Critical Incident Analysis Using Bortons Framework

Giving birth to a baby is the most amazing and miraculous experiences for parents and their loved ones. Every woman’s birth story is different and full of joy. Furthermore, the process from the moment a woman knows that she’s pregnant to being in the delivering room is very critical to both her and the newborn baby. Prenatal care is extremely important and it can impact greatly the quality of life of the baby. In this paper, the topic of giving birth will be discussed thoroughly by describing the stories of two mothers who gave birth in different decades and see how their prenatal cares are different from each other with correlation of the advancement of modern medicine between four decades.

For hundred of years, women have wrestled with their womanhood, bodies, and what it means to be a woman in our society. Being a woman comes with a wonderful and empowering responsibility--giving birth. What sets us aside from other countries is that the process and expectations of giving birth has changed in our society; coming from midwifery, as it has always been since the early times, to hospitals where it is now expected to give birth at. Midwifery was a common practice in delivering babies in

physics of birth; moving from sitting and squatting, which was used historically by midwives and

Nowadays the women have the possibility to choose the way in which their babies will be delivered.

I encountered an interesting incident this week. One of my patients was a 77-year-old patient male who was very confused and somewhat combative. His admitting diagnosis was UTI, but he was awaiting clearance so that he could be relocated to a nursing home. The issue arose when myself and my preceptor were notified that because he needed to be transferred to a nursing home, he was not allowed to be in restraints, have a sitter or be medicated within 24 hours of being discharged, otherwise the nursing home wouldn’t accept him. These stipulations were baffling to me because after laying eyes on the patient, I witnessed his instability and the potential for a fall if he were to be left unattended. The day nurse was very frustrated with the doctor’s lack of concern for the patient, as was myself.

The authors have done a thorough literature review and presented their findings by starting out with some important statistics about typical supportive care during the birth process, and elaborating on the last 50 years of research done on the types of pushing efforts and how they related to the outcomes of the births. It reflects on the role of midwives as being supportive of spontaneous pushing by the mother and the positive outcomes for those women and children. They did report on a recent meta-analysis which supported the use of spontaneous pushing and only recommended directed pushing in certain hazardous situations. The authors’ review of the current literature affirms their claim that there have been no studies done to analyze the role

The implementation of this routine tradition has been linked to a lack of education of the nurses of the various benefits of upright birthing positions and thus deficient knowledge of the mothers on their different options for positioning during delivery. Furthermore, research has determined that upright positions for delivery, such as squatting and sitting, yield more positive outcomes physically and psychologically for the mother and the baby than gravity-neutral supine positions. Nurses and other obstetric medical professionals are reluctant to “change their ways” of practice because of barriers to obtaining such knowledge related to their scope of practice. It is the job of the nursing managers on the unit to educate their floor nurses on the benefits of upright delivery positions and the more detrimental effects of supine delivery positions so their patients can have full knowledge and control of the birthing process when deciding on a birthing position as to achieve the most optimal delivery experience as possible.

A traditional vaginal labor video was shown to the class. The mother in the video was positioned in the supine position with her feet in stirrups. “The birthing book presented to the class offers several relaxing/pain management strategies: changing positions, warm water bath, touch massage, rhythmical breathing techniques, double hip squeeze, birthing ball, and aroma therapy” (Moran,

Providing continuous physical and emotional support during labour can reducing maternal fear, stress, and anxiety and protect physiological birth (Steen, 2012). Research shows that fear and anxiety during labour and birth can be detrimental to physiological birth. An environment that women feel unsafe in may stimulate a surge of neuro-hormones that can influence both fetal and maternal physiology, causing irregularity of contractions, fetal distress and subsequent medical inteverntions (Fahy & Parratt, 2006). Conversly, maintaining an environment where women feel safe, protected and supported can facilitate favourable physiological performance (Fahy & Parratt, 2006). Midwives can do this by giving women one-on-one continuous support and placing her at the centre of care throughout childbirth (Steen, 2012). As observed in practice, by constantly reassuring the woman about her progress, her baby’s health and addressing any of her concerns, the midwife can provide a calm and relaxing environment that is conducive to the labouring woman (Buckley, 2015; Steen, 2012). The midwife worked with the woman, encouraging her throughout labour and birth by telling her that she was doing extremely well. The midwife also breathed in-tune with the woman while giving her a back massage, inducing a sense of comfort. The atmosphere was calm and this contributed to the woman garnering confidence in her ability to avoid medical pain relief. Downe (2008) noted that the positive impact of

This paper will focus on the differences and conflicts between doctors and midwifes. Doctors have been been the lead care providers for women for hundreds of years. Just short of one-hundred years ago Mary Breckinridge became the first midwife in the united states. Today there doctors and midwives have an ongoing feud. Many doctors feel as if midwives are uneducated and are not trained enough to provide health care to women, and do not agree with their more natural approach to child birth. However there conflict is slowly but surly being resolved, as many health care facilities are allowing midwives to have more authority in the work place. Secondly, this paper will go over the differences between doctors and midwives, many people are uneducated

Per the article by Dekker, What is the Evidence for Pushing Position, “Most women in the U.S. give birth either lying on their backs (57%) or in the semi-sitting/ lying position with the head of the bed raised up (35%). A small minority of women give birth in alternative positions such as side lying (4%), squatting or sitting (3%), or hand-knees position (1%).” During the second stage of labor, the recumbent position, in which the patient is lying on their back with the hips and knees flexed, has been the ‘gold standard’ position used in the hospital setting. Is the recumbent position the most effective position for natural childbirth, or are alternative birthing positions being overlooked and something to be considered for better outcomes? Could an alternative position be a better method for natural childbirth and aid in the reduction of complications?

The research article that was chosen for critique was regarding the maternal repositioning during the labor process and does this impact the progression of the birthing process. Upon reviewing this article, it was obvious that the findings were in favor of maternal position changes during labor, and that it did indeed have a positive impact on the progression of the labor process. The findings of a positive impact on labor were indicated by maternal and fetal monitoring, maternal opinion of the labor process, and the length of stages of labor. Below is an analysis of the article that was chosen to critique.

Levels of oxytocin increases throughout the labor and it reaches its peak just before birth. Moving around during labor is one of the most important aspect to help the mother’s uterus to contract and in response to the contraction, the baby descend into the cervix. Induced labor usually requires an intravenous line and continuous electronic fetal monitoring, which makes it really difficult for the laboring mother to move around. Continuous emotional and physical support helps the expectant mothers to forge ahead. The instructor showed the participant’s different positions to assume once the intensity of the labor is high. She encouraged the partners to try the positions with their spouse. The instructor also emphasized that to relived back

Several studies have been piloted on various facets of Home Birth, centering on the levels of safety, benefits, risks and the impact of place in terms of all-inclusive postpartum care at home. Despite a wealth of evidence accompanying planned home birth as a safe option for women with low risk pregnancies, the setting remains provocative in most high resource countries. Birth is an event of great significance in family life; giving birth at home is a custom in many parts of the world because of inadequate access to health care facilities. Although, pregnancy and delivery are, under healthy conditions, normal social and physiological activities, childbirth has become hospital centered in most industrialized countries. Views are exceptionally polarized in the United States, with interventions and costs of hospital births escalating and midwives involved with home births being denied the ability to assist in mothers’ wishes of birthing at home. According to the Population Reference Bureau 's "2010 World Population Data Sheet" approximately 260 babies are born every minute. Approximately 500,000 pregnant women are laboring in the world on any given day (Population, n.d.). However, for being such a routine experience, as seen above, the event of childbirth holds an ‘anything but common place’ in the life experience of a woman.

For the presentation of this case study the client group that will be discussed by the author are physically disabled women. The author gained an interest in this client group after caring for a women in labour with a physical disability. What the author took from caring for this lady is that physically disabled women face a lot of challenges when it comes to embarking on parenthood. In addition to trying to deliver the best and most beneficial start to their babies throughout pregnancy, at birth and through parenthood, women in this group can face challenges in getting suitable support and information to allow them to get ready physiologically and plan for birth.