9: Failure to progress 2nd stage Flashcards
if mom stops having UCs in 2nd stage concerned about…
uterine atony, possibly leading to hemorrhage
Resting phase
let her rest! until urge to push
May appear physiologically ready but isn’t emotionally/
If she doesnt have it, Urge can be stimulated by
pressing on pos wall of vagina at 4 and 8 o’clock
sitting on birth chair
squatting–if at +1 or lower station
Premature pushing…dont do it because:
cervix can swell! change her position to decrease pressure and urge
can deoxygenate the baby
can overstretch the ligaments that support the baby
Anterior lip
Means she isn’t fully dilated yet!
If its a lateral lips, likely means asynclitic presentation
Anterior lip management
Position changes; mom lies on back and rolls on side between UCs
exaggerated crawling
hot bath
Arnica, Lobelia, Gelsemium
Factors affecting length of second stage
Strength and coordination of contractions
Strength of mom’s pushing
Resistance of lower birth canal outlet or rigid perineum
[normally CPD will arrest in 1st stage, but could be full bladder/rectum]
Size, presentation, position of presenting part
[malpres, macrosomia/big head, asynclitic]
If things are going slow, augment:
Eval UCs
O2 if she is SOB
Coach pushing after 1 hr, process emotions
Evaluate for CPD
Position changes every ___ if no progress
Half hour
Positions to try!
Semi reclined Side lying Birth chair-tuck coccyx don't arch back Squatting-tiring, increase change of tear Hands and knees-if macrosomia, mom goes here anyway Kneeling Standing Up and down stairs Pelvic rocks Internal Pressure
Symphysiotomy
Surgical division of symphysis pubis
:o
Risks of delivering with full bladder
Obstruction of presenting part during pushing
Obstruction of uterus in clamping down after placenal delivery [may cause uterine atony –>hemorrhage]
Increase chance of injury to bladder
Rigid perineum management
(Issue once baby at +4)
prenatal massage: at 4 and 8 oclock; may not prevent laceration but will help mom deal with stretching/buring feeling
Hot packs: during 2nd stage to increase blood supply and relax muscles
Vaginal massage (but not too much, tissue is weak)
Gelsemium and Lobelia botanicals
Ritgen maneuver
Way to manage rigid perineum
Double glove hand, insert into rectum and hook chin of baby
Drag out as asst flexes and delivers head
Transport if:
fetal distress! bleeding! >2hrs of pushing sans progress mom wants to high BP maternal fever of unknown origin
