Hi,
Delivery is not an aseptic technique. The vagina is not sterile. We do not wear sterile gloves for delivery it is a clean procedure. If suturing is required we wear sterile gloves.
________________________________
From: A forum for discussion on midwifery and reproductive health research. on behalf of margy hughes
Sent: Wed 20/10/2010 11:52
To: [log in to unmask]
Subject: Re: Aseptic technique and normal birth
Dear All,
This comment/question may seem very basic, but it is something I have a problem with in maintaining aseptic technique:
When caring for a woman who is classed as low risk, (ie: no CTG running) and if there is no one else available to auscultate the FHR during second stage, at what point do I put my sterile gloves on? At one time, Infection Prevention did not cavil at double gloving (stripping off the top glove for delivery); now it forbids it.
I would be very grateful for other Midwives sharing how they manage this (without using ten pairs of gloves!)
Thanks and regards,
Margy Hughes
________________________________
Date: Wed, 20 Oct 2010 09:59:33 +0100
From: [log in to unmask]
Subject: Re: Aseptic technique and normal birth
To: [log in to unmask]
Dear Pam and Kathy,
We have 'standards' imposed by the general nursing side about infection control.
After being in the UK NHS since 1977 when I first learnt aseptic technique I was assessed by a colleague who deemed me 'passable'.
In hospital though we have to remember we are not in an ideal environment as Florence taught us 'hospitals should do the sick no harm' http://womenshistory.about.com/cs/quotes/a/qu_nightingale.htm
Most importantly is maintaining the environment in hospitals and standards of clinical hygiene especially when a lot of midwives are pushed to deliver care with inadequate support workers, and or clinical cleaners. Who's role is grossly underestimated in the protection against infection.
I work in a flagship hospital, with a raising birthrate, it is important to maintain basic standards. Eventually we will run out of effective antibiotics then where will we be?
Regards,
Lorraine
--- On Tue, 19/10/10, Kathy Carter-Lee <[log in to unmask]> wrote:
From: Kathy Carter-Lee <[log in to unmask]>
Subject: Re: Aseptic technique and normal birth
To: [log in to unmask]
Date: Tuesday, 19 October, 2010, 10:25
Pam I too have no research, but I am glad you are looking into it as I think aseptic technique is an important issue to think about.
A few thoughts:
At a basic level universal prevention of infection measures are important. Having worked a short time in a labour ward during my time in Afghanistan, I feel great sympathy for staff there who are expected to give care where water, supplies and systems do not support such care. On one night shift I worked there were clean (possibly sterile) instruments and clean linen for 6 births, when perhaps 20 or more births could be expected. In such an environment people do the best they can and end up protecting themselves from contamination and possible infection. Here on the other hand, in my care as a caseloading midwife (at home, in birth units and in hospitals), I find myself thinking around the 'infection prevention' side of my care for women much more in terms of preventing myself or the environment passing on anything that might threaten to disturb the woman's natural balance of organisms.
Thanks
from
Kathy Carter-Lee
Caseloading MW, NZ
>
> Hi Pam, no research but over 2 decades of experience that when the woman is well, invasive
> procedures (VE, ARM, FSE) are not used and the environment has familiar organisms (woman's
> own home), postnatal uterine or vaginal infection is extremely rare - and this is with a high
> proportion of waterbirths.
>
> I can't say I have ever worn a sterile apron or glasses. Definitely clean clothes for each birth
> attendance (and each day J). Hand washing is soap and water, and dried with the woman's
> bathroom towel - but I do not examine cadavers before attending women in labour!
>
> It's important to remember that exposure to blood and secretions is about 'delivery' and not
> about supporting women to give birth where the woman catches her own baby, wipes the baby
> down, births the placenta in a bucket in an active birth position (rather than lying on a bed with
> blood and other body fluids all over her back, buttocks and upper legs), and she cares for her
> own hygiene postnatally.
>
> It's important to teach the historical context but isn't asepsis (as a concept) contextual to care.
>
> kind regards
> Maggie Banks
> Check out Birthspirit Midwifery Journal
> Birthspirit's Mind, Body and Spirit Workshop 23-29 January 2011
> 15 Te Awa Road, RD 3, Hamilton 3283, New Zealand
> Phone 64 7 8564612; Fax 64 7 8563070; Email [log in to unmask]
>
>
> From: A forum for discussion on midwifery and reproductive health research.
> [mailto:[log in to unmask]] On Behalf Of Pamela Harnden
> Sent: Tuesday, 19 October 2010 1:37 p.m.
> To: [log in to unmask]
> Subject: Aseptic technique and normal birth
>
>
> Hi everyone,
>
>
>
> I am currently writing an online module for student midwives covering aseptic technique
> and infection control.
>
>
>
> I came across this in their recommended text book , Skills for Midwifery Practice,
>
>
>
> "It is important that delivery is an aseptic procedure for both the woman and the baby to
> reduce the incidence of postnatal infection. The midwife will use a sterile delivery pack,
> establishing a sterile field both on the working surface and in the area of the woman's
> perineum"p.216
>
>
>
> Whilst I agree that there needs to be adherence to hand washing, aprons, sterile gloves
> and eye protection I am concerned about aherence to an aseptic technique.
>
>
>
> I have attempted a search of CINAHL database regarding asepsis and normal birth.
>
>
>
> There were a couple of results,
>
>
>
> Roberts, J., Hammes, B., & Gundersen, J. (1986). Professional attire at delivery: effect on
> postpartum and neonatal infection. Journal of Nurse-Midwifery, 31(1), 16-19.
>
>
>
> "The implementation of many hospital alternative birthing centers has been accompanied
> by a relaxation in the use of surgical drapes or sterile professional attire. To determine if
> the use or nonuse of sterile attire was accompanied by any difference in postpartum
> maternal or neonatal infectious morbidity, a retrospective review of records for 1 year
> was done in a hospital that permits variation in professional attire for spontaneous birth
> to women at low obstetric risk. A comparison of the incidence of standard features of
> morbidity among six practitioners and three attire groups revealed no differences. Until
> contrary documentation is available, this supports the safety of allowing variation in
> attire under circumstances of low obstetric risk and minimal intervention deliveries"
>
>
>
> Cronin, W., Quansah, M., & Larson, E. (1993). Obstetric infection control in a
> developing country. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing,
> 22(2), 137-144.
> "In Ghana, infection has been identified as a major cause of birth-related mortality.
> Results of a 2-month observation of infection control practices among Ghanaian obstetric
> nurses and midwives indicated that most personnel did not practice basic rules of asepsis.
> Problems included frequent breaks in technique, inadequate sterilization and disinfection,
> and repeated exposure to large amounts of blood and vaginal secretions. Supplies were
> limited and, even when available, not always used appropriately.. The situation in
> developing countries is different from that in the United States. Therefore, an
> observational needs assessment is essential to plan relevant and practical measures for
> change."
>
>
>
> I wondered if anyone knew of any research regarding modern use of aseptic technique
> during normal birth and whether it is strictly adhered to
>
>
>
> many thanks
>
> Pam Harnden
>
> --
> Pam Harnden
> http://pamdh.wordpress.com
> http://www.facebook.com/#/pages/Young-Mums-and-Maori-Antenatal-
> Classes/180461813792?ref=sgm
> http://pamdh.blip.tv/
> http://midwifeblogger.blogspot.com
> http://www.youtube.com/Midwifepam
> http://nzmidwiferypractisingreflection.blogspot.com
> http://midwifepam.wikispaces.com
> http://www.google.com/profiles/Pam.Harnden
>
>
==============================
Kathy Carter-Lee
Midwife
Mobile: 021 425 115
Home: 09 425 6749
Warkworth Birthing Centre: 09 425 8201
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