Care of 2nd stage labour

Question 1

What are the aims for providing care?

Answer 1

protecting and promoting physiological processes
Preventing complications
positive experiences for mother
detecting deviation from normal and referral when needed.

Question 2

What are the principles of care in the 2nd stage?

Answer 2

Maternal observations
Fetal observations
labour is progressing

Question 3

What are the maternal observation in 2nd stage labour?

Answer 3

Timing contractions every 30 minutes for 10 minutes
Continue; temp, Pulse, Blood pressure, respiration rate
verbal and non verbal communication

Question 4

Wha are the fetal observations in 2nd stage labour?

Answer 4

fetal heart rare every 5 minutes following a contraction

Question 5

What do you do if no obvious signs of progressing labour?

Answer 5

decent, rotation and flexion of the presenting part by performing a VE as per guideline consent

Question 6

What are the observations for second stage labour?

Answer 6

temp 4 hourly 
pulse every 15 min
BP hourly
abdominal palpation to access decent and progress 
assess per vaginum discharge
encourage regular bladder emptying

Question 7

What is the passive stage of stage 2?

Answer 7

full dilation of the cervix in the absence on involuntary explosive contractions

Question 8

What is the active stage of stage 2 labour?

Answer 8

the baby is visible, expulsive contractions with a finding a full dilatation of other signs of full dilatation

Question 9

What is the definition of second stage delay in nulliparous women?

Answer 9

progress of decent of the presenting part is inadequate after 1 hour of active second stage

Question 10

What is the definition of delay of second stage labour delay in multiparous wmone?

Answer 10

progress of descent of the presenting part is inadequate after 30 minutes of active second stage

Question 11

What is the semi- recumbent position?

Answer 11

supported sitting, most common reduces pelvic outlet

Question 12

describe left lateral position

Answer 12

if unable to abduct their hips, or if epidural in use

Question 13

describe upright positions

Answer 13

squatting, kneeling, all fours, standing, using birthing ball

reduces second stage, fewer assisted births, fewer episiotomies, reduced pain in 2nd stage

Question 14

describe lying flat on your back

Answer 14

increased risk of hypertension, reduce placental perfusion and fetal oxygenation, reduced uterine contractions

Question 15

describe the birth of the head

Answer 15

swabbing perineum
covering anus with clean pad
unhurried active phase to safeguard the perineum
once the head has crowned, gently blowing with contractions to minimise active pushing

Question 16

Why do you not check for the chord when the head is born?

Answer 16

causes maternal discomfort distraction: would cause delayed contraction
stopping blood flow to the baby

Question 17

What can you do to untangle to the chord front eh babies neck?

Answer 17

the somersault manoeuvre

Question 18

What do you do with the birth of the shoulder?

Answer 18

hands on the baby’s head covering ears
Gentle downward tracking to assist the birth of anterior shoulder
Oxytocic agent if active management is the choice
gentle upward traction to deliver posterior shoulder
time of birth is noted and recorded

Question 19

What do you do immediately after the birth?

Answer 19

dry baby
start skin to skin
keep mother and baby warm
Facilitate breastfeeding within the first hour

Question 20

When do you clamp the chord?

Answer 20

Mothers preference, inform and allow to choose
Benefits of delayed cord clamping; facilitates adaption to extra utterine life
placental transfusion prevents anaemia in baby