THE MATERNAL LYING-IN WARD

A suction machine

The lying-in ward is a division in the maternity ward where pregnant women who have given birth either by caesarean or by natural birth are placed under observation until they are discharged.
For pregnant women who had spontaneous delivery (natural birth), the observation is done for both the mother and the baby. The uterus is checked whether it is has contracted again and if there are any signs of the woman bleeding. The mothers are taught how to breastfeed their babies. The vital signs of the mother such as pulse, temperature, respiration and blood pressure are monitored.
Observation for the baby, its umbilical cord is checked for any signs of bleeding. After birth the baby needs to pass his first stool and urine if it hasn’t then there is the need for immediate surgery to help the baby pass out its first stool and urine. The baby’s sucking reflexes are checked. Most normal babies know how to feed unlike premature babies who have to be taught. The skin color of the baby is checked for cyanosis (lack of oxygen).
For women who have had caesarean operation, there is an additional observation after the general observation which is for both the mother and the baby. The incision site where she was operated is checked for any signs of bleeding. The fluids given to the mother is checked to ensure that the quantity being admitted into her body is equal to the quantity passing out of her body. Antibiotics is given to the woman to protect the incision site from any infection.
For anti-postpartum cases i.e. women who are not due for delivery. Women with high blood pressure and hypertension are observed and anti-hypertensive and anti-convulsant drugs are administered unto them. Women who are not due for delivery are not supposed to bleed, bleeding during pregnancy calls for immediate medical attention since one can lose the baby. The urine, protein of the mother is checked and the baby’s fetal rate is also checked.
In conclusion, women who have given birth by spontaneous vaginal delivery are discharged after six hours of observation. Women who have given birth by caesarean are observed for three days until they are discharged and women who are not yet due can be discharged after few hours of observation.http://youtu.be/Vt7E-ITkSMg

STAGES OF LABOR (MATERNAL)

An example of a partograph

Defining labor in medical terms, it refers to the physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled out of the uterus. Pregnancy is different in every woman and there’s wide variation in the length of labor. For some women, its lasts much longer and for others it’s much over sooner. There are three stages of labor.

 

• The first stage (early labor) 

This stage begins when the pregnant woman starts having contractions and ends with complete cervical dilation at 10cm.A pathograph is a graphical representation tool that is used in assessing the progress of labor and  identifying interventions when necessary. The pathograph is also in divisions. In the first division, it is used to monitor the fetal heart rate, whether it is in the range of 160bpm and 120bpm, the color of the amniotic fluid, whether it is clear or meconium stained (contains fetus fecal waste).There are two phases in the early stages of labor. The latent phase begins with mild, irregular uterine contractions that softens and shortens the cervix. It ranges from 0cm to 3cm cervical dilation, whiles the active phase is characterized by rapid cervical dilation ranging from 3cm to 4cm and the descent of the presently fetal part.

 

• The second stage of labor  

The second stage of labor begins with the complete cervical dilation and ends with the delivery of the fetus. Getting to the delivery stage, contractions become regular, painful and stronger. The muscles of the cervix has to stretch to enable the expulsion of the fetus. The woman in labor needs to dilate 1cm every hour to get into the active phase of labor. The woman is positioned on the bed in a relaxed style to be able to push comfortably. The woman has to push when she feels the contractions and relaxes when the contractions are over. It is essential for the baby to be expelled with the head out first, being expelled with the back first means, immediate action needs be taken for the safety of the baby and mother.

 

• The third stage of labor

The third stage is defined by the time period between the delivery of the fetus and the delivery of the placenta and fetal membranes. During this period, a drug called oxytocin is administered to the patient to enable the uterus contract to expel the placenta and stop excessive bleeding on the part of the mother. After childbirth, the mother and the baby is monitored for about 4-6 hours to check their vital signs or any complications that may arise before being discharged.

 

In conclusion, it is crucial for expecting mothers to go to the hospital for doctors and midwives to monitor the progress of their labor for healthy and safety delivery.

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PROCESSES FOR REFERRALS IN THE MATERNITY SUITE

A midwife at the 37 Military Hospital[/caption

The term referral is used in different ways: for instance it is used to indicate the advice of a health worker to a patient to attend a higher-level health unit whether followed or not. In this case, the term referral is, any upwards movements of health care seeking individuals in the health system.

In referral there are many ways to do this with respect to pathway, timing, and urgency. Referrals can be categorized in pregnancy and childbirth as:

 

• Institutional or self-referral: The patient deciding to move to another hospital depending on the involvement of first line services, the proximity of residence to the hospital.
• Antenatal, delivery, or postnatal referral: The patient deciding to refer to another hospital during pregnancy, delivery or after child birth.
• Elective or emergency referrals: Depending on the current critical condition of the patient. 

 

Hospitals that take referrals are known as referral points. Before a patient’s referral is accepted, there are certain requirements needed to be fulfilled. These are the necessary things needed on the referral form.

 

(1)   The personal history of the patient is recorded, which includes name, age, and sex, address and telephone number.

(2)   The name of the specialist referring you and the specialist you are being referred to and the hospital you wish to be referred to.

(3)   Insurance membership number: This explains if you have insured yourself or you are a member of an insurance company.

(4)   Provisional diagnosis: This explains that, your current diagnosis may change again during any period of another examination.

(5)   Medical history (summary): It explains your medical history, whether it is your first pregnancy, the number of times you have been pregnant (parity) and your current medical condition.

(6) Examination findings: The series of tests you have undergone and the outcomes of it.

(7) Treatment received: This explains if any sort of medication was administered onto the patient before being given a referral.

(8) Reasons for referral: For ante natal care, delivery, post natal care or self-referral.

(9) Accompanying information: This explains whether the patient has x- rays records, case notes or laboratory records.

(10) The date and signature: The referring doctor signs and adds the date of referral before it can be accepted in any referral point.

 

In conclusion, to make referrals meaningful and to improve the survival chances for the mother and baby, the referral point or hospital has to provide good quality obstetric care.

 

http://www.youtube.com/watch?v=iJ4SzwdDL_Q http://youtu.be/drm9I-ZvM-w

EQUIPMENT USED IN THE MATERNITY SUITE

https://www.youtube.com/watch?v=D1nq8jw8YMk It is extremely important for every maternity suite in hospitals to be well equipped in order to ensure that deliveries are as safe as possible for both mothers and newborn babies, patients vital signs are monitored and given critical care. These are some of the equipment used in the maternity wards in Ghana.

The ultra sound machine: is a machine that uses sound waves to create images of a developing fetus in the womb. The ultra sound machine performs many functions; it is used in confirming pregnancy, to calculate the average gestation of the mother, determine the sex of the baby, estimate the baby’s weight, determine the volume of amniotic fluid and the location of the placenta, incorrect location of the placenta can lead to complications. The test is performed by smearing a water-based gel on the belly and pelvis area and then a hand-held probe is moved over the area. The probe helps transmit sound waves which bounce of body structures including the baby’s, which creates an image on the machine.

The cardiotocographic machine (CTG): is a machine that uses graphical representation to record the heartbeat of the baby and also check uterine contractions. When the contractions are stronger and normal then it means there is the need for the patient to be rushed to the labour ward for delivery. On the other hand, if the contractions are weaker, then there is no need for an emergency, but the patient will be gradually monitored. A typical cardiotocography reading is printed on a paper or stored on a computer later for reference.

Resuscitaire machine: The resuscitaire machine as the name explains itself(to revive)is an essential machine which combines  an effective warming therapy platform for warming babies who have just been delivered by caesarean  operation. It is also used in administering oxygen to the baby and  for suctioning the baby. It is an ideal device needed during labour and delivery procedures.

Glucometer: The glucometer is a machine designed to check sugar content in the blood. This enables the patient to know if they have lower or higher sugar level content, since women who are diabetic tend to have bigger babies than the normal size which makes delivery painful and difficult.

In conclusion, thermometers, weighing scales, tape measures are also equipment used in the maternity ward. The use of state- of- the- art equipment makes it simple and easier for doctors and midwives to monitor and record the progress of babies and their mothers.</<a https://www.youtube.com/watch?v=aLNZt7kJPGA

ADMISSION PROCEDURES IN THE MATERNITY SUITE

This article serves as a guide to what to expect when women arrive at the hospital when they are either in their early stages or late stages of pregnancy. There can be many variations in admission procedures depending on the individual hospitals and birthing centers. A woman can be admitted irrespective of her current stage of pregnancy.

The first phase when a pregnant woman arrives at the hospital is, contacting the reception desk to register. This is where booking informations are held. The patient is then directed to the admission ward in the maternity ward. The admission ward is also staffed by midwives and doctors who will welcome you cordially and admission papers will be given to you since it is a legal requirement of the hospital to have the patient’s signature to authorize the hospital to claim treatment for the patient.

The first chat, after filling in the admission papers, is offering the patient a bed and checking her vital signs by the midwife. Her vital signs include temperature, pulse, respiration, blood pressure.  The next stage is history taking, it includes, the patients personal history (name, date of birth, age and sex, family history and also if there are certain diseases in the family that will endanger the patient and the baby. Past medical history; have you been pregnant before?  Any complications? The patients past obstetrics; number of pregnancies over the years, have natural births or caesarean deliveries and also her social history concerning place of occupation and residence.

Examination is also conducted. The midwife measures and feels the bump to see the roundness of the baby. She then checks its vital signs such as the heart beat, palpation and the position of its head in the womb depending on the patient’s current condition. Blood samples are taken from the mother in case of emergency, blood group is checked and cross matching is done for women in labour.If the patient is in active labour which means, she is dilating 4centimetres and above and has to be rushed to the labour ward. If a person is not in active labour, she is directed to the in-line ward and if there is early labour the midwife tries to halt contractions.

In conclusion, it is essential for pregnant women to visit hospitals and birthing centers to be aware of their progress in the various stages of pregnancy. This can also aid in reducing birth complications and enable the midwives and doctors to closely monitor the progress of the baby.

HISTORY OF MIDWIFERY

A midwife at the 37 Military Hospital

Midwifery can trace its early historical perspective from the Bible, before the advent of modern obstetrics. The word “Midwifery” is derived from Middle English “midwyf” meaning with woman i.e. woman assisting a mother at birth. In the subsequent years, midwifery has become a profession that is practiced by all and sundry, irrespective of one’s gender.

Expatiating the word midwifery, it is a health care profession in which expertise in the field of maternal health care; provide supervision for pregnant women from the moment she conceived, monitoring the growth of the fetus, the woman going into labor and the delivery of the baby. A person who branches into this line of work is called a midwife. A midwife as defined by the International Confederate of Midwives is a person who has been proficiently coached in the midwifery educational program which is acknowledged in the practitioner’s specific country, who has the requisite qualifications and the legal license to practice midwifery. The code of practice varies from country to country.

In the conventional setting during primeval times in Ghana, women who assist in the delivery of babies were called traditional birth attendants. Their knowledge and skills in assisting pregnant women was impacted into them through their predecessors. In the distant past, methods and equipments most birth attendants used were outmoded but were quite useful. Regardless of the deficiency in their methods and approaches and the absence of modern facilities, traditional birth attendants always put in their maximum effort in assisting to bring life into the world. Today, in our contemporary society, enhanced methods, state-of-the art facilities and modern obstetrics approaches are being utilized which are safer and healthier than the methods of primeval eras. With present-day obstetrics and expertise in the field of midwifery there can be three or more deliveries at the same time.

In consenting to be a practitioner in this field, the practitioner is shrouded with roles and responsibilities he or she must manage. Midwives are specialized practitioners in childbirth, postpartum and maternal health care. They have undergone education and training and know how to handle the variations in the normal progress of a labor and also deal with deviations from normal births and intervene in high risk situations, giving assistance to women in labor and carrying out emergency issues. Midwives are held accountable and are responsible for the women and their new babies. They proficiently manage difficult deliveries’ including twin births, breech births and where the baby is in a posterior position i.e. the baby faces the mum’s back inside her uterus on either her left or right side. Midwives therefore use non-invasive techniques to force the baby out.

Currently in Ghana, there have been lower intervention rates and lower infant mortality rates due to improved methods, modern obstetrics and modern maternal health care facilities. Women are no longer petrified to go through the stages of pregnancy due to the love, devotion and patience of these midwives.