Case Study Ellise's Contractions

Improved Essays
Interpretting CTG’s is a competence I am still developing and admit I need to focus on. Aided by my new knowledge of the ‘criteria’ for a good CTG based on the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (n.d) education programe, I worked systematically with Amanda through the trace. I clearly articulated what I thought, paying attention to the DR C BRAVADO nuemonic (COMPETENCE, COMMUNICATION). During this time I also included Ellise by tailoring my communication and explaing that her baby was happy and how I was intereting the CTG (PARTNERSHIP). I also recoginsed that Ellise’s contractions were not as regular as we would like and quaried this with Amanda as I was unfimilar with the management of syntocinon. …show more content…
I also wanted to get a better understanding of Ellise’s contractions as CTG machines do not accurately display the strength of contractions, and the epidural numbed maternal recognition (ADHB, 2013) (COMPETENCE; PRACTICE REASONING). I explained this to Ellise and asked permission to sit beside her and palpate her uterus to feel for the strength of her contractions manually over a ten minute period (Pairman, Pincombe, Thorogood, & Tracy, 2010) (PARTNERSHIP). Palpating contractions is a skill that I am slowly beginning to advance. Working with women who have epidurals provides a challenge but good opportunity to further my abilities in the art of palpation, especially if women are unable to sense tightenings. I made a point of not watching the CTG machine uterine activity continuously and worked on my physical palpation skills and visual ability to identify Ellise’s contractions. Ellise was incredibly facilitative and began to work with me, I would say when I though a contraction was beginning and she would tell me if the CTG was providing the same information …show more content…
Amanda agreed this was a good suggestion and because Ellise began to feel an urge to push, Amanda did a Vaginal examination to confirm fully dilatation. Ellise was fully so we assisted her into a kneeling position on the bed. However we left the CTG on as per the guidelines when there is an epidural and/or syntocinon infussion (ADHB, 2013). She began to bear down and was pushing well. Her pain increased too much after 10minutes of pushing and therefore she requested another topup of the epidural. In recognition of my scope I did not take the opportunity presented to me to give Ellise her top up through a syringe as it was done in the hospital we were in (PROFESSIONALSIM). Instead I offered to do the blood pressure monitoring that is required prior to and after the insertion as women can become hypotensive after epidural top ups because of vasodilation (Johnson & Taylor, 2010). I also took note of the CTG recording as epirdural top ups can, in some fetuses, cause fetal heart rare abnormailities specifically prolonged decelerations and reduced baseline variability due to maternal hypotension (COMPETENCE; KNOWLEDGE; PRACTICE REASONING) (RANZCOG, N.D; Chandraharan & Arulkumaran,

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