Quiz 3: Care and support during labour and immediately after delivery

Please choose the one, most correct answer to each question or statement.

What decision would need to be considered if there was no birth care plan in place prior to delivery?
- The method of delivery, resuscitation, interventions and memory-making opportunities
- Should a midwife deliver the baby
- What doctor needs to be called to the delivery
- What ward the mother should be admitted to after delivery
Should the fetal heart rate be monitored in labour if the baby has a life-limiting condition?
- Usually not as a Caesarean section for fetal distress would not be offered
- It depends on whether the baby is still moving
- It depends on the gestational age
- Always as it is a legal requirement
Immediate assessment post-delivery is important to:
- Check whether it is a boy or girl
- Check the Apgar scores
- Determine gestational age
- Determine if the options in the birth plan are still appropriate and if anything needs to be discussed or changed with parents
Holistic comfort care after birth consists of:
- Checking the baby’s vital signs half hourly
- Not leaving the mother alone with her baby
- Providing warmth, enteral feeding, pain medication and other simple interventions
- Taking the baby to the nursery immediately after the delivery to spare the parents any emotional pain
What kind of symptom is the baby most likely to experience after birth?
- Breathlessness
- Nausea and vomiting
- Fatigue and restlessness
- Anxiety
Holistic support of the mother includes which of the following:
- Only managing her pain
- Only monitoring the mothers blood loss after delivery
- Physical, psychosocial and spiritual support
- Deciding for the mother when the baby should be taken to the nursery
When supporting parents at the time of delivery it is important:
- Not to give too much of an explanation of what is happening as it may upset them
- To explain to parents what to expect and the order of events using non-medical terms
- To use direct medical terms to describe what is most likely to occur after the delivery if the baby is not breathing
- To not inform them what the baby may look like to spare their feelings
Palliative care in the delivery room:
- May require preparation for the ‘hello’ (birth) and the possibility of ‘goodbye’ (death) at the same time
- Can only be provided if the baby is dying
- Needs to be provided by a specialised palliative care team
- Means deciding for the parents that full resuscitation is not feasible
If the baby has severe physical abnormalities such as anencephaly it is a good idea to:
- Explain to the parents what the baby may look like and cover the head with a dressing or blanket so that only the face is seen
- Not inform or prepare the parents for what the baby may look like
- Take the baby away immediately after delivery
- Deliver the baby by Caesarean section only
What is bonding?
- It is the memory the parents have after their baby has died
- It is the love that parents develop once they realise their baby may be dying
- It is the relationship between a pregnant mother and her partner
- It is an emotional attachment that parents develop with their baby during pregnancy and once it is born
How can you encourage parents to bond with their baby?
- Wrap the baby up warmly and hold it for the parents to look at
- Allow parents as much time with their baby as they need if they choose to
- Insist that they hold their baby and spend time with him/her
- The parents should wash their hands before touching their baby
If the family have named their baby and have shared this information then respect and honour both them and the baby by:
- Calling the baby by his/her name
- Suggesting that they need to officially name their baby
- Avoiding using the baby’s name
- Saying that the name suits the baby
Another way to respect parents is to:
- Invite parents to share their beliefs and practices and respect any differing practices or needs
- Avoid speaking to them about their baby if he/she has died
- Discourage any other family members visiting the baby
- Insist that they baptize the baby immediately
If the baby is expected to die soon after delivery, performing rites or rituals can be considered where and when possible and include:
- Only after bathing the baby
- Blessing the baby, a baptism or a naming ceremony
- Feeding the baby immediately after it is born
- Only allowing the hospital spiritual worker to say a prayer
Siblings will also need extra support at this time and are often referred to as:
- Those that are left behind
- Those poor kids
- The forgotten mourners
- The sorrowful siblings
If siblings are present and are going to meet their baby brother or sister they should:
- Not be told that the baby will possibly die
- Be given detailed medical explanations
- Be given simple and truthful answers and explanations of what to expect and what is happening
- Be told nothing
If the baby is likely to die in the delivery room, one of the important interventions is to:
- Fetch the priest immediately
- Call the doctor to break the bad news
- Rush the baby to the NICU/nursery as soon as possible
- Explain to the parents the physical changes that are likely to occur as their baby dies such as terminal gasping
If the baby appears to be in distress immediately after delivery
- Reassure the parents that everything possible will be done to manage pain and distressing symptoms
- Ask the doctor to sedate the baby
- Explain to the parents that this is part of the dying process and they should let nature take its course
- Give the baby a dummy to suck on
Memory-making activities such as taking photographs, videos, handprints or footprints:
- Will make the parents feel guilty that they did not do enough for their baby
- Can be a helpful way to manage feelings of grief and bereavement
- Needs to be done by an experienced staff member
- Will lead to the parents experiencing complicated grief at a later stage
If the baby lives longer than expected and can be discharged home, there needs to be:
- A plan for ongoing palliative care support, advance care planning and end-of-life care
- Only a referral letter to the community clinic saying that nothing needs to be done for the baby as it is likely to die soon
- Only a palliative care plan and referral letter
- No further care interventions offered