intrapartum bladder care

[2017], 1.10.39 If digital fetal scalp stimulation (during vaginal examination) leads to an acceleration in fetal heart rate, regard this as a sign that the baby is healthy. [2007], 1.9.19 Either patient‑controlled epidural analgesia or intermittent bolus given by healthcare professionals are the preferred modes of administration for maintenance of epidural analgesia. Transfer of care refers to the transfer between midwifery‑led care and obstetric‑led care. 1.14.14 After administering oxytocin, clamp and cut the cord. [2017], 1.4.10 Offer cardiotocography if intermittent auscultation indicates possible fetal heart rate abnormalities, and explain to the woman why this is being offered. [2017], 1.10.46 Take fetal blood samples with the woman in the left-lateral position. [2014]. [2014]. These tables include and summarise individual recommendations about fetal monitoring (1.10.11 to 1.10.35), fetal scalp stimulation (1.10.38 and 1.10.39), fetal blood sampling (1.10.40 to 1.10.55) and intrauterine resuscitation (1.10.36 and 1.10.37) in this guideline. [2007], 1.12.16 Whether or not a woman has agreed to an amniotomy, advise all women with suspected delay in the established first stage of labour to have a vaginal examination 2 hours later, and diagnose delay if progress is less than 1 cm. 3.1 Care throughout labour and birth 19 3.2 First stage of labour 35 3.3 Second stage of labour 120 3.4 Third stage of labour 159 3.5 Care of the newborn 162 3.6 Care of the woman after birth 165 4. [2014], 1.14.6 Explain to the woman antenatally about what to expect with each package of care for managing the third stage of labour and the benefits and risks associated with each. [2007], birth would be expected to take place within 3 hours of the start of the active second stage in most women, diagnose delay in the active second stage when it has lasted 2 hours and refer the woman to a healthcare professional trained to undertake an operative vaginal birth if birth is not imminent. 1.3.1 For the purposes of this guideline, use the following definitions of labour: Latent first stage of labour – a period of time, not necessarily continuous, when: there is some cervical change, including cervical effacement and dilatation up to 4 cm. Variation in the practice of intrapartum and postpartum bladder care reported by 189 maternity units in England and Wales hospitals was evaluated by analysing the data obtained from a postal questionnaire … After completion of the repair, document an accurate detailed account covering the extent of the trauma, the method of repair and the materials used. [2014]. 1.16.1 Carry out the following observations of the woman after birth: Record her temperature, pulse and blood pressure. 1.12.18 For all women with confirmed delay in the established first stage of labour: transfer the woman to obstetric‑led care for an obstetric review and a decision about management options, including the use of oxytocin (follow the general principles for transfer of care described in section 1.6) [2014], explain to her that using oxytocin after spontaneous or artificial rupture of the membranes will bring forward the time of birth but will not influence the mode of birth or other outcomes. [2014], 1.15.20 If there has been significant meconium (see recommendation 1.5.2) and the baby does not have normal respiration, heart rate and tone, follow nationally accredited guidelines on neonatal resuscitation, including early laryngoscopy and suction under direct vision. [2007], 1.13.17 Do not offer episiotomy routinely at vaginal birth after previous third‑ or fourth‑degree trauma. [2014], 1.15.6 Encourage women to have skin‑to‑skin contact with their babies as soon as possible after the birth[7]. [2007], 1.8.9 Support the playing of music of the woman's choice in labour. [2007], 1.9.16 Establish epidural analgesia with a low‑concentration local anaesthetic and opioid solution with, for example, 10–15 ml of 0.0625–0.1% bupivacaine with 1–2 micrograms per ml fentanyl. 1.10.23 If variable decelerations with no concerning characteristics (see recommendation 1.10.22) are observed: be aware that these are very common, can be a normal feature in an otherwise uncomplicated labour and birth, and are usually a result of cord compression, ask the woman to change position or mobilise. [2014]. [2007], 1.12.10 Do not routinely offer the package known as active management of labour (one‑to‑one continuous support; strict definition of established labour; early routine amniotomy; routine 2‑hourly vaginal examination; oxytocin if labour becomes slow). 1.2.2 To establish communication with the woman: Greet the woman with a smile and a personal welcome, establish her language needs, introduce yourself and explain your role in her care. * If there are any concerns about the baby's wellbeing, be aware of the possible underlying causes and start one or more of the following conservative measures based on an assessment of the most likely cause(s): encourage the woman to mobilise or adopt an alternative position (and to avoid being supine); offer intravenous fluids if the woman is hypotensive; reduce contraction frequency by reducing or stopping oxytocin if it is being used and/or offering a tocolytic drug (a suggested regimen is subcutaneous terbutaline 0.25 mg). [2014], 1.15.4 Do not take paired cord blood samples (for blood gas analysis) routinely. [2014]. Intrapartum bladder care and the management and prevention of postpartum urinary retention are of great clinical importance. [2007], 1.15.30 Refer a baby with any symptom of possible sepsis, or born to a woman who has evidence of chorioamnionitis, to a neonatal care specialist immediately. *** Blix reported epidural analgesia and Birthplace reported spinal or epidural analgesia. [2017]. If this is not possible or not wanted, check that the birth companion(s) have or can arrange their own transport. 1.10.12 When reviewing the cardiotocograph trace, assess and document contractions and all 4 features of fetal heart rate: presence or absence of decelerations, and concerning characteristics of variable decelerations if present (see recommendation 1.10.22). Only continue with fetal blood sampling if the cardiotocograph trace remains pathological (see recommendation 1.10.27). Ensure that the focus of care remains on the woman rather than the CTG trace. If a fetal blood sample cannot be obtained and the cardiotocograph trace has not improved, expediting the birth will be advised. If there are concerns about cardiotocography findings, undertake this assessment more frequently. [2014], bear in mind that it will be necessary to call for help if the baby needs resuscitation, and plan accordingly, ensure that there are facilities for resuscitation, and for transferring the baby to another location if necessary, develop emergency referral pathways for both the woman and the baby, and implement these if necessary. Check equipment and count swabs and needles before and after the procedure. [2017], 1.10.45 Do not take a fetal blood sample during or immediately after a prolonged deceleration. Fractured humerus and clavicle were uncommon outcomes – less than 4% of adverse events. For the frequency of these events (how often any of them actually occurred), see appendix A. RCM Midwives. [2007]. See recommendation 1.3.1 for the definition of the first stage of labour. Bladder cancer Lower urinary tract symptoms in men Prostate cancer Renal cancer Urinary incontinence. [2014], 1.5.4 If significant meconium is present, transfer the woman to obstetric‑led care provided that it is safe to do so and the birth is unlikely to occur before transfer is completed. This is defined as dark green or black amniotic fluid that is thick or tenacious, or any meconium‑stained amniotic fluid containing lumps of meconium. [2014]. [2007, amended 2014], 1.13.6 For a multiparous woman, suspect delay if progress (in terms of rotation and/or descent of the presenting part) is inadequate after 30 minutes of active second stage. [2014]. [2007], 1.13.10 Inform the woman that in the second stage she should be guided by her own urge to push. Follow the general principles for transfer of care described in section 1.6. 1.12.13 If delay in the established first stage is suspected, take the following into account: referral to the appropriate healthcare professional.Offer the woman support, hydration, and appropriate and effective pain relief. It should be recognised that some women will require an individualised bladder care [2007], 1.15.8 Avoid separation of a woman and her baby within the first hour of the birth for routine postnatal procedures, for example, weighing, measuring and bathing, unless these measures are requested by the woman, or are necessary for the immediate care of the baby[7]. [2007]. �!�8��$��/}q$�7Qq�9�>ƃؑ:I��7E��rT�Q��FE�##�-�\,�ϴ3��. Clinical curricula and guidelines recommend that patients void every two to four hours throughout labor, as a full bladder may obstruct the descent of … 1.16.13 When carrying out perineal repair: ensure that tested effective analgesia is in place, using infiltration with up to 20 ml of 1% lidocaine or equivalent, top up the epidural or insert a spinal anaesthetic if necessary. Make a documented systematic assessment of the condition of the woman and unborn baby (including cardiotocography [CTG] findings) every hour, or more frequently if there are concerns. [2017]. [2017]. [2007], 1.13.22 Provide tested effective analgesia before carrying out an episiotomy, except in an emergency because of acute fetal compromise. If the woman appears to be in established labour, offer a vaginal examination. [2007, amended 2014], Ongoing consideration should be given to the woman's position, hydration, coping strategies and pain relief throughout the second stage. Intrapartum bladder care Prevention of postpartum voiding dysfunction starts with good bladder management intrapartum which includes the documentation of frequency and volume of bladder emptying. [2014], talk with the woman and her birth companion(s) about the reasons for this and what they can expect, including the time needed for transfer, address any concerns she has and try to allay her anxiety, ensure that her wishes are respected and her informed consent is obtained. A caesarean section or instrumental birth (forceps or ventouse) may be advised, depending on the results of the procedure. [2007], 1.2.6 Routine hygiene measures taken by staff caring for women in labour, including standard hand hygiene and single‑use non‑sterile gloves, are appropriate to reduce cross‑contamination between women, babies and healthcare professionals. endobj Carry out auscultation immediately after a contraction for at least 1 minute and record it as a single rate. 1.10.2 Offer intermittent auscultation of the fetal heart rate to women at low risk of complications in established first stage of labour: Carry out intermittent auscultation immediately after a contraction for at least 1 minute, at least every 15 minutes, and record it as a single rate. [2014], 1.14.19 Offer a change from physiological management to active management if the woman wants to shorten the third stage. [2014], 1.14.1 Recognise that the time immediately after the birth is when the woman and her birth companion(s) are meeting and getting to know the baby. Do not make any decision about a woman's care in labour on the basis of CTG findings alone. Palpate the maternal pulse hourly, or more often if there are any concerns, to differentiate between the maternal and fetal heartbeats. [2007], 1.13.23 Inform women that there is insufficient high‑quality evidence to either support or discourage giving birth in water. Lancet 343: 1399–404. [2017]. Assess whether to transfer the woman (with her baby) to obstetric‑led care after 6 hours if her bladder is palpable and she is unable to pass urine.If transferring the woman to obstetric‑led care, follow the general principles for transfer of care described in section 1.6. <> Bladder Management - Intrapartum and Postpartum (including Trial of Void) Uncontrolled document when printed Published: 27/07/2020 Page 2 of 6 4.2 Prevention Prevention of acute bladder distension … Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster. [2007], 1.9.18 Do not use high concentrations of local anaesthetic solutions (0.25% or above of bupivacaine or equivalent) routinely for either establishing or maintaining epidural analgesia. [2007], 1.9.7 Encourage women with regional analgesia to move and adopt whatever upright positions they find comfortable throughout labour. 1.15.23 If any of the following are observed after any degree of meconium, ask a neonatologist to assess the baby (transfer both the woman and baby if they are at home or in a freestanding midwifery unit, following the general principles for transfer of care described in section 1.6): heart rate below 100 or above 160 beats/minute, body temperature of 38°C or above, or 37.5°C on 2 occasions 30 minutes apart, oxygen saturation below 95% (measuring oxygen saturation is optional after non‑significant meconium), presence of central cyanosis, confirmed by pulse oximetry if available. Early assessment of the woman's emotional and psychological condition in response to labour and birth. [2007], 1.13.30 Because instrumental birth is an operative procedure, advise the woman to have tested effective anaesthesia. [2007], 1.15.28 Advise women with prelabour rupture of the membranes to inform their healthcare professionals immediately of any concerns they have about their baby's wellbeing in the first 5 days after birth, particularly in the first 12 hours when the risk of infection is greatest.

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