Early labour

This lesson should take approximately 60 minutes and is appropriate for senior midwifery students, as well as anyone interested in childbirth. With a partner you will work your way through a scenario that focuses on the admission of a woman to the birth unit who is in early labour. This scenario is designed to support you to think about midwifery assessment and actions, decision-making and sharing information when you are working with women in early labour.

Resources

• Computer and Internet with access to Second Life
• Basic ability to use Second Life and access the virtual birth unit http://slurl.com/secondlife/Kowhai/82/213/35/
• Resource Pack that can be found in the meeting room on the second floor of the birth unit. -----need to check that!!!
• Midwife's self-assessment form and script for woman.
• Extra resources to support this scenario either as links or printed handouts:

• New Zealand College of Midwives. 2008. Midwives handbook for practice. New Zealand College of Midwives: Christchurch

• New Zealand College of Midwives. (No date). Providing feedback about your midwife. Retrieved 15 July, 2009, from: http://www.midwife.org.nz/index.cfm/1,136,html

• Pairman, S., Pincombe, J., Thorogood, C., & Tracy, S. (2006). Midwifery. Preparation for practice. Sydney: Elsevier.
  

• Soni BL. Effect of partogram use on outcomes for women in spontaneous labour at term: RHL commentary (last revised: 1 June 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.
  

• Rory Windrim, P. Gareth Seaward, Ellen Hodnett, Hani Akoury, John Kingdom, Mary Ellen Salenieks, Shafagh Fallah, Greg Ryan. A Randomized Controlled Trial of a Bedside Partogram in the Active Management of Primiparous Labour. J Obstet Gynaecol Can 2007;29(1):27–34.

Clinical notes for midwife

Date xx/xx/xx Time 6 hours ago. Phone call.
Lisa Smith rang the birth unit with history of contracting 1: 10 mins, lasting 30 secs. Had been contracting 1:15 previously. G1 P0. Term plus 2 days. In good health. Urine normal but has had slight diarrhea for 24 hours. Also feeling slightly nauseated all day. No headaches or visual disturbances. Intact membranes. No vaginal bleeding but small amount of mucasy 'show'. Good fetal movements.

Advised to stay at home and await events. Try to get as much rest as possible; relax in warm shower/bath. Continue to eat and drink normally. To ring again if contractions become more painful and/or frequent; membranes rupture and/or fluid is any colour other than clear; have vaginal bleeding; or have any concerns about baby's movements. AN Other Midwife

Midwife's self-assessment form

Use this self-assessment form to assess your performance, reflect on what you did well and what you can improve in the future.

Script for woman

Here is the information about the last few hours for you to pass onto the midwife, along with your background story as and when it is appropriate or relevant. Feel free to add lib a little but please keep everything ‘normal’.

The idea of this scenario is for the midwife to welcome you to the birth unit, assess your condition and make a plan of action for the next few hours and advice/support you. Wait until the midwife asks you questions – don’t give out all the information at once. Feel free to ask questions which you think will help to test the midwife's knowledge of normal childbirth

• Contractions

You are in very early, unestablished labour. You started getting contractions about six hours ago 1:15 minutes which started like period pains, all in your back. They are now 1:7 minutes, lasting 20-30 seconds and have been like this for the last three hours. You can talk very easily through them. The feel like severe period pains when they come. They are bad enough to make it difficult to relax properly.

• General condition
  

Usually you don’t have any problems with passing urine but over the last couple of hours you have been on and off the toilet but it doesn’t hurt when you pass urine. You have had a couple of bouts of diarrhea today but you think that was because of the curry you had for supper yesterday. You have been very slightly nauseated all day so have only been snacking as opposed to eating regular meals. You don’t think your waters have broken. You have been wearing a thin sanitary pad and there is no discharge at the moment.

• Abdominal palpation
  

You are happy to have an abdominal palpation. It is a little sore when the midwife palpates you, especially when she tries to feel where the baby's head is.

• Vaginal Examination

You are used to having regular cervical smears but are still a little anxious about having a vaginal examination. You are a little shy but you want to know how you're progressing so you're happy for her to get on with things.

• How you are feeling
  

You are excited about possibly being in labour but are a little anxious about what to expect. The midwife may give you the choice of staying at the birth unit or going home again. Insist that you stay because you are a little nervous about being at home by yourself, what with your husband being away for work.

Also check your birth plan which is in the antenatal notes in the Resource Pack for the decisions you have made about your labour.

Here are some questions you may wish to ask.

• When will I have my baby?
• How much more painful will my contractions get?
• Why do I need to have a vaginal examination?
• What will happen if there is an emergency?
• Can I have something to eat?
• What can I do to stop feeling sick?
• What is the rope hanging from the ceiling for?

Learning objectives

• Demonstrate an understanding of the role of the midwife in the normal childbirth process.
• Demonstrate effective evidence based, midwifery practice guided by a sound knowledge base.
• Demonstrate an understanding of significance of concepts of accountability, responsibility and independent practice as they relate to midwifery practice in New Zealand.

Instructions for Scenario Two - Early Labour

1. Read the 'Introduction for students' which will give you a general background to the virtual birthing unit project. Set up your Second Life account and create your avatar. If you are using a personal computer, download Second Life.
2. Read the orientation package which will introduce you to Second Life and the skills you will need in this scenario.
3. Make your way with your partner to the back room of the birth unit, on the second floor.
4. Open the Resource Box - here are the instructions on how to open the Resource Box.
5............
6............
7.
8. The scenario ends when the woman is happy she has all the information she needs and has had all her questions answered and the midwife is satisfied with her assessment of the situation and the plan of action that she has developed.
9. Once the scenario ends, the woman will pass her feedback form to the midwife. The midwife will also carry out a self-assessment for her personal learning.
10. The midwife will complete her documentation on a notecard and post it into the filing cabinet in the midwives' office. The documentation will be automatically sent to a midwifery lecturer (in real life) who will give you feedback on how effectively you have documented your assessment and actions. The midwife will also be able to send her documentation to the woman. The student playing the woman will also be able to give feedback about the documentation.
11. Feel free to ad lib and role play as much or as long as you like but please remember that the scenario is programed to be a 'normal' labour and birth. For example, if you decide you would like to practice how to deal with an obstetric emergency, you will be unable to do so because the scenario has not been set up to present that eventuality.
12. This scenario involves role play so do not be shy; let your imagination run so that you and your partner gain maximum learning benefit from this simulation. At the same time, have fun. If you make a mistake or miss an action or assessment, you can start all over again and keep practicing until you are happy with your performance.