Scene Three: Established labour

Noral birth scenario in virtual birthing unit Image by Sarah Stewart. Second Life build by Aaron Griffiths for the SLENZ project. CC By

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 in established 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 established 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 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 9 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 3 hours ago Lisa Smith admitted to birth unit. In good health. Normal pregnancy. Slightly elevated blood pressure at the end of pregnancy 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

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 are in established labour. The midwife should assess your condition and make a plan of action for the next few hours and advice/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 having a lot of pain and don't think you can cope for much longer. End the scene when you are happy all your questions have been answered and you are clear about the plan of action for the next few hours.

• Contractions
  

You are in established labour and getting contractions every 5 minutes with the pain in your back radiating around to the front of your stomach. They last about 30-40 secs. They have been like this for the last hour. You have to stop and breathe heavily through the contractions and cannot speak. They are stopping you from resting.

You have been drinking water and have had a few snacks but are feeling a little sick so don't want to eat anything much. You would like to know what you can eat that won't make you feel sick.
You have a little clear, sticky discharge or 'show' on your sanitary pad.

• How you are feeling

You are excited that things are getting going at last but the painful contractions are tiring you.You have gone from feeling cheerful to concentrating hard on working through the contractions.

• 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. You don't like lying on your back when you have a contraction because it is very painful so you want the midwife to get the palpation and vaginal examination over with as quickly as possible so you can get up on your feet again.

• Vaginal Examination
  

You have had a vaginal examination which you found a little sore but you want another one to check your progress.

• What you want to do
  

You are a lot more comfortable up right and/or leaning on something. You plan to have a warm shower once the midwife has checked you over.

Here are some questions you may wish to ask.

• When will I have my baby?
• What will happen if I decide to have an epidural?
• What do I have to do to have a waterbirth?
• I want to lie down on the bed, is that alright?
• I am worried about the baby. How do you know the baby is alright?

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 Three - Established Labour

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