Tuesday, January 28, 2020

Role of the Midwife in Care Interventions

Role of the Midwife in Care Interventions Title: Discuss the following statement in relation to birth. Midwifery expertise is as much about knowing when not to interfere in the physiological process of pregnancy and birth as it is about recognising when and how to intervene in a way that will facilitate and enhance the womans ability to give birth. Essay Women have been giving birth throughout the ages. On the one hand this can be regarded as a normal physiological process which has evolved over the millennia to be a successful method of perpetuating the species and like most evolutionary honed processes, is likely to work well most of the time. On the other hand, as any experienced clinician knows well, any physiological process has the ability to malfunction. A large proportion of professional medical care in any field of medicine is to be able to recognise the normal variations and differentiate them from the abnormal. As a general rule it is only the abnormal that requires treatment or intervention. (Hunt T 1994) Hippocrates is reputed to have said that it is the first rule for a physician that â€Å"one should do no harm†. (Carrick P 2000). In a modern context, this often means â€Å"leave the normal alone† as the ability to produce iatrogenic complications is well known. (Halpern S D 2005) If we restrict ourselves to the consideration of the field of midwifery, the preceding statement can be well illustrated in the writings of Dr Ignaz Semmelweis who was horrified by the levels of puerperal fever that was killing nearly 40% of the pregnant women on his wards. (Semmelweis I P. 1861). Although he discovered the concept of asepsis from his observations, we note that on a simple level, the vast majority of the morbidity and mortality in this case was caused directly by the intervention of the healthcare professionals in what were otherwise normal pregnancies. On a matter of more immediate concern we can consider the issues relating to stress incontinence as being an excellent illustrative example of how midwives can elect to intervene during pregnancy and the birth process in order to facilitate not only the birth process but the whole area of potential morbidity surrounding maternity in general. Pregnancy itself is an independent variable risk factor for stress incontinence (Rortveit et al 2003). Although the midwife is not generally involved in the very early stages of pregnancy, there is good evidence that prenatal involvement in terms of preparation of the woman for the process of childbirth will reduce the incidence of stress incontinence post partum. (Reilly E T C et al. 2002). Instruction in the practice of antenatal pelvic floor exercises has been shown to reduce both the incidence and severity of pelvic floor damage during parturition (Salvesen et al. 2004) At the time of the delivery the midwife can make a number of interventions which will help to reduce the eventual morbidity including having the knowledge that a large birth weight baby is more likely to produce pelvic floor damage and will therefore be more likely to consider doing a prophylactic episiotomy to minimise the potential for pelvic floor damage. Equally, in the time prior to the actual delivery, her intervention to establish the lie and orientation of the baby will help to prevent malpresentations and the associated possibility of instrumentally assisted deliveries with the attendant possibility of resulting morbidity.(Norton C. 1996) Part of the acquisition of professional skill during training is to gain the knowledge which allows the ability not to intervene if the pregnancy and delivery are proceeding smoothly. Unnecessary intervention also has a more subtle downside in that it encourages dependence by the mother on the midwife. On an ethical dimension one can argue that this unnecessary dependence erodes the patient’s autonomy. (Coulter A. 2002). During pregnancy and birth, many women will find it all to easy to be subsumed by the medicalisation of the birth process. The professional midwife should be aware of this phenomenon and try to reduce its effect as far as possible. For many women, the midwife becomes the foremost trusted healthcare professional for the majority of her pregnancy and is the first point of contact with the medical establishment. The woman implicitly comes to trust the midwife’s professional status and believes that the midwife will do what is necessary but not what is unnecessary. The midwife’s professional status is therefore based ultimately on this premise, and a sound professional judgement based on a firm evidence base, is central to her abi lity to produce benefit when she decides that intervention is necessary. (Paine L L et al. 1999). An area where non-intervention is actively practiced is during the third stage of labour where the experienced midwife will observe and allow the fundus to contract rather than immediately intervene to deliver the placenta. There is a delicate line to be drawn between actively delivering the placenta too soon and thereby increasing the risk of uterine haemorrhage or uterine inversion, and not intervening at all and allowing the placenta to become entrapped in the contracting uterus with the implications of having to do a manual removal of the placenta possibly under a general anaesthetic. (Romero R et al. 1999). In conclusion we can consider that the role of the midwife is primarily to assist the pregnant woman through her pregnancy, her delivery and in the immediate post partum period. As we observed at the beginning of this essay, it is quite possible to intervene at virtually every stage of this process, but we would suggest that it is inherent within the role of the professional midwife that she should be able to draw a distinction between those occasions where intervention is mandatory, those when intervention is prudent and those occasions where it is perfectly appropriate to do nothing. References Carrick P (2000) Medical Ethics in the Ancient World. Georgetown University press 2000 ISBN: 0878408495 Coulter A. (2002) The autonomous patient. London : The Nuffield Trust, 2002. Halpern S D (2005) Towards evidence based bioethics. BMJ, Oct 2005 ; 331 : 901 903 Hunt T (1994) Ethical issues in Nursing. London : Routledge 1994 Norton C. (1996) Commissioning comprehensive continence services, Guidance for purchasers. London : Continence Foundation, 1996. Paine L L, J M Lang, D M Strobino, T R Johnson, J F DeJoseph, E R Declercq, D R Gagnon, A Scupholme and A Ross (1999) Characteristics of nurse-midwife patients and visits, American Journal of Public Health, Vol. 89, Issue 6 906 909, Reilly E T C, Freeman R M, Waterfield M R, Waterfield A E, Steggles P, Pedlar F. (2002) Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynaecol 2002 ;109 : 68 76. Romero R, Y C Hsu, A P Athanassiadis, Z Hagay, et al. (1999) Preterm delivery : a risk factor for retained placenta. Am J Obstet Gynecol, 1999 Rortveit G, Daltveit A K, Hannestad Y S, Hunskaar S. (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003 ; 348 : 900 – 907. Ryan G L , Quinn T J ,. Syrop C H , Hansen W F, (2002) Placenta Accreta Postpartum Obstetrics Gynecology 2002 ; 100 : 1069 1072 Salvesen, Kjell, Mà ¸rkved, Siv (2004) Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ Volume 329 (7462)14 August 2004pp 378 380 Semmelweis IP. (1861) Die aetiologie, der begriff und die prophylaxis des kindbettfiebers. Pest, Wien und Leipzig : CA Hartlebens Verlags-Expedition 1861.

Monday, January 20, 2020

Ancient Civilizations Essay example -- essays research papers

#1   Ã‚  Ã‚  Ã‚  Ã‚  A pattern that was common among the ancient civilizations of China, Rome, Greece, Mesopotamia, Egypt, and India was that most of them started as a dictatorship, a monarchy, or a dynasty. Eventually, most of them changed to a democracy, republic, or to class systems. Almost all of the civilizations had one or two great leaders. For example, Egypt had King Tut, Greece had Alexander the Great and Rome had Julius Caesar.   Ã‚  Ã‚  Ã‚  Ã‚  China has had many different leaders through the years. Dynasties, or a series of rulers from the same decent, ruled this government. Some of the most powerful dynasties were the Shang, Zhou, and Qin. These dynasties and many others ruled from the times of 1500 BC to 1900 AD. The dynasty that lasted the longest was the Zhou Dynasty. It lasted from 1122 BC through 256 BC. The Qin Dynasty had one of the strongest central governments, but only lasted fourteen years. The most peaceful time was when the Han Dynasty ruled.   Ã‚  Ã‚  Ã‚  Ã‚  Another ancient civilization was the Romans. They started out as a monarchy government by having one ruler. Eventually an idea of republicanism overthrew the monarchy. The Romans thought that this would keep any one person from gaining too much power. The most powerful governing body was the senate. The senators elected two consuls each year. The consul’s jobs were to supervise the business of government and command the armies. They could only se...

Sunday, January 12, 2020

In class essay about play Antigone Essay

Creon, the king of Thebes, is one of the major characters. The author utilized several characters/ foils in order to build up the king’s image, the pride, cruel, stubborn and superior ruler. Through those conflicts, arguments and persuations, the king’s figure was gradually set up and was foreshadowing the tragic ending of his own life. The conflict between Antigone and Creon in the play is very outstanding and intense. Creon commanded that Eteocles would be buried in formal way, meanwhile, Creon also made laws to prevent people from burying Polynices. Let his corpse rot and be eaten by animals. Antigone buried the body without any hesitation that she was violating the laws. Because Antigone believed there is nothing can be superior to the gods, the gods would agree with her action. She argued that Creon, a mere mortal, did not have the power to override the gods, which enraged Creon. The things Antigone believed utterly subverted Creon’s value. In contrast, Creon thought the king’s power overtopped any other thing, all the laws he made should be obeyed no matter they were right or wrong. He also believed once the king made the decision, there is no way that the king was about to make mistake. Nobody should doubt the power of the king. Compare to Antigone, Creon was too pride of being a king, he wallowed in dominant power, forgot and betrayed the traditions of gods. The closed bonding between Antigone and Polynices also urged Antigone to decide to bury his body. Antigone said, once father, mother and brothers passed away, there would never be another one. Antigone treated the dead fairly because she knew let the body of her family rot in the desolate place was cruel, just like killing the person twice. Creon never regard Polynices was his family but a bastard traitor. He did not want to forgive his sin even though he had already received deserved punishment. Creon ignored Antigone’s argument and sentenced her to death. Once again he thought he was doing the right thing, he did not consider about the impact that would fall on Antigone’s fiancà ©, his son Haemon. Creon was cold inside his stone-like heart, which is a great contrast to Antigone’s selfless and devoted characteristic. Heamon was judicious and sensibl, not like his father Creon. Knowing Antigone sentenced to death, Haemon tried to persuade his father in a rational and  peaceful way. He brought up the general opinion from the citizens that Antigone did not deserve death. He pointed out Creon’s mistake and he would admire his father more if he could fix the situation. But Creon did not take in Haemon’s advise. Creon analysed things with a fixed perpective that he was always right. He was pride and irrational. There is no need to consider advises from lower class people, in this case, his son and his citizens. It was conventional that father gave lessons to son. Though Haemon came to argue with a positive and irenic attitude, not to pick up a fight, Cremon distorted his meaning with the assumption he was on Antigone’s side and called his son the woman’s slave. Readers would conclude Cremon was bad at controling his sentiment and was very easy to get maddened. Tiresias, the prophet also came to persuaded Creon. Tiresias encountered strange phenomenon that indicated the gods was angry about the decision Creon had made. He told Creon to change his mind. Creon found his speech so harsh and dreadful. Once again he felt his power was being challenged by other ordinary people, he doubt Tiresias’s purpose and wondered if he came for his own profit. Creon showed no repects for the messenger of gods, Tiresias, same as the gods themselves. This instance lead to the climax of the play, the gods were enraged and Creon was punished for his mistakes. The above three charaters, as the major foils for Creon, their contrasting traits exposed Creon’s peremptory ruling and cruel father image. The intense conflicts also add more tension and help with the development of the plot.

Friday, January 3, 2020

Graduate Studies Challenges and Strategies for Success Essay

Graduate Study Challenges and Strategies for Success James HCS 504 August 2, 2010 Anne Graduate Study Challenges and Strategies for Success Making the decision to go back to school after many years within the workforce was a difficult decision. Before making that decision, I had to research the challenges that graduate students face during their studies. In my research, I have found that three of the most challenging obstacles that will affect my studies during my desire to achieve a higher education will be financial, effective time management, and stress. I will describe effective strategies for managing each of these challenges to achieve success, while pursuing my graduate degree in masters of health administration (MHA).†¦show more content†¦Also there are also merit-based programs such as LEAP and the Robert C. Byrd Honors Scholarship Grants. After the student has concluded that they cannot pay for his or her tuition with any of the last three methods the student can use the last method, which is loans. They could apply for either a subsidized or unsubsidized loan to meet their financial needs. The second challenge that one must overcome is time management. As an adult learner, I decided my best avenue of approach to attain my post graduate degree was to acquire it through an online source. Students must balance work, family, and school demands where feelings of being rushed and fatigued are common (Kramer, 2007, p. 158). The first strategy to overcome the challenge is to select the right school that will meet your needs. As I stated before, I selected an online source to attain my educational goals because it fit my complex work schedule. The second strategy to diminish the challenge of time management is to become organized. Start by becoming familiar with the course syllabus so you know what is expected of you. 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