Report Example: Practicing Intrapartum Care

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Reflection on Practicing Intrapartum Care

Introduction

Midwifery is an international profession where midwives contribute to the survival, health and wellbeing of childbearing women, newborns, and their family members (Roques, 2010). According to NMC Code, Midwives make an essential contribution to the safety and quality of maternal care; therefore, they are obliged to follow the standards of proficiency published by the NMC Code to be registered to practice in the UK (Standards of proficiency for midwives, 2019).

Being the final year student Midwife, I got an opportunity to practise intrapartum care for women while experiencing the distant supervision of my mentor. My mentor adopted the approach of distant supervision to enable me to go through midwifery and present good care to my patients. This is also to prepare me for my future career.

Considering this, my mentor was available on the phone and was approached to the labour room to see my patient when there was an emergency. I would like to reflect on my learning and development of leadership and management skills using Gibb’s Reflective Cycle. Therefore, it is essential here to describe Gibb’s Reflective Cycle briefly.

Gibb’s Reflective Cycle is a framework to examine experiences based on six stages. The model was developed in 1988 by Graham Gibbs and provided the cyclic nature of personal experiences that leads to repeat good experiences and allows people to learn and plan things (Potter, 2015). Using this model, individuals learn and play to bring improvement in their learning experiences. The following six stages are demonstrated by this cycle:

• Description of the experience
• Thoughts and feelings of the experience
• Good or bad evaluation of the experience
• Analysis of the experience to bring improvement
• The conclusion includes a summary of what is learnt through experience
• Action plan to make appropriate changes in future experiences (The University of Edinburgh, 2019)

The philosophy behind applying Gibb’s Reflection Cycle in reflecting experiences is to slow down the thought processes and analysis of the happening and not reach a conclusion too quickly.

Intrapartum Care Reflection

Following the NMC – the Nursery and Midwifery Council’s Code and International Standards, I ensured that I am obliged to uphold human rights and work for the wellbeing of my patients. Under the distant supervision of my mentor, I provided Intrapartum care to Jennifer from the start of her pregnancy. But, one day, when she was brought to the labour room in my hospital, suffering from PPROM – preterm pre-labour rupture of the membrane. The patient was hospitalised with a gestational age of 35 weeks and five days, with the ruptured membranes at 33 weeks and one day in the pregnancy.

Jennifer started experiencing regular contractions of approximately 3 every 15 minutes. I did her ultrasound to confirm the progress of the fetus and FMAU. I recognised from an assessment that the cervical was 2 cm, no bleeding, clear fluid and normal maternal observation. Moreover, it was Jennifer’s first baby, and she had no previous medical record history regarding previous pregnancies. Considering this, I was quite satisfied that this was low-risk pregnancy; however, I expected that Jennifer could have spontaneous vaginal delivery between 38 and 41 weeks.

If I applied this episode of care to Gibb’s reflective cycle, I would like to describe my experience of Jennifer’s Intrapartum care in the first stage. I recognised the concept of best practice within the context of Intrapartum care. I am glad that I worked under my mentor’s distant supervision. This practice enabled me to learn about caring for pregnant women during the Intrapartum period, diagnose associated pregnancy risks, and prescribe effective medication (Chabeli, Malesela and Nolte, 2017). For instance, during early pregnancy, my mentor suggested prescribing Entonox because it is helpful pain relief in labour and is relatively safer for the baby and the mother (National Child Birth Trust, 2020).

This is because it was her first pregnancy of Jennifer and she may face the issue of early pain contractions during her pregnancy. I realised that midwives need to adopt personalised care and women-centred approaches to understand the risk perceptions associated with their profession.

In the second stage of Gibb’s reflection cycle, I would like to describe my feelings or thoughts on the Intrapartum care of Jennifer. I would like to mention that initially, I was quite nervous and scared to experience this episode of care as it was the first time during my student life that I got an opportunity to treat a patient completely in her pregnancy period. This is because it requires a high level of care and best practices because of the nature of sensitivity involved in it. However, the supervision of my mentor, though it was distant and she was available on the phone to advise me, still helped me to overcome my fear and nervousness.

During the entire Intrapartum care, I ensured that my patient felt good and happy that she was going to be a mother, and I was happy and satisfied too that the pregnancy was going well. I also feel good about conducting this practice because it also involved the wellbeing and care of Jennifer’s family and counselling their family members to take care of Jennifer. This process developed a sense of social care, and I am satisfied with it.

The third stage of Gibb’s reflection cycle is about the evaluation of the experience – which may be good or bad. However, in my case of Intrapartum care of Jennifer, the experience was totally a good experience. I learned many things and recognised that I have to still learn many things. For instance, during the gestational age of 33 weeks, when Jennifer was experiencing contractions, I discussed the use of Pethidine with my mentor, suggesting that it can be a useful medicine for pain relief (Kariniemi and Rosti, 2012).

However, my mentor refused to inject Pethidine in this time; she told me that having contractions on week 33 is normal in the first pregnancy and prescribing Pethidine to pregnant women in preterm labour can cause a significant cycling pattern leading to a suspicious cardiotocography (CTG) trace (Ayres-de-Campos, Arteiro, Costa-Santos and Bernardes, 2011).

Moreover, she advised me that this medicine should only be given to preterm if possible advantages outweigh possible risks to the unborn baby. My mentor further told me that the evidence of the use of intramuscular pethidine injections in labour and its results on preterm fetal outcome are unknown. Here, I realised that my understanding of certain medications during pregnancy is very limited, and I have to learn a lot about this aspect of midwifery.

In the fourth stage of Gibb’s reflection cycle, I am supposed to analyse my experience of Intrapartum care of Jennifer. Here, I would like to mention that the use of the continuity model of care remained far helpful for me in Jennifer’s case, leading her to reach the Gestational age of 33 weeks without any complications.

The continuity model of midwifery care enabled me to understand and share the natural ability of women to experience a normal birth with minimum intervention with Jennifer, to monitor the entire pregnancy period of Jennifer to ensure safe pregnancy and birth and the psychological, physical, social and spiritual care of the Jennifer and her family. During this episode of care, I also followed the recommendations of local guidelines for the use of neuroprotectors with established labour between 24 and 29+6 for those who have a planned preterm birth or are in established preterm birth (Vigil-De Gracia, Ramirez, Durán and Quintero, 2017).

However, I was curious about the application of intramuscular injection of MGSO4 during the Gestational age of 33 weeks when Jenifer experienced contractions. However, under the guidance of my mentor and my research, I recognised that the administration of MGSO4 reduces the risks of CP – Cerebral Play and prevents seizures due to worsening preeclampsia, preventing injuries to the preterm baby’s brain and slows preterm labour. On the other hand, from research pieces of evidence and guidelines of the Royal College of Obstetricians and Gynaecologists(2022), I examined that Magnesium Sulphate is thought to relax uterine muscles and is not linked with long-term adverse impacts on feta lot maternal outcomes.

Considering these, it is analysed that I became able to understand the legal and regulatory framework to support midwives in informed choices as well as overcoming the barriers and challenges for midwives during preterm labour.

In stage five, I would like to conclude my experience by stating that it was though a very learning and helpful experience for me as I not only learnt the practice as a midwife, but I also understand standards and guidelines essential for midwives to follow. I also understood the important role of midwives in maternal care in ensuring that the best practice and appropriate care is given to pregnant women. Moreover, through research, I explored the main characteristics of midwifery philosophy is informed choices that emphasises promoting positive physical and mental care outcomes.

Regarding action plan, which is stage 6 of Gibb’s Reflection Cycle, I would like to mention that the philosophy or field of midwifery is also not free from significant various barriers and challenges. According to Plessis et al. (2022), some of the key challenges and barriers are limited or inadequate training and knowledge, litigation and fear of being blamed which can lead to adverse results within the midwifery practice. In this regard, an important role needs to be played by appropriate, relevant medical authorities to design policies and strategies that can assist midwives in overcoming respective challenges. In this regard, future work needs to be done. For instance, future practices should be conducted in the context of informed decisions and this can be done through improvement of midwives’ knowledge. In this regard, midwives should be more educated, provided with support and need to be well-trained to make informed choices and play their role appropriately in the best interest of their patients.

On the other hand, appropriate training programs need to be conducted to enhance leadership and management skills of midwives and to support them in appropriate decision making. Moreover, I would also like to recommend the patients to provide adequate and accurate information to midwives so that they can take proper informed decisions on pregnant women’s health and guide them with best practice and care.

Summary of Learning and Action Plan for Future Development

The following are key summarised points of this reflection:

Under distant supervision of my mentor, I provided Intrapartum care to Jennifer from the start of her pregnancy. In the first stage, I recognised the concept of best practice within the context of Intrapartum care. In the second stage, I described my feelings. I would like to mention that initially I was quite nervous and scared to experience this episode of care as it was the first time during my student life that I got an opportunity to treat a patient completely in her pregnancy period.

However, this episode of care developed a sense of care amongst me and I am satisfied with it. From the evaluation of my experience, it is demonstrated that the experience was totally a good experience. I learnt many things and recognised that I have to still learn on many things. Analysing my experience, I mentioned that I understood the legal and regulatory framework to support midwives in informed choices and overcome the barriers and challenges for midwives during preterm labour. In stage five, I would like to conclude my experience by stating that it was though a very learning and helpful experience for me.

The action plan for me future development includes conducting future practices in the context of informed decisions and this can be done through attending training sessions, being more educated and practising a lot. This recommendation is based on the research evidence that training-based care provided by midwives can promote in the delivery of quality oriented and safe child birth process.

References

Ayres-de-Campos, D., Arteiro, D., Costa-Santos, C. and Bernardes, J., 2011. Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph.BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), pp.978-984.

Chabeli, M., Malesela, J. and Nolte, A., 2017. Best practice during intrapartum care: A concept analysis.Health SA Gesondheid, 22.

Kariniemi, V. and Rosti, J., 2012. Intramuscular Pethidine (meperidine) during labor associated with metabolic acidosis in the newborn.Journal of Perinatal Medicine, 14(2), pp.131-135.

NCT (National Childbirth Trust). 2020.Labour pain relief: Gas and air (Entonox). [online] Available at: https://www.nct.org.uk/labour-birth/your-pain-relief-options/labour-pain-relief-gas-and-air-entonox. [Accessed 10 June 2022].

Nmc.org.uk. 2019.Standards of proficiency for midwives. [online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/standards-of-proficiency-for-midwives.pdf [Accessed 10 June 2022].

Plessis, A., van Rooyen, D. and ten Ham-Baloyi, W., 2022. Screening and managing women with chorioamnionitis in resource-constrained healthcare settings: Evidence-based recommendations.Midwifery, 107, p.103287.

Potter, C., 2015. Leadership development: an applied comparison of Gibbs’ Reflective Cycle and Scharmer’s Theory U.Industrial and Commercial Training, 47(6), pp.336-342.

Roques, F., 2010.Midwifery. 11th ed. London: Arnold.

Royal College of Obstetricians and Gynaecologists. 2022.Guidelines for Midwives. [online] Available at: https://www.rcog.org.uk/guidance/ [Accessed 10 June 2022].

The University of Edinburgh. 2019.Gibbs’ Reflective Cycle. [online] Available at: https://www.ed.ac.uk/reflection/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle [Accessed 10 June 2022].

Vigil-De Gracia, P., Ramirez, R., Durán, Y. and Quintero, A., 2017. Magnesium sulfate for 6 vs 24 hours post delivery in patients who received magnesium sulfate for less than 8 hours before birth: a randomised clinical trial.BMC Pregnancy and Childbirth, 17(1).

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