Birth Chat Flashcards
Where to have your baby
Very limited in Plymouth - we don’t have any freestanding midwifery led units or birth centres.
Options are - hospital (consultant led unit) or home birth
can choose to have a pool birth in hospital, do not have to get on the bed can use the room as your own.
Hospital/ birth centre visit
There’s a tour on the maternity hospital website of the labour ward if you wanted to see the outlay of the ward, our labour ward is on level 4 just past triage, use the same entrance to triage.
What to bring?
something comfortable to wear during labour
Something to put on after labour
Toiletries shower gel etc
Flip flops
large pants
Pads
an outfit and hat for baby, and some spare changes of clothes.
Nappies
sugary snacks and drinks for labour
top for partner
Signs of labour?
Contractions - contracting 3/10 lasting 60 seconds. These will start of irregular May feel like back ache and move round to your tummy become stronger and more regular may take up to 24 hours for this to happen.
Waters breaking - pop a pad in and call triage, unless waters a greeny/brown colour then come straight in. would like to monitor baby more closely (swallow meconium can cause problems with breathing with they take there first breath) don’t want to prolong labour, can be a gush or trickle.
Inducing labour - methods used
Stretch and sweep - separates the bag of waters from the wall of the cervix and stimulates prostaglandins which can bring on contractions needed to ripen and dilate the cervix.
propess - looks like a small tampon inserted behind the cervix, releases prostaglandins to ripen and dilate the cervix, so that we can break the waters. Involves a vaginal examination, can cause bleeding and discomfort, pains like period pains. Reviewed after 24 hours involves a second vaginal examination to see if cervix is progressing, can then be put back in for another 6 hours.
Cook balloons - applies pressure to the cervix to release prostaglandins to ripen and dilate the cervix.
Might not need the propess due to cervix ripening on its own, cervix begins as a long hard tube, posterior, we need it to shorten dilate and come forward.
Awaiting CDS
Amniotomy - use something called an amniohook to break the bag of waters your baby is sat in, can help to speed up the labour process, sterile procedure as can increase the risk of infection, doesn’t hurt the baby.
Oxytocin infusion - this is a synthetic form of a naturally produced hormone that contracts the uterus, (brings on labour contractions) the uterus then causes the baby to push on the cervix and ripens and dilates the cervix.
Assessment during labour - of progress
We measure progress mainly through VE’s - offer them 4 hourly and in the first stage and hourly in the second stage, look for:
dilation 4cm established labour - 10cm (fully)
Effacement (from a long hard tube to thin and stretchy)
Position - moved central
Station - measured in relation to the fetal head and ischial spines in the pelvis - the further the fetal head moves away from the ischial spines the further labour is progressing.
Your choice to accept/ decline these
Physical signs - change in behaviour tend to generally sound different when in the second stage of labour.
Bearing down overwhelming urge to push
Anal cleft line - purplish line extending from the buttocks
Rhombus of Michaelis - wedge shaped area of bone on your back that moves backwards during the second stage of labour making it more prominent.
Assessment during labour - fetal monitoring
Listen in to FHR every 15 minutes during the first stage of labour and every 5 minutes during the second stage of labour.
Will either be using intermittent auscultation using a Doppler the same as in community for one minute, or if indicated a continuous monitoring, two monitors on your tummy one measures babies heart rate and one measures contractions, will be strapped on using fabric belts, able to move around whilst on the CTG. Gives us a continuous trace of babies heart rate.
If we’re struggling to pick up babies heart rate using the CTG as sometimes they like to wriggle around, we will offer to measure their heart rate using a fetal scalp electrode - this is essentially a spiral wire that can be attached to babies scalp, it doesn’t hurt the baby it may just cause a minor Knick or scratch to top of babies head. this involves a vaginal examination to apply.
Pain relief
Encourage you to take paracetamol during the very early stages of labour and a hot bath can help, the same way they help with period cramps.
Can rent a tens machine from the children’s centre for a small fee - reduce the pain signals going to spinal cord and brain which may help relive pain and relax muscles.
Entonox - takes seconds to get in and seconds to get out of your system, so if you don’t get along with it can just stop using it, takes you away from the pain. Can use as much as you want.
Injections (diamorphine) - given into the leg, takes about 20 minutes to kick in, strong form of pain relief, we give it with an anti emetic as can make you feel quite sick, if we think your labour is progressing quickly we may suggest carrying out a vaginal examination before giving it to check progress, as we don’t want to give it to close to birth as this can make baby sleepy, and mean they may require oxygen to help them breath. Have to wait 2 hours between doses and can have a maximum of two doses, if having a pool birth have to wait two hours after having it before getting back in the pool and have to get out the pool to have it.
Epidural/spinal - spinal is an injection of local anaesthetic into your back which numbs you from the waist down, last approx 2-3 hours so may require a couple of those injections.
Epidural involves an injection to numb the area in your back, and then insertion of a small tube which continuously releases pain relief, and you have control over this have a button to top up when necessary, goes green when you can top this up.
With these will require a catheter to be put in as won’t be able to get up and go to the toilet as won’t be able to feel your legs.
Types of birth
C section - there are times when a c section is the safest option if we have concerns for yourself or baby, such as if baby is distressed or labour is prolonged, c section involves delivering your baby through a cut in your abdomen, usually below the bikini line, you will usually be awake for this and given an epidural prior to surgery.
Instrumental delivery - extra help may be needed if you have already progressed to pushing but the delivery needs to be speeded up, ventouse uses a suction cup which is placed on the top of babies head and forceps are spoon shaped instruments placed around babies head, you push whilst we pull, can cause some bruising, swelling or marks to babies head.
Vaginal delivery - where you would deliver through pushing your baby out through the vaginal birth canal.
Water birth - deliver in the pool, we will do a hands off approach, recommend baby stays under water whilst your pushing as when they come out of the water they take their first breath, will need to get out of the pool to deliver placenta. natural way to adopt an upright and active position. natural form of pain relief, calming and beautiful.
VBAC -
If you have had one Caesarean section in the past you gave a good chance 75% of having a vaginal birth this time, we will monitor you more closely to make sure the scar on your uterus doesn’t tear, if you have had more than one c section your consultant will discuss with you the safest option for delivery, can opt to have another section after having a previous section.
Perineum
The perineum the area between vagina and anus stretches to allow baby to be delivered, it usually stretches well but sometimes may tear and you may require stitches post birth.
Can reduce your chances of this by doing perineal massages with natural oils, massaging the area.
An episiotomy is a cut to make the vaginal opening larger, it is not done routinely but may be necessary to avoid a larger more damaging tear as they are easier to repair, or to speed up birth if baby becomes distressed or at the time of an instrumental delivery. Will be given a local anaesthetic so that you don’t feel the cut, or epidural can be topped up, this will also require stitches (these are dissolvable)
Delivery of the placenta
Active management - offer an oxytocin Injection in your thigh which helps the uterus to contract and reduces your chance of heavy bleeding, we use routine axial traction to deliver the placenta.
Physiological management - can decline active management and have physiological management where you don’t have the injection and we don’t touch the placenta we let it deliver on its own, there may be times where we carry out physiological management but then decide active management is needed for example if you were to to start heavily bleeding.
Delayed cord clamping - routinely carry out delayed cord clamping so we wait at least one minute or until the umbilical cord stops pulsating to cut the cord, this decreases the chance of anaemia for the baby, the chances of baby needing a blood transfusion, and increases RBC.
