Registered Midwife Procedures



DESCRIPTION

This is a process of building a therapeutic relationship with the client and family. It makes the client and family feel comfortable in disclosing sensitive information which will aid in individualized care, based on their needs.

AIMS

  1. Develop mutual trust between client and midwife
  2. Reduce anxiety, promote positive client experience and well-being
  3. Enhance respectful maternity care of client and family
  4. Promote effective communication
  5. Work within the midwifery services framework

TYPES

  1. N/A

DESCRIPTION

This is the process of describing a procedure, an action or task that will be carried out by the midwife for a patient/client during delivering of care.

AIMS

  1. Seek patient/client’s co-operation and consent
  2. Provide clear understanding of the action or task
  3. Allay fear and anxiety
  4. Indicate the purpose of the procedure

TYPES

  1. N/A

DESCRIPTION

This is the process of obtaining a comprehensive information from a client in order to make appropriate diagnoses for management.

AIMS

  1. Assess patient/client within the midwifery services framework
  2. Obtain baseline information for informed patient care
  3. Identify the risk level of the client and the foetus
  4. Help with health promotion and management of the client
  5. Gain insight into client’s general health condition

TYPES

  1. Personal History
  2. Social History
  3. Past Obstetric History
  4. Present Obstetric History
  5. Gynaecological History
  6. Menstrual History
  7. Medical/Surgical History
  8. Family History
  9. Lactation History
  10. Nutritional History
  11. Contraceptive History

DESCRIPTION

This is the first assessment of the pregnant client/woman at the Antenatal Clinic through the use of all the senses and appropriate tools.

AIMS

  1. Obtain baseline data for informed patient care
  2. Detect any abnormalities
  3. Treat any identified anomalies
  4. Prevent complications
  5. Give appropriate health education to the client
  6. Assess nutritional status

TYPES

  1. General Assessment
  2. - General appearance

DESCRIPTION

This is the process of obtaining obstetric information on previous pregnancy(ies) and outcome of delivery(ies) through skilful communication.

AIMS

  1. Obtain baseline information
  2. Identify the risk level of the client and foetus
  3. Help with health promotion and management of the client
  4. Inform the mode of delivery
  5. Anticipate complications and manage

TYPES

  1. N/A

DESCRIPTION

This is the process of obtaining accurate obstetric information on current pregnancy by the midwife through skilful communication.

AIMS

  1. Obtain baseline information
  2. Identify the risk level of the client and foetus
  3. Help with health promotion and management of the client
  4. Inform the mode of delivery
  5. Anticipate complications and manage
  6. Ensure effective and accurate clinical decision making

TYPES

  1. N/A

DESCRIPTION

This is an assessment done on a pregnant woman to ascertain the progress of pregnancy and detect any deviation from normal through inspection, palpation and auscultation.

AIMS

  1. Estimate gestational age
  2. Determine any deviation from normal
  3. Identify the position of the foetus
  4. Determine foetal viability
  5. Determine the lie of the foetus
  6. Provide prompt intervention
  7. Determine the foetal heart beat

TYPES

  1. N/A

DESCRIPTION

This is the process of assessing the breast of a pregnant woman through inspection and palpation at the antenatal clinic. It gives an opportunity for the midwife and mother to discuss the importance of breastfeeding.

AIMS

  1. Provide baseline data
  2. Identify any abnormalities and manage promptly
  3. Educate mother on appropriate nutrition towards lactation
  4. Teach the woman breast self-examination

TYPES

  1. Clinical breast examination
  2. Breast self-examination

DESCRIPTION

This is a routine investigation carried out on clients during pregnancy, labour and puerperium. Midstream urine is obtained from clients in clean bottle for analysis.

AIMS

  1. Analyse urine sugar to rule out gestational diabetes
  2. Analyse urine protein to rule out pre-eclampsia

TYPES

  1. Urine dipsticks analysis
  2. Urine analyser analysis (at the laboratory)

DESCRIPTION

This is the process of educating the pregnant woman on malaria before, during and after pregnancy.

AIMS

  1. Educate the pregnant woman on measures to prevent malaria
  2. Identify signs and symptoms of malaria early for prompt management
  3. Prevent associated complications of malaria in pregnancy

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

This is the process of educating the pregnant woman on appropriate nutrition for the well-being of the mother and proper development of the foetus. This spans from before, during and after pregnancy.

AIMS

  1. Educate on importance of appropriate nutrition during pregnancy
  2. Teach the various food nutrients and their sources
  3. Assist the woman/client to have an appropriate dietary plan
  4. Assist the woman/client to avoid harmful cravings
  5. Assist the woman/client to prevent nutritional deficiencies (anaemia)
  6. Assist the woman/client to prevent birth defects

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

This is the process of educating the pregnant woman/client on self-cleanliness and immediate surrounding in order to prevent associated diseases.

AIMS

  1. Keep mother and foetus healthy
  2. Prevent associated infections
  3. Prevent spread of communicable diseases
  4. Prevent complications

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

This is the process of sharing information with the pregnant woman and her family on early detection and recognition of specific signs which can be life threatening and complicate the pregnancy. Some of the danger signs are vaginal bleeding, severe headache, blurred vision and epigastric pain.

AIMS

  1. Creates awareness on danger signs of pregnancy
  2. Seek prompt attention
  3. Promotes early health seeking behaviour
  4. Helps plan for appropriate referral
  5. Reduce maternal and prenatal morbidity and mortality

TYPES

  1. Individual
  2. Group

DESCRIPTION

This is a process of educating the pregnant woman and her family to access timely skilled maternal and neonatal care leading to child birth.

AIMS

  1. Prepare the client and family adequately for confinement
  2. Reduce delays in skilled maternal and neonatal care
  3. Promote skilled birth attendance
  4. Promote prompt referral of complications for management
  5. Gain cooperation of the family in the care of the woman/client

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

This is a timely intervention by the midwife to a pregnant woman who is bleeding from the genital tract. The bleeding may occur between 24 to 28 weeks of pregnancy and before the delivery of the baby.

AIMS

  1. Prevent further vaginal bleeding
  2. Prevent hypovolemic shock
  3. Provide initial and subsequent management
  4. Determine the cause of bleeding
  5. Prevent post-partum haemorrhage
  6. Reduce maternal and neonatal morbidity and mortality

TYPES

  1. Conservative management
  2. Surgical management

DESCRIPTION

This is an obstetric emergency care given by the midwife to a postpartum woman bleeding excessively and progressively (500ml or more) that can cause deterioration in the client’s condition within or after 24 hours of delivery. It can be due to trauma, atonic uterus or infection.

AIMS

  1. Resuscitate client
  2. Manage hypovolemic shock
  3. Prevent atonic uterus
  4. Identify and repair vaginal or cervical tears
  5. Prevent maternal morbidity and mortality

TYPES

  1. N/A

DESCRIPTION

This is a systematic sensitive assessment of the vagina performed by a Midwife by inserting her index and middle fingers into the vagina to ascertain various physiological changes and abnormalities in the birth canal during labour. It is normally done 4 hourly unless otherwise indicated. It requires adequate preparation of the woman on the purpose and rationale.

AIMS

  1. Make positive diagnoses of labour
  2. Monitor cervical dilatation, consistency and position of the cervix
  3. Determine engagement of the descent of the presenting part
  4. Determine whether membranes have ruptured or rupture it artificially
  5. Confirm full dilation of the cervix
  6. Identify possible cord prolapse after the membranes have ruptured
  7. Assess progress or delay in labour
  8. Confirm the presentation of the second twin in multiple pregnancy
  9. Assess the adequacy of the pelvis
  10. Determine the position of the presenting of the foetus
  11. Apply a foetal scalp electrode

TYPES

  1. Digital
  2. Speculum

DESCRIPTION

This is an intervention by the midwife during labour when there is full dilatation of the cervix to complete expulsion of the foetus or the last baby in multiple pregnancy.

AIMS

  1. Minimise injury to both mother and baby
  2. Prevent delays in delivery
  3. Ensure safe delivery of healthy new born and mother
  4. Prevent excessive bleeding

TYPES

  1. N/A

DESCRIPTION

This is a technique which is used by the midwife to manage the 3rd stage of labour. It involves the administration of the uterotonic drugs, early cord clamping and controlled cord traction to deliver the placenta and membrane and control haemorrhage.

AIMS

  1. Prevent delay in the delivery of placenta and membranes
  2. Reduce the risk of postpartum haemorrhage
  3. Reduce maternal morbidity and mortality
  4. Prevent infection

TYPES

  1. N/A

DESCRIPTION

This is an intervention by the midwife to the puerperal mother during the first 6 hours after complete expulsion of the placenta and membranes. The puerperal mother is stabilized through close observation and adequate care to enhance the proper contraction of the uterus.

AIMS

  1. Offer the mother the opportunity to initiate bonding with the baby
  2. Prevent excessive bleeding
  3. Establish breastfeeding
  4. Ensure adequate rest
  5. Rule out abnormal physiological changes

TYPES

  1. Immediate management
  2. Subsequent management

DESCRIPTION

This is a surgical incision of the vaginal opening and the perineal tissue performed by the midwife to increase the passage of the foetus during delivery when the need arises.

AIMS

  1. Shorten the 2nd Stage of labour e.g. in foetal compromise
  2. Prevent perineal tears/trauma
  3. Widen the vaginal opening for assisted/instrumental delivery
  4. Prevent injury to the baby
  5. Prevent infection
  6. Reduce blood loss

TYPES

  1. Mediolateral/oblique
  2. Midline (median)
  3. J-shaped
  4. Lateral

DESCRIPTION

This is a thorough assessment of a new born baby by the midwife from head to toe after birth to confirm normality, exclude any congenital abnormalities and medical concerns. It is done initially within 48 hours at birth and before baby is discharged home.

AIMS

  1. Assess APGAR Score (Appearance, Pulse, Grimace, Activity and Respiration)
  2. Detect acutely unwell neonates who require urgent treatment
  3. Evaluate and address the family’s concerns about the neonates
  4. Review the neonate weight and other parameters
  5. Assess whether urine and meconium have been passed
  6. Identify any congenital malformations and arrange any required management
  7. Discuss matters relevant to the neonate with mother (e.g. neonatal care, feeding, vitamin K, Hepatitis B and BCG immunization)
  8. Explain issues such as jaundice that may arise in the following days or weeks
  9. Discuss how the family will be able to access additional support if required
  10. Educate the mother on breastfeeding
  11. Confirm sex of the baby

TYPES

  1. Immediate assessment
  2. Subsequent assessment

DESCRIPTION

It is a process of ensuring that the mother acquires all the techniques to start early breastfeeding after birth. This is very essential to establish early lactation and bonding as well as provide all the necessary nutrient to the neonate.

AIMS

  1. Teach mother the various position to adopt during breastfeeding
  2. Educate mother on how to latch the baby to the breast
  3. Affirm baby friendly protocol
  4. Reduce discomfort during breastfeeding
  5. Prevent the contraction of the uterus
  6. Prevent minor disorders of breastfeeding (such as sore nipples, breast engorgement)
  7. Promote involution
  8. Promote bonding
  9. Provide needed nutrient to baby

TYPES

  1. Cradle hold
  2. Cross-cradle
  3. Football or clutch
  4. Laid-back
  5. Side-lying
  6. Upright
  7. Others

DESCRIPTION

This is an assessment of the client after delivery by the midwife in the lying-in ward, before discharge and at the Postnatal Clinic. This is to ensure her well-being physiologically, physically and psychologically.

AIMS

  1. Detect and prevent complication early
  2. Provide prompt management for any anomalies detected
  3. Provide counselling in the post-partum period
  4. Provide support for client and family

TYPES

  1. Immediate examination
  2. Subsequent examination

DESCRIPTION

This is the initial process of cleaning the newborn baby thoroughly by the midwife. It is usually performed between 6 to 24 hours after delivery irrespective of the condition of the mother. On the other hand, initial baby bath is delayed in the case where baby is critically ill.

AIMS

  1. Maintain personal cleanliness
  2. Prevent skin infections
  3. Enhance comfort and relaxation of baby
  4. Promote positive interaction
  5. Induce sleep
  6. Offer opportunity for health education to the mother
  7. Offer opportunity to examine the baby

TYPES

  1. Top and tail
  2. Complete bath

DESCRIPTION

This is an aseptic technique performed by the midwife in the dressing of the umbilical cord. This is done after delivery using the recommended/prescribed antiseptic lotion to optimize the health of the baby until the cord drops off and the complete healing of the wound.

AIMS

  1. Prevent superficial (omphalitis) and systemic infection
  2. Help the umbilical cord stamp to fall of the naval quickly
  3. Promote healing
  4. Create an opportunity for health education to the mother
  5. Prevent bleeding from the stump
  6. Promote progressive dryness

TYPES

  1. N/A

DESCRIPTION

This is a procedure performed by the midwife daily between 1-3weeks to clean the vulva/perineum after delivery of the baby to optimise the health of the puerperal woman.

AIMS

  1. Help prevent infection
  2. Keep vulva dry and free from irritant
  3. Promote healing of the vulva
  4. Assess lochia

TYPES

  1. Swabbing
  2. Jug Douching

DESCRIPTION

These are series of midwifery interventions carried out on a woman in labour to ascertain normality and deviation. It consists of the latent and active phase of first stage of labour using the partograph/WHO Labour Care Guide.

AIMS

  1. Evaluate accurately the progress of labour
  2. Render supportive care to client and companion
  3. Identify and address emerging complications of labour
  4. Manage client with poor progress promptly

TYPES

  1. N/A

DESCRIPTION

This is the process where the midwife minimizes the degree of pain in labour through pharmacological and non-pharmacological approach or both. Methods employ include deep breathing exercises, positioning, sacral massage and psychological care to the client.

AIMS

  1. Provide maximum relief of pain
  2. Allow labour to progress rapidly
  3. Ensure a positive experience of labour
  4. Improves birth experience of mother
  5. Help the woman maintain control

TYPES

  1. Pharmacological
  2. Non pharmacological
  3. Combined method

DESCRIPTION

This is the process where the midwife observes and inspect the placenta accurately after its expulsion.

AIMS

  1. Ensure that the placenta is complete
  2. Facilitate early detection of any abnormality of the placenta, membranes, lobes and cord
  3. Aid in further examination of the mother for retained products of conception
  4. Prevent postpartum haemorrhage

TYPES

  1. N/A

DESCRIPTION

This is the care rendered by the midwife to a client before and after an emergency or a planned caesarean section.

AIMS

  1. Prevent complications in pregnancy
  2. Prevent maternal and neonatal morbidity/mortality

TYPES

  1. Pre-operative management
  2. Post-operative management

DESCRIPTION

This is the care rendered by the midwife to a client before and after an emergency or a planned caesarean section.

AIMS

  1. Prevent complications in pregnancy
  2. Prevent maternal and neonatal morbidity/mortality

TYPES

  1. N/A

DESCRIPTION

This is the care rendered by the midwife to a client before and after an emergency or a planned caesarean section.

AIMS

  1. Prevent complications in pregnancy
  2. Prevent maternal and neonatal morbidity/mortality

TYPES

  1. N/A

DESCRIPTION

This is where the midwife gives information and coping strategies to a pregnant client/woman on nauseated feeling during pregnancy which occurs in the early trimester.

AIMS

  1. Eliminate nauseating foods from diet
  2. Ensure proper nourishment of client and foetus
  3. Prevents precipitating factors contributing to vomiting
  4. Identify danger signs and report to the hospital
  5. Restore electrolyte balance

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

These are series of interventions and giving of information by the midwife to a pregnant client/woman who is experiencing a burning sensation in the oesophagus that occurs after eating, bending forwards or lying down at night.

AIMS

  1. Prevent reflux of food into the oesophagus
  2. Help digestion of meals
  3. Eliminate food substances that predispose to heart burn
  4. Prevent discomfort and improve nutrition

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

These are series of information given by the midwife to a pregnant client/woman on how to cope and manage the pain associated with haemorrhoids and prevention of constipation which is major contributing factor.

AIMS

  1. Aid in free bowel elimination
  2. Prevent infection
  3. Reduce associated pain
  4. Prevent anal fistula in severe cases
  5. Prevent complications such as anaemia
  6. Promote comfort

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

These are series of information given by the midwife to assist the pregnant client/woman to gain knowledge in the prevention and management of constipation.

AIMS

  1. Prevent constipation as much as possible
  2. Aid free bowel elimination
  3. Prevent haemorrhoids
  4. Prevent discomfort
  5. Prevent rectal bleeding

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

These are series of interventions and giving of information by the midwife to a pregnant client on coping strategies of spasms in the limbs during pregnancy.

AIMS

  1. Minimise frequency of occurrence
  2. Minimise pain and the duration of cramps
  3. Promote good circulation of blood in the limbs
  4. Promote comfort

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

These are series of information given by the midwife to assist the pregnant client/woman gain knowledge and coping strategies in the management of mild, odourless and clear vaginal discharge.

AIMS

  1. Provide knowledge on characteristics of the normal vaginal discharge
  2. Provide knowledge on keeping underwear clean
  3. Enhance knowledge on personal hygiene
  4. Prevent infection to the mother and foetus

TYPES

  1. Individual education
  2. Group education

DESCRIPTION

This is an emergency or urgent care rendered by the nurse/midwife to a client/mother to avert or restore a condition where the circulatory system cannot provide adequate blood supply to vital organs of the body.

AIMS

  1. Improve blood supply to vital organs in the body
  2. Prevent irreversible organ damage
  3. Replace fluids and electrolytes
  4. Identify the cause and manage it
  5. Prevent anaerobic metabolism in the tissue
  6. Offer appropriate supportive care

TYPES

  1. N/A

DESCRIPTION

This is an emergency or urgent care rendered by the nurse/midwife to a client/mother to avert or restore a condition where the circulatory system cannot provide adequate blood supply to vital organs of the body.

AIMS

  1. Improve blood supply to vital organs in the body
  2. Prevent irreversible organ damage
  3. Replace fluids and electrolytes
  4. Identify the cause and manage it
  5. Prevent anaerobic metabolism in the tissue
  6. Offer appropriate supportive care

TYPES

  1. N/A

DESCRIPTION

This is an acute obstetric emergency care given by the midwife to the mother/client when the cord is felt in the lower uterine segment either adjacent or below the presenting part after rupture of the membranes.

AIMS

  1. Relieve cord compression from the presenting part
  2. Prevent vasospasms of the umbilical cord
  3. Assess viability of the foetus
  4. Prevent foetal hypoxia
  5. Reduce chorioamnionitis
  6. Reduce neonatal morbidity and mortality

TYPES

  1. N/A

DESCRIPTION

This is the management given to the pregnant woman by the midwife when membranes have ruptured or leaking before the onset of labour. It can occur either when the foetus is immature (preterm or before 37 weeks) or when pregnancy has reached term.

AIMS

  1. Prevent infection
  2. Make early diagnosis for management
  3. Prevent complications such as Chorioamnionitis and Pulmonary Embolism
  4. Help foetal lungs to mature in preterm or before 37 weeks
  5. Prevent neonatal complications such as Respiratory Distress Syndrome and Intraventricular haemorrhage

TYPES

  1. N/A

DESCRIPTION

This is an obstetric care rendered by the midwife to a pregnant woman/client with an elevated blood pressure of 140/90 mmHg and proteinuria after 20 weeks of gestation. This management is also rendered for a client with an increase systolic of 15 – 20 mmHg and diastolic of 10 mmHg with proteinuria irrespective of client’s normal blood pressure.

AIMS

  1. Stabilise client’s blood pressure
  2. Prevent severe Pre-eclampsia, Imminent Eclampsia and Eclampsia
  3. Prevent and manage complications
  4. Reduce maternal and foetal morbidity and mortality

TYPES

  1. Out-Patient Management
  2. In-Patient Management

DESCRIPTION

This is an intervention by the midwife to a pregnant woman/client with mild with high blood pressure and protein in urine.

AIMS

  1. Prevent client from having eclampsia
  2. Prevent foetal compromise and death
  3. Prevent other maternal morbidities and complications

TYPES

  1. N/A

DESCRIPTION

This is an emergency obstetric care given by the midwife to a pregnant woman/client with a systolic blood pressure of 160mmHg and diastolic pressure of at least 110mmHg with proteinuria. There may be other related symptoms such as blurred vision, epigastric pain and persistent frontal headache.

AIMS

  1. Prevent client from having eclampsia
  2. Prevent foetal compromise and death
  3. Prevent other maternal morbidities
  4. Expedite delivery of foetus
  5. Prevent complications

TYPES

  1. N/A

DESCRIPTION

This is an obstetric emergency care rendered by the midwife to a pregnant woman/client in a state of convulsion which is not related to an existing brain condition, followed by coma and posing a threat to client and foetus.

AIMS

  1. Stop convulsion
  2. Reduce blood pressure
  3. Delivery of foetus as soon as possible
  4. Prevent injuries to the client and foetus
  5. Resuscitate client and foetus
  6. Prevent associated complications to client and foetus

TYPES

  1. N/A

DESCRIPTION

This is an obstetric emergency care rendered by the midwife to a pregnant woman/client in a state of convulsion which is not related to an existing brain condition, followed by coma and posing a threat to client and foetus.

AIMS

  1. Stop convulsion
  2. Reduce blood pressure
  3. Delivery of foetus as soon as possible
  4. Prevent injuries to the client and foetus
  5. Resuscitate client and foetus
  6. Prevent associated complications to client and foetus

TYPES

  1. N/A

DESCRIPTION

This is the suturing of an episiotomy or vaginal tears soon after the second stage of labour. It is an uncomfortable and painful procedure and as such, it must be done under local infiltration of anaesthesia.

AIMS

  1. Secure haemostasis
  2. Reapproximate the lacerated or cut tissues, vaginal mucosa and muscles
  3. Prevent infection of the wound
  4. Promote fast healing of the wound
  5. Promote self esteem

TYPES

  1. N/A

DESCRIPTION

This is the systematic approach of suturing the layers of the vagina lining. This involves the suturing of three layers; namely vaginal epithelium, the muscles and the perineal skin.

AIMS

  1. Bring the torn or cut vaginal linings into apposition
  2. Eliminate (dead space) spaces between the muscles for collection of blood
  3. Prevent complications
  4. Promote healing and comfort

TYPES

  1. N/A

DESCRIPTION

This is the continuous assessment by the midwife on the pregnant woman in labour in order to ascertain the progress of mother and foetus as well as identify any abnormalities. This is the period of time characterized by regular rhythmic painful uterine contractions and dilatation of cervix.

AIMS

  1. Determine duration, frequency and intensity of uterine contractions
  2. Detect changes in the normal foetal heart rate pattern during labour
  3. Evaluate the descent of the presenting part
  4. Detect maternal abnormalities and take prompt action
  5. Know the importance of the alert and action lines on the labour care guide

TYPES

  1. Manual and electronic maternal monitoring
  2. Manual and electronic Foetal monitoring