Unit of competency details

Unit Descriptor 

This unit describes advanced skills and knowledge required to support women during childbirth and manage the process of childbirth in a community setting

Application 

This unit is intended to build on clinical skills and knowledge developed at Certificate IV level in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice)

Pre-requisites 

This unit must be assessed after successful achievement of pre-requisites:

• HLTAHW401B Assess client's physical well being
• HLTAHW403B Plan and implement health care in a primary health care context

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Support women during childbirth

1.1 Identify local birthing practices and cultural beliefs and discuss with women in planning and advocating for appropriate childbirth

1.2 Discuss roles, relationships and responsibilities to support safe birthing, including the role of the Aboriginal and/or Torres Strait Islander Health Worker as an advocate for women and families

1.3 Discuss and identify signs of onset of labour and support women to attend a birthing facility as required

1.4 Provide physical and emotional support to women as appropriate during hospitalisation

2. Prepare for unplanned childbirth in the community setting

2.1 Maintain emergency delivery bundles and instructions in isolated community settings

2.2 Identify signs and symptoms of imminent unplanned childbirth

2.3 Seek urgent professional assistance and advice with birthing

2.4 Prepare to manage unplanned delivery in a community setting using the best available resources

2.5 Identify helpers and allocate tasks as appropriate based on experience and knowledge

2.6 Prepare appropriate equipment and medication for delivery

2.7 Basic management of second and third stages of labour is instituted if needed

2.8 Undertake initial management of post-partum haemorrhage according to emergency care guidelines and organisational protocols

2.9 Arrange safe evacuation in consultation with medical staff

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Organisation policies and procedures relating to client confidentiality
• Anatomy/physiology, pharmacology, pathology and basic microbiology relevant to pregnancy, maternal and/or infant health
• Knowledge of microbiology relevant to maternal and/or infant health and prevention of infection or cross infection
• Birthing practices suitable for culturally appropriate birth outcomes
• Health conditions, obstetric problems and associated issues related to pregnancy, maternal and infant health
• Medical problems occurring in pregnancy requiring referral
• Relevant assessment methods and use of associated equipment, testing procedures
• Relevant treatments, medicines and associated care services available
• Risks and contraindications associated with relevant treatments and medication
• Realistic expectation of client condition during monitoring of progress

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Support women during the birthing process
• Prepare for unplanned childbirth in a community setting
• Manage an emergency delivery

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Prepare for and manage a normal delivery
• Recognise situations requiring immediate or urgent action
• Communicate effectively with client to obtain information and ensure understanding of information provided
• Liaise between service providers, individuals, families and community groups
• Holistically evaluate impact of treatment on client's physical, mental and emotional condition and behaviour
• Reflect on and improve own level and application of skills and knowledge to achieve desirable outcomes and maintain own capabilities

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects of assessment :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Consistency of performance should be demonstrated over the required range of situations relevant to the workplace
• Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Conditions of assessment :

This unit includes skills and knowledge specific to Aboriginal and/or Torres Strait Islander culture

Assessment must therefore be undertaken by a workplace assessor who has expertise in the unit of competency or who has the current qualification being assessed and who is:

• Aboriginal or Torres Strait Islander him/herself

or:

• accompanied and advised by an Aboriginal or Torres Strait Islander person who is a recognised member of the community with experience in primary health care

Context of assessment :

Competence should be demonstrated working individually, under supervision or as part of a primary health care team working with Aboriginal and/or Torres Strait Islander clients

Assessment should replicate workplace conditions as far as possible

Related units :

This competency unit should be assessed in conjunction with:

• HLTAHW516B Provide antenatal health care
• HLTAHW518B Provide postnatal and infant health care

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Cultural respect 

This competency standard supports the recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander peoples

It recognises that the improvement of the health status of Aboriginal and Torres Strait Islander people must include attention to physical, spiritual, cultural, emotional and social well being, community capacity and governance

Its application must be culturally sensitive and supportive of traditional healing and health, knowledge and practices

Community control 

Community participation and control in decision-making is essential to all aspects of health work, and the role of the health worker is to support the community in this process

Supervision 

Supervision must be conducted in accordance with prevailing state/territory and organisation legislative and regulatory requirements

References to supervision may include either direct or indirect supervision of work by more experienced workers, supervisors, managers or other health professionals

A person at this level should only  be required to make decisions about clients within the organisation's standard treatment protocols and associated guidelines

Legislative requirements 

Federal, state or territory legislation may impact on workers' practices and responsibilities. Implementation of the competency standards should reflect the legislative framework in which a health worker operates. It is recognised that this may sometimes reduce the application of the Range of Variables in practice. However, assessment in the workplace or through simulation should address all essential skills and knowledge across the Range of Variables

Aboriginal and/or Torres Strait Islander Health Workers may be required to operate in situations that do not constitute 'usual practice' due to lack of resources, remote locations and community needs. As a result, they may need to possess more competencies than described by 'usual practice circumstances'

Under all circumstances, the employer must enable the worker to function within the prevailing legislative framework

Obstetric problems to be identified and managed include :

• Antepartum haemorrhage
• Vaginal discharges
• Importance of a 'show' before 38 weeks of pregnancy
• Fluid loss from the vagina
• Ruptured membranes (including onset of labour, prolapsed cord, infection)
• Abdominal pain in pregnancy (including braxton hicks contractions and labour contractions)
• Incompetent cervix

Vital signs taken during labour include :

• TPR
• BP
• foetal heart beat detected using foetal stethoscope and doppler
• rate of contractions

Delivery may include :

• Hospital or birthing centre
• Community setting

Baseline observations include :

• TPR
• BP
• PV loss
• Condition of fundus.

Information provided includes :

• Normal and abnormal vaginal discharge
• Care of the perineum
• Episiotomy or caesarean wound and breasts
• Resumption of sexual relations
• Obtaining baby clothes and nappies
• Sources of advice and support
• Welfare payments and other financial assistance

Immediate care of the newborn may involve :

• Jaundice
• Humidicribs
• IV infusions