Midwifery VIVA - promoting normality

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Author:
kaustwick
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257673
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Midwifery VIVA - promoting normality
Updated:
2014-01-21 11:48:04
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VBAC
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VIVA examination - promoting normality in complex situation, heading and associated references
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  1. CHOICE
    • Changing Childbirth (1993)
    • Maternity Matters (2007)
    • NMC Code (2008)
  2. DIET/ACTIVITY
    • HB Levels UP
    • BMI down
    • Active - OP position
  3. Optimal Fetal Positioning
    JEAN SUTTON (1996) - all 4's, birth ball, leaning forward, lying on side.
  4. CLASSES/BIRTH PLAN
    CONTROL
    Birth and Beyond (2009) & Birth plans - leads to better birth satisfaction.

    • Ford et al (2009)
    • Goodman et al (2004) - increased control leads to better birth experience/satisfaction - better postnatal recovery, bonding/attachment, reduced PND.
  5. PURPOSE OF PAIN
    • LEAP and ANDERSON (2008)
    • Working with Pain - transition/rite of passage, heightens joy, clues as to progress, triggers neuro-hormonal cascade - endorphins - bodies own pain killers
  6. OXYTOCIN
    • Odent (2001)
    • Buckley (2010

    Fergusons Reflex - Dance of labour
  7. ENVIRONMENT
    HODNETT, DOWNE and WALSH (2012) - homely environment, lights dimmed, hospital equipment disguised, bed not focus, sensory stimulation. Affects care givers behaviour as well. Increased birth satisfaction and NVD rate.
  8. PRIVACY
    Kitzinger (2000) -
  9. SUPPORT
    Rossen (2004) - care by known, untrained woman was most effectiveoxytocin released in women exposed to stress triggers tending and befriending behavour
  10. CONTINUITY
    HODNETT et al (2011) - reduced CS, analgesia, assisted births, better APGAR scores, shorter labour length and positive birth experience.
  11. POSITION/MOBILITY
    • Lawrence et al (2013)
    • Gravity and maximises outlet, help resolve op position, shorter 1st and 2nd stage, reduced fetal distress, reduced cs rates, less need epidural, less assisted births
  12. WATER
    Cluett & Burns (2009) - no evidence re VBAC in water but reduced CS, epidural, increased satisfaction

    Cluett (2004) - beneficial for dystocia in labour
  13. COPING MECHANISMS
    • Hypnobirthing, music
    • Touch - massage
    • Aromatherapy
    • Sexual Expression - Kitzinger
    • Reflexology/homeopathy
    • Acupressure
  14. HYDRATION/NUTRITION
    • Singata et al (2013)
    • shows no benefit or harm for woman at low risk of complication - no studies looked specifically at woman at high risk so no evidence to support restrictions of intake.
  15. MONITORING
    RCOG (2007) & NICE (2011) - recommends due to risk of uterine rupture, abnormal ctg present in 55-87% of these. Consider alternative observations?

    ALFIREVIC (2013) - reduced seizures but increased risk of CS and assisted delivery.
  16. PAIN RELIEF
    Anim-Somuah (2011) - epidural increases length of 2nd stage, oxytocin augmentation and instrumental
  17. SPONTANEOUS PUSHING
    BETTANY-SALTIKOV (2006) - valsalva should be discontinued, negative effects on fetal heart and perineum. No benefit other than slightly shorter 2nd stage.
  18. THIRD STAGE
    Delayed Cord Clamping
    Physiological 3rd stage
    • McDONALD et al (2013) -¬†increases early haemoglobin concentrations and iron stores in infants. Increased risk of jaundice
    • BEGLEY et al (2011) - if low risk, no statistically significant difference in major pph.
  19. SKIN TO SKIN
    MOORE et al (2013) - improved breastfeeding outcomes, keeps baby warm, stimulates oxytocin, regulates heart, decrease infant crying, promote bonding and attachment.

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