Implementing A Framework for Maternity ... - Scottish Government

Clinical judgement and decision-making skills
All maternity care professionals must have the clinical judgement and decision-making skills
required to work in Level I areas. In many instances, midwives may be aware of the appropriate
line of diagnosis and care but will refer to a midwife or doctor for assurance that her decision is
right. The appropriate referral mechanism should be utilised. This option may not be available
to a midwife working in a CMU. However, even though the unit may be geographically distant
to the consultant unit, there should always be an explicit network for advice and management
of increasing levels of care.
Maternal history taking
CEMD (2001) highlighted the importance of good history taking at booking. It stressed the
importance of a risk and needs assessment at booking which should be reviewed regularly.
Crucial to ensuring a quality service for each woman and her family is the management of risk
and identification and prevention of complications.
Counselling and communication skills
The professional must have the skills to communicate clearly with women, their partners and
maternity care team members particularly when problems become evident. These skills are also
central to obtaining good maternal history and providing informed choice about care options.
Risk assessment and management skills
Although midwives working in maternity units have many of these skills, the nature and
environment of a CMU will mean that the type of risk management and decisions about care
will differ to those of a midwife working in an obstetric maternity unit. Frequent updating and
‘fire drill’ scenarios will be necessary. Included in this is the management of uncertainty. All health
service professionals who are involved in maternity care in remote areas must have these
skills.
Venepuncture and intravenous cannulation and the subsequent management of IV fluid
replacement
Not all midwives have this skill although most units run courses and there are anatomically
correct models which can be used for practise purposes. Both subgroups stressed that as well as
being able to cannulate the professional must have the skills to manage IV fluid replacement.
There are opportunities for professionals to refresh these skills in areas such as day surgery.
Adult resuscitation
CEMD (2001) stressed the importance of managing emergencies such as severe haemorrhage.
This is a core skill of every midwife and health care professional but in order to maintain
competency midwives must attend an annual update course. This course must include early
identification of and care of the ill woman, including the recognition of sepsis.
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