2: Normal labour and peurperium Flashcards
What is a birth plan?
Note of what the woman wants re: labour and post birth
Is a woman required to have a birth plan?
No
Which hormones
a) encourage
b) discourage
uterine contractions?
a) Oestrogen, oxytocin
b) Progesterone
Which chemicals are released in response to oxytocin, inducing labour?
Prostaglandins
Stretch of the uterine muscles increases their excitability.
What can therefore trigger labour?
Growth of baby
Multiple pregnancy
What is the Ferguson reflex?
Oxytocin release in response to cervical stretch
Encouraging uterine contractions and childbirth
Which two hormones trigger prostaglandin formation?
Oestrogen
Oxytocin
Which reflex causes oxytocin release in response to the stretching of uterine / cervical muscle?
Ferguson’s reflex
What ruptures at the beginning of labour?
Amniotic sac
“floods” of amniotic fluid
What is membrane rupture also known as?
Water break
When can membrane rupture occur?
Pre-labour (as intended)
Pre-term (bad)
Or baby can be born “in a caul” i.e still in the amniotic sac
What happens to the cervix as labour progresses?
Softens and dilates
What score is used to determine whether or not a medical induction of labour will be required?
Bishop score
What type of labour is advised if a woman’s Bishop score is high?
Spontaneous labour
What type of labour is advised if a woman’s Bishop score is low?
Medical induction of labour
manual membrane rupture –> oxytocin
How many stages of labour are there?
Three stages
As labour progresses, the ___ dilates until expulsion occurs.
cervix dilates
How long does labour last on average?
Around 10 hours
What diameter does the cervix contract to in the first stage of labour?
3cm
What diameter describes complete dilatation of the cervix?
10cm
In which stage of labour is the baby actually delivered?
Third stage
How long does the third stage of labour last?
10 minutes
After how long in the third stage of labour would you consider a caesarean section?
1 hour
What is the medical name for false labour contractions?
Braxton-Hicks contractions
When do Braxton-Hicks contractions occur?
Third trimester
What increases a woman’s chances of having Braxton-Hicks contractions?
Multiparity
Which hormone is primarily responsible for true labour contractions?
Oxytocin
Describe true labour contractions.
Regular rhythm
Duration = 10 - 45s
Frequency = 1 - 4 / 10 mins
Gradually shortening intervals
Painful
What is the purpose of labour contractions?
Pushes baby down into the pelvis ready for delivery
The power of uterine contractions is dependent on what?
Uterine muscles
How do true labour contractions change over time?
More frequent
Longer duration
Greater power
The shape of a woman’s ___ will influence the success of natural birth.
pelvis
What bony features can be felt on vaginal examination to figure out the lie and presentation of a baby?
Sutures
Fontanelles
What therapy do many women require during labour?
Analgesia
What analgesic drugs are used in labour?
Paracetamol
Co-codamol
progressing to diamorphine (which is heroin)
What surgical methods of analgesia can be used in labour?
Spinal / Epidural anaesthesia
Pudendal nerve block
What gas can be used to temporarily reduce labour pain?
Entonox
‘laughing gas’
What is an important effect of spinal anaesthesia re: labour?
Woman can’t push (contractions still present but numb)
Numb from the waist down (so woman can’t walk about)
What are the seven cardinal movements of labour?
Engagement
Descent
Internal rotation of head
Flexion of head
Crowning and extension of head
Restitution (external rotation of head back in line with body)
Expulsion (release of both shoulders with careful maneouvres)
What is engagement?
Widest part of presenting part descends below pelvic inlet
How many fifths of the foetal head needs to pass beneath the pelvic inlet to be described as engaged?
3/5ths
Why is the baby’s head externally rotated during engagement?
So shortest head diameter (biparietal diameter) and can fit through largest pelvic diameter (anteroposterior diameter) during descent
Why does the baby flex its head during an occipito-anterior birth?
Smallest possible diameter
Does the rotation of the body change during birth?
No
It’s all head movements
How long after birth should the umbilical cord be clamped and cut?
Why?
3 - 5 minutes
Allows continued transfer of blood between mother and foetus
What sort of contact improves bonding and breastfeeding success after birth?
Skin-to-skin contact
How long after birth is the placenta expelled on average?
5 - 10 mins
Which drug is often given during the third stage of pregnancy to encourage expulsion of the placenta?
Oxytocin
Which hormones are responsible for the production and expulsion of breast milk?
Production - prolactin
Expulsion - oxytocin
What is a mother’s first breast milk called?
What’s special about it?
Colostrum
Contains very little fat and loads of immunoglobulins
