L23: Intrapartum Physiotherapy Management Flashcards
What is the prognosis for vaginal deliveries?
Vaginal deliveries
- Really good –> natural
- Recovery –> good
What are the stages of labour?
Stage 1
Stage 2
Stage 3
What is the 1st stage of labour?
Water has broken but no contractions yet
- Early labour
- Transitional
- Active
What is the 2nd stage of labour?
Pushing
- Don’t want to be pushing for longer than 2 hrs
- Hospitals not more than 3 hrs if they have an epidurals
What is the 3rd stage of labour?
Placenta birth
Baby is born –> cord cut –> waiting for baby to get placenta out Waiting of contraction of uterus again –> clot falls out If it doesn’t –> pull it out If placenta is out –> cord = artery –> can cause bleeding
What are the 3 benefits of relaxation in labour?
- Your body is more efficient
- More energy for 2ndstage labour (Nervous = fatigued)
- Reduce tense muscles (ie. pelvic floor) (While baby is trying to get out of birth canal)
What are 3 characteristics of relaxation in labour?
- Decrease stress –increase in oxytocin (natural pain reliever)
- Decrease stress –increased
- rhythmical breathing.
- Decreased chance of intervention or LSCS (Less risk of forceps or C section)
What are 6 characteristics of pain or fear in the pain cycle?
- Breath holding
- Facial expression
- Tense shoulders/ arms/ fingers/ face
- Vocalisation (Get I cant do this (transiting –> fully dilated to pushing the baby out))
- Lack of support (birth partner)
- Increased pain/fear –Increased perception of pain and reactions Heightened pain
What are 2 characteristics of positive pain when breaking the pain cycle?
- Strong sensations not always bad…..
- Dilating cervix and moving baby down birth canal (hypnobirthing?)
Visualise what is happening + breathing
What are 4 important points of breaking the pain cycle?
- Positive/empowering midwife- Supportive team!
- Rapport with OBGYN- Supportive team!
- Know your body (pain levels)
- Music / lights / massage/ birth partner / birth plan / TENS / water / positioning.
What does the pain-tension-pain cycle look like?
What are 7 types of pain relief during labour?
- Natural –Endorphins (released by body / natural response to pain)
- Massage (sacrum)- Can be taught in antenatal classes
- Obstetric TENS (trial before labour)- Stimulates sensory nerves
- Intracutaneous injections of sterile water (sacrum) Michaeli’s Rhomboid- Works like TENS
- Pethidine
- If its too late for an epidural (as epidural has to be before fully dilated)
- Epidural
- Can’t be fully dilated
- Entonox (gas and air) half nitrous oxide and half oxygen
- Quick pain relief
- 10 secs before contractions
- Not between contractions
- Quick pain relief
What are characteristics of obstetric TENS?
- No contraindications
- Warnings
- Must be used before
- Could really work well –> don’t know they are fully dilated
- Need to turn it so can still feel contractions when at home
What does massage of sacrum look like?
What does entonox look like?
What does an epidural look like?
Why do some women want an epidural?
If they are so out of control/calm them down
How do Sterile Water Injections work?
How common are Sterile Water Injections
Less common option
What are some comfortable positions during labour?
Resting positions using pillows / bed to conserve energy and reduce pain.
What are some specific upright positions during labour?
How can positions in water be helpful during labour?
Can be good pain relief
What are 4 things that you need to know as a physiotherapist?
- Know stages of labour -for communication with other health professionals and patients.
- Physiotherapy only useful in 1ststage of labour? And educating patients antenatally?
- Post partum LSCS management.
- You can help –Physiotherapist’s are experts at managing pain, pain relief, and muscle function.
