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Library of Congress Cataloging-in-Publication Data
Names: Lindsay, Patricia, 1951- editor. | Bagness, Carmel, editor. |
Peate, Ian, editor.
Title: Midwifery skills at a glance / edited by Patricia Lindsay, Carmel Bagness,
Ian Peate.
Description: Hoboken, NJ : Wiley, 2018. | Series: At a glance series |
Includes bibliographical references and index. |
Identifiers: LCCN 2017025965 (print) | LCCN 2017026824 (ebook) | ISBN
9781119233985 (pdf) | ISBN 9781119235125 (epub) | ISBN 9781119233916 (pbk.)
Subjects: | MESH: Midwifery | Handbooks
Classification: LCC RG950 (ebook) | LCC RG950 (print) | NLM WQ 165 | DDC
618.2–dc23
LC record available at https://lccn.loc.gov/2017025965
Cover design: Wiley
Cover image: © Monkey Business Images/Shutterstock
Adelaide Aduboffour RN, RM, MSc, Fellow HEA, ITEC
Chapters 30, 67
Midwifery Lecturer
University of West London;
Perineal Specialist Midwife
Chelsea and Westminster and West Middlesex University Hospital;
Director
Peri Health Limited, London, UK
Andrea Aras-Payne MA, PGDip, BSc (Hons), RM, RGN, FHEA fe
Chapter 27
Senior Lecturer
University of West London
London, UK
Carmel Bagness MA RN RM ADM PGCEA
Chapters 10, 17, 20, 21
Professional Lead for Midwifery and Women’s Health
Royal College of Nursing
London, UK
Karen Bartholomew RN, RM, BA (Hons) MSc, PGCEA
Chapter 33
Senior Lecturer/Course Leader
Anglia Ruskin University
Chelmsford, Essex, UK
Marcia Bartholomew RN, RM, MSc Health Promotion, PgDip Teaching and Learning in Health Care
Chapters 28, 78, 79
Senior Lecturer
University of West London
London, UK
Judy Bothamley RN, RM, ADM PGCEA, MA
Chapter 81
Senior Lecturer (Midwifery)
University of West London
London, UK
Maureen Boyle RN, RM, MSc, PGCEA
Chapter 50
Senior Lecturer (Midwifery)
University of West London
London, UK
Jenny Brewster RN, RM, BSc (Hons), MEd, PGCEA
Chapter 26
Senior Lecturer in Midwifery
University of West London
London, UK
Alison Busby BNurs, RN, RM, ADM, MSc, PGDE
Chapter 43
Senior Lecturer Midwifery
School of Health Sciences
University of Manchester
Manchester, UK
Helen Crafter RN, RM, FP Cert, PGCEA, MSc
Chapter 18
Senior Lecturer in Midwifery
University of West London
London, UK
Doreen Crawford MA, PGCE, BSc (Hons) SRN, RSCN
Chapter 1
Consultant Nurse Editor Nursing Children and Young People
Crawford-McKenzie Healthcare Consultancy
Nurse Advisor, Independent Healthcare Consultancy
Helen Donovan BSc (Hons) Med, RGN, RHV, RM
Chapter 77
Professional Lead for Public Health Nursing
Royal College of Nursing;
Visiting Senior Lecturer
University of Hertfordshire;
Independent Nurse Lead
NHS Barnet CCG Governing Body
London, UK
Sarah Emberley RM, BSc, MSc, PGDPE
Chapters 6, 22, 47
Midwifery Lecturer/Clinical Skills
Bournemouth University
Bournemouth
Dorset, UK
David Foster PhD, MSc, RN, RM, FCIPD
Chapters 14, 15, 16
Registered Midwife, formerly Head of the Nursing, Midwifery and Allied Health Professions Policy Unit and Midwifery Advisor at the Department of Health
London, UK
Sophie French RN, RM, MSc, PGCEA, Senior Fellow HEA
Chapters 41, 42, 59, 60
Midwifery Lecturer
King’s College London University
London, UK
Rose Gallagher
Chapters 1, 5, 9, 51, 52
Professional Lead for Infection Prevention and Control
Royal College of Nursing
London, UK
Shauna Gnanapragasam BSc (Hons), MSc
Chapters 48, 76
Midwifery Clinical Skills Tutor
Anglia Ruskin University
Cambridge, UK
Clare Gordon RM, SCPHN–SN, BSc (Hons), MSc, PG Cert Academic Practice
Chapters 32, 73
Senior Lecturer in Midwifery
Programme Leader Berkshire Midwifery
University of West London
London, UK
Caroline Hunter RM, MSc, FHEA
Chapter 44
Senior Teaching Fellow, Midwifery
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
King’s College London
London, UK
Louise Jenkins RN, RM, BSc (Hons), MSc, PGDip, SFHEA
Chapters 57, 61
Deputy Head of Department Midwifery, Child and Community Nursing
Anglia Ruskin University
Essex, UK
Julie Jones RM, Dip HE, BSc (Hons) Mid, BSc (Hons) Psych, PG Cert Academic Practice, MMedSci
Chapters 24, 53
Senior Lecturer in Midwifery
University of West London
London, UK
Lyn Jones RMN, RGN, RM, MSc
Chapters 54, 55, 56
Senior Lecturer Midwifery
Anglia Ruskin University
Cambridge, UK
Patricia Lindsay RN, RM, ADM, MSc, PGCEA, DHC
Chapters 11, 12, 13, 29, 37, 40, 45, 49, 62, 75
Registered Midwife
Jayne E Marshall PHFEA, PhD, MA, PGCEA, ADM, RM, RGN
Chapters 70, 71
Foundation Professor of Midwifery
NMC Lead Midwife for Education
School of Allied Health Professions
University of Leicester
Leicester, UK
Marianne Mitchell MA, BSc (Hons), DipHE, RM, RN, FHEA
Chapter 19
Senior Lecturer, Midwifery
University of Hertfordshire
Hertfordshire, UK
Martha Murtagh RM, RGN, RNT, MSc Ed
Chapter 80
Clinical Skills Facilitator
Regional Hospital Mullingar
Co. Westmeath, Eire
Kate Nash RGN, RM, BSc Hons, MSc
Chapter 72
Senior Lecturer in Midwifery
University of West London
London, UK
Ian Peate OBE
FRCN, EN(G), RGN DipN (Lond), RNT BEd (Hons), MA (Lond) LLM
Chapters 2, 4
Editor in Chief British Journal of Nursing;
Visiting Professor of Nursing St George’s University of London and
Kingston University, London;
Head of School
School of Health Studies
Gibraltar
Elisabeth Podsiadly RN, BScN, MSc, PGCEA, Cert in Perinatal Nursing
Chapters 63, 64, 65, 66
Senior Lecturer, Neonatal Nursing
Faculty of Health, Social Care and Education
Kingston University and St George’s University of London
London, UK
David Quayle PGC, RGN, FETC
Chapter 58
Clinical Services Manager
Air Alliance Medflight UK
Birmingham Airport
Birmingham, UK
Hazel Ransome RM, BSc (Hons), PGCLTHE, HEA Fellow
Chapters 68, 69
Senior Lecturer in Midwifery
Kingston University
Kingston Upon Thames
Surrey, UK
Maureen D Raynor RMN, RGN, RM, ADM, PGCEA, MA
Chapter 36
Senior Midwifery Lecturer
Leicester School of Nursing and Midwifery
De Montfort University
Leicester, UK
Lindsey Rose MSc, RM, HEA Fellow
Chapter 39
Senior Midwifery Lecturer
Anglia Ruskin University
Cambridge, UK
Jancis Shepherd RN, RM, ADM, MTD, PGCEA, MA, Senior Fellow of the Higher Education Academy
Chapter 31
Lead Midwife for Education and Head of Midwifery
University of West London
London, UK
Antonio Sierra RN RM MSc
Chapter 74
Lead Midwife for Midwifery Education
West Hertfordshire NHS Hospitals
Hertfordshire,UK
Helen Simpson RN, RM, RSCPHN, HEA Fellow
Chapter 23
Senior Lecturer in Midwifery
University of West London
London, UK
Sheena Simpson RN, RM, 405 Course, BSc (Hons), PGDip in Education, MA, HEA Fellow
Chapter 25
University of West London
London, UK
Sara Smith RM, BSc, MSc, PGCE
Chapter 34
Senior Lecturer in Midwifery
Anglia Ruskin University
Essex, UK
Tina South RM, BA (Hons), BSc (Hons), PGCert (Research), PhD(c)
Chapter 38
Midwifery Lecturer
University of West London
London, UK
Kim Sunley CMIOSH
Chapters 7, 8
National Officer (Health and Safety)
Royal College of Nursing
London, UK
Maxine Wallis-Redworth RN, RM, BSc, MSc, PGCEA, IBCLC
Chapters 48, 76
Course Leader BSc (Hons) Midwifery
Anglia Ruskin University
Cambridge, UK
Helen Williams RN, RM, DPSM, MSc
Chapters 14, 15, 16
Associate Director and Head of Midwifery
Yeovil District Hospital NHS Foundation Trust
Somerset, UK
Nicola Winson MA, PGCEA, RN, RM
Chapter 3
Senior Lecturer in Midwifery
University of West London
London, UK
Sandy Wong MSc (Midwifery), ADM, RM, RGN, PgCert (HE), FHEA
Chapters 35, 46
Senior Lecturer Midwifery
University of Hertfordshire
Hertfordshire, UK
I am delighted to have been asked to write the foreword for this text. The At a Glance series has supported nursing practice for many years; to have a Midwifery Skills text is a bonus for practitioners.
Midwives and student midwives are faced with a plethora changes and challenges in practice and finding relevant and up to date information, which is accessible to support practice, is essential.
Maternity care and services are provided in a variety of settings through different models of care, resulting in midwives and student midwives working in varied surroundings and situations; consequently, keeping current with practices and procedures can sometimes seem overwhelming. This text provides an easy access resource to fundamental aspects of practice.
The At a Glance series provides information in easy to digest bite-size pieces, practitioners can dip in to particular aspects of practice as needed. The text gives key messages supported by illustrations to provide clear guidance for practice.
The book is divided into four parts with further subdivisions and chapters, which makes navigation of themes and topics easy and the presentation of complex skills is made simple.
This text will be of great value to all student midwives, midwives and mentors who will appreciate the importance of the book when undertaking new midwifery skills and in preparation for practice assessment, for example OSCEs (Objective, Structured Clinical Examination) and professional conversations.
Midwives can be reassured that the content is appropriate for practice; many of the authors are renowned for their expertise in their midwifery practice and education as well as expertise provided by professionals from outside of midwifery care, for example in supporting safe practice in the work environment.
The editors bring their own experience to support the gravitas of the text. Dr Patricia Lindsay is an experienced midwife, midwife teacher and academic, who has supported the development of students and midwives throughout her career. Patricia is passionate about safe and effective care for women and families and appreciates the importance of ensuring that professionals have access to contemporary, relevant information for care. Professor Ian Peate shares his nursing experience and the application to midwifery practice. In addition, Ian has a long-established academic career and has produced excellent resources for professional development. Carmel Bagness is an experienced practitioner and academic and brings to the text her wide experience of midwifery practice and issues relating to women’s healthcare and health policy.
I have no doubt that this book will prove to be an invaluable resource for midwives, student midwives and other practitioners working in maternity services. Professionals will find themselves dipping in to the text to support their daily practice. The clear concise approach will provide midwives with the confidence to address practice safely as well as signposting to further information or evidence where appropriate.
Gail Johnson
Professional Advisor for Education
Royal College of Midwives
At the time of writing, midwifery as a profession, and the context of practice, are undergoing some changes. However, the needs of women, their babies and their families remain the same and midwives have a unique and privileged role in providing care to this client group. A high level of competence and confidence in skills ensures care is safe and of a high quality. In addition, the use of evidence and local knowledge, as well as understanding policy and services available, must be drawn on to provide the best care possible. Multiprofessional working and the judicious use of voluntary and other services are also required to provide a complete service to the childbearing woman and her family.
This text has been written with the student midwife in mind but is equally useful for others providing care, for example maternity support workers, registered midwives or medical students. It offers educational support for practitioners in the application of midwifery knowledge to clinical practice in relation to women, their babies and their families through the childbearing continuum. It follows the familiar At a Glance format, which has been shown to be beneficial to the success of student groups’ knowledge of many topics. This volume is unique in that it is related to midwifery practice, but demonstrates links with other relevant healthcare professionals across many disciplines who may also care for women during the childbearing period. The text therefore draws on the wisdom of expert practitioners in midwifery, or in fields pertinent to midwifery, and offers readable, easily digestible information, supported with illustrations to enhance application to practice. Wherever possible the voice of service users has been included to add a different, and important, perspective, one which is often absent from skills books.
The chapters reflect a variety of skills, ranging from fundamental personal care skills to more complex matters such as ECG monitoring or assessment of clinical deterioration. In addition, topics related to risk management and quality assurance are also addressed. When using the book, and carrying out clinical care, practitioners must remain aware of and abide by standards set and published by the regulatory bodies such as NMC Code (The Code, 2015. London: Nursing and Midwifery Council. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf). They must also remain aware that psychosocial care skills are equally important.
While the information in the chapters provides guidance and insight, the reader must ensure that they are competent to carry out the care and, where necessary, have had their competence assessed and confirmed. Everyone has a duty to ensure that care provided is safe and effective at all times, is based on the best available evidence and the woman must be central to every interaction.
Patricia Lindsay
Carmel Bagness
Ian Peate
The prevention of infection is a core element of safe and effective midwifery practice. Midwives and other healthcare professionals should consider the development of infection as an ‘adverse’ event, and monitor and investigate all infections as part of their organisation’s patient safety systems and learning culture. Box 1.1 indicates how infections may occur.
As knowledge of microbiology and the epidemiology of multiresistant organisms has increased, prevention now also includes the avoidance of colonisation of bacteria of clinical importance including (but not limited to):
Viruses can also be problematic, in particular blood-borne viruses (hepatitis B and C, HIV) and chickenpox.
Box 1.2 provides examples of common infections associated with pregnant and postnatal women.
A number of different practice interventions are described supporting the midwife to prevent or interrupt the development of infection or colonisation, which may lead to risks specifically in-patient care setting. They are:
Many women and babies who develop an infection recover well; a small proportion go on to develop sepsis, a potentially life-threatening condition (Chapter 5). The importance of sepsis as a cause of maternal death has been recognised in reports such as MBRRACE UK.
Sepsis cannot be transmitted from person to person. It is a condition that occurs due to overwhelming infection, resulting in an immune cascade leading to septic shock. It can affect both mothers and neonates. Information on neonatal sepsis is detailed below. See Chapter 5 for the management of sepsis in adults.
Isolation: Physical (source) isolation has traditionally been used to separate people receiving hospital care from others due to a risk of spread of infection. In midwifery and neonatal care, isolation may be through the provision of single room accommodation (for mother or mother and baby) or an incubator/cot in the neonatal setting.
The route of transmission for the infection must always be known; this identifies which specific practice precautions are required. Box 1.3 indicates the requirements when source isolation is used.
Midwives are uniquely placed to identify deviations from the normal in the newborn they care for as part of holistic family-centred care. There are some factors that can predispose to a higher risk of early-onset neonatal sepsis. The neonate may be exposed to organisms from the mother during pregnancy as well as vaginal delivery and in many cases of early-onset neonatal sepsis there have been intrapartum complications identified. Identifying these babies and providing the appropriate management will save lives.
NICE (2014a) recommends that all infants born to women who had prelabour rupture of the membranes at term are closely observed for the first 12 hours of life (at 1, 2, 6 and 12 hours).
The assessments recommended are:
If any of the above are present, a neonatologist assesses the baby and advises the family of any need for transfer to appropriate neonatal services if required. In the absence of a neonatal assessment (e.g. non-hospital settings) an urgent referral or transfer to a hospital will be required.
Neonatal sepsis can present with subtle and non-specific symptoms. By the time sepsis is considered the infant may already be very ill. NICE recommendations (2014b) include the use of the red flag to support clinical decision making and British Association of Perinatal Medicine (BAPM) have developed a Newborn Early Warning Trigger and Track (NEWTT) framework to alert midwives to babies who need further help. The framework provides a visual prompt, aiding the identification of abnormal parameters by using a colour code.
Signs and symptoms of sepsis are provided in Box 1.4.
The diagnosis of shock does not require that a neonate be hypotensive. This is a late finding in septic shock and when it occurs confirms progression towards decompensated shock (Robinson et al. 2008). A tense or bulging anterior fontanelle is suggestive of meningitis, common in late-onset sepsis. The assessment of the infant’s fontanelles should be made with the infant held and supported in an upright position.
Temperature instability can be an indication of infection. An neonate who is difficult to keep warm is a concern, as too is a baby who develops pyrexia due to pyrogens secreted by the bacteria.
Healthcare-associated infections (HCAIs) cost the health service millions of pounds per year, as well as causing women and their families unnecessary suffering and concern.
In the mid 1800s, Semmelweis established that hospital-acquired diseases were transmitted via the hands of healthcare workers. He observed that maternal mortality rates, predominantly attributed to puerperal fever, were higher in one clinic than another. As a consequence, Semmelweis recommended that hands be scrubbed using chlorinated lime solution before every contact.
An HCAI is described by the 2006 Health Care Act as any infection to which a person may be exposed or is made susceptible (or more susceptible) in circumstances where healthcare is being, or has been delivered, to that or any other individual, and the risk of exposure to the infection, or susceptibility (or increased susceptibility) to it, is directly or indirectly attributable to the provision of healthcare.
HCAIs are the most common complication affecting those in hospital; the problem does not just affect people in hospital and hospital workers. HCAIs occur in any healthcare setting, including the general practice setting, clinics and long-term care facilities. HCAI is a potentially preventable adverse event, as opposed to unpredictable complications. Anybody working in or entering any healthcare facility can transmit infection or become infected. This risk can be significantly reduced when effective infection prevention and control procedures are implemented.
It is acknowledged that not all infections are preventable. Managing infection control and ensuring best practice can improve care outcomes and service user safety significantly.
Transmission of infections can occur through contaminated hands of a healthcare worker, equipment and medical devices used.
All healthcare workers will come into contact with people who have infections and/or contagious diseases; they must know how to prevent or reduce the transmission of infection.
The National Institute for Health and Care Excellence has produced evidence-based guidelines regarding management and how to prevent and control HCAIs.
Hand hygiene is seen as the single most important activity for minimising the likelihood of infection. Pathogens on the hands of midwives can be removed by hand washing if transmission is to be prevented. Infection involves a cycle of events that permits the spread (transmission) of infection occurring (Figure 2.1).
Healthcare workers, including midwives, have the greatest potential to spread micro-organisms that can result in infection; this is related to the number of times that they have contact with people in the care environment. Hands, therefore, are very efficient vehicles for the transmission of micro-organisms.
Hands should be decontaminated before direct contact with women and after any activity or contact that contaminates the hands; this includes after gloves have been removed. Alcohol hand gels and rubs are a practical alternative to soap and water; however, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with soap and water and dried thoroughly. Hand preparation increases the effectiveness of decontamination. Whenever feasible, staff should have access to the means to clean their hands at the point of care; where possible soap and water should be used. However, this is not always possible with the placement of sinks or access to sinks in the home. The ability to clean the hands is possible when the midwife uses alternative methods.
Detergent wipes should be used if soap and water is not available and this should be followed by drying the hands thoroughly with paper towels or air drying; then alcohol gel can be used. Only use alcohol gel if the hands are visibly clean; using alcohol gel on contaminated hands renders the solution ineffective. Detergent wipes and hand rubs should be readily available at the point of care; if not, the chance of using them will be lost and hands will retain potentially dangerous microbes. Alcohol gel should be used between different care activities with the woman or baby.
The midwife should keep nails short, clean and polish free and should avoid wearing wristwatches and jewellery, particularly rings with ridges or stones. Artificial nails must not be worn and any cuts and abrasions must be covered with a waterproof dressing.
Wristwatches and any bracelets should be removed and long sleeves rolled up before washing the hands and wrists. The NHS has implemented a ‘naked below the elbows’ rule that has banned healthcare workers from wearing long sleeves, wrist watches and jewelry to promote effective hand and wrist washing; this includes the avoidance of wearing ties when carrying out clinical activity.
Hospitals are unique places that differ considerably in terms of the risk of potential infection spread when compared to a ‘normal’ home environment. While risks occur wherever direct contact between people or equipment happens, inpatient hospitals have a large number of people who are living in a small physical area. Moreover, those being cared for may have direct contact with a large number of people as a result of their on going care needs, allowing for many more opportunities for micro-organisms to be spread from one person to another than would normally occur at home. Some of these micro-organisms may be resistant to antibiotics.
Figure 2.2 demonstrates the correct technique for hand washing.
The five moments of hand hygiene (Figure 2.3, which can be found in the Appendices at the end of the book) define the key times, providing a standardised approach to hand washing that is simple and straightforward.
Along with an understanding of hand hygiene, the midwife must also understand how infection is transmitted. Knowing how and when to apply the fundamental principles of infection prevention is key to controlling infection.
The midwife’s responsibilities start with familiarity with which pathogens to consider and awareness of where to refer women. In the unwell woman, knowledge of symptoms as well as investigations that should be instigated at appointments are critical.
Non-pathogenic organisms are essential to health. They can be found in the large intestine, referred to as ‘gut flora’, synthesising vitamins and controlling pathogenic organisms. They can be found in the vagina, where lactobacilli cause the mucoid secretions to be slightly acidic thereby preventing the growth of pathogenic organisms. Pathogenic organisms are ones that affect the woman’s health and wellbeing. They could be viruses, bacteria, fungi, protozoa or worms. Pathogenic organisms enter the body by different routes: some will enter via the lungs (respiratory transmission, inhalation); by the gastrointestinal tract (ingestion); into the blood circulation via the skin (inoculation); or through mucosa in the throat or vagina (direct contact). The incubation period is the length of time between the organism entering the body and symptoms appearing.
The body has defences against the invasion of pathogens. Skin, sebum, (which contains antibacterial and antifungal properties), normal flora (non-pathogenic organisms) and mucous membranes prevent entry into the body. Ciliated epithelial cells waft unwanted material away. Saliva contains IgA and the stomach produces hydrochloric acid, which kills many swallowed pathogens. The lowered pH of the vaginal mucosa renders the environment hostile to pathogenic organisms.
The main defence against infection is the immune system. It produces phagocytic cells, enzymes and proteins that destroy pathogens.
There are various leucocytes (white blood cells) in the blood. B and T lymphocytes identify pathogens and mark them with a specific protein, indicating that cells with this protein need to be destroyed. Other leucocytes are neutrophils, monocytes, eosinophils and basophils. These are measured in haematological tests and identified by the levels and the ratio of each to the others. Bacterial or viral infections can be identified.
The immune system will, when identifying a specific pathogen, produce antibodies to that pathogen such that if it invades the body a second or subsequent time the antibodies are present to prevent illness occurring.
Physiological changes in the anatomy in pregnancy make women vulnerable. Gut motility is slower. The pH of the stomach is less acid, so ingested pathogens will not be destroyed so effectively. Non-pasteurised cheese would not cause a problem in the non-pregnant state but in pregnancy the gut may not be able to neutralise the bacteria. The pH of the vagina is changed and pathogens are more able to grow in this less hostile environment. There is a higher risk of infectious disease transmission.
In pregnancy, the maternal immune response is altered to permit tolerance of the semiallogeneic fetal–placental unit. This is achieved through the activity of uterine macrophages and regulatory T cells, and effectively protects the fetus from rejection by the maternal immune system. While the changes between T1 and T2 helper cells protect the fetus, this has implications for maternal protection from infection. The maternal immune response is not suppressed but is moderated to accommodate the fetus. This means that pregnant women have increased susceptibility to infections and may suffer more severe consequences if infected. For example, pregnant women with influenza have a higher risk of developing pneumonia. Maternal infection during pregnancy has been linked to an increased risk of brain disorders in the offspring, such as schizophrenia.
Table 3.1 lists some common infections and Box 3.1 indicates some signs of infectious disease in women. It is important to note where the rash is, where it started and were it spread to. The same applies if ulceration is present. These observations help with diagnosis.
The midwife should be aware of local or national outbreaks of infectious diseases and needs to be aware of how to prevent the spread of an infectious condition.
At every visit check whether the woman has travelled or lived in a high-risk area. If the woman has a rash, it is advisable that she separated from other pregnant women.
Give advice regarding the prevention or spread of infection. Demonstrate and maintain good practice such as hand washing, wearing of gloves where appropriate and use of Standard Precautions. The midwife should liaise with the infection control specialist nurse in the hospital.
The midwife must screen the woman appropriately. This may mean taking blood or urine samples. The results must be obtained and followed up.
If a positive diagnosis is made, the woman may now be considered to have a high-risk pregnancy so more frequent antenatal checks are required. Obstetric input together with skills from the virologist, fetal medicine specialist, neonatologist and GP are required. The woman (and partner) need to be informed of the risks of suspected or diagnosed infections.
A multidisciplinary meeting should be convened to discuss management of the woman and baby.
The midwife should remain up to date on diagnosis and vaccines that are becoming available. Postnatally the woman can be vaccinated against some infectious diseases but the midwife must check the suitability of vaccines if the woman is breastfeeding.