CBL 2_Active Labour and Non-Pharmacological Pain Management Flashcards
Mechanisms of labour for OA?
ROA
1. Babes head enters inlet of pelvis (in transverse diameter – oval to oval)
2. Fetal axis pressure – makes babes head flex (smallest diameter of fetal head presenting)
3. Increased pressure on fetal axis – causes descent of fetus through pelvis
4. Occiput meets resistance of maternal pelvic floor – occipate rotates anteriorly by 1/8 (babe head OA) – but shoulders Do Not rotate
5. Increasing fetal descent, occipate slips beneath suprapubic arch (top of pelvic brim) CROWNING
6. Babes head extends (releases face and chin)- sweep perinium
7. Restitution – fetal head and fetal shoulders re-align – anterior shoulder meets suprabupic arch and 1/8 rotates
9. Anterior shoulder sweeps under the pubic arch and posterior shoulder sweeps under the curve of the pelvis (hollow of the sacrum) = lateral flexion of fetus**BUT NOW RESEARCH IS SAYING POSTERIOR SHOULDER IDK?
Mechanisms of labour for OP?
ROP – long rotation, only difference to ROA is head goes long way around
- Babes head enters inlet of pelvis (similar position of OA)
- Fetal axis pressure – makes babes head flex (smallest diameter of fetal head presenting)
- Increased pressure on fetal axis – causes descent of fetus through pelvis
4.Occiput meets resistance of maternal pelvic floor – occipat rotates anteriorly by 3/8 – and shoulders rotate 2/8 (same misalignment of OA position) - Increasing fetal descent, occiput slips beneath suprapubic arch (top of pelvic brim) CROWNING
- Babes head extends (releases face and chin)- sweep perinium
- Restitution – fetal head and fetal shoulders re-align – anterior shoulder meets suprabupic arch and 1/8 rotates
- Anterior shoulder sweeps under the pubic arch and posterior shoulder sweeps under the curve of the pelvis (hollow of the sacrum) = lateral flexion of fetus
How can we avoid causing iatrogenic hyponatremia? (4)
DRINK PER THIRST
-Isotonic drinks
-Know the symptoms of hyponatremia (Nausea and vomiting)
-Have standards in place on fluid intake in labour
What are heightened levels of fear associated with in birth?(7)
- C/S
- Epidural
- Neg birth exp
- Neg prenatal exp
- Neg pp exp
- Less confidence as a parent pp
- nreased anxiety
What is the midwife’s role with fear and birth?
● Address client beliefs, attitudes, and previous experiences to foster feelings of autonomy and reduced anxiety
● Prenatal discussions
● Providers who do not value vaginal birth, and who seem to make decisions based on fear instead of evidence, are associated with higher cesarean rates for clients
Can hyponatremia occur in the absence of IV fluids?
Yes sometimes
Key factors to support physiological first stage? (4 Ps)
- Power
- Passenger
- Passage
- Psyche
(POSITION)
How do we support Power?
- INCREASE NATURAL OXY - safe environment
- Dim lighting, minimal sounds, with limited disturbances and strangers.
- Foster a sense of safety – whatever that means to them.
How do we support Passenger?
- Movement and position changes can assist the contractions in positioning the fetus through the pelvis
- Some examples: side-lying release, lunges, sitting on toilet with one foot on stool and the other foot on the floor, and continuing to move during a contraction without “freezing” the body with tension
How do we support the Passage?
Empty bladder
Opren the pelvis - squatting, kneeling, hands and knees
Support intuitive positioning - don’t boss client around
How do we support the psyche?
- The emotional wellbeing of the birthing person relates to labour progress
- Fear and anxiety produce beta-endorphins, adrenocorticotropic hormone, cortisol, and epinephrine (stress hormones)
- These hormones act on the uterus’s smooth muscle causing decreased blood flow resulting in contractions to become weaker, shorter, and further apart which can also impact dilation progress (4).
- Continuous support i
- safety
- music, aromatherapy, encouragement
Routine care for active 1st stage? (4)
● Assess birther and fetal well-being
● Monitor progress of labour
● Offering support /recommendations for non-pharmacological pain management
● Facilitating access to pharmacological pain management when requested/ appropriate
How often birther vital measured in active first stage?
Every 4 hours (BP, temp, HR, RR)
Is high HR common in labour?
Yes, but we don’t want it persistently above 100 – that’s tachy.
How often FHS in active 1st stage?
Every 15 min – 30 mins
When extra FHS in active 1st stage? (6)
- Before meds
- Before and after AROM
- After SROM
- Before and after VE
- Before starting epidural
- concerning reading
What should we observe about the birther in labour? (4)
●Coping/pain
●Emotions
●Energy/fatigue
●Fluid intake and output
Cervical dilation rates for active first stage (Zhang et al)?
0.1 cm hour to 2.4 cm hour
When does active labour occur SOGC?
3-4 nulip
4-5 multip
AND cervical length 1 cm
(not evidence based cummon SOGC)
What does active labour look like?
-Regular, intense contractions
-Progressive cervical change
-Stopping to focus on contractions
When does active labour occur ACOG and SMFM?
6 cm dilation
What are we always assessing in labour?
1- Maternal condition and coping
2- Fetal condition
3-labour status
What does the evidence tell us about going to the hospital too soon in labour?
Avoid early admission when not in active labour – because it will lead to more interventions
How often should someone be drinking in labour?
As per thirst
