Chapter 6 - Part 2 Flashcards
How does labour begin?
Labor may begin in a variety of ways
Small amount of “Bloody show” as cervix begins to efface (thin) and dilate
Amniotic sac may rupture
-May or may not bring on contractions right away
Mucous plug may be lost weeks before labour begins
- May be accompanied by bloody show
- mucous and blood
What is Parturition?
whole process of childbirth Labour -Effacement -Dilation -Transition
Birth
- Dilation,
- Pushing,
- Delivery of the baby,
- Delivery of the
What is effacement?
Thinning out of the cervix during labor
- expressed as %
- happens before dilation
What do we say when baby is -3, 0, +3?
- -3 head is above spine of mom
- 0 making way down birth canal
- +3 crowning
What does the first stage of labour look like in terms of dilation?
dilation from 0-10 centimetres
Dilation/Dilatation
0-7 centimeter
What are the characteristics of the transition phase?
7 – 10 centimetres (the last phase of dilation)
10 centimeters is complete dilation
At the end of transition the woman can begin pushing with her contractions
What is the transition phase?
A time when a woman delivering needs a lot of support and encouragement
Birth partner and other team members may also feel tired and vulnerable
How to provide physical and emotional care
Questions about “how much longer”?
What are contractions like in the transition phase?
During transition
contractions are stronger, come closer together and last longer;
contractions every 2-3 minutes, lasting 90 seconds.
This is the most intense stage of labor, but it is also usually the shortest.
What is a doula ?
Not a clinical care giver
Informational support and planning during pregnancy
-Birth Plan
Emotional and physical support during labor
Post-partum support
- Breast-feeding
- Emotional support
What is a midwife?
Primary clinical care provider
Normal pregnancy
Provides care throughout the entire process
- pregnancy
- birth
- post partum
What is the second stage of labour?
The pushing stage
Begins when cervix is fully dilated (10 centimetres)
-Bulging of the perineum
Urge to push or bear down
-May not occur if medicated (epidural)
Crowning
-top of the head is visible
Baby is born during stage 2
What is an episiotomy?
Episiotomy may be performed
- incision that is
sometimes made at the vaginal entrance during birth
How long can pushing take for the first child?
Up to 2 hours
What is the 3rd stage of labour?
Placenta detaches from walls of the uterus
Afterbirth (placenta) is expelled
Several contractions may
accompany placental expulsion
-Afterpains more intense with subsequent pregnancies
Episiotomy and tears are sewn up
How do we know there is no placenta left in the uterus?
Placenta is examined for completeness
What is Lamaze technique?
Use of breathing to relax and assist in natural childbirth
What are pain relief options for hospital birth?
Hypnotherapy,
-Hydrotherapy, Manual Therapy, Props (birthing ball)
Demerol
Local anesthesia
Regional anesthesia
General Anesthesia
What does local anesthesia do?
!-numbs a painful area
!-may be used after delivery if stitching of the perineum is necessary
What is regional anesthesia?
Regional anesthesia (epidural/spinal anesthesia)
- anesthesiologist administered
- woman remains awake
- reduces pain throughout the birthing process (variability)
- spinal block used for c-section procedures
What is general anesthesia?
- complete/woman is asleep
- used in high risk and emergency procedures
Why are women afraid of labour?
Family of origin
Media
Peers
Myths and Misinformation
Medicalization of childbirth
What is the midwifery model of care?
Principles
- Woman-centred care
- Informed choice
- Continuity of care provider-Choice of birthplace
What is the scope of practice of a midwife?
Collaborate with health professionals
Certification in skills (delivery complications,
resuscitation, treatment of hemorrhages)
Prescribe, administer drugs
Order, interpret tests (blood/urine, ultrasound, neonatal metabolic screening)
Carry emergency equipment
Where can women give birth?
Home birth
-Home births attended by midwives
Birthing centres
-Usually attended by midwives
Hospital birth
-Births attended by MDs, Obstetricians, Midwives
What is a c section?
A method of delivering a baby surgically, by an incision in the abdomen
What are the medical reasons for a c section?
Baby is too large, mother’s pelvis is too small
-Cephalo-pelvic disproportion
Cervix is not dilating after a trial of labour
Umbilical cord prolapses
-Obstetrical emergency
Excessive bleeding
Placenta previa
- Vaginal delivery not possible
- Danger of hemorrhage
What % of babies in Canada are delivered with C section?
28%
Brazil is 90% (due to how its framed)
What is the cultural associations with postpartum?
Postpartum period valued more historically
Cultural associations with the postpartum period where mother recuperates and bonds with/ nourishes child
Modern day associates the word postpartum with depression
What are the physical changes in post partum period?
Hormone levels return to normal
Woman may feel exhausted
Discomfort from episiotomy or perineal tearing/ stitches
What are the psychological changes in post partum period?
Postpartum “blues” or depressed state
What is post Patum depression?
Prolonged depressed state that inhibits daily functioning or caring for self and/or baby
Mild form called “baby blues”
-Associated with hormonal changes after childbirth and with breast feedin
What is the treatment for post partum depression?
Treatment may include counselling; nutrition/vitamin therapy; pharmaceutical anti- depressants
What is Postpartum dysphoria?
Severe form of post partum
Strong self-doubt and loss of confidence in ability to be a mother
Woman envisions harming child and/ or self
Rare condition
Always requires intervention
When should you have sex again after baby?
Couple should wait at least 2-6 weeks before resuming intercourse
What must be completed before sex post baby?
Lochia, bleeding, vaginal discharges must be completed before intercourse to avoid potential infections
Is there pain during sex post baby?
Pain after vaginal delivery
Pain after c section
When can bonding with baby occur?
Bonding cna occur before and after the baby is born
-facilitated by breast-feeding process
What is the critical period of bonding?
Occurs in minutes and hours immediately after birth
What are the chemicals released during breastfeeding?
Prolactin: Stimulates breasts to produce milk
Oxytocin: stimulates breasts to eject milk
