate, make recommendations
Explore values and preferences
Come to a decision together and name the decision
Provide additional information about this option as needed
Apply the Shared Decision Making process in a clinical situation.
Example: carrier screening testing, does the patient want it done? do that understand what it is? do they understand the risks and benefits?
Example: for a patient high risk of pre-eclampsia. Are they open to discussing? Do they understand the risks of pre-e? Are they open to prevention with baby ASA? Do they understand the risks of ASA in pregnancy?
Understand the best way to present statistics (numbers) when explaining the evidence for different care options during Shared Decision Making.
It is best to explain statistics to patients with x/100, x/1000, x/10,000 and not in x% because it is more informative of risk and not as fear mongering.
