Negligence in Midwifery

remissness in MidwiferyChristine BorgAfter a spontaneous vaginal delivery a woman suffered a severe haemorrhage leading to hypovolaeima and severe adult respiratory distress. She was admitted to an Intensive Care Unit but had continual bleeding, than collapsed. After resuscitation in theatre, a substantial piece of placental tissue was removed under general anaesthesia. Upon routine checking the staff accouche lend oneself was initially enigmatic about the placenta, but then she documented that the placenta was arrest. Discuss.IntroductionA practising registered accoucheuse is an accountable person who en accrediteds that wellness and safety laws are implemented in her reverence supportd (Dimond, 2002 pg.312). The registered accoucheuse puts into priority the safety of the nonplus and her baby. The competent midwife is knowledgeable, understanding, skilled, and accountable. Unfortunately any behaviour that the research based professional carries out or fails to prolong out , that result in harm to the mother or the child will have legal implications (Dimond, 2002).Postpartum haemorrhageUncontrolled bleeding of more than 500mls from the womens genital tract, at any time following delivery to 12 weeks postpartum is described as postpartum haemorrhage (Williams, 2011 pg.113). Blood lost goat be either evident or concealed, resulting in shock (Tiran, 2012). Postpartum haemorrhage is the most common cause of maternal death occurring worldwide (Fraser Cooper, 2009). optimum management of the third and fourth stage of project is a matter of great concern towards preserving maternal wellness. Postpartum haemorrhage is most often a case of inappropriate management of the third stage of labour, along with an unprofessional inspection of the placenta (Fraser Cooper, 2009).Examination of the placentaInspection of the placenta is a practical examination done in the labouring room by a fully qualified midwife. This exam includes the assessment of both the fetal and maternal membranes. Evaluation of the placenta is part of the work of business organization of the midwife in the first hour following birth. On the delivery of the placenta, either by expectant or active management of the third stage, the midwife holds up the placenta from the umbilical cord with the fetal surfaces being examined first. The membranes are examined for integrity, completeness and any present abnormalities. Membranes the amnion and the chorion should be made sure to be present and complete (De Kock, 2004).This assessment is usually done in the mien of the mother. The maternal surface is examined for completeness, so as to make sure that no cotyledons have been left indoors the uterus. If a cotyledon is found to be missing, or if the midwife is un current with regards to placental findings, help from other health professionals should be sought and the placenta kept for kick upstairs examination. Of utmost enormousness is to include the mother in the examinat ion, describing reasons for the examination procedure, slice explaining the possible risks of an incomplete placenta (De Kock, 2004).Womens right for informationThe mother has the right to be informed of both the normal and abnormal findings. Communication is a required instrument in midwifery. While being cultivation to the woman, the midwife should have explained the smirch and kept the mother calm, while talking her through the necessary procedures that were to civilise place (ICM, 2011)The midwifeThe title midwife can barely be use by the person who has successfully completed a midwifery educational programme, that is duly recognized in the country where it is located and that is based on the ICM native Competencies for Basic Midwifery Practice and the framework of ICM Global Standards for Midwifery Education who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title midwife and who demonstrates compete ncy in the practice of midwifery (Midwives code of practice, 2005).The core competencies of the midwifeThe midwife is fit to practise if she has the necessary knowledge and skills, has a good professional behaviour, character and a good health status, meeting the standards and competencies required (ICM, 2011). Competencies are set up as a guide for midwives to finish their profession. The guidelines provided by the code of practise in midwifery, aims to put in priority the safety of the mother and the child. The competencies of the expert of normality include her ability to work with the women and provide constant care and support.Being competent means, that a high quality care and a cultural sensitive assistance is given to the mother during birth. such(prenominal)(prenominal) event is the monitor of the fetal and maternal tumefybeing and providing the assistance towards actualizeing a safe birth. The midwife must be aware of the possible risks occurring during labour being ab le to observe, recognize and act when warning signs present (ICM, 2011).Being competent and accountable- the case scenarioThe skills and abilities allow the midwife to inspect the placenta for integrity and completeness, however, in such a case as described above, having a midwife not sure of herself, referral to other health care professionals should have been considered while assisting the latter if possible.Having the mother notified of the findings and given consent with relation to the procedures that needed to take place, appropriate analgesia should have been administered. Once the doctor confirms that a part of the placenta is missing, a vaginal exam followed by an examination of the uterus under sterile conditions is usually performed. Should the midwife acted as a liable professional, she must have been in control to take the necessary urgent measures if help from other health professionals was not accessible, keeping in mind the risk against the benefits.In such a case t he priority of the midwife should have been managing postpartum bleeding so as to avoid the incidence of haemorrhage (ICM, 2011). The skills and abilities of the midwife allow her to perform a fundal massage in install to stimulate a contraction and help any remaining clots left in the uterine or vaginal cavity to be delivered (De Kock, 2004). Of utmost importance in the delivering the appropriate care, was the monitoring and estimation of the maternal blood loss. Oxytocic drugs should have been administered while regularly assessing merry signs of the mother, in addition to the recording of laconic and accurate data of the events (ICM, 2011).In such a case were haemorrhage occurred, lifesaving drugs could have been administered to the woman in order for shock and respiratory distress to be avoided. The midwife shall have the skill to identify shock and be able to manage it. An intravenous line should have been inserted in such case and while administering the appropriate fluids and drugs, drawing of blood for laboratory testing could have been made possible. The woman with serious complication needed to be transferred to a higher level of care so as for emergency care to be given as required. In extreme cases the midwife must be able to perform cardio pulmonary resuscitation (De Kock, 2004). Furthermore, following such care, the midwife must have given great importance to the postnatal period of the woman. Observations of the womans progress and monitoring of the vital signs should have taken place (ICM, 2011).Record Keeping- A professional tool aroundAccurate financial support of the process of labour and birth is a responsible office staff of the midwife. Appropriate write information about the progress of labour and the on-going care provided during this experience, gives out relative information about the mother and the fetal offbeat during the birth events. The midwife must take in that all the records are filled appropriately before transferrin g the woman to the future health care professionals (De Kock, 2004). The purpose of documentation is to provide a written evidence of events as they take place (Dimond, 2002).Appropriate written communication in the event of labour shall be factual, well up dictated, concise, consistent, accurate, clean, legible, applicable and signed. Writing shall include detailed information of the care provided, the plan, actions, observations and the events occurring during labour (Dimond, 2002) All the information being documented is to be written as a contemporaneous manner of events. Documenting childbirth is a description of the birthing process. Relative information shall include data of the estimated blood loss during labour, the findings from the placenta examination as well as the results of the mothers vital signs, whenever taken during the mothers stay. Assessment of the perineum and vagina along with identification of necessary repairs, type and quantity of sutures required should alike be noted (Dimond, 2002). The midwife must preserve all information recorded. Keeping all the records provides guidance to the health professional (Dimond, 2002). Documentation is a tool in the experts practise and it shall be considered as an essential part of care and not as additional to the care offered (Dimond, 2002)When writing out records one is to fend off abbreviations and write in a manner that is easily understood by others. Records shall be clear so as to serve as a tool to facilitate an investigation. If any mistake is present in the recording of information, this should be corrected by cutting out neatly the mistake, while making sure that a signature and a date is presented. All information recorded by students is to be seen and signed by the midwife assigned. Information is to be written in a consecutive manner, having problems arising during the birth identified, and the actions and plans noted (Dimond, 2002). Regular training on documentation shall be propo sed specially in situations where pressure is present especially at the time of the delivery where time is limited and record keeping is given a low priority. Written information shall reflect a clear evidence of the care being constantly provided to the mother and the baby (Dimond, 2002)A record becomes a legal document whenever it is required as an evidence of events occurred and is relevant in a court of law (Dimond, 2002). Tools of documentation are necessary in the court of law, as although they are not always a consequence of truth records are an instrument of evidence and are tool for criticism by the judge. All written records are to be accurately dated timed, and signed.NegligenceNegligence may be best defined as actionable harm where a patient claims compensation caused by the carelessness of a midwife in breach of their duty of care (Griffith, 2008).Negligence is the failure to take care of someone or something. This is the most brought up action in health services for compensation (Dimond, 2002 pg.182). Compensation can only be given when the midwife infracted the law in her duty of care, when harm has been recognised, or in the presence of a negative result that had been led to by the disrupted duty of care.The midwife has the responsibility of the duty of care towards all her clients. The duty of care involves compassionate safely for the women and family, being able to communicate effectively, sharing evidence based information, giving advice, notifying the women of risks and acting in a way to promote health (Dimond, 2002 pg.184). The duty of care does not only relate to the care and treatment, but includes also the act of recording factual information and storing records. Duty of care involves all actions and activities that ensure safety. The midwife must aim to avoid acts that put the person at risk of harm. The person described is one who is directly affected by the midwife act. The aim is to have a positive effect on the mother, new-bor n, family and the overall experience (Dimond, 2002 pg.185). When a midwife is found guilty of putting the mother close to death a custodial sentence is most likely to be received by midwife (Griffith, 2010).Legislation of careThis case scenario is a representative example of a dispute in the legal duty of care. In this case the midwife must have first understood the present standards of care (Dimond, 2002). The midwife described here has failed to understand and follow the protocols, guidelines and procedures drawn up nationally and locally. The midwife has also failed to understand the importance of accurate record keeping. The midwife is challenged on her inappropriate actions. Her records, if written precisely can also aid in defending her actions (Griffith, 2010).As a general rule, midwives who are not certain about the changing and revised standards of care, being practised in the area, are to make sure that all necessary information is gathered, understood and followed, so as to enhance safety in the care given to the mother and the family (Griffith, 2008). All midwives are responsible to obey to all policies. Trained and competent midwives are indisputable and the element of trust in a qualified midwife reflects her level of competencies (Dimond, 2002).The government aims to increase the standard of the registered professionals and makes sure that all practioners totaled on the registration list are safe and protective towards the public.Legislation aims to protect the mothers from dangerous professional staff. When a professional staff identifies that she has made a mistake, she shall not be complacent. It is the role of the midwife to communicate effectively with the woman and give all the acknowledgment, explanations and apologies, so as to act in the best way to correct her behaviour towards safeguarding the women and her family (Dimond, 2002 pg. 220).Although health professionals are to be knowledgeable and assertive, being over confident with t heir behaviour might put the mother and child at risk. With regard to this case scenario, having the midwife not seeking help from other professionals signifies, that her over confidence has led her to reduce the quality of care provided. Furthermore, a competent midwife would not only make sure that the placenta is examined correctly, but would also ensure that the placenta is examined in the presence of the mother, having findings continuously being communicated and explained. Any competent assessment of the risk would have to take in account the post birth vital signs of the women.The midwifes failure to document correctly, take action and evaluate the mothers vital signs was a direct cause towards the deterioration of the mother (Dimond, 2002).ConclusionThe professional care provided by the midwife should be based on research and be within the law. As the claims for compensation continue to rise, the need for midwives to understand and reflect on the cases of scorn is important so as to minimize the risk of negligence and increase the levels of standards of care (Dimond, 2002 pg.226). It is the midwives duty to understand the elements of negligence and take care of their actions and behaviours. A holistic approach of care provided by the midwife includes leadership clinical knowledge and skills documentation guideline development risk management and debrief audit and education (De Kock, 2004).ReferencesThe core competencies for basic midwifery practice. 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