The Midwife's Labour and Birth Handbook

 
 
Wiley-Blackwell (Verlag)
  • 4. Auflage
  • |
  • erschienen am 15. November 2017
  • |
  • 464 Seiten
 
E-Book | ePUB mit Adobe DRM | Systemvoraussetzungen
978-1-119-23509-5 (ISBN)
 
Praise for the previous edition:
"...An outstanding handbook. It will be a familiar volume on most midwifery bookshelves, providing an excellent guide to midwifery focused care of both woman and child in the birthing setting."
- Nursing Times Online
Providing a practical and comprehensive guide to midwifery care, The Midwife's Labour and Birth Handbook continues to promote best practice and a safe, satisfying birthing experience with a focus on women-centred care.
Covering all aspects of care during labour and birth, from obstetric emergencies to the practicalities of perineal repair (including left-hand suturing), the fourth edition has been fully revised and updated to include:
* Full colour photographs of kneeling extended breech and footling breech births
* New water birth and breech water birth photographs
* Female genital mutilation
* Sepsis
* Group B streptococcus
* Care of the woman with diabetes /Neonatal hypoglycaemia
* Mental health
* Seeding/microbirthing
It also addresses important issues such as:
* Why are the numbers of UK women giving birth in stirrups RISING rather than falling?
* Why are so few preterm babies given bedside resuscitation with the cord intact?
* Would the creation of midwife breech practitioners/specialists enable more women to choose vaginal breech birth and is breech water birth safe?
* What is the legal position for women who choose to free birth - and their birth partners?
* Why are midwives challenging the OASI care bundle?
Incorporating research, evidence and anecdotal observations, The Midwife's Labour and Birth Handbook remains an essential resource for both student midwives and experienced practising midwives.
4. Auflage
  • Englisch
  • Newark
  • |
  • Großbritannien
John Wiley & Sons
  • 19,98 MB
978-1-119-23509-5 (9781119235095)
111923509X (111923509X)
weitere Ausgaben werden ermittelt
  • Intro
  • Title Page
  • Copyright Page
  • Contents
  • Preface
  • Contributors
  • Chapter 1 Labour and normal birth
  • Introduction
  • Facts and recommendations for care
  • Mode of delivery
  • The birth environment
  • Signs that precede labour
  • Prelabour rupture of membranes at term
  • First stage of labour
  • Latent stage
  • Established first stage of labour
  • Analgesia
  • Non-pharmacological analgesia
  • Pharmacological analgesia
  • Regional anaesthesia
  • Care for a woman with regional analgesia (NICE, 2014
  • RCOG, 2015a)
  • Mobility and positions
  • Transition
  • Second stage of labour
  • Characteristics of the second stage
  • Midwifery care in the second stage
  • Pushing
  • The birth
  • Third stage of labour
  • Pros and cons of physiological versus active management
  • Active management of the third stage of labour
  • After the birth
  • Mental health/safeguarding
  • Early discharge home
  • Useful contacts and information
  • References
  • Appendix 1.1 Group B Streptococcus
  • Chapter 2 Vaginal examinations and amniotomy
  • Vaginal examinations
  • Incidence and facts
  • Accuracy and timing of vaginal examinations
  • Consent or compliance?
  • Performing a vaginal examination
  • Before a vaginal examination
  • Vaginal examination procedure
  • Following the examination
  • Some common findings
  • Poor progress
  • Subverting results
  • Anterior lip
  • Oedematous cervix
  • Invasive examinations and sexual abuse
  • Phobias and behaviours linked to past abuse
  • What can the midwife do to help?
  • Amniotomy/artificial rupture of the membranes
  • Possible indications for amniotomy
  • Contraindications and risks of amniotomy
  • Summary
  • References
  • Chapter 3 Fetal heart rate monitoring in labour
  • Introduction
  • Intermittent auscultation
  • Using a Pinard/hand-held Doppler
  • Electronic fetal monitoring
  • Indications for electronic fetal monitoring
  • Avoiding unnecessary electronic fetal monitoring
  • Performing cardiotocography
  • Fetal scalp electrode
  • ST analysis
  • Classification of fetal heart rate features (NICE, 2014, updated 2017)
  • Action for CTG concerns
  • Summary
  • References
  • Chapter 4 Perineal trauma and suturing
  • Introduction
  • Incidence and facts
  • Reducing perineal trauma
  • Assessment of perineal trauma
  • Labial tears
  • Urethral tears
  • First- and second-degree tears
  • Third- and fourth-degree tears (obstetric anal sphincter injury)
  • Risk factors and management of obstetric anal sphincter injury
  • Episiotomy
  • Providing care for survivors of childhood sexual abuse
  • Female genital mutilation
  • Suturing procedure
  • Pain relief
  • Optimising the effect of local anaesthetic
  • Suturing materials
  • Suturing techniques
  • Left-handed suturing
  • Suturing at home
  • Perineal suturing procedure
  • Recommended reading
  • References
  • Appendix 4.1: Obstetric Anal Sphincter Injury (OASI) Care Bundle Project
  • Manual perineal protection
  • Episiotomy
  • Conclusion
  • Chapter 5 Examination of the newborn baby at birth
  • Introduction
  • The midwife's assessment of the baby at birth
  • Colour
  • Respirations and cry
  • Heart rate
  • Muscle tone
  • Measurements of the newborn
  • Weight
  • Length
  • Head circumference
  • Vitamin K prophylaxis
  • Top-to-toe check
  • Head
  • Face
  • Eyes
  • Ears
  • Mouth
  • Neck
  • Chest and abdomen
  • Genitalia
  • Anus
  • Back and spine
  • Limbs
  • Skin
  • Neonatal infection
  • Antenatal/intrapartum risk factors for infection
  • Hypoglycaemia of the newborn
  • Giving upsetting news to parents
  • Useful contacts
  • References
  • Chapter 6 Home birth
  • Introduction
  • Incidence and facts
  • Benefits of home birth
  • Average cost of birth
  • Issues to consider before choosing home birth
  • Freebirthing
  • Attending home births
  • Preparing for a home birth
  • Home visit
  • Environmental planning/risk assessment
  • Equipment preparation
  • Preparation by the mother
  • Care in labour
  • Early labour
  • Labour
  • The birth
  • Home birth problems
  • Transfer to hospital
  • Non-emergency transfer to hospital
  • Emergency transfer to hospital
  • Useful contacts
  • References
  • Chapter 7 Water for labour and birth
  • Introduction
  • Facts
  • Benefits of warm water immersion
  • Possible risks of warm water immersion
  • Criteria for labouring in water
  • Relative contraindications
  • Preparation
  • Water temperature
  • Cleansing
  • Equipment
  • Water birth at home
  • Labour care
  • First stage of labour
  • Second stage of labour
  • Third stage of labour
  • Possible problems
  • Most common reasons to leave the pool
  • Cord entanglement
  • Snapped cord
  • Shoulder dystocia
  • Postpartum haemorrhage
  • Loss of consciousness
  • Summary
  • Useful contacts
  • Recommended reading
  • References
  • Chapter 8 Malpositions and malpresentations in Labour
  • Introduction
  • Definitions
  • Malposition
  • Malpresentation
  • Occipitoposterior position
  • Incidence and facts
  • Diagnosis
  • Characteristics of OP labour and birth
  • Manual rotation during the second stage from OP to OA
  • MR technique
  • Midwifery care for OP
  • What else may help?
  • Mobilisation and upright postures
  • Face presentation
  • Incidence and facts
  • Characteristics of a face presentation
  • Midwifery care
  • Brow presentation
  • Incidence and facts
  • Characteristics of a brow presentation
  • Midwifery care
  • Breech presentation
  • Transverse lie (shoulder presentation)
  • Incidence and facts
  • Characteristics of a transverse lie/shoulder presentation
  • Midwifery care
  • Summary
  • References
  • Chapter 9 Slow progress in labour
  • Introduction
  • Incidence and facts
  • Prolonged labour
  • Defining labour onset
  • Assessing progress in labour and the partogram
  • Causes of a prolonged labour
  • Prolonged latent phase
  • Midwifery care
  • Prolonged active first stage
  • Midwifery care
  • Prolonged second stage
  • Assessing progress
  • How midwives can help in a slow second stage
  • Effective positions for a slow second stage
  • Epidural anaesthesia in the second stage
  • Obstetric referral for a delayed second stage
  • Obstructed labour
  • Summary
  • Slow progress in labour
  • Factors that slow labour
  • Interventions that may help progress
  • Recommended reading
  • References
  • Chapter 10 Assisted birth: ventouse and forceps
  • Introduction
  • Incidence and facts
  • Avoiding an instrumental delivery
  • Indications for an instrumental delivery
  • Types of instrument
  • Choice of instrument
  • Care of a woman undergoing instrumental delivery
  • Communication
  • Reducing fear
  • Analgesia
  • Use of IV oxytocin
  • Positioning
  • Bladder care
  • Episiotomy
  • Assisting at an instrumental delivery
  • Mutual staff support
  • Equipment preparation
  • Instrumental procedure
  • Advocacy/accountability
  • Post-procedure care
  • Midwife instrumental delivery
  • Criteria for a midwife instrumental delivery
  • Preparation
  • Midwife ventouse delivery
  • Midwife forceps delivery
  • Advocacy/accountability
  • Postnatal care
  • Records
  • Summary
  • References
  • Appendix 10.1 Assisted birth practitioner midwife log book record
  • Appendix 10.2 Decision to decline ABP delivery
  • Chapter 11 Caesarean section
  • Introduction
  • Incidence and facts
  • Risks and benefits of CS
  • Benefits/indications
  • Risks
  • Stemming the flow
  • Indications for elective CS
  • Maternal request
  • The experience of CS
  • Elective CS birth plan
  • Midwifery care for CS
  • Physical preparation
  • In theatre
  • Postnatal care
  • Summary
  • Support groups for women following CS
  • Recommended reading
  • References
  • Chapter 12 Vaginal birth after caesarean section
  • Introduction
  • Incidence and facts
  • Women's decision-making
  • Considerations and risks associated with VBAC
  • Considerations and risks associated with elective repeat CS (ERCS)
  • Home VBAC
  • Induction of labour for VBAC
  • Midwifery care for VBAC labour
  • Second stage of labour
  • Third stage
  • Summary
  • In hospital
  • At home/birthing centre
  • Recommended reading
  • References
  • Chapter 13 Preterm birth
  • Introduction
  • Incidence and facts
  • Causes and associated factors of preterm birth
  • Place of delivery
  • Preterm prelabour rupture of membranes (PPROM)
  • Possible complications of PPROM
  • Diagnosis of PPROM
  • Management of PPROM
  • Diagnosing preterm labour in women with intact membranes
  • Corticosteroids for threatened preterm birth
  • Magnesium sulfate for neuroprotection
  • Tocolysis in threatened preterm labour
  • Monitoring the fetal heart in preterm labour
  • Midwifery care
  • Second stage of labour
  • Mode of delivery
  • Care immediately after birth
  • Delayed/deferred cord clamping (DCC)
  • Skin-to-skin contact
  • Resuscitation
  • Immediate action following birth for babies needing resuscitation
  • Care related to specific types of preterm labour
  • Very preterm infants (22-26 weeks)
  • Breech presentation
  • Multiple pregnancies
  • Preterm birth at home
  • Postnatal care
  • Summary
  • Useful contacts
  • References
  • Chapter 14 Breech birth
  • Introduction
  • Incidence
  • Facts
  • Types of breech presentation
  • Women's options and the provision of care
  • Self-help measures
  • External cephalic version
  • Caesarean section
  • Positions for labour and birth
  • Concerns and possible complications with a breech birth
  • Hypoxia
  • Umbilical cord prolapse
  • Entrapment of the aftercoming head
  • Deflexion and hyperextension (star gazing) of the baby's head
  • Head and neck trauma
  • Premature placental separation
  • Labour and birth
  • Preparation/birth planning
  • The midwife's role
  • Mechanisms of a breech birth
  • Onset of labour
  • Coping with pain in a breech labour
  • First stage
  • Second stage
  • The birth
  • Third stage
  • Assisted breech delivery
  • Total breech extraction (TBE)
  • The baby at birth
  • Summary
  • Useful contacts
  • Recommended reading
  • References
  • Chapter 15 Twins and higher order births
  • Introduction
  • Incidence and facts
  • Mode of delivery
  • Monochorionic multiple pregnancy
  • Care in labour for multiple pregnancy
  • Monitoring the fetal heart rates
  • Second stage of labour
  • Birth of the first baby
  • Birth of the second/subsequent baby
  • Third stage of labour
  • Active management
  • Physiological third stage
  • Care after the birth
  • Summary
  • Useful contacts
  • References
  • Chapter 16 Obstetric haemorrhage
  • Introduction
  • Incidence and facts
  • Antepartum haemorrhage
  • Placenta praevia
  • Incidence and facts
  • Vasa praevia
  • Placental abruption
  • Incidence and facts
  • Care of a woman with antepartum haemorrhage
  • Third-stage management in vaginal delivery following APH
  • Postpartum haemorrhage
  • Incidence and facts
  • The 4Ts: Tone, Tissue, Trauma, Thrombophilias
  • Tone (uterine atony)
  • Tissue
  • Trauma
  • Thrombophilias/clotting problems
  • Perineal haematoma
  • Signs and symptoms of haematoma
  • Treatment
  • Retained placenta
  • Incidence and facts
  • Placenta accreta/increta/percreta
  • Treatment
  • Role of the midwife caring for a woman with retained placenta
  • Summary
  • Significant antepartum haemorrhage
  • Postpartum haemorrhage
  • References
  • Chapter 17 Emergencies in labour and birth
  • Introduction
  • Cord prolapse and cord presentation
  • Incidence and facts
  • Diagnosis of cord prolapse
  • Management
  • Amniotic fluid embolism
  • Incidence and facts
  • Signs and symptoms of AFE
  • Treatment
  • Uterine rupture
  • Incidence and facts
  • Associated risk factors
  • Management
  • Aftercare
  • Shoulder dystocia
  • Incidence and facts
  • Associated risk factors
  • Diagnosing shoulder dystocia
  • The advantages of upright birthing positions
  • A systematic approach to shoulder dystocia
  • McRoberts manoeuvre
  • Suprapubic pressure
  • All fours position
  • Internal manoeuvres
  • Internal rotational manoeuvres
  • Delivery of the posterior arm
  • Last resort procedures
  • Immediately following birth
  • Aftercare
  • Inverted uterus
  • Incidence and facts
  • Associated risk factors
  • Signs and symptoms
  • Practice recommendations
  • Aftercare
  • Sepsis
  • Maternal collapse/shock
  • Haemorrhagic
  • Non-haemorrhagic
  • Summary
  • Cord prolapse
  • Amniotic fluid embolism
  • Uterine rupture
  • Shoulder dystocia
  • Inverted uterus
  • Sepsis
  • Maternal shock/collapse
  • References
  • Appendix 17.1:
  • Chapter 18 Neonatal and maternal resuscitation
  • Introduction
  • Perinatal transition/resuscitation
  • Incidence and facts
  • Risk management: anticipation
  • Basic neonatal resuscitation
  • Environment and early management
  • Assessment
  • ABC of neonatal resuscitation
  • Stimulation
  • Suction
  • The initial five breaths
  • Ongoing neonatal resuscitation/complications
  • Continued ventilation
  • Compressions
  • Chest compression technique
  • The umbilical cord
  • Intubation
  • Drugs and fluids
  • Termination of neonatal resuscitation
  • Maternal resuscitation
  • Incidence and facts
  • Basic life support
  • The ABC of maternal resuscitation
  • The left lateral tilt position or manual displacement of the uterus
  • Advanced life support
  • Summary
  • Newborn resuscitation
  • Maternal resuscitation
  • References
  • Chapter 19 Induction of labour
  • Introduction
  • Definition
  • Incidence and facts
  • Indications for IOL
  • Induction for post-term pregnancy
  • Risks and side-effects
  • Other risks/issues
  • Information giving and informed consent
  • Assessing the cervix
  • Methods of induction
  • Natural/complementary methods
  • Surgical/mechanical/pharmacological methods
  • Care of a woman during IOL
  • Midwifery care for IOL
  • Continuing IOL: care with IV oxytocin
  • Summary
  • References
  • Chapter 20 Pre-eclampsia and diabetes
  • Pre-eclampsia
  • Introduction
  • Incidence and facts
  • Associated risk factors
  • Signs and symptoms
  • BP measurement
  • Care during labour
  • Preterm birth
  • Psychological support
  • Intrapartum BP management
  • Fluid balance management
  • Second stage
  • Drugs for severe hypertension
  • Treatment to prevent or treat seizures: magnesium sulfate
  • Care of a woman receiving drug treatment for severe hypertension
  • Eclampsia
  • Facts
  • Care for an eclamptic fit
  • Drug treatment for eclampsia: magnesium sulfate anticonvulsant therapy
  • Care of the woman receiving a magnesium sulfate infusion
  • Postnatal BP management for women with pre-eclampsia or eclampsia
  • HELLP syndrome
  • Incidence
  • Signs and symptoms of HELLP
  • Care of women with HELLP syndrome
  • Diabetes
  • Incidence and facts
  • Care in labour
  • Post-birth
  • Summary
  • First stage labour care for severe pre-eclampsia
  • Second stage labour care for severe pre-eclampsia
  • Eclamptic fit
  • Diabetes
  • Useful resources
  • References
  • Chapter 21 Stillbirth and neonatal death
  • Introduction
  • Definitions (MBRRACE, 2016)
  • Incidence and facts
  • Causes and predisposing factors for perinatal death
  • Diagnosing fetal death and decision-making
  • The beginning of the grieving process
  • Decision-making and choices
  • Mode of delivery
  • Induction or expectant management
  • Place of birth
  • Midwifery care in labour following intrauterine death
  • Compassion and individualised care
  • Observations
  • Analgesia
  • The birth of the baby
  • Third stage of labour
  • Neonatal death and unexpected death at/after birth
  • Expected death of a baby
  • Unexpected stillbirth or neonatal death
  • Immediate care following stillbirth/NND: precious moments with the baby
  • Creating memories and mementos
  • Ongoing postnatal care
  • Checklists, tests and paperwork
  • Post-mortem (autopsy)
  • Registering the baby's death
  • Spiritual beliefs and funeral arrangements
  • Staying in hospital
  • The option of taking the baby home
  • Going home
  • Planning for a future pregnancy
  • Supporting staff
  • Useful contacts
  • References
  • Appendix 21.1 Checklist following a pregnancy loss after 24 weeks
  • Chapter 22 Risk management, litigation and complaints
  • Introduction
  • Incidence and facts
  • Clinical risk management: learning from adverse events
  • The process of event analysis
  • Litigation
  • Vicarious liability of employer
  • Clinical risk management organisations
  • Records
  • Complaints
  • Writing a statement
  • Caring for the mother or father following an adverse event
  • Conclusion
  • Useful contacts
  • References
  • Chapter 23 Intrapartum blood tests
  • Blood tests
  • Maternal reference ranges
  • Taking a blood sample
  • Tips for tricky veins
  • Portable blood testing
  • Biochemistry
  • Electrolytes
  • Renal function tests
  • Lactate
  • Glucose
  • Liver function tests
  • Serum bile acid/total bile acids (TBA)
  • Serum ferritin
  • C-reactive protein
  • Haematology and coagulopathy
  • Full blood count
  • Clotting screening
  • Blood bank (immunohaematology)
  • Group and save
  • Cross-matching
  • Kleihauer and fetal rhesus genotype testing
  • Direct Coombs test (DCT)
  • Blood tests for specific conditions and blood pictures
  • Pre-eclampsia
  • HELLP syndrome
  • Disseminated intravascular coagulation (DIC)
  • Stillbirth
  • Severe haemorrhage
  • Fetal blood tests
  • Fetal blood pH sampling and lactate testing
  • Fetal blood sampling procedure and maternal consent
  • Cord blood gas sampling
  • References
  • Chapter 24 Medicines and the midwife
  • Introduction
  • Incidence and Facts
  • Midwife Exemption Orders
  • Aren't midwives prescribing?
  • Towards a National Formulary
  • Supply
  • Administration
  • Student midwives and sign-off mentors
  • Patient Group Directions
  • Safety, drug errors and documentation
  • Documentation
  • Reporting drug errors
  • Abbreviations and common terms
  • Useful information
  • References
  • Index
  • Appendix A: Blood reference ranges and tests for specific conditions
  • EULA

1
Labour and normal birth


Cathy Charles

  1. The birth environment
  2. Signs that precede labour
  3. First stage of labour
  4. Analgesia
  5. Regional anaesthesia
  6. Mobility and positions
  7. Transition
  8. Second stage of labour
  9. Pushing
  10. The birth
  11. Third stage of labour
  12. After the birth
  13. Mental health/safeguarding
  14. Early discharge home
  15. Appendix 1.1: Group B Streptococcus

Introduction


Undisturbed birth . is the balance and involvement of an exquisitely complex and finely tuned orchestra of hormones.

(Buckley, 2004a)

The most exciting activity of a midwife is assisting a woman in labour. The care and support of a midwife may well have a direct result on a woman's ability to labour and birth her baby. Every woman and each birthing experience is unique.

Many midwives manage excessive workloads and, particularly in hospitals, may be pressured by colleagues and policies into offering medicalised care. Yet the midwifery philosophy of helping women to work with their amazing bodies enables many women to have a safe pleasurable birth. Most good midwives find ways to provide good care, whatever the environment, and their example will be passed on to the colleagues and students with whom they work.

Some labours are inherently harder than others, despite all the best efforts of woman and midwife. A midwife should be flexible and adaptable, accepting that it may be neither the midwife's nor the mother's fault if things do not go to plan. The aim is a healthy happy outcome, whatever the means.

This chapter aims to give an overview of the process of labour, but it is recognised that labour does not simplistically divide into distinct stages. It is a complex phenomenon of interdependent physical, hormonal and emotional changes, which can vary enormously between individual women. The limitation of the medical model undermines the importance of the midwife's observation and interpretation of a woman's behaviour.

Facts and recommendations for care


  • Women should have as normal a labour and birth as possible, and medical intervention should be used only when beneficial to mother and/or baby (DoH, 2007; NICE, 2016).
  • Midwife-led care gives the best outcomes worldwide: more spontaneous births, fewer episiotomies and epidurals, better breastfeeding rates. Women report that they feel more in control of their labour (Sandall et al., 2016).
  • Although 88% of women give birth in an obstetric unit many would not choose to: low-risk women (i.e. around 60%) should also be offered the choice of birth either at home or in a midwife-led unit; a woman has a right to choose her place of birth (DoH, 2007; NICE, 2014; NHS England, 2016).
  • Women should be offered one-to-one care in labour (NICE, 2014). The presence of a caring and supportive caregiver has been proved to shorten labour, reduce intervention and improve maternal and neonatal outcomes (Green et al., 2000; Hodnett et al., 2013).
  • The UK birth rate continues to rise, while England alone is short of 3500 midwives (RCM, 2016).
  • 1-2% of mothers develop birth-related post-traumatic stress disorder (Andersen et al. 2012) and midwives can too (Sheen et al., 2015).
  • The attitude of the caregiver seems to be the most powerful influence on women's satisfaction in labour (NICE, 2014).
  • 89% of fathers attend the birth (Redshaw and Heikkila, 2010); other relationships, e.g. same-sex couples, have been less closely studied.
  • The birth rate for women aged >40 rose above that for women <20 for the first time since 1947 (ONS, 2016).
  • 27.5% of births in England and Wales are to women born overseas (ONS, 2016).
  • 20% of pregnant women in England are clinically obese (Health and Social Care Information Centre, 2016), increasing the risk of complications.

Mode of delivery


  • The UK normal birth rate is around 60% (ONS, 2016; NHSD, 2017).
  • The instrumental delivery rate is around 10-15% (ONS, 2016; NHSD, 2017).
  • The episiotomy rate for England is around 20% (see Chapter 4).
  • The caesarean section (CS) rate is around 26% (NHSD, 2017).

The birth environment


In what kind of surroundings do people like to make love? A brightly lit bare room with a high metal bed in the centre? Lots of background noise, with a series of strangers popping in and out to see how things are going? The answers to these questions may seem obvious. If we accept that oxytocin levels for sexual intercourse are directly affected by mood and environment, why is it that women in labour receive less consideration? The intensely complex relationship between birth and sexuality is an increasing source of study and reflection by birth writers.

Once women gave birth where and when they chose, adopting the position they wanted, using their instinctive knowledge to help themselves and each other. Recently birth has become more medicalised, and the place of birth often restricted. No one would deny that appropriate intervention saves lives. For some women an obstetric unit is the safest choice, and for others it feels like the safest, so that makes them feel happier. But does it have to be the choice for everyone?

The clinical environment and increased medicalisation of many birth settings directly affect a woman's privacy and sense of control (Walsh, 2010a). Home-like birthing rooms ('alternative settings'), even within an obstetric unit, increase the likelihood of spontaneous vaginal birth, labour/birth without analgesia/anaesthesia, breastfeeding at 6-8 weeks postpartum and satisfaction with care; these rooms also result in a reduction in oxytocin augmentation, assisted vaginal/CS birth and episiotomy (Hodnett et al., 2012). This may be due partly to the fact that women simply feel more relaxed at home, or in a home-like setting. However, simply changing the curtains and hiding the suction machine does not always mean a change of philosophy of care. A more telling factor may be that the type of midwives who choose to work in the community or birth centre, or who gravitate towards more home-like rooms, are those with a less interventionist approach.

Women should be able to choose where to give birth; it would be still more wonderful if women could simply decide in labour whether they wish to stay at home or go to a birth centre or an obstetric unit, and indeed if they could change their mind during labour. Such choices do exist, but UK service provision is patchy. The Better Births report (NHS England, 2016) and the Best Start report (Scottish Government, 2017) may influence change in this respect. It is also heartening to see midwife-led units opening in Northern Ireland: there are now eight, whereas in 2000 there were none at all (Healy and Gillen, 2016). In many other countries women have little or no choice.

Although it has been estimated that at least two-thirds of women are suitable for labour at home or in a midwife-led birthing centre (DoH, 2007), and 87% of women believe that birth in a stand-alone birth centre is a safe option (Rogers et al., 2011), for many reasons most mothers and midwives in the UK will still meet in labour in an acute unit. It is incumbent on all midwives to make the environment, irrespective of its location, warm, welcoming and safe. Always remember that the quality of the caregiver is the thing that most strongly influences a woman's satisfaction with her labour.

Midwives who are asked by family or friends, or perhaps a previous client, to deliver them outside normal working conditions may refer to the guidance produced by the Royal College of Midwives (RCM, 2017a). Most things are possible with good communication and flexibility.

The RCM Campaign for Normal Birth http://www.midwives.org.hk/doc/resources/RCMTopTipsenglish.pdf) suggests 'ten top tips' to promote normal birth (Box 1.1). The Association for Improvements in the Maternity Services (AIMS, 2012) has also produced 'ten top tips for what women want from their midwives', which include compassion, courage, respect and positivity: 'Women appreciate midwives who are genuinely confident and upbeat when . women are flagging . and who are able to . encourage: "you're doing so, so well", "you're amazing", "you're so strong", "well done, that's another one gone".'

Box 1.1 Ten top tips for normal birth (RCM, 2017b).


(1) Wait and see


The single practice most likely to help a woman have a normal birth is patience. In order to be able to let natural physiology take its own time, we have to be very confident of our own knowledge and experience . of normal birth - and know when the time is right to take action.

(2) Build her a nest


Mammals try to find warm, secure, dark places to give birth - and human beings are no...

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