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Strategies to support women who have had an epidural in labour
Abstracts / Women and Birth 30(S1) (2017) 1–47
the Perth metropolitan area. This model could be applied to other cities and rural areas in Australia. http://dx.doi.org/10.1016/j.wombi.2017.08.118 P22 Actions: Louder than words Sharon Rance, Liz McNeill Flinders University, South Australia, Australia Introduction: The realities of working in institutionalised settings often creates difficulties for graduate midwives when ‘with institution’ versus ‘with women’ challenges their moral beliefs and ideals. Graduates conform to institutional culture to belong, commonly being fearful of the potential consequences that result from raising concerns and speaking up. Evidence shows that undergraduate education on speaking up and assertiveness training has resulted in increased advocacy for patient safety. Aim: A simulated activity was designed that challenged third year midwifery students to speak up when confronted by poor practice and to subsequently act to alert the experienced practitioner to cease the practice. Students were sent into an unknown scenario and the interactions were videoed and watched during debriefing sessions. When IT issues caused a loss of audio it resulted in unexpected but extremely powerful learning. Without the distraction of audio, the moment of action and how the unintentional body language of the students impacted on the communication during the interaction was evident. Actions included students physically placing themselves between the poor practitioner and the woman, fundamentally displaying protection and woman centred care. Innovation: Very little has been written about using video without audio to concentrate on non-verbal communication and body language. The learning activity which was originally designed to focus on verbal communication taught us all that our actions are indeed louder than words. Implications and application: The unintended learning that came from a simple IT issue reinforced the power of non-verbal communication; which evidence suggests equates to around 60% of human communication. Undergraduate education can help students to develop confidence to promote behaviours and skills needed to act upon poor practice and this should help them to understand the power of non-verbal communication in the provision of safe, quality midwifery care. http://dx.doi.org/10.1016/j.wombi.2017.08.119 P23 Strategies to support women who have had an epidural in labour Heather Borradale Setpoint Clinical Solutions, Australia Midwives face many challenges within the clinical setting. Two of the most commonly encountered challenges are the management and use of epidural pain relief and induction of labour. Finding tools to assist women in birth when the women’s mobility may be compromised due to an epidural or an increased need for pain relief in the induction of labour is constantly evolving. The midwife is challenged to support the woman in the physiological birth process despite the impact of medical intervention. The use of the peanut ball is one of the tools that assists in optimal positioning in labour and has been embraced in some parts of the world.
45
Use of the peanut ball in labour enables optimal position for fetal decent toward the larger posterior part of the pelvic inlet where there is more room for the baby to flex, rotate and descend. This is achieved by creating positions where the mother is upright, has her upper leg as far as possible away from her lower leg (increasing the transverse diameter of the pelvis) and free space to allow the sacrum and coccyx to move back (increasing the anterior-posterior diameter of the pelvis). The peanut ball has been a very useful tool in the hospital I work in and there is definitely a positive buzz around the use of the ball. I have been surprised at the increase in progress once a peanut ball is used. The cost saving for the hospital and patient cannot be underestimated and the option for subsequent births to be vaginal flows into this cost saving long term. Using the peanut ball midwives can support women in labour despite the choices made in regard to induction of labour and epidural analgesia. The active support of these women is rewarding for the midwife and patient. http://dx.doi.org/10.1016/j.wombi.2017.08.120 P24 What do we understand about maternal–fetal drug disposition? Critical issues and knowledge for midwives practicing across the childbearing continuum Maryam Bazargan 1,∗ , Roslyn Donnellan-Fernandez 2 , Kristen Graham 1 1
Flinders University South Australia, Australia Menzies Health Institute Queensland, Griffith University, Queensland, Australia 2
Introduction: Generalised use of pharmaceutical compounds during pregnancy and birth is very common. 59% of women use some form of prescribed medication during pregnancy (Andrade et al., 2004) resulting in advertent and inadvertent drug exposure for the fetus. Trans?placental transfer of drugs can occur both from mother to fetus, which causes fetal exposure to drugs, and from fetus to mother, which eliminates drugs from the fetal circulation. Non-placental elimination of drugs in the fetus and mother also affect fetal drug exposure. Whilst evidence exists to suggest that many drugs present in the maternal circulation can cross the placental and reach the fetus, the body of research regarding the maternal and neonatal health outcomes after exposure to many of these pharmaceutical drugs is lacking. Aim: The aim of this poster is to expand midwives’ knowledge of pharmacology in relation to mother, fetus and the newborn baby by examining findings of recent PhD research. Information obtained from this study has the potential to provide novel insights into the process of drug disposition in human pregnancy. Method: This poster will apply pharmacology knowledge to midwifery clinical practice. It will cover the broad theoretical principles of pharmacokinetics and pharmacodynamics in relation to medicines commonly prescribed in pregnancy and childbearing. This will include theoretical analysis of maternal–fetal drug transfer, metabolism and excretion. An example from recent PhD research will be used to demonstrate the significance of this knowledge for midwifery practice. This will be applied to a variety of settings/scenarios in order to optimise care of mother, fetus and newborn baby in the antenatal, intrapartum and postpartum periods. Several practical, case study examples will be provided including induction of labour, implications of operative birth, and initiation of successful breastfeeding. Implications for practice: In this study, drug pharmacokinetics in the pregnant ewe and fetus using rosiglitazone was investigated.
the Perth metropolitan area. This model could be applied to other cities and rural areas in Australia. http://dx.doi.org/10.1016/j.wombi.2017.08.118 P22 Actions: Louder than words Sharon Rance, Liz McNeill Flinders University, South Australia, Australia Introduction: The realities of working in institutionalised settings often creates difficulties for graduate midwives when ‘with institution’ versus ‘with women’ challenges their moral beliefs and ideals. Graduates conform to institutional culture to belong, commonly being fearful of the potential consequences that result from raising concerns and speaking up. Evidence shows that undergraduate education on speaking up and assertiveness training has resulted in increased advocacy for patient safety. Aim: A simulated activity was designed that challenged third year midwifery students to speak up when confronted by poor practice and to subsequently act to alert the experienced practitioner to cease the practice. Students were sent into an unknown scenario and the interactions were videoed and watched during debriefing sessions. When IT issues caused a loss of audio it resulted in unexpected but extremely powerful learning. Without the distraction of audio, the moment of action and how the unintentional body language of the students impacted on the communication during the interaction was evident. Actions included students physically placing themselves between the poor practitioner and the woman, fundamentally displaying protection and woman centred care. Innovation: Very little has been written about using video without audio to concentrate on non-verbal communication and body language. The learning activity which was originally designed to focus on verbal communication taught us all that our actions are indeed louder than words. Implications and application: The unintended learning that came from a simple IT issue reinforced the power of non-verbal communication; which evidence suggests equates to around 60% of human communication. Undergraduate education can help students to develop confidence to promote behaviours and skills needed to act upon poor practice and this should help them to understand the power of non-verbal communication in the provision of safe, quality midwifery care. http://dx.doi.org/10.1016/j.wombi.2017.08.119 P23 Strategies to support women who have had an epidural in labour Heather Borradale Setpoint Clinical Solutions, Australia Midwives face many challenges within the clinical setting. Two of the most commonly encountered challenges are the management and use of epidural pain relief and induction of labour. Finding tools to assist women in birth when the women’s mobility may be compromised due to an epidural or an increased need for pain relief in the induction of labour is constantly evolving. The midwife is challenged to support the woman in the physiological birth process despite the impact of medical intervention. The use of the peanut ball is one of the tools that assists in optimal positioning in labour and has been embraced in some parts of the world.
45
Use of the peanut ball in labour enables optimal position for fetal decent toward the larger posterior part of the pelvic inlet where there is more room for the baby to flex, rotate and descend. This is achieved by creating positions where the mother is upright, has her upper leg as far as possible away from her lower leg (increasing the transverse diameter of the pelvis) and free space to allow the sacrum and coccyx to move back (increasing the anterior-posterior diameter of the pelvis). The peanut ball has been a very useful tool in the hospital I work in and there is definitely a positive buzz around the use of the ball. I have been surprised at the increase in progress once a peanut ball is used. The cost saving for the hospital and patient cannot be underestimated and the option for subsequent births to be vaginal flows into this cost saving long term. Using the peanut ball midwives can support women in labour despite the choices made in regard to induction of labour and epidural analgesia. The active support of these women is rewarding for the midwife and patient. http://dx.doi.org/10.1016/j.wombi.2017.08.120 P24 What do we understand about maternal–fetal drug disposition? Critical issues and knowledge for midwives practicing across the childbearing continuum Maryam Bazargan 1,∗ , Roslyn Donnellan-Fernandez 2 , Kristen Graham 1 1
Flinders University South Australia, Australia Menzies Health Institute Queensland, Griffith University, Queensland, Australia 2
Introduction: Generalised use of pharmaceutical compounds during pregnancy and birth is very common. 59% of women use some form of prescribed medication during pregnancy (Andrade et al., 2004) resulting in advertent and inadvertent drug exposure for the fetus. Trans?placental transfer of drugs can occur both from mother to fetus, which causes fetal exposure to drugs, and from fetus to mother, which eliminates drugs from the fetal circulation. Non-placental elimination of drugs in the fetus and mother also affect fetal drug exposure. Whilst evidence exists to suggest that many drugs present in the maternal circulation can cross the placental and reach the fetus, the body of research regarding the maternal and neonatal health outcomes after exposure to many of these pharmaceutical drugs is lacking. Aim: The aim of this poster is to expand midwives’ knowledge of pharmacology in relation to mother, fetus and the newborn baby by examining findings of recent PhD research. Information obtained from this study has the potential to provide novel insights into the process of drug disposition in human pregnancy. Method: This poster will apply pharmacology knowledge to midwifery clinical practice. It will cover the broad theoretical principles of pharmacokinetics and pharmacodynamics in relation to medicines commonly prescribed in pregnancy and childbearing. This will include theoretical analysis of maternal–fetal drug transfer, metabolism and excretion. An example from recent PhD research will be used to demonstrate the significance of this knowledge for midwifery practice. This will be applied to a variety of settings/scenarios in order to optimise care of mother, fetus and newborn baby in the antenatal, intrapartum and postpartum periods. Several practical, case study examples will be provided including induction of labour, implications of operative birth, and initiation of successful breastfeeding. Implications for practice: In this study, drug pharmacokinetics in the pregnant ewe and fetus using rosiglitazone was investigated.