OAR@UM Collection:

Midwives' perception on fetal monitoring by cardiotocography during labor

Sun, 01 Jan 2006 00:00:00 GMT

Title: Midwives' perception on fetal monitoring by cardiotocography during labor Abstract: In the Western world, continuous electronic fetal heart rate monitoring (EFM) by cardiotocography is currently the most widely used technique for assessing fetal status during labor. Unfortunately, electronic fetal monitoring has not lived up to early hopes and expectations (Dover and Gauge 1995). This small scale descriptive study aimed to report a survey on midwives' perceptions of fetal monitoring by cardiotocography (CTG) during labor. Twenty midwives responded to a self-structured questionnaire, seeking information on midwives' experiences, views and perceived competence with the use of CTG machines on the labor ward. The survey sought perceptions of midwives on the advantages and disadvantages of CTGs and perceptions in relation to the routine use of CTGs. Other perceptions involved those regarding interpretation skills of CTG traces and perceptions of the relationship between the increased cesarean section rate and EFM by CTGs. The questionnaires were distributed by the researcher herself and a 100% response rate occurred. The majority of midwives in the survey find that in general cardiotocography is beneficial even though it comprises some disadvantages, such as diversity m interpretation skills. The great majority agreed between them on each CTG trace presented, however some were unsure or disagreed at times, thus showing a variation in interpretation skills was evident amongst the midwives in the sample. l\1idvvives viewed that CTG improves both maternal and neonatal outcomes but they do not feel it is used routinely in Malta. The respondents also state that they find the increase in cesarean section rate locally of great concern and they perceive that the rise has a direct relationship with the use of EFM by CTG. If the various findings in this sample survey were to be consolidated for midwives as a whole, they suggest t~at improvements could be adopted in the quality of care provided locally by midwives when utilizing CTGs, such a.<; communication skills and promotion of privacy of clients. A standard policy on CTG use should be established for midwives to be aware of and follow in order to standardize delivery of care. Training regarding interpretation skills would be beneficial if offered to midwives. Ways and means could be adopted by midwives in order to try and reduce the cesarean rate by being more assertive and not letting CTGs give rise to wrong decisions. Such issue will prevent midwives from loosing their autonomy and skills. Description: B.SC.(HONS)MIDWIFERY

Midwives' perception on the use of episiotomy.

Sun, 01 Jan 2006 00:00:00 GMT

Title: Midwives' perception on the use of episiotomy. Abstract: The use of episiotomy is part of the midwifery practice since from the 1960's. The perceptions on its use have always been questioned ever since it has been used in midwifery. Locally episiotomy is used according to the situations, that is, selectively and there are no protocols that indicate routine episiotomy with every normal delivery. The use of episiotomy in the presence of fetal distress has been always a justificable indication (Sleep, 1990). The main aim of the study was to investigate midwives' perceptions on the use of episiotomy. A descriptive non-experimental design was used and data was collected by means of structured interviews using open-ended questions. The sample comprised ten midwives (n=10) from the labour ward at one of the local hospitals. From this study it was found that midwives regarded that the most important indications for an episiotomy are, fetal distress, preterm deliveries and big babies. Midwives also perceived that the risks of episiotomy are excessive bleeding, breakdown of sutures and more pain when compared to perineal tears. Midwives identified that when choosing between having perineal tears and episiotomies during deliveries, they preferred perineal tears, as these are less painful than episiotomies, they involve less muscle tissues of the perineal area and they can be superficial such as first degree tears. Due to the small size of the sample, the results cannot be generalised for the whole population of midwives working in the Labour Ward. Description: B.SC.(HONS)MIDWIFERY

The midwives' management of the third stage of labour : an observational study.

Sun, 01 Jan 2006 00:00:00 GMT

Title: The midwives' management of the third stage of labour : an observational study. Abstract: The third stage of labour is normally short but is not lacking in risk when considering that serious complications which may lead to severe morbidity and mortality for women may take place. No wander that debate continues to arise over the best way to deal with the third stage of labour. For this reason the aim of this study was to observe midwives' management of the third stage of labour. Such an aim was achieved by observing the midwives' practices during the third stage of labour, by considering carefully whether their practice reflects the literature and by investigating if any variations exist in the management of the third stage of labour. In this descriptive, non-experimental, small scale study a structured observation schedule was used for collecting data. Ten qualified midwives working at the labour ward were chosen by convenience sampling for this study and each midwife was observed managing the third stage of labour. Observations started with the crowning of the baby's head and ended five minutes after complete expulsion of the placenta and membranes. Findings suggested that variations amongst midwives do exist in certain aspects of third stage management. Such variations may be attributed to the gap between knowledge and practice as not all the midwives' practices during third stage management reflected the literature. On the other hand, this study revealed that certain aspects of third stage management are conforming and uniform among these same midwives. Finally, limitations of this study together with recommendations for clinical practice, education and research were discussed. Description: B.SC.(HONS)MIDWIFERY

Pregnant adolescents' perceptions of pregnancy

Sun, 01 Jan 2006 00:00:00 GMT

Title: Pregnant adolescents' perceptions of pregnancy Abstract: "She learned to multiply before she could divide" (p.46) is an expression that correlates to teenage pregnancy, which is more commonly used in the media as the teenage pregnancy rate is rising, asserts Pearce (1993). In point of fact, nowadays, more teenage pregnant-women with all their needs and choices are seen at the local maternity wards. This led this research to evolve into a small scale study to gain a clearer understanding of pregnant adolescents' perceptions of pregnancy. This study is aimed at examining how the participants are dealing with their pregnancy, to identify any physical/biological, emotional, lifestyle and behavioural changes due to pregnancy and to assess how their life changed in terms of transforming their relationships, the transition to motherhood and their future goals. To do this, a descriptive non-experimental approach was chosen and through a self-administered semi-structured questionnaire was used to collect quantitative data as well as some qualitative data. The sample consisted of twenty-four pregnant adolescents of age ranging from 14 to 19 years, who were chosen 'conveniently' from a specialised school for pregnant schoolgirls. A great number of the adolescents was and is still living within single parent families, while a substantial percentage were living with their parents prior to and during pregnancy. These findings showed that most of the adolescents had an unplanned pregnancy, which brought about different reactions. The pregnant teens were affected physically/biologically, emotionally and in their lifestyles as well as their behaviour. The participants have also transformed relationships. In spite of all these changes these adolescents appeared to shed the role of a mother. On the other hand, for some pregnancy improved their life situation would be improved and would like to get married, but for the majority hindered them to continue with their education. Description: B.SC.(HONS)MIDWIFERY