failure to progress in 2nd stage

Question 1

how can you stimulate ferguson’s reflex

Answer 1

press on posterior wall of vagina at 4 and 8 o’clock
sitting in birth chair if baby is high
squatting if at a 1+ or lower

Question 2

reasons to not push before complete dilation

Answer 2

can cause cervix to swell causing a decrease in dilation
causes the intrauterine pressure to rise decreasing fetal oxygenation
can overstretch ligaments supporting fetus

Question 3

how to reduce an anterior lip

Answer 3

lift cervix up over head at beginning of contraction before mom starts pushing
massaging the lip
position changes
mom lies on back and rolls side to side between or during contraction
exaggerated crawling
hot bath
arnica 200c

Question 4

factors affecting length and degree of ease of 2nd stage

Answer 4

strength and coordination of contractions
strength and ability of mom’s pushing effort
resistance of lower birth canal (outlet contraction or rigid perineum)
size, presentation, and position of presenting part

Question 5

how to evaluate maternal pushing effort

Answer 5

a. Try to let her figure out what works for her on her own
b. If she doesn’t get it in 30-60 minutes coach her
c. Deal with emotional issues-fear of pain, tearing, being a mother, image issues, disturbance from someone in birth room, victim survival patterns
d. Evaluate progress internally during contractions
e. Pushing with held breath gives the diaphragm resistance to push against and increases power. The disadvantage is it decreases oxygen to the baby and mom
f. Most primips need the added power, some multips can get baby out without holding breath
g. If she’s been pushing in water try getting out of tub to add gravity to power
h. Try pushing on toilet
i. As a last resort, consider vacuum extractor once presenting part is at +2 to add to maternal effort

Question 6

evaluate for CPD

Answer 6

malpresentation
asynclitism
big baby
outlet contracture
tight pelvic floor

Question 7

there is an increased chance of tearing with which position

Answer 7

squatting

bring mom back up onto chair or forward onto hands and knees right before crowning to deliver head

Question 8

what is the best position for shoulder dystocia

Answer 8

hands and knees

Question 9

other ideas for opening up pelvis so head can descend

Answer 9

position changes every 1/2 hour
go up and down stairs
pelvic rocks and wiggling during contractions
pressure b.l on sacral alas to open pelvic girdle in front
pressure internally b/l on ischial tuberosities
encourage frequent urination

Question 10

risks of delivering with a full bladder

Answer 10

1. Obstruction of presenting part during pushing
2. Obstruction of uterus in clamping down after placental delivery-possible cause of uterine atony causing PPH 3. Increases chance of injury to bladder

Question 11

ideas of there is a rigid perineum once baby is at +4 or crowning

Answer 11

perineal massage (prevention)
hot packs applied during 2nd stage
vaginal massage (start when +2 or +3 station)
gelsemium- unyielding, hard ring at introitus
lobelia- perineal and vaginal rigidity
pumping the vagina
ritgen maneuver- insert gloved finger into rectum and hook chin of baby

Question 12

when to transport

Answer 12

a. Fetal distress or serious bleeding which doesn’t respond to treatment and there is time to transport
b. Longer than 2 hours of pushing and no progress
c. Mom gives up and wants to transport
d. Maternal problems-high BP or fever