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Interventions in Labor Analysis

Naturally, it is expected that a pregnant woman will give birth through the natural method which is giving birth vaginally. However and unfortunately this is not always the case and as a matter of fact, natural births are decreasing by the day. Natural births occur when there are no drugs and or interventions employed while a woman is giving birth. Giving birth is a sophisticated natural process and when this process is needlessly interfered with, it upsets the balance and sequence of events and as a result one set of interventions leads to another. It is important to note here that though intervention should be avoided at all costs, medical practitioners including obstetricians, midwives, general practitioners should not hesitate to use whatever method of intervention is available and required to save both or either the life of the mother and the child.

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Interventions in labor can be done in various ways depending on the risk involved. Some interventions methods include Electronic Fetal Monitoring which is basically the use of electronic fetal heart monitoring for the evaluation of fetal wellbeing in labor. This method was introduced with an aim of reducing perinatal mortality and cerebral palsy. However, it is not an automatic method and so both the midwife and the parent need to not only act on the knowledge but must also consider the clinical situation and decide what to do during labor. Other common modes of interventions include cesarean birth, induction, rupturing the membranes, etc.

Introduction

As days go by cases of intervention especially in Australia are increasing, Australia has a higher rate of interventions than those recommended by the World Health Organization (WHO). National Perinatal Statistics Unit Sydney shows that though the intervention rate is increasing, it is doing so in the private sector more than it is in the public sector. 40.3 percent cesarean births occur within the private sector compared to 27.1

percent in public hospitals. Also, there is a great difference in rate of spontaneous vaginal births with public hospitals having a rate of 56.7 percent to 66.9 percent as compared to rate of 39.2 percent to 60.8 percent in private sector. Currently Australia’s rate of intervention is 22.2% which is double the WHO goal of 10% since almost 90% of Australia births include some form of intervention. This is higher than in other countries with the same economies such as Canada, New Zealand, UK, and the Netherlands. Worse still is that Australian women and children do not experience better results despite the costly maternity bill they have to pay. Private hospitals have been found to have high rates of interventions mainly because of defensive medical practice and social choice practiced by both the mother and the obstetrician.

Discussion

Due to economic pressure and competition, private hospitals are more concerned with the outcome than the process or even the future of both the mother and the child after birth. Private hospitals will thus advice for interventions sooner than expected to avoid litigation for prenatal accidents and incident both for economic and competition reasons. As the private hospitals seek to keep economic and competition pressures under control, the parent to be on the other side is looking for convenience and so the two meet at the middle. Many working mothers are not able to give birth naturally not because of choice but due to work commitments.

As a result of both pressures at the private hospitals and the parents-to-be contribute the increasing high rate of interventions. At the same time, obstetrician convenience is also a contributing factor. Obstetrician working mainly for the private sector can induce labor instead of waiting for due time simply because they don’t want to be called to review the pregnant woman at an inconvenient time. Though this is selfish on the side of medical practitioner it happens contributing to the increased rate of interventions. (Henderson McCandlish and Petrou 2001)

The increased rate of intervention does not have to increase. There are policies that can be put in place to ensure that interventions are only done rightly. The World Health Organizations recommends midwifery care as the most efficient way of looking and caring for women. Unfortunately in Australia midwifery is not given the position it deserves though midwife appears to be the most efficient type of health care for parent to be mothers.

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It has been proved that though obstetricians are more qualified than midwives they cannot provide the care and attention needed all through the pregnancy since pregnancy s a long nine months process midwives should let deal with it so long as they are no complications that need advanced help. Again it is important to note that pregnancy is not a sickness and midwifes are well trained to assess and recognize any abnormality. However this is not the case in Australia, pregnancy is treated as normal sickness other than a gestation period and as a result the pregnant women do not get the much needed care from the busy obstetrician and midwifes end up being under utilized. (Kenny, King, Cameron and Shiell 1993).

Since as said earlier in this paper pregnancy is not diseases, by enabling midwives to provide all the care needed since conception up to birth, expectant women will have the opportunity to access the care and attention they need. It is important to note here that for effective and successful birth to take place, care does not begin in the labor ward but during antenatal care and this is where the midwife comes in handy. However, since not all pregnancies are normal it is important to note that midwifery is not the final stage of care and attention.

There are general practitioners who provide normal or basic care from birthing till after bath, there is then secondary maternity services who will attend to women who have higher risk pregnancy; those who have complications that require advanced medical care, then there is finally tertiary maternity services provided to those women and babies who need multidisciplinary specialist care. However, besides there being many medical practitioners involved in this, midwives will still be required to provide support and clinical care during antenatal, labor, birth, and even few weeks after the child has been born. There is therefore need for collaboration between all maternity care providers so as to ensure safety and effectiveness of both mothers and children. (Fraser Turcot and krauss 2004)

Solutions

Midwife Interventions

In Australia, midwives are well trained and educated to provide all the care needed since conception till when the child is born. The government will therefore not be required to use a lot of money to change the current medically based system to a midwife system where basic maternity care is provided by midwives who manage their own caseloads. Since pregnancy is expected to be a normal gestation period, midwifery becomes an integral support to both the child and the mother to be despite there being more other doctors. Midwifery is aimed at enhancing the physiological process taking place during labor.

They are aware that any intervention will interfere the normal process of giving birth and therefore there steps should be wisely calculated. They need to be timely and accurate in their judgment to avoid any accidents and or incidents since this could cause unrecoverable losses.

During the child bearing process, there are different stages that a woman goes through and it during this time that the midwives apply knowledge combining it with assessments done prior to the day of giving birth together with the present situation and are able to help efficiently help the woman. Since the process of giving birth could be long, midwives are the most suitable people to handle since they have all the time as opposed to other practitioners who are always on call.

Midwife assessments focus more on well being of the mother and do not necessarily consider the length of labor. This is different from other services offered by general practitioners. As this paper clearly identified earlier, obstetricians especially in private hospitals have no time for the birth to take place and are thus hasty in introducing interventions. However as mentioned before midwifery is not a stand alone event but rather a collaboration of all necessary medical practitioners. (Walsh D, 2000)

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Some of the interventions that are included in the midwifery toolkit include, maximizing the environment where the woman should feel that she is in the right place for her to give birth this would include issues of her privacy, culture and standards. There are women who would feel safe in the hands of midwives alone but there are others who need to feel they are in a place where advanced medical care is easily available. The woman should also feel free to move around as much as she wants. Another aspect that should be considered is position. Midwives make sure that the woman are giving birth in the right position which is mainly an upright position.

As discussed earlier, the process of giving birth does not begin at the labor. Midwives ensure that women adopt good eating and drinking habits which reduce chances of interventions as a result of dehydration and ketosis. Midwives also take time to visit the pregnant women at home and this reduces chances of interventions through early monitoring. (Micklewright Champion and Labouring 2002)

Policy framework

Ministries within a government need a policy framework in order for them to provide the required services to the community. First and foremost affordability of the services must be ensured for all expecting mothers. Currently in Australia, public funding for maternity care is only provided for and maternity providers based in a hospital. This excludes midwives from providing their services during pregnancy since it becomes expensive for women to source for the much required services regularly. There should therefore be a review of the existing policy that allows only for doctors to access the fund, so that even the midwives enjoy an equal pay for their work just as the doctors do.

The economic benefits of reviewing the policies will go a long way in ensuring that there is better utilization of maternity care funding, there is access to various maternity services not only in the city but in rural and remote areas since cultural considerations will be looked into, and finally there will be noticeable improvements in services provided by the maternity care service providers. There will also be a need to ensure that expectant mothers make well informed decisions.

There should therefore be forums through which mothers are taught about birth centers, know your midwife programs and also homebirth programs. This will increase the choice of Australian women who currently have little or no choice of their maternity providers at all. Once this has been done, it is expected that the number of women who prefer midwives to general practitioners will increase just as witnessed in New Zealand where 75% of women opt for midwife as compared to 1% in Australia.

These reforms were also reported to contribute to reduced health expenditure in New Zealand and the same should be expected in Australia. Moreover, there is a shortage of medical workforce in Australia and this is contributed unfavorable reforms which seek to exclude midwives from a role that they can perform so well, while at the same time overburdening other general practitioners. (Henderson, McCandlish, Kumiega and Petrou 2001)

Conclusion

Naturally, births are expected to take place naturally without any interventions, unfortunately this is not always the case and interventions are necessary in order to ensure not only the efficient maternity services but safety of both the child and the mother. However as seen in this paper interventions are employed unnecessarily especially in private practice where there is economic, time and convenience pressure. Provision of large subsidies through health insurance to private sector which is not even accountable to their outcome has been another cause of high rate of intervention in Australia and this needs to be considered so that also the midwives can get access to the funding and once they do access better services will be provided to parents-to-be.

Since midwives are well trained for their work, they should also be given the honor they deserve and be allowed to deal with normal pregnancy as opposed to under utilizing them by allowing them to serve just as support staff. By so doing, there will be better utilization of the already decreasing medical care practitioners and enhanced services for the parents-to-be. Again by allowing midwives to work as they should, all women regardless of their cultural background will be served efficiently.

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We have also established that there is need for maternity provider who will provide continuity of these services all through even after birth, this can mainly be possible if women use midwives as their health care providers since they the midwives have been involved since early stages of pregnancy and are thus familiar with all the changes during the pregnancy. However, in this paper it has also been made clear that midwifery is not a substitute to other necessary medical practitioners and collaboration of all practitioners has been encouraged but only if need.

References

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