Home Delivery 1 Home delivery may be also

Home Delivery 1

Home delivery may be also known as ‘Domiciliary midwifery’ or ‘Out of the Hospital Birth’. 2

Professional Relationships of a Domiciliary Nurse Midwife n n n Hospital and hospital staff Maternity and Child Health Clinics Vaccinators Medico-social workers Health officers Registrars Medical Practitioners Special clinics Voluntary societies Community Health centres Sanitary Workers Dais 3

Advantages n n n n Delivers in a familiar surroundings. Removes fear of the hospital and is at ease at childbirth Few chances of cross infection Avoids financial strain Mother is relaxed and less tensed Mother can keep an eye on other children Family can assist and be a part iof the excitement 4

Disadvantages n n n Less medical and nursing intervention Less rest for the mother Diet and medication may be neglected. Medical care is delayed in case of complications Home may be not suitable 5

Contraindications Home Ø Over crowding Ø Poor environmental conditions Ø Infectious diseases Ø Destitution Maternal Factors Ø Cephalo pelvic disproportion Ø PIH Ø Eclampsia Ø Multiple pregnancy Ø Hydramnios Ø Ante partum hemorrhage Ø Rh-isoimmunization Ø Elderly primigravida Ø Grand multipara Fetal Factors Ø History of previouss stillbirths or neonatal deaths Ø Malpresentation Ø Prematurity Ø Postmaturity Ø IUGR n n Previous LSCS Difficult Obstetrical Forceps delivery PPH Medical disorders like Cardiac diseases, tuberculosis, diabetes hypertension 6

Equipment Contents in the UNICEF tin § § § § Kidney tray-1 Bowls for lotion-2 Instrument sterelizer-1 Enema can with tubing and catheter Fetal stethoscope-1 Torch-1 Safety razor-1 Plain rubber catheter-1 Spirit lamp-1 Test tubes-2 Test tube holder-1 Match box-1 2 ml syringes and needles Cheatle’s forcep-1 Thermometer-1 Mucus catheter-1 n n n n n Scissors-1 Umbilical clamps-2 Dressing forceps-2 Methylated spirit-1 bottle Dettol-1 bottle Gentian violet-1 bottle Salvon-1 bottle Sterile cord ligatures-1 bottle Drugs like Pitocin, Methergin, adrenaline Plastic bag with apron, sheet, soap, nailbrush, towel 7

Equipment (cont) Contents in the shoulder bag Lower portion (unsterile) § Nailbrush-1 § Soap in a soap dish-1 § Towel-1 § Apron-1 § Tape measure-1 § Unsterile swabs-1 packet § Spring balance-1 § Scissors-1 § Clinical thermometer-1 § Enema can § Large cotton bag-1 § Urine analysis outfit-1 Upper portion (sterile) § Apron in a bag-1 § Towels in a bag-2 § Gloves in a bag-2 pairs § Sterile swabs-1 packet § Sterile bandages-1 packet § Cord and perineal dressings § Cord ligatures § Eye antiseptics Outer back packet § Mother’s card § Newspaper 8

Procedure Survey the community for antenatal mothers n Check which are allowed for home delivery n 9

On entering the house 1. Greet patient and family 2. Note: 1. Home preparation 2. Mother’s general condition 3. Bed and bed linen 3. Collect details on history of labour 4. Preparation of the family 5. Necessary support from the family 6. Preparation of the partner and the children 10

Preparation of the home Preparation of the room v Check for privacy v Check for cleanliness v Avoid more than one person in the room v Keep ready candles, lamps v Large paper bag v Earthern pots if any Preparation of the bed v Protection of bed linen and furniture v Rubber sheets on the bottom with cotton sheet on top v Check for the placing of the bed 11

Items provided by the mother For the delivery purpose: q Wash up bowl q Towels-2 q Old night dress q Old pant q Sanitary towels q Dustbin For the baby: q Soft towel q Cot and beddings q Baby clothes q Hot water bottles 12

Preparation of the kit 1) 2) 3) 4) Bag technique to be followed If no table, place bag in a box or newspaper Once labour is established, place equipment on fire to boil Spread half of the towel from the kit on the table or floor, leaving the other half t cover the equipment once it has been sterilized 13

Preparation of the patient 1. Examination a. General condition b. Abdominal examination c. FHS, BP, TPR 2. Soap and water enema 3. Part preparation 4. Bath (optional) 5. Dress in clean clothes 14

Preparation of midwife n n n Wear the apron from the start. Gloves and face mask while performing vaginal examinations. Maintaining asepsis throughout ‘Prevent infections’ 15

Management of labour First stage n Encourage walking n Empty bladder n Provide drinks n Monitor FHS and pulse every 2 hours Second Stage n Before scrubbibg, check all equipment, reheat swabs and prepare lotion n Position patient n Avoid unnecessary conversation Third stage n Careful expulsion of placenta n Observe for PPH, general condition of mother n Examination of the baby 16

Placental Examination I. Examination of placenta II. Cover well III. Arrange for the disposal Abdominal binder Not necessary but may provide comfort Perineal examination I. Bleeding II. Tears or lacerations 17

Immediate Postnatal Care n n n Provide comfort Warm drink Warm wash below hips or hot bath after 2 hours with assistance Assess general condition Assess fundal height Assess blood loss On leaving the house • • • Keep house clean Discard all dressings Soak all blood stained clothes for wash 18

Postnatal Care 1) 2) 3) 4) 5) Daily 2 times for 3 days Daily for 10 days Visit can de decided upon condition of the mother. ‘Visit daily for 40 days’ Assess for bleeding, bowel and bladder, breast, involution of uterus, vital signs, lochia, sleep pattern, diet in the mother. Assess for colour, umbilicus, feeding, eye discharge, bowel and bladder, weight, immunization. 19

Maintenance of records n n n n Mother’s name Father’s name Date and time of delivery Sex of the child Status of the baby Place of birth Immunization of the baby 20