2nd Stage of Labour (W/S 9)

Question 1

What is the definition of the 2nd stage of labour?

Answer 1

From full dilatation of the cervix until the birth of the baby.

Question 2

What needs to be prepared / checked prior to the birth / 2nd stage?

Answer 2

• Warm linen/towels for the baby
• Check access and availability of adult oxygen and suction equipment
• Check and set up the newborn resuscitation equipment
• Prepare and check any medications that will be given
  at the birth
• Have at hand the appropriate protective / infection control items – for example, plastic apron, gloves and goggles if provided in your clinical setting (and prepare the woman for this)
• Birth trolley

Question 3

What are some options for ‘pain relief’ for the perineum?

Answer 3

Gel (e.g. lignocaine) or infiltration (xylocaine).
Note: Infiltrating - changes integrity of skin, fluid in tissues, could tear.

Warm compress.

Question 4

What is needed for the birth trolley?

Answer 4

• Gloves
• Plastic apron
• Forceps for clamping the cord
• Scissors for cutting the cord
• Scissors for an episiotomy
• A plastic cord clamp
• Gauze swabs
• Plastic bowls with warm water
• Linen
• Cord blood collection bottle and heparinised syringes and needles for cord gas collection
• Syringe and needle for oxytocic
• Oxytocic: Syntometrine 1 amp for primips and Syntocinon 10 iu for multips
• (10ml syringe and 20ml lignocaine 1% under trolley)
• (If membranes not ruptured amnihook under trolley)

Question 5

With the birth of the head, what are the hands on steps?

Answer 5

Flex the head
Control the head at crowning
Control gentle extension of the head

Question 6

Following the birth of the head, what are the hands on steps?

Answer 6

Cup head in hands.
Downward traction to release anterior shoulder from beneath the symphysis pubis.
Then gentle upward traction for the posterior shoulder.

Question 7

What to consider / do with nuchal cord

Answer 7

• Loose?
• Tight?
• Several loops?
• Holding shoulder back?
• Clamp and cut?
• Loop over?
• Push over the shoulder?

Question 8

What is the APGAR score and what is it used for?

Answer 8

It describes the condition of the newborn infant immediately after birth and, when properly applied, is a tool for standardised assessment.

Question 9

When is the APGAR score completed?

Answer 9

1 min, 5 mins and 10 mins post birth.

Question 10

What 5 ‘elements’ does the APGAR assess?

Answer 10

A - Appearance / Colour
P - Pulse / Heart Rate
G - Grimace / Reflex Irritability
A - Activity / Muscle Tone
R - Respiratory Effort

Question 11

APGAR: For appearance / colour, what would score a 0, 1 and 2?

Answer 11

0 - blue
1 - blue at extremities, body pink
2 - body and extremities pink all over

Question 12

APGAR: For pulse / heart rate, what would score a 0, 1 and 2?

Answer 12

0 - absent
1 - <100
2- >100

Question 13

APGAR: For grimace / reflex irritability, what would score a 0, 1 and 2?

Answer 13

0 - no response to stimulation
1 - grimace/feeble cry when stimulated
2 - sneeze/cough/pulls away when stimulated

Question 14

APGAR: For activity / muscle tone, what would score a 0, 1 and 2?

Answer 14

0 - none
1 - some flexion
2 - active movement

Question 15

APGAR: For respiratory effort, what would score a 0, 1 and 2?

Answer 15

0 - absent
1 - weak or irregular
2 - strong

Question 16

Exam question example: “Samantha’s baby is born in this condition: pink, blue hands and feet, floppy arms, making a few breathing movements, heart rate 90, slight response when rubbed. What is the baby’s APGAR score?”

Answer 16

A - pink, blue hands and feet = 1
P - 90bpm i.e. <100 = 1
G - slight response when rubbed = 1
A - floppy arms i.e. no muscle tone / activity = 0
R - making a few breathing movements i.e. weak or irregular respiratory effort = 1

APGAR Score = 4

Question 17

What are the 7 mechanisms of labour?

Answer 17

1. Engagement: flexion, descent
2. Further descent, internal rotation (the occiput, being the leading part, meets the resistance of the pelvic floor and rotates forward)
3. Complete rotation, beginning extension
4. Complete extension
5. Restitution
6. Delivery of anterior shoulder
7. Delivery of posterior shoulder

Question 18

Describe restitution

Answer 18

After the head of the baby is born, there is a slight pause in the action of labour. During this pause, the baby must rotate so that his/her face moves from facing the mother’s backbone to facing either of her inner thighs. This movement is called external rotation / restitution. The rotation is necessary as the baby’s shoulders must fit around and under the mother’s pubic bone.