Editing Midwifery (section)

==Main areas of midwifery==
=== Pregnancy ===
{{Main|Pregnancy|Prenatal care}}

==== First trimester ====
Trimester means "three months". A normal pregnancy lasts about nine months and has three trimesters.<ref name="MedlinePlus" />

First trimester screening varies by country. Women are typically offered [[urinalysis]] (UA) and blood tests including a [[complete blood count]] (CBC), [[blood group|blood typing]] (including Rh screen), [[syphilis]], [[hepatitis]], [[HIV]], and [[rubella]] testing.<ref name="MedlinePlus" /> Additionally, women may have [[Chlamydia infection|chlamydia]] testing via a urine sample, and women considered at high risk are screened for [[sickle cell disease]] and [[thalassemia]].<ref name="MedlinePlus" /> Women must consent to all tests before they are carried out. The woman's [[blood pressure]], height and weight are measured.  Her past pregnancies and family, social, and medical history are discussed.  Women may have an [[ultrasound]] scan during the first trimester which may be used to help find the [[Estimated date of confinement|estimated due date]].  Some women may have [[genetic testing]], such as screening for [[Down syndrome]].  Diet, exercise, and common disorders of pregnancy such as [[morning sickness]] are discussed.<ref name="MedlinePlus">{{cite web | url=https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000544.htm | title=Prenatal care in your first trimester | publisher=U.S. Department of Health & Human Services | date=1 July 1015 | access-date=8 August 2015 | archive-date=5 September 2015 | archive-url=https://web.archive.org/web/20150905070923/https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000544.htm | url-status=live }}</ref>
[[File:Pregnancy trimesters.jpg|thumb|This image shows the progression of pregnancy over the three trimesters.]]

====Second trimester====
The mother visits the [[midwife]] monthly or more often during the second trimester.  The mother's partner and/or the birth companion may accompany her.  The midwife will discuss pregnancy issues such as fatigue, heartburn, varicose veins, and other common problems such as back pain. Blood pressure and weight are monitored and the midwife measures the mother's abdomen to see if the baby is growing as expected.  Lab tests such as a UA, CBC, and [[glucose tolerance test]] are done if clinically indicated.<ref name="MedlinePlus2">{{cite web | url=https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000557.htm | title=Prenatal care in your second trimester | publisher=U.S. Department of Health & Human Services | date=1 July 2015 | access-date=8 August 2015 | archive-date=5 September 2015 | archive-url=https://web.archive.org/web/20150905064608/https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000557.htm | url-status=live }}</ref>

====Third trimester====
In the third trimester the midwife will see the mother every two weeks until week 36 and every week after that.  Weight, blood pressure, and abdominal measurements will continue to be done.  Lab tests such as a CBC and UA may be done with additional testing done for at-risk pregnancies.  The midwife palpates the woman's abdomen to establish the lie, presentation and position of the fetus and later, the engagement. A pelvic exam may be done to see if the mother's cervix is dilating.<ref name="MedlinePlus3">{{cite web | url=https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000558.htm | title=Prenatal care in your third trimester | publisher=U.S. Department of Health and Human Services | date=6 November 2014 | access-date=10 August 2015 | archive-date=5 September 2015 | archive-url=https://web.archive.org/web/20150905064930/https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000558.htm | url-status=live }}</ref>  The midwife and the mother discuss birthing options and write a birth care plan.<ref>{{cite web | url=https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/how-to-make-a-birth-plan/ | title=How to make a birth plan| publisher=National Health Service | date=24 June 2024 | access-date=7 March 2025}}</ref>

=== Childbirth ===
==== Labor and delivery ====
[[File:Cephalicpre.JPG|thumb|An illustration of normal head-first presentation.  The membranes have ruptured and the cervix is fully dilated.]]
[[File:Geburt 01.jpg|thumb|Newborn rests as caregiver checks breath sounds.]]
{{Main|Childbirth}}

Midwives are qualified to assist with a normal vaginal delivery while more complicated deliveries are handled by a health care provider who has had further training.  Childbirth is divided into four stages.

:'''First stage of labor''' The first stage of labour involves the opening of the cervix.<ref name=":0">{{Cite web|url=https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour/|title=Stages of Labour|website=The women's: The Royal Women's Hospital|access-date=17 May 2016|archive-date=3 June 2016|archive-url=https://web.archive.org/web/20160603220548/https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour/|url-status=live}}</ref> In the early parts of this stage the cervix will become soft and thin thus preparing for the delivery of the baby.<ref name=":0" /> The first stage of labour is complete when the cervix has dilated the full 10cm.<ref name=":0" /> During the first stage of labor the mother begins to feel strong and regular contractions that come every 5 to 20 minutes and last 30 to 60 seconds.  Contractions gradually become stronger, more frequent, and longer lasting.

:'''Second stage of labor''' During the second stage the baby begins to move down the birth canal.  As the baby moves to the opening of the vagina it "crowns", meaning the top of the head can be seen at the vaginal entrance. At one time an "episiotomy", (an incision in the tissue at the opening of the vagina) was done routinely because it was believed that it prevented excessive tearing and healed more readily than a natural tear.<ref name="Mayo Clinic" />  However, more recent research shows that a surgical incision may be more extensive than a natural tear, and is more likely to contribute to later incontinence and pain during sex than a natural tear would have.<ref name="Mayo Clinic">{{cite web | url=http://www.mayoclinic.org/episiotomy/ART-20047282?p=1 | title=Labor and delivery, postpartum care | publisher=Mayo Clinic | date=30 July 2015 | access-date=15 August 2015 | author=Mayo Clinic staff | archive-date=27 July 2015 | archive-url=https://web.archive.org/web/20150727152444/http://www.mayoclinic.org/episiotomy/ART-20047282?p=1 | url-status=live }}</ref>

:The midwife assists the baby as needed and when fully emerged, cuts the umbilical cord.  If desired, either of the baby's parents may cut the cord.  In the past the cord was cut shortly after birth, but there is growing evidence that delayed cord clamping may benefit the infant.<ref name="MedlinePlus4">{{cite web | url=http://consumer.healthday.com/women-s-health-information-34/birth-health-news-61/delaying-umbilical-cord-clamping-might-boost-child-development-699710.html | title=Delaying Umbilical Cord Clamping Might Boost Child Development | last=Mozes | first=Alan | date=26 May 2015 | access-date=18 October 2015 | archive-date=16 September 2015 | archive-url=https://web.archive.org/web/20150916002348/http://consumer.healthday.com/women-s-health-information-34/birth-health-news-61/delaying-umbilical-cord-clamping-might-boost-child-development-699710.html | url-status=dead }}</ref>

:'''Third stage of labor'''  The third stage of labour is where the mother must deliver the [[placenta]].<ref name=":0" /> In order for the mother to do this they may need to push. Just like the contractions in the first stage of labour they may experience one or two of these.<ref name=":0" /> The midwife may assist the mother in delivering the placenta by gently pulling on the umbilical cord.<ref name=":0" />

:'''Fourth stage of labor'''  The fourth stage of labor is the period beginning immediately after the birth and extending for about six weeks.  The [[World Health Organization]] describes this period as the most critical and yet the most neglected phase in the lives of mothers and babies.<ref name="World Health Organization">{{cite web | url=https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | archive-url=https://web.archive.org/web/20140307050915/http://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | url-status=dead | archive-date=March 7, 2014 | title=WHO recommendations on postnatal care of the mother and newborn | publisher=WHO | access-date=22 December 2014 | author=WHO}}</ref>  Until recently babies were routinely removed from their mothers following birth, however beginning around 2000, some authorities began to suggest that early skin-to-skin contact (placing the naked baby on the mother's chest) is of benefit to both mother and infant. As of 2014, early skin-to-skin contact is endorsed by all major organizations that are responsible for the well-being of infants.<ref name="Medscape">{{cite web | url=http://www.medscape.com/viewarticle/806325_9 | title=Uninterrupted Skin-to-Skin Contact Immediately After Birth | publisher=Medscape | access-date=21 December 2014 | author=Phillips, Raylene | archive-date=3 April 2015 | archive-url=https://web.archive.org/web/20150403065140/http://www.medscape.com/viewarticle/806325_9 | url-status=live }}</ref>  Thus, to help establish bonding and successful breastfeeding, the midwife carries out immediate mother and infant assessments as the infant lies on the mother's chest and removes the infant for further observations only after they have had their first breastfeed.

Following the birth, if the mother had an [[episiotomy]] or a tearing of the [[perineum]], it is sutured. The midwife does regular assessments for uterine contraction, [[fundal height]],<ref name="Maternal-Newborn Care">{{cite web | url=http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | title=Postpartum Assessment | publisher=ATI Nursing Education | access-date=24 December 2014 | archive-url=https://web.archive.org/web/20141224072821/http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | archive-date=2014-12-24 | url-status=dead }}</ref> and vaginal bleeding.<ref name="Labor and Delivery:  Postpartum Care">{{cite web | url=http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | title=Postpartum care: What to expect after a vaginal delivery | publisher=Mayo Clinic | access-date=23 December 2014 | author=Mayo clinic staff | archive-date=21 December 2014 | archive-url=https://web.archive.org/web/20141221202550/http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | url-status=live }}</ref>  Throughout labor and delivery the mother's [[vital signs]] (temperature, blood pressure, and pulse) are closely monitored and her fluid intake and output are measured. The midwife also monitors the baby's pulse rate, palpates the mother's abdomen to monitor the baby's position, and does vaginal examinations as indicated.  If the birth deviates from the norm at any stage, the midwife requests assistance from the multi-disciplinary team.

==== Birthing positions ====
{{Main|Childbirth positions}}

Until the last century most women have used both the upright position and alternative positions to give birth.  The [[lithotomy position]] was not used until the advent of forceps in the seventeenth century and since then childbirth has progressively moved from a woman supported experience in the home to a medical intervention within the hospital.
There are significant advantages to assuming an upright position in labor and birth, such as stronger and more efficient uterine contractions aiding cervical dilatation, increased pelvic inlet and outlet diameters and improved uterine contractility.<ref name="Factors influencing maternal positions during labor">{{cite web | url=http://www.instituteofmidwifery.org/MSFinalProj.nsf/a9ee58d7a82396768525684f0056be8d/45f9de25c6ca395e85257715003dad3f?OpenDocument | title=Factors influencing maternal positions during labor | date=April 2010 | access-date=10 August 2015 | author=Searle, Lorraine | archive-url=https://web.archive.org/web/20160222212343/http://www.instituteofmidwifery.org/MSFinalProj.nsf/a9ee58d7a82396768525684f0056be8d/45f9de25c6ca395e85257715003dad3f?OpenDocument | archive-date=22 February 2016 | url-status=dead }}</ref>  Upright positions in the second stage include sitting, squatting, kneeling, and being on hands and knees.<ref name="Gelis122-134">Gelis, Jacues. History of Childbirth. Boston: Northern University Press, 1991: 122-134</ref>

===Postpartum period===
{{Main|Postpartum period}}

For women who have a hospital birth, the minimum hospital stay is six hours. Women who leave before this do so against medical advice. Women may choose when to leave the hospital. Full postnatal assessments are conducted daily whilst inpatient, or more frequently if needed. A postnatal assessment includes the woman's observations, general well-being, breasts (either a discussion and assistance with breastfeeding or a discussion about lactation suppression), abdominal palpation (if she has not had a caesarean section) to check for involution of the uterus, or a check of her caesarean wound (the dressing does not need to be removed for this), a check of her perineum, particularly if she tore or had stitches, reviewing her lochia, ensuring she has passed urine and had her bowels open and checking for signs and symptoms of a DVT. The baby is also checked for jaundice, signs of adequate feeding, or other concerns. The baby has a nursery exam between six and seventy two hours of birth to check for conditions such as heart defects, hip problems, or eye problems.<ref>{{Cite journal |date=2022-01-18 |title=Normal and Abnormal Puerperium: Overview, Routine Postpartum Care, Hemorrhage |url=https://emedicine.medscape.com/article/260187-overview |access-date=2022-10-05 |archive-date=2017-11-09 |archive-url=https://web.archive.org/web/20171109022920/https://emedicine.medscape.com/article/260187-overview |url-status=live }}</ref>

In the community, the community midwife sees the woman at least until day ten. This does not mean she sees the woman and baby daily, but she cannot discharge them from her care until day ten at the earliest. Postnatal checks include neonatal screening test (NST, or heel prick test) around day five. The baby is weighed and the midwife plans visits according to the health and needs of mother and baby. They are discharged to the care of the health visitor.<ref>{{Cite web |title=Episiotomy: When it's needed, when it's not - Mayo Clinic |url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282?p=1 |access-date=2022-10-05 |website=www.mayoclinic.org |archive-date=2022-10-05 |archive-url=https://web.archive.org/web/20221005171440/https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282?p=1 |url-status=live }}</ref>

===Care of the newborn===
{{Further|Newborn}}

At birth, the baby receives an [[Apgar score]] at, at the least, one minute and five minutes of age.<ref>{{Cite web |title=The Apgar Score |url=https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score |access-date=2022-10-05 |website=www.acog.org |language=en |archive-date=2022-10-05 |archive-url=https://web.archive.org/web/20221005171736/https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score |url-status=live }}</ref> This is a score out of 10 that assesses the baby on five different areas—each worth between 0 and 2 points. These areas are: colour, respiratory effort, tone, heart rate, and response to stimuli.<ref>{{Citation |last1=Simon |first1=Leslie V. |title=APGAR Score |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK470569/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262097 |access-date=2022-10-05 |last2=Hashmi |first2=Muhammad F. |last3=Bragg |first3=Bradley N. |archive-date=2022-07-26 |archive-url=https://web.archive.org/web/20220726062107/https://www.ncbi.nlm.nih.gov/books/NBK470569/ |url-status=live }}</ref> The [[midwife]] checks the baby for any obvious problems, weighs the baby, and measure head circumference. The midwife ensures the cord has been clamped securely and the baby has the appropriate name tags on (if in hospital). Babies lengths are not routinely measured. The midwife performs these checks as close to the mother as possible and returns the baby to the mother quickly. Skin-to-skin is encouraged, as this regulates the baby's heart rate, breathing, oxygen saturation, and temperature—and promotes bonding and breastfeeding.{{citation needed|date=June 2024}}

In some countries, such as [[Chile]], the midwife is the professional who can direct neonatal intensive care units. This is an advantage for these professionals, who can use the knowledge of [[perinatology]] to bring a high quality care of the newborn, with medical or surgical conditions.<ref>{{Cite journal |date=June 2016 |title=Midwifery in Chile - A Successful Experience to Improve Women ́s Sexual and Reproductive Health: Facilitators & Challenges |url=https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1036&context=jam |journal=Journal of Asian Midwives  |volume=3 |issue=1 |pages=63–69 |access-date=2022-10-05 |archive-date=2023-10-29 |archive-url=https://web.archive.org/web/20231029185626/https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1036&context=jam |url-status=live }}</ref>