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CRITICAL INCIDENT REPORTING OF SHOULDER DYSTOCIA This essay is a critical analysis of an incident that occurred in the author's place of practice. The issues identified in the client's care will be discussed and the management implemented will be reflected on using current researched evidence. The rationale for choosing this incident is because it inspired me to reflect on my practise and develop my clinical competences. According to Miller (1999) reflective thinking have been regarded as an important tool both as a learning process and directing future clinical practice. This can only be achieved by being honest with ourselves and our performance, ask for help from our colleagues if necessary and ensure our practice is based on up- to- date relevant research. This have been also highlighted by Glenn (1993)who stated that the development of critical thinking is essential to sound professional practice and is the hallmark of the effective practitioner". Burnard (1990) suggested that successful reflective thought enhances the individual's ability to : Generate opinions See possibilities Discriminate intelligently Be creative Identify new ideas The incident is a reflection of the author's management of shoulder dystocia in her practice area. This piece of essay will be discussed into different themes that emerged from the client's case study, using relevant evidence. WHAT IS SHOULDER DYSTOCIA? Shoulder dystocia is defined as a delivery that requires additional obstetrics manoeuvres to release the shoulders after gentle downward traction have failed (Resnick 1980). It is said to occur when either the anterior or less commonly the posterior fetal shoulder impacts on the maternal symphysis or sacral promontory (RCOG 2005). ...read more.


2000). Gestational diabetes mellitus is prevalence to type 2 diabetes mellitus and is highest in areas with a high proportion of ethnic groups (Hutchinson 2001). This has also been identified in the author's practice area, where in the highest population of the maternity service users are of Asian origin. In the United States of America, the African- American population is affected by gestational diabetes compared to their Caucasian and Filipino counterparts (Griffen et al 2000). Mrs. Kargbo had risk factors of developing gestational diabetes mellitus: Previous GDM, over forty years old, African and high body mass index. All these features have been found in various studies by different authors i.e. Griffen et al 2000, Hutchinson 2001, DOH 2001 & Jensen et al 2000. During pregnancy, metabolic changes occur to optimise fetal growth. Therefore, insulin secretion need to increase throughout pregnancy to maintain material glucose control (Hutchinson 2001). The management of gestational diabetes in pregnancy is to optimise glycaemic control, which reduces the risk of congenital malformation, intrauterine death, neonatal hypoglycaemia and respiratory distress syndrome (Dang et al 2000). Women should aim to maintain blood glucose as near to non- diabetic range as possible without risk of hypoglycaemia. This means targeting levels within the range of 4 and 7 mmol/l. According to the Turok et al (2003),it is imperative for diabetic women to be referred to a multidisciplinary team led by a named obstetrician and physician for the provision of maternity care. Diabetes specialist midwives should educate and teach women in home blood glucose monitoring and dietary advice given where Mrs. Kargbo have been cared for throughout her pregnancy. This have also been the common practice in the author's practice area. ...read more.


Although, several authors have mentioned in their studies about the insufficiency of predictive risk assessment in the prevention of the large majority of cases(RCOG2005). Secondly, the author was able to institute the HELLPER Mnemonic of shoulder dystocia by summoning help and requesting for the appropriate personnel at the delivery. In so doing the author was exercising her professional accountability as recommended by the midwives rules and code of practice (NMC2004), CEMACH(2004) and also the NICE guidelines(2004). Implication for midwifery practice All birth attendants should be trained in the management of shoulder dystocia to enable us to fulfil our duty of care to both mother and babies(NMC 2004 & Carr2004).Gould et al (2004) also mention the value of continuous professional development in order to meet the needs of the health service and its users. A high level of awareness and training have also been recommended by the fifth CESDI report. The Royal College of Midwives and the RCOG have jointly recommended annual skill drills for birth attendants. Incident reporting and debriefing of a critical incident of any obstetric emergency will enable personnel involved to reflect on the actions, learn and also share experience with colleagues. Auditing the number of cases by keeping a register of all cases of shoulder dystocia and outcome of mother and baby. Accurate documentation of events by the use of a pro forma will reduce the successful litigation after a shoulder dystocia (Carr2004, NMC2004, RCM 2000, RCOG 2005). On reflection, the whole scenario have been a learning curve for the author not only the care and management implemented during the incident but writing this critical report have enabled me to generate new ideas from the research/ evidence read. ...read more.

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