MIDW216 EXAM
What is self determination?
• Self-determination supports people to feel that they
have control over their choices and lives.
• Self determination is when a person gains control or becomes an active
participant in the decisions that impact them. To do this it requires them to be
fully informed on the implications of the various options available to them.
What is the NMBA decision making framework?
Provides guidance on:
• Individual practice decisions
• Expanding scope of practice
• Delegation of aspects of care to others
THE DMF can be used to:
• Self assess practice
• Planning for and changing practice
• Discussion in relation to scope of practice & decision making
• In education programs
• Identify where practice falls outside the accepted scope of the midwife
What is the BRAIN acronym?
B - Benefits:
,• what are the benefits of the suggested course of action? - for the woman, for
the baby
R - Risks:
• what are the risks associated with the decision? Any side effects?
A - Alternatives:
• are there other options? What are they?
I - Intuition:
• how do I feel about this? Take a moment to reflect on this and talk with support
people
N - Nothing:
• what if I do nothing - or wait for an hour/ day/ week?
`what is the best practice to reduce instrumental birth?
• Physical, emotional, psychological support in labour
• One to one care in labour
• Nutrition & hydration in labour
• Use of movement, gravity & upright positions
• intermittent auscultation where there in no clinical indication for CTG
• avoid epidural
• in the event of epidural, delay onset of active pushing
• assessing labour by progress vs time
• approapriate use of oxytocic for dystocia in 2nd stage
,• looking holistically at labour assessments including CTG interpretation
• fetal blood sample rather then expediting birth where FHR abnormalities noted
What are the maternal indications for instrumental birth?
• Distress / exhaustion
• Ineffective pushing efforts
• Lack of progress
• Dense epidural or spinal block > ineffective pushing
• Pulmonary oedema
• Infection
• Neurological disease (e.g. spinal cord injury)
• Prophylactic need for short 2nd stage (e.g. PE, cardiovascular disease,
hypertension)
What are the fetal indications for instrumental birth?
• Malposition
• Fetal distress/ presumed fetal compromise
• Fetal scalp pH ≤7.20
• Assisted breech birth
What are the obstetric indications for instrumental birth?
• Malposition
, • Cord prolapse
• Placental abruption
• Dystocia in 2nd stage
• Control of after coming head of breech
• Controlled birth of head at C/S
What is instrumental birth performed?
Performed if it is necessary to expedite the birth of the baby
What are contraindications for instrumental birth?
• Cervical dilation not complete
• Unknown fetal position
• PP at or above spines
• >1/5 above brim palpable abdominally • Inexperienced accoucheur
• Evidence of genuine CPD
What is CPD (cephalopelvic disproportion)?
Any condition leading to a misfit between the fetal head and the maternal pelvis
What causes cephalopelvic disproportion?
What is self determination?
• Self-determination supports people to feel that they
have control over their choices and lives.
• Self determination is when a person gains control or becomes an active
participant in the decisions that impact them. To do this it requires them to be
fully informed on the implications of the various options available to them.
What is the NMBA decision making framework?
Provides guidance on:
• Individual practice decisions
• Expanding scope of practice
• Delegation of aspects of care to others
THE DMF can be used to:
• Self assess practice
• Planning for and changing practice
• Discussion in relation to scope of practice & decision making
• In education programs
• Identify where practice falls outside the accepted scope of the midwife
What is the BRAIN acronym?
B - Benefits:
,• what are the benefits of the suggested course of action? - for the woman, for
the baby
R - Risks:
• what are the risks associated with the decision? Any side effects?
A - Alternatives:
• are there other options? What are they?
I - Intuition:
• how do I feel about this? Take a moment to reflect on this and talk with support
people
N - Nothing:
• what if I do nothing - or wait for an hour/ day/ week?
`what is the best practice to reduce instrumental birth?
• Physical, emotional, psychological support in labour
• One to one care in labour
• Nutrition & hydration in labour
• Use of movement, gravity & upright positions
• intermittent auscultation where there in no clinical indication for CTG
• avoid epidural
• in the event of epidural, delay onset of active pushing
• assessing labour by progress vs time
• approapriate use of oxytocic for dystocia in 2nd stage
,• looking holistically at labour assessments including CTG interpretation
• fetal blood sample rather then expediting birth where FHR abnormalities noted
What are the maternal indications for instrumental birth?
• Distress / exhaustion
• Ineffective pushing efforts
• Lack of progress
• Dense epidural or spinal block > ineffective pushing
• Pulmonary oedema
• Infection
• Neurological disease (e.g. spinal cord injury)
• Prophylactic need for short 2nd stage (e.g. PE, cardiovascular disease,
hypertension)
What are the fetal indications for instrumental birth?
• Malposition
• Fetal distress/ presumed fetal compromise
• Fetal scalp pH ≤7.20
• Assisted breech birth
What are the obstetric indications for instrumental birth?
• Malposition
, • Cord prolapse
• Placental abruption
• Dystocia in 2nd stage
• Control of after coming head of breech
• Controlled birth of head at C/S
What is instrumental birth performed?
Performed if it is necessary to expedite the birth of the baby
What are contraindications for instrumental birth?
• Cervical dilation not complete
• Unknown fetal position
• PP at or above spines
• >1/5 above brim palpable abdominally • Inexperienced accoucheur
• Evidence of genuine CPD
What is CPD (cephalopelvic disproportion)?
Any condition leading to a misfit between the fetal head and the maternal pelvis
What causes cephalopelvic disproportion?
