Abstract
The extent of cesarean and forceps delivery has been increased over the last decade due to which the health related risks to the infant and mother has been increased. The procedure of cesarean delivery can incorporate the nerve damage whereas, the process of forceps delivery tends to cause the cerebral trauma on the infant, which eventually hinders the quality of life of the infant and also enhances the mortality rate. In this paper, the effect of the forceps delivery on the occurrence of cerebral palsy among the infants has been determined with respect to the cesarean delivery. The PICOT question has been developed in this manner to provide the systematic guidance towards the determination of the related scholar articles so that adequate interventions in this respect can be provided. The detailed analysis of the scholar articles indicated that cesarean delivery causes the unspecified trauma on the infant, which is independent from the cerebral trauma or cerebral palsy. It is also found that the cerebral trauma, including cerebral palsy, is related to the forceps delivery, which eventually indicates the negative effects of the forceps delivery on the infant. The interventions in this respect comprehend that the nurses are required to incorporate the periodic observation of the fetus movement since the first stage of the labor so that the nurse can possess the adequate information with respect to the fetus movement and can enlighten the obstetrician in an effective manner so that adequate decision for the delivery procedure can be made. Moreover, the nurses are also responsible to motivate and reinforce the women in labor with the labor teachings so that their extent of discomfort can be minimized due to their readiness towards the labor pain, which eventually reduces their extent of being exhausted during the delivery and consider the alternate methods of delivery.
Keywords: Forceps Delivery, Cesarean Delivery, Cerebral Trauma, Cerebral Palsy, Nursing Interventions.
The procedure of forceps, cesarean and vaginal delivery incorporate a higher extent risks to the fetus and mother. The number of cesarean and forceps delivery has been increased over the years by 7.5 percent, which eventually indicates the significance of identifying the safety concerns that prevail in the cesarean delivery (Moczygemba et al., 2010). The forceps and cesarean procedure is incorporated due to the prolonged second stage of labor, however, scholars have argued the prevalence of nerve injury due to the use of forceps in the cesarean procedure. The increase in the procedure of cesarean and forceps delivery has enhanced the importance of determining its impact on the newborns in order to maintain the healthcare quality (Kearney et al., 2010). This paper aims to discuss the prevalence of cerebral palsy among newborns due to the forceps delivery by means of enlightening the scholar researches and providing the nursing interventions to reduce the extent of cerebral palsy among newborns.
PICOT
The PICOT question enlightened in this paper is as follows:
“In newborns, how does forceps delivery compared to cesarean delivery leads towards the cerebral palsy in second stage arrest?”
whereas:
P = patient population = newborns
I = issue of interest = forceps delivery
C = comparison of issue = cesarean delivery
O = Outcome = cerebral palsy
T = Time frame = second stage arrest
Discussion
According to Moczygemba et al. (2010), the concerns related to maternal safety are addressed in an effective manner by the healthcare institutions, however, the notion that addresses the effects of cesarean delivery on the newborns remain understudy. The study conducted by Moczygemba et al. (2010) was focused on enlightening the neonatal birth trauma by means of the route of delivery, comprising of vaginal and cesarean delivery. The data based on the singleton infants in accordance with the hospital discharge records were acquired from the Nationwide Inpatient Sample (NIS), which is the database organization that keeps the hospital records from private and public healthcare institutions.
The data were comprised of two years’ records and accounted for 37 states. The data was validated for consistency by using the Medicare Provider Analysis and traumatic birth records were sorted by means of the cerebral hemorrhage, scalp injuries, clavicle fracture, facial and nerve injuries, specified and unspecified birth traumas. The total sample comprised of 8,176, 523 newborns. The results of the study indicated the prevalence of birth trauma at the rate of 25.85 per 1,000 births, whereas, the cesarean delivery which incorporated the forceps delivery indicated the higher extant of birth trauma than vaginal delivery.
However, the association between cerebral trauma and cesarean delivery was found to be reduced than the vaginal delivery. In this instance, it was concluded that cesarean delivery was highly associated with the other specified traumas and indicated reduced rate of cerebral trauma and the association was rationalized on the basis of decreased odds of scalp injuries during the cesarean procedure. Therefore, the study proved that infants delivered with the cesarean procedure are at the high risk of traumas, but these traumas do not account for cerebral palsy. Therefore, cerebral trauma is considered to account for the vaginal delivery, however, the sub-types of vaginal delivery remain unidentified in the study (Moczygemba et al., 2010).
The study conducted by Moczygemba et al. (2010) as focused only on two types of deliveries, i.e. vaginal and cerebral and hence, the vaginal delivery with respect to the forceps or vacuum delivery was not distinguished. In this way, the holistic data were acquired from the PSI and the data were not distinguished on the basis of the different types of deliveries. The study was focused on the various traumas rather their determining their causal factors so that the adequate delivery procedures can be identified with respect to their trauma.
On the contrary, the study comprehended the large number of data due to which the validity and consistency of the result prevails. The study indicated the higher rate of unspecified trauma during cesarean procedure, but refrained the prevalence of cerebral trauma among the infants born by cesarean procedure. In this way, the study provided the direction in which the vaginal delivery is considered to be associated with cerebral trauma or cerebral palsy, however, the data of vaginal delivery was not sorted into the vacuum or forceps delivery and hence, the exact delivery procedures that causes the cerebral palsy remained unidentified. Moreover, the future direction of the study provides the direction for identifying the cause of neonatal cerebral trauma either from vacuum or forceps delivery (Moczygemba et al. 2010).
Brouwer et al. (2010) indicated that cerebral traumas are common among newborns and are considered as the most significant cause of neonatal death. However, the mortality rate has been curbed due to the advancements in technology but, the effects of cerebral traumas tend to effect the infant’s quality of life. It is enlightened by Brouwer et al. (2010) that the forceps delivery can cause the vein rupture due to which bleeding occurs from the hemorrhage and hence, the accumulation of blood can incorporate the prevalence of the neurological symptoms. Therefore, the study was based on determining the factors that impact the neurodevelopmental outcome of newborns.
The clinical data for the study were collected from the neonatal intensive care unit and the data were comprised of delivery mode, neurodevelopmental outcomes, symptoms and treatment. The neuroimaging of infants was conducted within the 6 hours and was repeated on a periodic basis whereas, the neurodevelopment outcomes were monitored by the periodic checkup of infants till the age of 20 months. The total sample size was comprised of 53 infants. The acquired data were analyzed by using the Mann-Whitney and chi-square (Brouwer et al. 2010).
The results of the study indicated that the mode of delivery is associated with the cerebral hemorrhage whereas, the results also indicated the prevalence of cerebral palsy among the infants who were born by the forceps delivery. The study concluded that intracranial hemorrhage among infants is caused due to forceps delivery procedure and can cause the mortality rate of 24.5% among the infants. Moreover, the extent of cerebral palsy is found to be 8.6% among the infants with intracranial hemorrhage. In this manner, the study supports the notion that forceps delivery causes the occurrence of cerebral palsy among infants (Brouwer et al. 2010).
The study is conducted by Brouwer et al. (2010) is considered relevant for the current paper because it addresses the cerebral traumas in accordance with the delivery modes. The study is focused on the cerebral development of infants and provides the holistic perspective in which the quality of life of infants after the forceps delivery is also enlightened. The findings from this study are applicable because they are concentrated on the cerebral development in accordance with the delivery modes. However, the study does not incorporate the large number of population due to which the consistency in the obtained results remains questioned.
Interventions
The interventions that can comprehend the decrease in the occurrence of cerebral palsy emphasizes on the effective management of labor, however, it is also indicated that variations in delivery time during the second stage prevail due to which immediate interventions in delivery modes is not recommended without the systematic review and decision of the obstetrician. The occurrence of cerebral palsy in association with the forceps delivery is found to be related to the decision of the forceps delivery and nursing interventions during the labor (Kearney et al., 2010).
The nurses are responsible for assessing the condition of the women in labor during the first and second stages of labor. The decision of forceps delivery is incorporated when the woman is exhausted from the labor and is unable to comprehend the physical effort. The nurses in this instance, are required to reinforce the labor teachings during the first stage of labor. Scholars have proved that when a woman is psychologically prepared during the first stage labor tend to encounter with the minimum level of discomfort (Lyndon et al., 2013).
The issues related to the cerebral trauma due to the forceps delivery are being addressed by the scholars whereas, the discussed nursing interventions can enhance the nursing practices during the labor management. The nurse practitioners can incorporate the interventions in which the periodic observations, i.e. once in every thirty minutes, is required so that the nurse practitioners can become aware about the fetus movement and can predict the occurrence of the possible stage by means of the time duration (Kearney et al., 2010; Lyndon et al., 2013).
Collins (2009) has indicated that mismanagement in the labor on behalf of the nurse practitioners take place when there exists miscommunication between the nurse and obstetrician and hence, the effective communication interventions among the operation theatre staff is required to be incorporated in order to make the surgical teams and labor teams well-integrated in accordance with the fetus condition.
Moreover, keen observations incorporated by the nurse in this respect can also make the nurse to provide the detailed analysis of the fetus movement to the obstetrician so that the decisions related to the forceps delivery can be incorporated under the severe labor condition. In this way, the extent of forceps delivery can be shifted towards the natural induction methods in delivery (Lyndon et al. 2013).
Effectiveness of PICOT
The development of the PICOT question in this paper has provided with the systematic direction towards analyzing the specific concern, i.e. forceps delivery and cerebral palsy in newborns. The PICOT question ensures the prevalence of the targeted population with respect to the health related concerns so that the health related concern can be evaluated in accordance with the comparative phenomenon for the provision of the adequate interventions. Moreover, it also helps in the selection of the related scholar work for the identified problem is identified in an effective manner and the evaluation for the scholar work became effective due to the clarity of the title developed due to the PICOT question.
References
Brouwer, A. J., Groenendaal, F., Koopman, C., Nievelstein, R. J. A., Han, S. K., & de Vries, L. S. (2010). Intracranial hemorrhage in full-term newborns: a hospital-based cohort study. Neuroradiology, 52(6), 567-576.
Collins, D. (2009). Legally Speaking: Risk Management in Obstetrics and Gynecology. Contemporary OB/GYN.
Kearney, R., Fitzpatrick, M., Brennan, S., Behan, M., Miller, J., Keane, D., & DeLancey, J. O. (2010). Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery. International Journal of Gynecology & Obstetrics,111(1), 19-22.
Lyndon, A., Zlatnik, M. G., & Wachter, R. M. (2011). Effective physician-nurse communication: a patient safety essential for labor and delivery.American journal of obstetrics and gynecology, 205(2), 91-96.
Moczygemba, C. K., Paramsothy, P., Meikle, S., Kourtis, A. P., Barfield, W. D., Kuklina, E., & Jamieson, D. J. (2010). Route of delivery and neonatal birth trauma. American journal of obstetrics and gynecology, 202(4), 361-e1.
