Summative assessment Flashcards
What are the types of discrimination
Direct, indirect, combined discrimination, harassment, victimistaion
What is unconscious bias?
When we make judgements or decisions based on our prior experience, our own personal deep-seated thought patterns, assumptions or interpretations and we are not aware that we are doing it
Why does the MBRRCE UK Report matter in maternity care?
- Evidence of systematic racism, discrimination and bias in health and social care.
- Large disparities in health outcomes and health inequalities
- Impact on accessibility to care
- Need for change
What were the better birth inquiry findings?
- Lack of physical and psychological safety
- Being ignored and disbelieved
- Racism by caregivers
- Dehumanisation
- Lack of choice, consent and coercion
- Structural barriers
- Workforce repretenation and culture
Better birth inquiry calls to action..
- commit to being anti-racist
- decolonise maternity curriculums and guidance
- make black and brown women the decision makers in their care and in the wider maternity system
- create safe, inclusive workforce cultures
- Dismantle structural barriers to racial equity through national policy change
What are the two different types of human rights?
Absolute - Some of our human
rights are absolute, meaning they
can never be restricted, limited or
interfered with.
* Non-absolute rights are rights that
can be restricted of limited in some
situations
When did the human rights act become a law?
1998
Practioner Guide to human rights
What is the decision?
Who has the decision affected + how?
Who has made the decision?
Will the decision restrict anyone’s rights as set out in the Human Rights Act?
Are the right and absolute rights?
Is the right to liberty involved?
Does the decision involve any human rights I can restrict?
Grounded theory
involves the construction of theories through identifying categories of meaning in the gathering and analysis of data. Literature review conducted after study
Phenomenology
Studies the world as it presents itself to humans. Concerned with consciousness and a subject’s direct experience of the world.
Ethnography
The study of a culture or society usually conducted through direct participant observation. Am immersive research method where the researcher can participate on extensive fieldwork.
Discourse analysis
Is a research method which studies tests (written, spoken, sign) and looks for meaning within the text in relation to social context. There are many different approaches to discourse analysis.
thematic analysis
Form of analysis in qualitative data which identifies, analyses and interprets meaning within qualitative data.
Participatory action research:
Includes ps are art of the research team. Goal of the research is to generate research thatw ill lead to action for the ps. Breaks down traditional dynamic od researcher/participant
Narrative approaches:
Narrative research involves working with narratives (these can be from different sources interviews, books, media etc). It usually focuses on a persons narrative told from their perspective (Squire et al, 2014)
Case control study
2 groups that are compared with each other, this is often used when the outcome is less common
Advantages of case control study
Advantages:
Good for rare outcomes
Can investigate a range of exposures
Potential for expensive data on small group
Less expensive
Disadvantges to case control study
Disadvantages:
Susceptible to bias: recall and selection bias
Can only look at limited outcomes
Susceptible to confounders
Cohort study
a group of subjects followed through time. Generally, used where the outcome is not rare
Advantages of a cohort study
More appropriate comparison groups of exposed and unexposed
Reduces recall bias
In depth data on a wide range of outcomes
Disadvantages of cohort study
Expensive and time consuming
Inefficient for rare outcomes
Suscptible to confounders
Cross sectional studies
describes the population studied at a point in time (without follow up). Determines prevalence (extent of the health condition in the population at that time). Look for trends
Advantges of cross sectional studies
Inexpensive
No loss to follow up
Disadvantges of cross sectional studies
Impossible to establish a causal relationship
Potential for too many confounders
Intervation studies
nonrandomised trials. To test initial effectiveness. Randomised controlled trials ‘gold standard for studying treatment effects.
Randomisation
Participants are randomly allocated to intervention or control
Known or unknown confounders are balanced equally across the groups
Any difference in outcomes between the groups can be attributed to the intervention (causality)
Advantages of randomisation
Eliminates or reduces confounding and bias
Assess causal relationship (with degrees of certainty)
Disadvantages:
Not always possible/ethically appropriate
Can be expensive
If too highly controlled – questionable relevance to practice
What is fear of childbrith called?
Tokophobia
what are the types of tokophobia
Primary, secondary, secondary to depressive illness in pregnancy
Health care proffessionals should inform womrn that the available evidence does not support the following methods for induction of labour
- herbal supplements
- acupuncture
- homeopathy
- castor oil
- hot baths
- enemas
- sexual intercourse
Onset of labour
Endocrine= progesterone withdrawal through the release of adrenocorticotropic and corticotropin hormones
Immune = leukocytes and leukotriene activation
mechanical = enhanced uterine stretching and amniochorionic membrane
Assessment - role of the midwife
- triage
-ADU
-MAC
-phone
To decide a plan of care - care pathway
Carry out an initial assessment to determine if midwifery led care in any setting is suitable for the woman, irrespective of any previous plan including consultant led care (NICE, 2023)
Amniotic fluid
Green - meconium stained
Golden -Rh incompatibility
Greenish yellow - post maturity
Dark coloured - concealed accident; haemorrhage
Dark brown: IUD
Clear/ colourless/pale straw amniotic fluid - normal
Purple line
Shepard et al - positive correlation between length or purple line and cervical dilatation, occurred in 76% of women
increase oxytocin by
- staying calm and confident
- avoid distrubances
reduce adrenalin by
- being informed and prepared
- trusr and confidence in caregivers
- environmental effects
increase endorpohins by
- staying calm and confident
- avoid distrubances
- delaying use of opiodis/ epidural
care in the 1st stage of labour
- half hourly documentaion of frequncy of contractions
- hourly pulse
- 4 hourly temp, bp & resps
- offer VE 4 hourly or if there is a concern about progress or in response to the woman wishes
Rhombus of michaelis
- wedge shaped area of bone moves backwards during the second stage of labour and as it moves back it pushes the wings of ilea out, increases the diameter of the pelivs
- we know its happening when the woman hands reach upwards to find something to hold onto, her head goes back and her back arches
Labour mechanism
Descent - the fetus begins to decend into the pelvis due to the force pf gravity and downward pressure of the contractions
Flexion - as the fetus descends the chin touches the chest and attitude of flexion is adopted. this increases further when the head meets the resistance of the birth canal
Internal rotation - head: as the occiput reaches the resistance of the pelvic floor it rotates. The slope of the pelvic floor aids this rotation and allows the head to emerge in the longest diameter.
Crowning - the head has crowned when it escapes under the pubic arch and no longer recedes between contractions because the widest transverse diameter of the head is born (biparietal)
Extension- with slight extension the forehead, face and child pass over the perineum and the head is born.
Resitiustin - when the head is born it will turn to the left or right so as to realign with the shoulders
Internal rotation - shoulders: the shoulders then rotate and lie in the anterior posterior position
Lateral flexion- birth of the shoulders by lateral flexion to accommodate the curve of carus
Characteristics of the second stage of labour
As baby rotates through the maternal pelvis, soft tissues are displaced, bladder displaces anteriorly, retum flattens (dilates), perienal body thins and stretches
what is schultze method
- separation starts in the centre of the placenta and this part descends first
- retroplacental clot forms which aids separation
- fetal surface appears first at the vulva with membranes tailing behind, the retroplacental clot is enclosed within the membranes
- associated with less blood loss ( quicker separation)
- most common 80%
Documentatation of second stage
timings of:
full dilation
onset of active 2nd stage
descent
when the presenting part is visible
head crowns
head born
baby born
what is the matthew duncan method
-separtion at the lower edge of the placenta
- placenta slips down sideways and the maternal surface appears at the vulva
- associated with longer duration, increased blood loss and ragged membranes
- less common 20 %
Control of bleeding (haemostatsis)
- the empty uterus fully contacts and the uterine walls come into apposition
- the myometrium continues to contract and retract. the interlacing muscle fibres become living ligatures constricting the torn blood vessels and sealing them.
- activation of coagulation and fibrinolytic systems
- breastfeeding and skin to skin increase oxytocin production
physiological 3rd stage: signs of separtipn and descent
- fundus rises up and becomes globular
- bulge just above symphysis pubis
- gush of blood per vaginum
- more cord becomes visible
- urges to bear down
- uterine contractions
-placenta enters vagina
Active management for optimal cord clamping
In active management of the third stage of labour after administering
oxytocin, clamp and cut the cord, >1 minute but <5 minutes unless the
woman requests otherwise (NICE, 2023).
* Delayed or optimal cord clamping expands neonatal blood volume by
20-50%, decreasing anaemia in babies (infants with better iron levels
seem to do better on tests of neurodevelopment later in childhood.)
* Reduces a sudden drop in neonatal blood pressure and therefore keeps
baby stable
Retained placenta
- placenta has separted but is retained ( trapped)
- the placenta has not separated
- the cord has snapped
- the placenta is morbidly adhered
- consider bladder care
–> removed manually in there under spinal by the obstetric team
when preforming a VE determine:
- the station of the presenting part
- the position of the presenting part
- the presence or absence of caput or moulding
- cervical effacement
- cervical dilatation
- presence or absence of membranes
antenatal maternal risk factors for CTG
- previous caesarean birth or full thickness uterine scar
- any hypertensive disorder requiring medication
- prolonged ruptured membranes
- any vaginal loss other than a show
- suspected chrioamnionitis or maternal sepsis
- pre existing diabetes and gestaional diabete requiring medication
antenatal fetal risk factors
- non cephalic presntation including while a decsion is made about mode of birth
- FGR
- small for gestational age
- advanced gestational age >42 weeks at onset of labour
-anhydramnios or polyhydramios - RFM in last 24 hours
