Currently the scope of practice of a professional nurse with midwifery (the vast majority of nursing staff running maternity units) does not allow them to perform assisted delivery
and manual vacuum aspiration.
The normal staff complement consists of professional nurses with midwifery, whose scope of practice does not include performing assisted delivery
. There is an absolute shortage of advanced midwives to work in CHCs and district hospitals.
An overall assisted delivery
rate of <1% is too low and is probably due to loss of skill in performing AVD and/or lack of willingness to perform it, as well as lack of the necessary equipment.
Manually assisted delivery
does not include vacuum extraction or forceps delivery, notes Dr.
Obstetric outcome Outcome N (%) Mode of delivery Normal vaginal delivery 82 (43.4) Assisted delivery
31 (16.4) Elective caesarean section 47 (24.9) Emergency caesarean section 28 (14.8) Undelivered 1 (0.5) Gestational age at delivery (weeks) Mean (SD) 35.8 [+ or -] 5.3 Minimum 9 Maximum 42 Table IV.
Mothers who gave birth during regular hours were 43% more likely to have an instrumentally assisted delivery
, 10% more likely to have an episiotomy, 86% more likely to have drug-augmented labor, and 30% more likely to experience severe tearing, the report indicates.
Recent figures for births without any form of intervention - including induction, Caesarean section, assisted delivery
or any form of anaesthetic - show just 44 per cent achieve a natural delivery.
The determination about whether to provide assisted delivery
by forceps or vacuum is usually left to physicians, but women could become more active participants in the decision-making process if they were informed beforehand about the varying risks of later incontinence before these procedures were performed.
Major risk factors identified were; home and assisted delivery
5 (75%), consanguinity 10 (50%), infections 8 (40%) and lack of antenatal care 6 (30%).
They are also more likely to end in an assisted delivery
with forceps, ventouse or a Caesarean.
has walked a long and winding road