The virtual birthing unit project/Scene Four: Birth of baby



''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 care of a woman as she moves into the second stage of labour and births her baby. 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 who are birthing their babies.''

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 first floor of the birth unit.
 * Midwife's self-assessment form and clinical notes, 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 14 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. Slight finger oedema. 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

Date xx/xx/xx Time 8 hours ago Lisa Smith admitted to birth unit. In good health. Normal pregnancy. Slightly elevated blood pressure at the end of pregnacy but settled. No headaches or visual disturbances. Passing urine normally. No show. Good fetal movements. Contracting every five minutes, lasting 20-30 seconds, in-coordinate, mild on palpation.

T. 36.4 degrees C P.78/min  R. 16/min BP 120/70  Urine - Protein nil, Glucose nil, Ketones  nil, Blood  nil.

Abdominal palpation: fundus =dates, longitudinal lie, cephalic presentation, back on the left, posterior, head at brim, 3/5th palpable. Fetal heart 135, no deceleration heard during contraction.

VE to assess progress: Cervix posterior, partially effaced, soft, thick, poorly applied, 2 cm dilated. Head presents, 2cm above ischial spines, position not defined. No caput, moulding or cord felt. Membranes intact. Fetal heart 145, no deceleration heard during contraction.

Impression: Labour is progressing normally and both Lisa and baby are well. Plan: To await events. Advised Lisa to rest as much as possible and also moblise when she feels like it. Showed her around the birthing unit and invited her to help herself to food and drink. AN Other Midwife

Date: xx/xx/xx Time: 5 hours ago Lisa is starting to get uncomfortable. She is contracting 1:3 minutes, lasting 30-40 seconds, moderate to palpate.

T. 36.6 degrees C P.82/min  R. 18/min BP 115/75  Urine - Protein nil, Glucose nil, Ketones  +, Blood  trace.

Abdominal palpation: fundus =dates, longitudinal lie, cephalic presentation, back on the left, lateral, head engaged, 2/5th palpable. Fetal heart 145, no decelerations heard during contractions.

VE to assess progress: Cervix slightly posterior, effaced, soft, thinning, loosely applied, 5 cm dilated. Vertex presents, 1cm above ischial spines, left occipito transverse, flexed. No caput, moulding or cord felt. Membranes intact. Fetal heart 140, no decelerations heard during contractions. Mucasy, blood stained show

Impression: Lisa is in established labour and coping very well at this stage. Plan: to continue ongoing monitoring and support Lisa to keep mobile, have a warm shower or get in to the birthing pool.

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 ad lib a little but please keep everything ‘normal’.

The idea of this scene is for the midwife to support you as you go into the second stage of labour and birth your baby. The midwife should assess your condition, advise you about how to birth your baby and support you. Please feel free to share information with the midwife as and when it is appropriate. Wait until the midwife asks you questions – don’t give out all the information at once. You do not have to remember all this information – we have provided it to get you ‘in character’. The midwife will be provided with your pregnancy notes that have a lot of this information provided. Feel free to ask questions which you think will help to test the midwife's knowledge of normal childbirth

Further information about your thoughts about birth can be found in your birth plan which can be found in your pregnancy notes.


 * Start and finish of the scene
 * To start the scene go to the red birth room and start a conversation with the midwife about how you think your waters have broken and you feel like you want to push when you have a contraction. End the scene the baby has been born and you have the baby in your arms, and you are happy all your questions have been answered and you know how to care for your baby for the next hour or so.


 * Contractions
 * You are approaching the second stage of labour. You are getting contractions every 2-3 minutes with severe pain in front of your stomach, low down. You don't know how long they are lasting because you are in too much pain to watch the clock. You do know that you are not getting much rest in between contractions. You need the midwife to softly talk to you and reassure you. You are also getting a lot of pressure in your bottom. You are starting to feel you want to push at the height of your contractions - you feel as if you want to go to the toilet and have a 'poo'. You are very worried you'll accidentally wet or soil yourself.


 * Membranes
 * You are pretty sure your membranes have broken. You are very wet and have soaked through several sanitary pads and draining clear fluid - you don't think it is urine. At first, you felt as if the pressure inside you was lifted but now the contractions seem much stronger and painful.


 * How you are feeling
 * You are very tired and in a lot of pain but it feels more comfortable when you are in an upright position. You are scared but reassured when the midwife talks to you and soothes you with back rub and encouraging you though a contraction. You feel at times that you cannot do this and want to be transferred to the hospital for an epidural. But when the midwife reassures you, you feel much better and remember that you want to birth the baby in the birth unit without any medication. You know it is much better for the baby if you don't have any drugs. You like to have heat on your back, preferably either in the shower or birthing pool.


 * Pushing and birthing the baby
 * There is no animation for 'pushing' or birthing the baby. It is your choice as to how much you role play those events.


 * Birthing the baby
 * After the baby is born, you are very tired but absolutely thrilled. You are keen to get the baby naked against your skin and start a breastfeed. You feel sore but otherwise exhilarated.

Also check your birth plan which is in the antenatal notes in the http://wikieducator.org/The_virtual_birthing_unit_project/Resource_pack 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?
 * What is the best position to push in?
 * What happens if the baby gets stuck when it is being born?
 * Do I have to have a cut when the baby is being born?
 * What happens if the baby can't breathe when it is born?
 * Who cuts the cord?
 * When will the cord be cut?

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 Scene Four - Birth of the baby
Click here for instructions for Scene Four - Birth of Baby