Duties and Responsibilities of Nurse-Midwife During Intranatal Period
Definition of Intranatal Care:
Intranatal care refers to care for a pregnant woman throughout labour to ensure safe delivery that is crucial to the women. It is the type of care which is given to the mother and baby at the time of delivery.
Roles and Responsibilities of Midwife-Nurse During Intranatal Period:
1. Advice: nutrition
Pregnant women should be encouraged to have a normal, healthy, balanced diet. Because of the dangers of toxoplasmosis and listeriosis, women should avoid:
- Uncooked meat or fish,
- Raw or partially cooked eggs and products such as fresh mayonnaise which may contain raw eggs,
- Milk that has not been pasteurized,
- Raw shellfish,
- Shark, swordfish and marlin (due to high mercury levels),
- More than two portions per week of oily fish,
- Unwashed fruit or vegetables.
Vegetarians, and especially vegans, may be at risk of nutritional deficiencies and may need to be referred to a dietician for advice about obtaining all nutrients through diet.
2. Advice: supplements
Folic acid:
All women intending to become pregnant, and those who are, should be advised to take 400 micrograms of folic acid up to 12 weeks of gestation to reduce incidence of fetal neural tube defects (NTDS). Supplementation with folic acid is one of the most significant interventions available. 400 micrograms/day for all women have been shown consistently to reduce the incidence of NTDs, such as spina bifida, significantly.
Vitamin D:
Adequate vitamin D stores during pregnancy and breastfeeding are important for the health of both mother and baby. All women should be advised to take vitamin D supplements (10 micrograms = 400 units per day). Caution with vitamin D supplementation is needed in women with sarcoidosis or renal disease.
Iron:
Iron should not be offered routinely as it has no benefit to either mother or baby and may cause constipation and other side-effects. Women should be given dietary advice, encouraging dietary intake of iron. Where supplementation is required, this will be picked up on routine blood tests at booking and 28 wecks. If established, it should be treated with 100-200 mg of oral elemental iron per day for three months and for at least six weeks postpartum.
Other vitamins:
Women should be warned that high levels of vitamin A may be teratogenic and therefore that they should avoid extra supplementation. Liver and liver products may contain high levels of vitamin A and should be avoided. Where using multivitamin preparations, women should use those which are specifically designed for pregnancy.
3. Advice: medication
Advise women to use as few medicines as possible during pregnancy and only when benefit outweighs risk. This includes OTC medication and complementary therapies, as few products have been shown to be definitely safe during pregnancy. Ideally review any regular medication pre-conception but, if this has not been done, as soon as possible in pregnancy.
4. Advice: lifestyle
Exercise:
Women who exercise regularly should be advised to continue to do so.
Sexual intercourse:
This has not been shown to cause any harm during pregnancy. It may be advisable to avoid it if there is risk of preterm rupture of membranes or if there is placenta praevia, although evidence is limited.
Alcohol:
High levels of alcohol consumption during pregnancy may result in the fetal alcohol syndrome (FAS). There are various components including growth restriction, general learning disability, facial anomalies and behavioral problems.
Smoking:
Smoking in pregnancy is associated with a large number of adverse effects in pregnancy including:
- Intrauterine growth restriction and low birth weight,
- Miscarriage and stillbirth,
- Premature delivery,
- Placental problems.
5. Treating symptoms of early pregnancy:
Nausea and vomiting of pregnancy generally resolve by 12-20 weeks of gestation. Heartburn may be alleviated by taking small meals and raising the head of the bed. It may need antacids. Constipation is another common symptom in early pregnancy. Women should be advised on diet to combat this (fluids and increasing dietary fibre) or may use bran or wheat fibre supplementation.
6. Recreational drug use should be avoided.
Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “[email protected]”
