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MIDW 230 > CBL 5_Waterbirth, Precipitous Birth, Newborn Dermatitis > Flashcards

CBL 5_Waterbirth, Precipitous Birth, Newborn Dermatitis Flashcards

1
Q

What drugs activate G1?

A

Miso and ergonovine

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2
Q

What does receptor that oxytocin binds to activate?

A

Gq

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3
Q

What drugs can compliment each other in a PPH?

A

Drugs that have different mechanisms ie (miso/ergonovine with oxy)

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4
Q

Are the numbers of homebirths with midwives increasing or decreasing in BC?

A

Decreasing.

15 % 2017
Less than 10 % now

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5
Q

What is the recommendation on HB for low-risk multips?

A

Planning to give birth at home or in a midwifery led unit (freestanding or alongside) is particularly suitable for them:

the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit

(seems a bit preachy ICD obvi needs to include birther preference)

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6
Q

How is a precip birth defined?

A

Less than 3 hours from regular cx

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7
Q

What is a theory about why precip birth happens?(3)

A

Theories:
* abnormally low resistance of the soft pass of birth canal,
* abnormally strong uterine and abdominal contractions
* rarely from the absence of painful sensations.

Under-studied

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8
Q

What do we know about precip birth?

A

One study - Precipitous labor was associated with some maternal complications including:

perineal lacerations
PPH
retained placenta
hemotransfusion
prolonged hospitalization.

Other study did NOT find associated complications.

PL NOT well studied nor well understood!

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9
Q

What recommendations would you give for someone with a hx of precip birth? (3)

A

Active management of 3rd stage
Call as soon as it might be labour!
Explore previous experience – how did she feel during/after birth?

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10
Q

Prep for hx of precip birth?

A
  • plastic or other protection for furniture/bed, blanket/towels for baby & Grace, bin for placenta – all of this in a corner in the room with instructions for partner
  • pager #
  • when to call 911 (if RM not present and delivery imminent)
  • having two phones if possible (911/RM)
  • focus on keeping baby skin to skin
  • blanket/towel for warmth
  • Warn them 911 will emphasize tying off cord but this is not important- more important to keep babe skin to skin and warm
  • If possible they should have two phones ready –one for 911 and one for continuing to talk to RM en route
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11
Q

What are your priorities for setup on arrival of precip HB?

A
  • Assess FHR first
  • client condition
  • let 2nd know/alert hospital
  • then set up for HB (esp oxy and NRP station)
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12
Q

Should VEs be routine for arrival at precip birth?

A

discuss reasons to do or NOT do VE at this time. It should NOT be done as a routine but for indication

Main indication in precip - position.

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13
Q

Evidence on waterbirth? (3)

A
  • may reduce the number of women having an epidural.
  • Does not appear to affect mode of birth
  • Does not effect number of women having a serious perineal tear.

=No evidence that labouring in water increases the risk of an adverse outcome for women or their newborns.

The trials varied in quality and further research is needed particularly for waterbirth and its use in birth settings outside hospital & about women’s and caregivers experiences of labour and birth in water.

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14
Q

What should client’s prepare for water birth?(5)

A
  • a pool that can be filled with water deep enough to cover your belly but not your neck
  • a reliable supply of hot water
  • space around the pool
  • a floor able to support the weight of a full pool of water
  • a nearby safe alternative space for birthing out of water if needed
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15
Q

Are there additional risks for waterbirth with GBS +?

A

No, esp w/ admin of abx

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16
Q

What are RM responsibilities for waterbirth?

A
  • Screening for low risk
  • Fetal monitoring
  • Clean and good temp
  • Avoid unnecessary fiddling in birth (try to be hands off but evidence is inconclusive)
  • Keep nb warm and dry after
  • Prepared with a plan to evacuate pool in case of emergency
  • Keeping babe’s head under water till fully born
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17
Q

Hands off or hands on for waterbirth?

A

HANDS OFF
(but evidence not clear)

Worry is hands on might stimulate breathing

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18
Q

What is the concern with hands on with NB breathing and waterbirth?

A

Sensory stimuli is one of the stimulis for breathing

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19
Q

What stimulates breathing in the nb?(3)

A
  • Chemical stimuli (elevated Carbon dioxide/ CO2 levels which occurs as part of normal birth process)
  • Thermal stimuli (decrease in ambient temperature.. Contact with cooler air)
  • Sensory stimuli (touch, sound)
20
Q

Do babies start breathing under water in waterbirth?

A

No

21
Q

Why don’t babies start breathing under water in normal birth for waterbirth?(4)

A
  • N labor = reduced fetal breathing movements
  • Ambient water & hands off = reduced sensory stimuli
  • hypotonic water vs hypertonic lung fluid prevents water entering lungs
  • dive reflex = closed glottis
22
Q

What should you do with waterbirth baby when born?

A

‘assisting’ : some midwives bring babe right to chest, others do slow/partial emergence with only head kept above water

If baby brought to the surface immediately:

face down to allow water drain away

Care NOT to pull on umbilical cord (cord avulsion)

23
Q

Active mgmt. for third stage with precip?

A

Yes recommended but research not consistent that precip =higher risk

24
Q

Is placenta birthed in water or out of water in waterbirth?

A

Many RMs recommend but not great evidence supporting one or the other

Can stay in or out, but things to consider are fetal warmth and assessing blood loss.

25
Q

If a parent calls with rash around nb bum what would you include in the triage?

A

Determine if it’s simple dd or due to candida or bacterial infection ie staph

Ask about location?
Look?
Hurts on touch or always?

26
Q

Candida dd treatment?

A

Common in first months

Tx:

eliminating impervious diaper covers
changing diapers frequently
leaving diapers off for long periods of time.

Topical antifungal (ex. miconazole) therapy is also recommended.

27
Q

Info on thrush?

A

IFF oral thrush – Nystatin, not fluconazole

Oropharyngeal candidiasis (thrush) may start as early as seven days after birth

5-10 % of bbs

Response to antifungal agents is usually good in neonates with no major underlying condition, but a prolonged course may be required and recurrences are common.

Colonization of the mother’s nipples in breastfed infants should be considered as a potential mode of transmission.

Use of an infant soother increases the incidence of thrush and may make treatment less effective, unless the soother is washed carefully after use

Patients with severe or recurrent thrush should be investigated for congenital or acquired immune deficiency.

The usual dosage of nystatin is highly effective, curing 80% of newborns after 2 weeks of treatment.

It should be administered after feeds.

28
Q

Should fluconazole be first line treatment of thrush?

A

Fluconazole is effective,
but it is not recommended for first-line management of thrush in immune-competent children

  • limited paediatric data
  • potentially significant adverse effects
  • higher cost
  • risk for promoting antifungal resistance
29
Q

What measures would you advise so to avoid re-infection of yeast? (7)

A
  • Wash hands before and after feedings & diaper changes. (reg soap or hand san)
  • Rinse nipples with plain water and air dry after feeds.
  • Wash bras, cloth breast pads and diapers in very hot water and dry well in hot drying or sunlight.
  • Items such as bottles, bottle nipples, soothers should be boiled continuously for 20 minutes every day.
  • Wash baby’s hands/soother often if he sucks on them.
  • If your baby has diaper rash, wash well with water, air dry and apply antifungal ointment at each change.
  • Discard any extra milk which is pumped during a yeast infection and is not used within a day. Saved milk that contains yeast may re-infect your baby.
30
Q

What can be a cause of yeast?

A

Poor latch and cracked nipples – nice home for yeast

31
Q

Simple diaper dermatitis looks like?

A

flat, reddened areas
minimal skinfold involvement
painful when touched

32
Q

Candida dd looks like?

A

raised and blotchy
satellite lesions
painful even when not touched

33
Q

Infection dd looks like?

A

peeling skin, vesicles

34
Q

Water birth maternal benefits?(7)

A
  • mat satisfaction
  • Decreased need analgesia
  • Shorter labour
  • Reduction of BP
  • Increased relaxation
  • Greater range of motion
  • Increased liklihood of intact peri

Risks: none for low risk birthers

35
Q

Waterbirth nb benefits?

A

Potentially a gentler entrance

36
Q

Waterbirth nb risks? (5)

A

(Evidence quality poor)
Infection
Umb cord rupture
Water asp
Resp distress
Hyponatremia

37
Q

Waterbirth coles notes for ICD? (3)

A

-Evidence on risk/benefit to nb is unclear
-evidence suggesting benefit to birther
-can be supported with informed choice

38
Q

Inclusion criteria prenatally and in birth for waterbirth?(4)

A

Uncomplicated term preg
Active labour
Normal VS
Normal FHR

39
Q

Exclusion criteria for labour and waterbirth? (4)

A

-medical condition effecting ease of mobility
-Epidural
-opioids within 3 hours
-confirmed maternal infection

40
Q

Exclusion criteria for birth waterbirth? (7)

A

-medical condition effecting ease of mobility
-epidural
-opioids within 24 hours
-confirmed mat infection
-mat SSRIs
-Mec Stained fluid
-Risk factos: history of PPH, big fibroids, unengaged head

41
Q

WB eligibility?

A

Low risk, uncomplicated pregnancy - 37+GA
Cephalic presentation
Ability to enter, exit tub
Active labour >4cm
N VS, N FHS

42
Q

Waterbirth exclusion (BCW)?

A

Reduced mobility, pre-preg BMI >35
Epidural; opioids within 3 hours
Maternal infection (respiratory, gastro, blood-borne)
Colonized with abx-resistant organisms (ARO - ex: MRSA, VRE, CPO, MDRO)
Skin lesions suggestive of VZH/HSV, active skin/soft tissue infection
Suspected cases of ARO, other communicable diseases
No agreement from care attendants/providers
Atypical or abnormal FHR
*GBS+ or ROM do not exclude

43
Q

Must have for waterbirth at BCW?

A

(These vary from community to community)

Clear amniotic fluid
Absence of obs risk
No opioid analgesia in last 6 hours
No medications during pregnancy or labour that may impact NB respiratory effort (ex: SSRIs)

44
Q

Temp of birth pool?

A

Water temp: 36.6-37.5, not exceed 38
BUT IRL feel with your hand

Assess birther temp every 30 min
If above 37.5 on 2 occasions, must exit water

45
Q

APGARs for waterbirth?

A

1 min APGARS starts when NB is exposed to air

46
Q

Risks of WB?

A

Q
Risks of waterbirth?

A
-0.4% vs 0.1% risk of cord avulsion
Use of water immersion in early labour may slow progress and reduce strength of ctx
With improper care
NB aspiration
Mat temp instability
Injury manouveuring in and out of water
NB temp instability
Infection
delayed/missed response to PPH
Suturing complications

MIDW 230 (13 decks)

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