Pregnancy places unique physiological demands on the maternal body. The growing uterus pushes the diaphragm upward, changing the chest cavity shape and increasing the maternal oxygen demand by twenty percent. Midwives must understand these normal anatomical changes to distinguish them from true respiratory compromise. A slight increase in tidal volume and a feeling of mild breathlessness are common in normal antenatal clients. True distress, however, involves objective signs like tachypnea, cyanosis, and the use of accessory muscles.
Taking a thorough respiratory history uncovers hidden risks that could threaten a pregnant or postnatal woman. Midwives should explore current symptoms, past medical history, and environmental exposures.
Physical examination begins the moment the midwife greets the client. Inspection involves observing the respiratory rate, rhythm, and effort from across the room. Count the rate quietly for a full minute without the client realizing, as conscious control alters breathing patterns. Look for asymmetrical chest expansion, intercostal recession, and cyanosis of the lips or nail beds. Palpation follows to confirm symmetry. Place your hands on the lower posterior chest wall with thumbs meeting near the spine, asking the client to take a deep breath to check for equal chest expansion.
Using a stethoscope correctly is essential for hearing underlying lung pathology. Place the diaphragm firmly against the bare skin, moving systematically from the upper apices down to the bases, comparing side to side.
| Sound Type | Description | Common Clinical Cause |
|---|---|---|
| Vesicular | Soft, low-pitched rustling heard over normal lung tissue | Normal finding |
| Crackles | Discontinuous popping sounds, often at the lung bases | Fluid in alveoli, pulmonary edema, or infection |
| Wheezes | High-pitched whistling sounds during expiration | Narrowed airways, asthma, or bronchospasm |
| Stridor | Harsh, high-pitched musical sound heard on inspiration | Upper airway obstruction |
A common mistake among learners is pressing the stethoscope tubing against clothing, which creates rustling artifacts that mimic abnormal breath sounds.
Pulse oximetry provides a quick, non-invasive measurement of peripheral oxygen saturation. Place the probe on a clean finger, toe, or earlobe, ensuring good peripheral perfusion. Cold extremities or nail polish can cause false low readings. Normal oxygen saturation in healthy pregnant women usually exceeds ninety-five percent on room air. When readings fall below normal limits, midwives may need to arrange for arterial blood gas analysis or a chest X-ray with abdominal shielding to investigate further.
Recognizing respiratory deterioration means nothing if the findings are not communicated quickly and clearly. Midwives must use structured communication tools like SBAR (Situation, Background, Assessment, Recommendation) when handing over to medical staff. Documentation in the client's chart must include exact respiratory rates, oxygen saturation levels, breath sounds, and the client's color and level of consciousness. Never delay emergency escalation while waiting for routine ward rounds if a woman shows signs of severe respiratory distress.