Role of the Midwife in Preterm Labour (Che) by Mark Miller https://padlet.com/mark_miller3/qa3jqxxvihvt Chelmsford en-us 2016-08-24 12:33:37 UTC 2016-09-26 21:38:00 UTC hello@padlet.com The role of the midwife would be to introduce herself, give reassurance to the mother and carry out observations with consent. The midwife would need to go through the woman's notes/history to check if her symptoms are indicating pre term labour or if it could be something else. If the midwife was not sure she could ask a more senior member of staff and once it was confirmed take the necessary steps according to the guidelines to give the best care. https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126049467 2016-09-23 15:28:49 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126049467 Katie https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126168942 Antenatally: risk assessment (obstetric, medical and social risk factors). Antenatal education for social risk factors such as smoking/alcohol/illicit drugs. Information given to mothers with obstetric/medical risk. Midwife's personal knowledge of the signs and symptoms of PTL (being especially aware that some of these are common 'normal' symptoms in late 2nd/ early 3rd trimester so not to dismiss or overlook PTL). Labour care: according to trust guidelines, delivered professionally with care and compassion. Ability to work as part of MDT, making timely and appropriate referrals. NICE PTL guidelines emphasise the importance of communication with both parents and other professionals throughout pregnancy and birth. Parents will need support, oral and written information, open space to ask questions, especially being mindful of heightened parental anxiety surrounding PTL.]]> 2016-09-24 15:23:56 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126168942 As the powerpoint states preterm birth occurred in approximately 7.3% in all live births in 2012. This is a significant proportion of women that midwives care for, therefore midwives need to have the skills necessary to care for a lady at risk of preterm labour, in preterm labour and during the birth. Initially the midwife needs to risk assess all women and refer to an obstetrician those that are at risk of preterm labour, therefore the midwife needs to be aware of all risk factors. Some women may be offered a cervical suture to help prevent preterm labour so they need to be aware of how to care for a women undergoing this procedure. The midwife along with the obstetricians need to educate the woman and her family of the likely outcomes of giving birth at each gestation, and help in supporting them all through this emotional time. When presented with a lady in preterm labour and after an obstetric review, the midwife will likely be instructed to give a tocolytic drug, to relax the muscles. Explain that this is not to prevent preterm birth but to be able to give corticosteroids such as dexamethasone and allow the correct amount of time for them to take effect. The midwife needs to gain consent to continually monitor the fetal heart and to interpret the trace whilst continually reassuring both parents and other birth partners.it is the midwives responsibility to ensure that the resuscitaire and all other equipment is available and in date in addition to informing the NICU of the neonates imminent arrival and to ensure that there are paediatric doctors present at delivery. Following delivery the midwives role is to support the woman medically and emotionally, to continue with third stage labour care but to be sensitive to any activity occurring with the paediatrician and the neonate. https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126228192 2016-09-25 18:38:10 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126228192 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126229773              ]]> 2016-09-25 19:00:33 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126229773 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126229833 If a woman is planning a home birth but labour begins at home before 37 weeks she needs to be admitted in hospital so as there is easy access to a neonatal unit if needed for the baby.
On admission to the ward any woman in preterm labour should be made to feel as comfortable as possible, just like any other woman would be. 
All observations should be taken as normal and the fetus should be continuously monitored throughout labour.
If the fetus is below 35 weeks a tocolytic drug may be used if there are no contraindications of doing so, like any sign of infection or rupture of membranes.
Any plans for the management of the labour and what may happen, for example the baby having to go to the neonatal unit, should be discussed with the parents so that they can understand what is happening and are able to ask any questions that they may have. 
Once labour is established, the neonatal unit needs to be informed of what is happening, along with the paediatrician and obstetrician. 


]]> 2016-09-25 19:01:39 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126229833 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126291478 The role of the midwife for pre-term labour is firstly the same as with any labour but also includes a greater discussion with colleagues to prepare the surrounding environment for variable outcomes and discuss this with the expectant parents to ensure they have an understanding of what is and will be happening. The neonatal unit need to be informed and on standby and the availability of cots should be noted.  Consent must be gained throughout the labour process regardless of term, and continuous monitoring of both mother and foetus Parents need to be made aware that a pre-term babies appearance can be different to a full term depending on the gestation and that the healthy cry that may be expected may not be as strong. Discussions also need to be held on medications that may be necessary for the baby and mother before and after birth ensuring parents have full understanding. The parents/birth partners should be constantly reassured and have transparency in their care. ]]> 2016-09-26 08:37:29 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126291478 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126304974 In the scenario the role of the midwife would be to introduce herself to the women, give reassurance. Settle the lady and partner in a room, carry out all maternal observations, read through the notes and take a brief history; ensure there are no obvious reasons the women may have gone into preterm labour, document in the notes everything that the women is telling us, document all appropriate observations, discussing rupture of membranes with the lady too. Discuss with other members of the team and take course of action regarding to trust guidelines and policies. Ensuring consent is gained throughout the care. ]]> 2016-09-26 09:50:31 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126304974 Katie HIlls katie_hills https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126312403 If a woman presents with a potential pre-term labour the first role of the midwife is to welcome and reassure the family.  Initial antenatal and history checks should be carried out including continuous CTG analysis to monitor the fetus and the contractions.  The obstetric team should be informed to enable them to review the woman to confirm pre-term labour (they may carry out a physical examination i.e Vaginal examination. They also may require an ultrasound to confirm position, gestational age, growth and fluid). 

 If pre-term labour is confirmed the midwife should ensure she acts in accordance with the trusts guidelines and firstly notifies the labour ward coordinator and the neonatal unit of the possible pre-term labour.  The obstetric Doctor may request tocolytic agents are given to try and stop uterine contractions. (Offered between 26 and 33+6 weeks gestation but considered 24 -25+6 weeks gestation who have intact membranes and are in suspected or diagnosed preterm labour). Corticosteroids are then given to decrease the incidence of RDS (only given between 24-34 weeks gestation) Tocolytic agents aim to provide time for these corticosteroids to be of benefit to the baby and if an in-utero transfer is required to another more specialised neonatal unit (depending on gestational age and the level of the unit at the trust).

 

While everything is put into place by the midwife and the multi-disciplinary team, the midwife also needs to reassure and ensure the parents are fully informed of the situation and what may need to happen and answer any questions they may have.  If there is time the midwife may request the paediatric team to be called in and talk with the parents about what type of care their baby may need once born .

If delivery is very imminent the midwife should also ensure there is a checked resucitaire and neonatal emergency drug trolleys are ready and close by. (Preferable in the room) and the paediatric and obstetric team are bleeped and ready to attend the delivery.  Another midwife may be required to assist, to enable the woman to have as much emotional support as needed whilst also ensuring the safety of her and her baby. 

A vaginal delivery is preferred unless clinically indicated otherwise. If the fetus is beech and under 1500gms in weight a caesarean may be carried out as birth trauma has been shown in trails to be greater with vaginal birth deliveries compared to caesarean births.   If a caesarean is performed on a particularly low gestation there is an increased risk of the women requiring a vertical uterine incision.  Other risks include, haemorrhage, bladder injury, and uterine tears. There are also increased risks in subsequent pregnancies, namely uterine rupture, placenta praevia, and placenta accrete.

Whilst giving clinical care is an enormously fundamental  aspect of a midwives role, ensuring the woman and her family are given reassurance, support and are informed in all aspects of their care is as of equal importance and can sometimes be overlooked in these situations.

]]> 2016-09-26 10:33:08 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126312403 The core role of the midwife remains the same what ever the gestation of labour. That is provide the care that is required to the woman and her family dependant on the situation that is presented. Pre-term labour is obviously a deviation from the norm and as such is an incident that requires escalation, for both the neonate and the woman.  https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126359625 The woman and ]]> 2016-09-26 13:30:04 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126359625 SID: 1418804 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126411960 - Welcome the woman and partner/birth partner onto the ward.
- Women experiencing pre-term labour will most likely be extremely anxious, therefore it is the role of the midwife to provide reassurance to the woman and to allow them the opportunity to ask questions.
- The midwife must review the woman's antenatal history, bloods, serology, placental site, ect. This may indicate a possible cause of preterm labour, however 40% of preterm labours are idiopathic.
- The midwife should assess the maternal and fetal condition (full observations, fetal movements, CTG monitoring - explaining to the mother why this is advised).
- The labour ward co-ordinator, doctor (registrar/con), neonatal unit should be informed. The woman will be reviewed, a plan should be put in place and the necessary equipment should be checked and be ready in preparation of birth.
- Once the woman has been reviewed by the doctor and a plan has been made it is essential that this is communicated effectively to the woman. The midwife must advocate for the woman, ensuring that her wishes are listened to and that she is kept involved in the decision making process.
- Women experiencing preterm birth will need additional support and potential counselling, as many babies born prematurely suffer with neurodevelopmental disabilities. It is important that the midwife refers the woman to the appropriate professional if additional support is required.]]> 2016-09-26 15:31:21 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126411960 1506040 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126421914 2016-09-26 15:53:53 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126421914 1506040 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126423585 If a woman is in suspected pre-term labour, a detailed medical history should be taken once she is admitted. Rupture of membranes should be confirmed by speculum. Maternal observations should be taken and the fetal heart rate should be monitored via CTG with consent to assess any signs of maternal/fetal infection such as fetal tachycardia. The midwife should continuously reassure the parents and discuss the process and outcomes of pre-term birth.]]> 2016-09-26 15:57:47 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126423585 Being the primary care giver and first point of contact, it is important that suspected PTL is investigated by the Midwife to conclude a diagnosis involving the MDT after initial assessment and monitoring of mother and fetus. Reassurance is hugely important and this can be achieved by discussing what is happening and why offering the opportunity for any questions regularly as a plan of care develops dependent on the findings, gestation, contraindications for actions etc to ensure that these decisions are made together with the parents having a clear understanding.    https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126430631

]]> 2016-09-26 16:18:30 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126430631 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126449160 There is a good section covering midwifery care during preterm labour in 'The midwife's labour and birth handbook'. It suggests that most care and support will be the same as for any labour but  women in preterm labour may be particularly anxious. Some of  the points listed are:
Continuous, supportive, one to one care as it reduces interventions and improves both maternal and fetal outcomes.
The discussions with parents about who will be present, likely resuscitation, ventilator support and the likelihood of NICU care.
The midwife should reduce external stressful stimuli (bright lights, noise, interruptions, lack of privacy) and be mindful that PTBs attract more staff (do they all need to be there?).
The midwife needs to (or delegate to someone else if the woman needs her)inform the labour ward coordinator, obstetrician, NICU and paediatric team.
Monitoring of the FHR. Although NICE (2007) recommends continuous electronic fetal monitoring studies suggest this has no advantage over intermittent auscultation and increases maternal morbidity, CS and possibly cerebral palsy. Very preterm babies can be difficult to monitor continuously and preterm CTGs may be difficult tio interpretas they tend to have a higher baseline and decelerations which are not necessarily truly pathological. The method of monitoring should be the woman's choice.
Minimise digital VEs to reduce the risk of ascending infection especially with PPROM.
Observe for infection (maternal pyrexia, fetal/maternal tachycardia or offensive smelling liquor. This may lead t further discussion with the obstetrician re the need for blood cultures or bacteriological specimens or swabs.
Eating and drinking is not contraindicated. (it does discuss the justification for 4 hourly antacids (ranitidine and cimetidine)in preterm labours that are considered at higher risk but not when using nifedipine as it can cause hypotension.
Avoid narcotic analgesia (pethidine) as it may cause neonatal respiratory depression, drowsiness and depressed reflexes.
Artifical ruptured of membranes is not recommended to avoid cord compression, ascending infection/chorioamnionitis
Prepare the resuscitaire. Checking equipment and gather baby's clothes, hat, warm towels, plastic/bubble wrap.
Keep the room warm and draught free.
Avoid forced pushing for delivery and let the woman push at her own pace.
Avoid episiotomy as it does not protect the preterm fetal head.
Summon all relevant staff for the delivery eg. obstetrician and an experienced practitioner in preterm resuscitation.
Always expect the unexpected. as preterm infants may arrive very quickly as maybe before the team has gathered, midwives should be aware of basic principles of resuscitation  and management of preterm babies.
After birth the midwife should address the immediate risks of heat loss ( due to high surface area relative to mass and less insulation fat) and respiratory difficulty (due to immature lungs and a reduced ability to endure hypoxia during labour).

There is still a lot of debate about when to clamp and cut the cord. The UK Resuscitation Council accepts  a possible jaundice risk, but states that delayed cord clamping for vigorous preterm babies improves blood pressure during stabilisation, reduces intraventricular haemorrhage and the need for blood transfusion. late onset sepsis may also be reduced. However the midwife may not be the only practitioner involved at this point and those babies that need extensive resuscitation and would probably benefit from delayed cord clamping the most, tend to be  taken quickly to the resuscitaire.
Where possible skin to skin should be considered because of the many physiological and psychological benefits

]]> 2016-09-26 17:07:57 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126449160 1500660 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126469454 The role of the midwife in a clinical scenario for PTL would be to ensure that a swift referral to the Dr can be made so a diagnosis and plan can be put into place. 
The midwife should also support the woman/partner/family throughout this time, ensuring that they understand fully at all times what is happening and are informed of all stages of the plan.
If PTL is confirmed the midwife should make the NICU team aware of the pre term labouring woman and keep them informed of progress.
The midwife should understand the need for a paediatrician at delivery.]]> 2016-09-26 18:04:55 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126469454 0800886 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126479910 Firstly introduce self to the women and partner and provide reassurance in order to minimise anxiety. Settle the women into the room, providing refreshments and spending a good amount of time taking a history from the woman/partner - focusing on her gestation/parity, preterm labour symptoms, ROM or vaginal bleeding and fetal movements. Perform maternal observations initially including urinalysis and then proceed to fetal observations - making sure to auscultate the fetal heart. 
Preterm labour then needs to be confirmed by visualising the cervix using a speculum - this is normally performed by a Doctor for women below 37 weeks gestation. This could also lead to a manual examination although it is advised to keep these to a minimum due tot he risk of infection - particularly if the membranes have ruptured. 
Once the preterm labour is confirmed and the findings are communicated to the woman and partner, the management of care needs to be discussed. If time allows, Tocolytic agents such as Atosiban may be given to delay the onset of labour and imminent delivery and also to allow for the use of Corticosteroids to take effect. 
If delivery is imminent, continuous fetal monitoring is recommended however it is the woman's choice. The midwife should communicate to the MDT, making sure the Neonatal team and Co-ordinators are aware. The resuscitaire and equipment should be checked and available for the birth. Vaginal delivery is encouraged unless clinically contraindicated - the midwife should also be aware that the cervix may not dilate fully to 10cm before delivery due to the fetus being a smaller size compared to term babies. The midwife should involve the woman in all aspects of her care - ultimately, it is still her birth, her choice!

]]> 2016-09-26 18:34:57 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126479910 If a woman was to present in suspected pre-term labour she will be experiencing many emotions and is likely to be scared of what will happen to her and her baby. Upon admission the midwife should be welcoming and offer reassurance to the woman and her family. A detailed medical and obstetric history should be taken from the woman and antenatal notes examined. It may be advisable at this point to make an obstetrician aware of the attendance even though they might ask for further observation before reviewing. Routine observations should be performed including a CTG to monitor the well-being of the fetus and to record any contractions that occur. If at any time the CTG becomes abnormal, the woman’s condition was to change or labour progresses the midwife should contact the obstetrician to request review sooner. The midwife should continue to offer support and reassurance, answering any questions they may have and referring them to other professionals where appropriate such as a paediatrician. https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126481695 2016-09-26 18:39:47 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126481695 In addition to what has already been said, the midwife role continues in the puerperium with regards to ongoing liaison with the Neonatal Unit, communication between the MDT and the parents. The mother will need support with establishing feeding and understanding her body's response in producing colostrum for her baby's needs, and how to sustain lactation. The parents may need a debrief session, and will be at higher risk of post-natal depression due to unexpected event, not having been prepared for baby's arrival. Future obstetric care needs to be considered too. https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126484525 2016-09-26 18:47:56 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126484525 SID:1501306 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126497874 The role of the MW in the clinical scenario of preterm labour should encompass the fundamental concepts that a midwife should bring to any labour she is involved with.   

Compassion: Be able to comfort and understand the fears of the woman and her family in that this is a scary time for them and perhaps a loss of their "ideal".  Have a sense of when the family need privacy and when they need support.  
Care: Ensure that the situation sees the woman and her family being involved in their care and decisions which are being made.  Individualise you're care to ensure it makes the family feel included, important and safe.
Commitment: Where possible try to facilitate continuity of care for the woman and ensure that she has access to the resources that she needs or would benefit from. Demonstrate to the woman that you are professionally equipped to help her through this scenario. Always ensure that consent is gained based on all evidence being made available.
Courage: Be able to be honest and open about the situation with the woman and their families rather than withholding information which may be difficult. Be strong enough to support the decisions or requests made by the woman and advocate her rights and wishes.
Communication: Keep the woman updated of progress and changes throughout, offer time to talk over what is happening, ensure that she is happy in the discussions that occur with other medical professionals ie terminology used by Drs, etc. Ensure that the MDT are working as one with same plan and not giving the woman conflicting advice and information.
Competence: Ensure that you are knowledgable in the current trust guidelines and protocols for the situation. Make sure information is evidence based/informed and that information is up to date and suitable for that woman and situation. If you feel you cant answer a question or are not the best person to offer care for that family then make this known to co-ordinator who can resolve it without detriment to the woman/family.

The questions that the woman and family may have are likely to be different and it is much more likely that there will be more involvement in the care plan from the Obstetric team as well as liaising in advance with the Paeds team and NNU. The aftercare needed is much more likely to be different and will depend on the outcome of the labour.]]> 2016-09-26 19:26:09 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126497874 Initially, the midwife should introduce herself and reassure the woman. It would be beneficial for the midwife to read through the woman's notes, as this could give indications of the possibility of preterm labour. Then take a set of observations once she has gained the woman's consent. https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126503513 2016-09-26 19:49:39 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126503513 41502826 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126509087 The overwhelming feeling for the woman will be fear of going into early labour, and the effect on the well-being of the baby. The midwife needs to consider how vulnerable and upset the parents will be, and try to reassure as often as possible. Sensitivity will be needed when explaining the findings of examinations as well as possible treatment options and prognosis. Privacy and comfort must be maintained as well as seeking to clarify the parent's understanding while they are emotionally compromised.  It is vital that each step of the process is clear and transparent to the woman, and that she is made part of the decision making throughout. The woman is suddenly being propelled from the normality of pregnancy into a highly medicalised environment, and the midwife must seek to diffuse her anxiety at every stage.

]]> 2016-09-26 20:17:46 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126509087 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126509292
Initially, the midwife should introduce herself and reassure the woman. It would be beneficial for the midwife to read through the woman's notes, as this could give indications of the possibility of preterm labour. Then take a set of observations once she has gained the woman's consent.It is important that the midwife communicates effectively with the woman and her family as this could be a worrying time for them. It would be necessary to establish whether the woman has gone into preterm labour through a VE and/or other tests. If preterm labour is confirmed, using an ultrasound scan; it would be useful to check the position of the fetus. CTG monitoring would also be beneficial. During the postnatal period, the mother and infant may require additional feeding support, whether they are breastfeeding or bottle feeding, as depending on how premature the infant is, the suckle reflex might not be fully developed. The midwife should also encourage a lot of skin to skin contact between mother and baby and explain the benefits of this to the woman and her family.

]]> 2016-09-26 20:18:53 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126509292 1519420 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126511489 The role of the midwife would not be any different on whether preterm or term, however i would expect more support would be needed for reassurance when anxiety is high. Labour can be a challenging and frightening time for any women, especially if its their first babies as they do not know what to expect, and hopefully the hospital is seen as a safe and secure place to be when things dont go to plan or happen earlier than expected. Woman-centred care is paramount, and the role of the midwife is to empower the woman, using the best evidence so they have a choice in their care. It may be worth considering whether to discuss such things such as resuscitation with the parents and the care they offer in NNU (as in NICE guidelines) and describe the clinical assessments that will be undertaken to distinguish whether she is likely to deliver soon, and what they would suggest be done to improve the chances of the fetus surviving. A paed should be available for the birth. There is lots to consider and the co ordinator and reg should be kept in the loop.]]> 2016-09-26 20:31:11 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126511489 1519420 https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126512267 If its preterm then the co odinator needs to be involved in the care and NNU informed if the baby is of a viable age e.g. over 24 weeks. The use of tocolytic therapy should be considered to delay birth and to allow steroids to be given to the fetus if between 24-34 weeks gestation. However sometimes there just isnt enough time for this. 
Communication with the parents is vital and neccessary to keep them aware of what staff are considering and suggestion. Obviously consent would be needed for any intervention. ]]> 2016-09-26 20:36:29 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126512267 The role of the Midwife would be very similar to any full term pregnancy in terms of care, providing information and reassurance. The Midwife would hopefully have shared information antenatally about risk factors that can increase pre term labour (PTL) as well as pre existing medical conditions that can also increase the likelihood. On arriving at the hospital I would expect the Midwife to welcome the women/family, having an opportunity to have a good look through the ladies notes including, social/medical and obstetric history. In the case of PTL working as a multidisciplinary team would be vital, bringing together experienced midwives, paediatricians as well as communication and care with the neonatal unit. It would be useful to have discussed with the parents the possible problems that can result in PTL and pre term birth, fully preparing them for any eventualities. It may, at a later time, be necessary for the women and her partner to access some kind of counselling, reflection services. By keeping the women at the centre of the care being provided at all times and being completely transparent with all that is happening will help build a trusting relationship. This relationship will be vital going forward as it will be a very stressful and emotional time for the lady/family. https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126519140 2016-09-26 21:26:27 UTC https://padlet.com/mark_miller3/qa3jqxxvihvt/wish/126519140