Moving and handling
In the Manual Handling Operations Regulations 1992, manual handling is defined as:
…any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or bodily force.
This definition is inclusive as it effectively covers any activity where an individual is required to lift, move or support a load (whatever that load may be). In the workplace an individual can be at risk of injury from these activities and the employer and employees have a responsibility to reduce that risk. Musculoskeletal injury occurs in over a third of all workplace injuries and this is caused by bad manual handling techniques, especially in relation to back injuries.
See Figure 6.1a–d for an overview of the biomechanics of moving and handling.
Although the women and families that midwives predominantly care for are mobile and independent, there are times when there is a need to support a woman with reduced mobility, for example women with epidurals, caesarean section or a disability, women who are overweight or obese (including bariatric women), and maternal collapse. Any activity has to be carried out with informed consent, comfort, privacy, dignity and respect.
As midwives work in a variety of environments (community and hospital) an understanding relating to safer ‘moving and handling’ in all these environments is paramount. The moving of equipment (homebirth kit, various equipment, trolleys, dry and fluid stores and beds – this list is not exhaustive) is a daily occurrence. Working at computers can also increase the risk of personal injury with the use of repetitive movements and static positions. Therefore regular workstation assessment is a legal requirement. Consideration of car driving is required (e.g. correct seat positioning and times of rest).
When considering and planning a manual handling activity it is a recommended requirement that a risk assessment is performed. This may have been carried out previously with local guidance already set or this may occur at the time, depending on the task. Several acronyms can be used to assist with the recall of this process. These include AARR and TILE.
- Avoid – does the task need to be performed?
- Assess – if it does, assess how it can be performed?
- Reduce – reduce the risk to the individuals involved
- Review – review the whole process assessing the potential to develop the procedure with ongoing risk assessment.
TILE: These are important factors to consider as issues relating to these could cause potential for harm for the individuals involved (Figure 6.1a–d).
- Individual capability
What is the task? Does it require repetitive movements, stooping or twisting, stretching upwards, holding a load away from the trunk (this increases stress on the lower back), insufficient rest or recovery, demanding pushing and/or pulling, changeable movement of an object or individual. This may also require the midwife assuming an awkward position to support a woman in labour or facilitate a birth (water birth, standing position, birthing on the floor). The task may involve the potential for twisting (e.g. monitoring of vital signs, monitoring of the fetal heart or venepuncture). Adopting a 45 degree angle or less of positioning will reduce that risk ensuring that shoulders are in alignment with feet with correct positioning of equipment. To change position move your feet and body, do not just twist your trunk.
This involves consideration of physical and mental capabilities, health status, current knowledge base, confidence and competence and age range (younger and older) of the person performing the task. The Health and Safety Executive (2004) state ‘employees in their teens and fifties and sixties’ have an increased risk of injury from manual handling activities. An individual also has a responsibility for their own competence (attending training and updates) and to inform their employer of any change in health.
Several questions need to be considered – is the load heavy, bulky, difficult to hold or harmful? An affirmative to any of these should trigger the need for assistance, whether that is the use of appropriate equipment or an individual. Within the provision of midwifery care, the load can be a woman, baby, equipment, bags, beds and so on. In relation to the woman, several factors can also impact, for example mobility, pain, understanding (language or deafness), and pre- or postsurgery (urinary catheters/dressings/intravenous infusions). These can be seen to affect the unpredictability and sometimes complexity of the load and therefore need to be considered.
This may be within a home or hospital situation but the principles are similar. These are: constraints of posture, floor surface (wet/carpeted, other hazards, e.g. bags, wires), poor lighting and variation of levels – be that floor or bed and other furniture.
Equipment to assist lifting and handling includes PAT slide, slide sheets, hoists and pneumatic hoists. Ensure the equipment is checked, intact and fit for purpose, and that individual users are updated with knowledge and understanding of its use.
Other considerations are:
- Ensure adequate numbers of staff are involved.
- Work as a team with appointment of a ‘leader’.