1st Stage of Labour - Epidural & Spinal (W/S 6)

Question 1

What changes occur to the uterus during pregnancy?

Answer 1

• Uterus grows from 60g to 1000g

- The lower segment formed at 32 weeks (due to increased stretching of uterine muscle fibres)

Question 2

What starts labour?

Answer 2

• Less progesterone released by placenta
• Increase in oestrogen:progesterone ratio
• Oestrogens increase the production of prostaglandins
  (F2alpha)
• Oestrogens increase the contractability of the
  myometrium
• Oxytocin triggers are not completely understood but
  pressure on the cervix causes release
• ?some release from the fetus?

Question 3

What is the definition of the first stage of labour?

Answer 3

From the onset of regular purposeful contractions (which cause cervical changes) until full dilatation of the cervix.

Question 4

What does TENS stand for?

Answer 4

Trans electrical nerve stimulation

Question 5

What does a TENS machine do?

Answer 5

Applies electrical current through the skin for pain control. It activates of opioid receptors in the central nervous system.

Question 6

What is the latent phase of labour?

Answer 6

1st stage - Up to 4cm dilatation of the cervix

Question 7

What is the active phase of labour?

Answer 7

1st stage - From 4cm to full dilatation of the cervix

Question 8

What is effacement?

Answer 8

Effacement is the thinning/shortening and softening of the cervix.

Question 9

What gets recorded on the partogram and how frequently?

Answer 9

FHR - 15-30 mins during 1st stage, 5 mins during 2nd stage (+ maternal pulse)

Blood pressure and temperature - every 4hrs

Contractions: length and frequency - every 30 mins

Cervical dilatation and descent of presenting part - every 4hrs

Amniotic fluid - every 4hrs

Question 10

Describe the action and alert lines

Answer 10

The Alert line starts at 4 cm of cervical dilatation and it travels diagonally upwards to the point of expected full dilatation (10 cm) at the rate of 1 cm per hour. The Action line is parallel to the Alert line, and 4 hours to the right of / after the Alert line.

Question 11

Describe the uterine muscles.

Answer 11

3 layers of muscle tissue.

Outer longitudinal muscle layer.

Middle oblique/spiral muscle layer.

Inner circular muscle layer.

The muscle layers are entwined between connective tissue of blood vessels, elastic fibres, and collagen fibres.

Question 12

During labour, what happens to the joints and ligaments of the pelvis?

Answer 12

Joints widen and ligaments soften.

Question 13

Explain contraction and retraction of the uterus.

Answer 13

Contraction is the tightening of uterine muscles fibres.

The uterine muscle fibres remain shortened after contracting during labour (i.e. retraction). This results in a gradual progression of the fetus downwards through the pelvis. The top of the uterus becomes thicker and pulls up the dilating cervix over the presenting part

Question 14

What does CTG stand for?

Answer 14

Cardiotocograph

Question 15

What does a CTG measure?

Answer 15

A CTG measures fetal heart and monitors uterine contractions.

Question 16

What is a retraction ring?

Answer 16

A pathologic retraction ring (Bandl’s ring) of the uterus is a constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with obstructed labor.

Usually involves syntocinon. Primps or multips with syntocinon.

Question 17

During the late first stage and early second stage, where is the pain most intense / highest level of intensity?

Answer 17

Uterine pain most intense

Question 18

During the late second stage, where is the pain most intense / highest level of intensity?

Answer 18

Perineal pain the most intense

Question 19

Describe first stage pain i.e. where it originates from and how it may be felt.

Answer 19

Originates from dilatation of the cervix, distension and stretching of the lower third of the uterus.

May be felt as referred pain in the abdomen, lower
back and rectum.

Question 20

Describe second stage pain i.e. where it originates from and how it may be felt.

Answer 20

There is less stimulation from the dilated cervix and increased pressure on receptors in the stretching tissues of the pelvic peritoneum, uterine ligaments,
bladder, urethra and rectum.

Pressure on lumbosacral nerve plexus with descent
of presenting part causes referred pain in the back, thighs and legs.

Question 21

What is the dose and route for morphine?

Answer 21

10mg IM

Question 22

What type of medication is morphine?

Answer 22

Opioid analgesic

Question 23

How long does it take morphine to work and how long does it last?

Answer 23

15 mins to work.

Lasts up to 4 hours.

Question 24

Morphine shouldn’t be given within how many hours of birth and why?

Answer 24

Should not be given within 4hrs of birth as it crosses the placenta and is a large dose for the fetus - could cause respiratory distress.

Question 25

When is morphine useful?

Answer 25

• Spurious labour
• OP positions
• Very tired women starting labour

Question 26

How long does it take for N2O to work?

Answer 26

Takes 45 secs to work (breathe it in at the very beginning of a contraction), and wears off quickly.

“Take 3 really deep breaths and keep the mouthpiece in your mouth to breathe out. As you feel the contraction fading breathe some fresh air.”

50/50 N20/02

Question 27

What are some example of non-medicinal pain relief?

Answer 27

• Shower
• Bath
• Hot packs
• Massage
• Distraction
• Water injections
• 1 to 1 support

Question 28

What is the name of the equipment that N20 and O2 goes through?

Answer 28

Entonox - the equipment it goes through.

Question 29

What are some of the ways women may feel when using gas and air?

Answer 29

May take the edge off, more relaxed, others something to focus on.
Some feel very sick and dizzy.

Question 30

Example exam question - “Adewale is in labour. What care and strategies could you put in place to help fulfil Adewale’s hopes of having a normal vaginal birth?”

Answer 30

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Question 31

Example exam question - “Adewale has been in labour for 8 hours and is finding it hard to cope with the intensity of her contractions, which are every 2-3 minutes and lasting 60 seconds. Detail the non-pharmacological options you can offer her.”

Answer 31

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