Management of retained placenta using intraumbilical oxytocin injection.

Manual removal of the placenta carries significant risk of hemorrhage and infection plus the risks associated with general anesthesia, if used. Transporting the patient from home or birthing center to hospital or from birthing room to delivery room or operating room is also disruptive to the patient and the initial parent-infant attachment process. The injection of oxytocin into the umbilical vein is a safe procedure that can cause placental separation and delivery, thus preventing the need for manual removal for some women. This technique can be useful in a nurse-midwifery practice in the management of a retained placenta or prolonged third stage of labor. The following review of current research and example of a protocol used in a nurse-midwifery service will provide guidance for incorporating this procedure into practice. As with any new technique, the need to continue to collect and publish outcome data is important.

Nurse-midwifery in rural Pakistan.

Pakistan is a relatively new nation of predominantly Islamic influence. Like many developing countries, it is plagued by extensive communicable diseases, malnutrition, inadequate sewage systems, and illiteracy. Religious beliefs and cultural influences impact heavily on access to health care and on maternal-child health outcomes. This paper examines the major maternal-child health problems encountered, as well as implications for midwifery practice in an Islamic country.

PIP: Efforts to improve health status in Pakistan are hindered by rampant communicable diseases, malnutrition, inadequate sewage systems, and a scarcity of safe drinking water. The infant mortality rate is 90/1000, while the maternal mortality rate is 4-6/1000. Further impediments to change are an 867% illiteracy rate (95% among women), the subordinate status of women, and absolute submission to the will of Allah. Access to prenatal care is severely limited, and the majority of rural births are attended by local dai. Premature labor, premature rupture of membranes, placenta previa, malpresentation, intrauterine fetal death, chorioamnionitis, uterine rupture, and eclampsia are frequent complications of childbirth. The fetal loss rate is 18% in women of parity 5 and over and 12% in women of parities 1-4. To improve infant and maternal survival, the Government of Pakistan has established a national midwifery training program and seeks to encourage contraceptive use. Many of these programs have encountered resistance from Muslims, and cultural practices such as arranged child marriages, consanguinity, purdah, and mandatory fasting continue to endanger the health of mothers and infants. Improved access to education for women, another government goal, may be the key to increasing access to health care within the context of a Muslim culture.

Prenatal screening for illegal drugs. Dilemma for the nurse-midwife.

Prenatal screening for illegal drugs poses very complex ethical problems for the nurse-midwife who must make the decision whether to screen for illegal drugs and whether to report positive results to state child abuse investigators. We argue that the results of prenatal screening for illegal drug use should not be used for determination of child abuse and that the nurse-midwife should not be required to report the results of these screens for illegal drugs to state child protection agencies. It is far from clear that required reporting offers any benefit to the fetus or future child, and there are serious ramifications of reporting for the fetus, the pregnant woman, and the nurse-midwifery profession. However, we do argue that prenatal screening for both illegal and legal drug use should be encouraged and should be done as early as possible in the pregnancy. Prenatal screening for drugs should only be used by the nurse-midwife as a diagnostic procedure wherein standard informed consent and confidentiality restraints are maintained.

[Women's experience during infertility treatment]. / Die belewenis van vroue tydens infertiliteitsbehandeling.

With this research it was endeavoured to gain more knowledge about the experiences of women during the treatment of infertility. The midwife and other medical staff involved with the treatment of infertility can use this knowledge to have better insight into the total problem of these women and also care for and support them better. A study of the literature was done to determine what the experts have already ascertained of this phenomenon. An in-depth study of the phenomenon was undertaken in which the autobiographical method was used. During April 1989 unstructured interviews were conducted with six selected infertile women living in the Witwaterand area. From the findings of this research it appears that infertile women have unique experiences of their infertility and the treatment of it. Universal experiences, e.g. pain and disappointment were identified, although the causes of these experiences sometimes differed. Recommendations were made on how the midwife can contribute by filling the gap (established during the research) in the care in this field. Suggestions were also made with regard to further research on this phenomenon.

[Maintaining epidural anesthesia by the midwife]. / Die instandhouding van epidurale narkose deur die vroedvrou.

Epidural anaesthesia as a method of pain relief during labour has lately become very popular. Statistics show that in some labour units up to 70 per cent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic. This anaesthetic loses its numbing effect within two to three hours and effective pain relief can only be achieved by administering a further dose of local anaesthetic via the epidural catheter. This procedure can be repeated between three to six times during the average duration of labour. Alternatively, a continuous epidural infusion procedure can be used. The last method, however, sometimes requires the administration of additional epidural "top-ups". There are some risks in administering additional "top-up" dosages. The possibility exists of the anaesthetic causing a spinal block as a result of being administered into the spinal fluid. The "top-up" can also cause convulsions if administered intravenously. In some units it is expected of the midwife to maintain epidural anaesthesia on prescription by the doctor. These side-effects can, however, also occur when the patient is being treated by medical personnel with ample experience and knowledge. It is expected of some midwives to maintain an epidural block on prescription by the anaesthetist. If the midwife lacks the necessary knowledge of epidural anaesthetic and its maintenance, she might unintentionally administer the local anaesthetic into the spinal fluid or intravascularly. This might cause a threat to the mother's and baby's lives. This research covers the maintenance of epidural anaesthesia as carried out by the midwife. The level of involvement of the midwife in the maintenance of epidural anaesthesia has been investigated. The midwife's knowledge about the maintenance of epidural anaesthesia, her legal rights, obligations and emergency treatment of patients have been investigated. It has also been considered whether protocols in the maintenance of epidural anaesthesia exist. All the abovementioned information was acquired by submitting a questionnaire for completion by midwives practising in labour wards in the Johannesburg area. The results of this research show that the midwife's knowledge as regards to epidural anaesthesia and its maintenance is inadequate.(ABSTRACT TRUNCATED AT 400 WORDS)