Sensitive Midwifery - Issue 44 - October 2019

Mom & Baby strain on nursing resources, while both could be prevented by performing more vaginal deliveries. If performed under safe circumstances, a vaginal delivery remains the delivery mode of choice: not only do complications necessitating admission of the newborn rarely occur, but caesarean delivery is associated with long-term adverse health e ff ects to both the mother and infant, notwithstanding a lack of evidence from randomised controlled trials – it would be unethical to assign low-risk healthy pregnant women to such trials! Mitigating vulnerability Midwives should be aware of the vulnerability of ‘healthy’ newborns born in the private sector as a result of caesarean section overuse, using it to strengthen their educational and advocacy roles. In addition, measures should be in place and routinely applied to help protect the mother-infant dyad from pregnancy to the postnatal phase, and infants through to childhood. 1. Pregnancy In the light of societal and service provider pressure to select C-section as a ‘safer option’, women, and primigravidas in particular, should be informed about the benefits of a vaginal delivery following spontaneous onset of labour. The reasons for choosing a C-section delivery (by women and service providers) should be investigated and addressed to facilitate an informed choice. Counselling should take place in non-threatening and calm circumstances. The undisputed complications to both the mother and her infant of a non-indicated caesarean delivery should be highlighted, as well as the long-term deleterious e ff ects. In general, the choice of service provider and place of delivery determine the mode of delivery; admission to a private hospital will most likely result in a C-section – either as a scheduled pre-labour procedure or after a failed induction of labour. Women with low-risk pregnancies who desire a vaginal delivery should be made aware that a medicalised environment increases the risk of a caesarean delivery. Admission to special care units to facilitate surveillance and manage complications of these infants is the norm, resulting in overcrowding of these units as well as intensive care units. While the expected date of delivery (EDD) can be estimated from the first day of the last menstrual period (LMP) it needs to be confirmed by an accurate early ultrasound examination. Thereafter, the adjustment of the expected date of delivery by any service provider is NOT evidence-based and should not be permissible . This practice increases the risk of an unfavourable outcome and death for the newborn infant due to iatrogenic prematurity. A scheduled delivery should not take place before a gestational age of 39 weeks. If an accurate gestational age is not available, a scheduled delivery is contraindicated. A suitable labour companion should be identified during pregnancy. 2. Delivery Active measures should be implemented to maintain maternal normothermia and decrease the risk of neonatal hypothermia. These include pre-operative and intra-operative active warming and the administration of warmed intravenous fluids. The ambient temperature of a theatre should be 23 ⁰ C and that of a delivery room 26 ⁰ C. Prophylactic antibiotic therapy should be administered intravenously within 60 minutes of the skin incision to e ff ect therapeutic blood levels at the time of surgery with the objective to prevent endometritis and wound sepsis. The drug of choice is cefazolin (2g), and this dose should be repeated three hours after surgery. Women who deliver by the vaginal route, do not need antibiotic prophylaxis. The pharynx and upper airway of an infant born through clear amniotic fluid should not be suctioned. Delay clamping of the cord for 30–60 seconds of delivering the infant. Refrain from the iatrogenic transfer of vaginal microbiota (‘vaginal seeding’) to the newborn Continued on page 48 47 eSensitive Midwifery Magazine Issue 44