Labor and Birth

Question 1

What is labor?

Answer 1

Sequence of events that cause cervix to efface and dilate leading to birth

Question 2

Prodromal Labor

Answer 2

• “Pre” labor
• Contractions may occur as “cramp-like” sensations low in abdomen
• Contractions may increase in intensity, frequency, and duration initially, then fail to consistently and persistently change
• These contractions may occur hours, days, or weeks before onset of labor
• Changes in cervix are usually minimal

Question 3

Prodromal Labor - Treatment

Answer 3

• Mother must maintain her food intake and excellent fluid intake
• Alternate activity - resting with mild activity if during day, and rest at night is essential
• Take warm bath
• Chamomile tea or Sleepy Time tea can increase rest and relaxation
• Benadryl or Tylenol PM may be suggested by some care providers
• Mother may engage in activities for distraction during day
• Use open knee position, pelvic tilt, or abdominal lift to increase comfort

Question 4

Conditions Affecting Labor - Posterior Cervix Treatment

Answer 4

• Abdominal lift
• Do not use pelvic tilt in hands and knees position if cervix is posterior as it hinders correcting posterior cervix
• Evening primrose oil taken orally is often recommended by midwives to soften scars on cervix. It should not be used before 37 weeks
• Squatting and use of birth ball may aid in correcting abnormal positions of cervix

Question 5

Conditions Affecting Labor - Posterior or Asynclitic

Answer 5

• TENS unit early in labor can be very helpful for back pain allowing mother to move about freely to aid in repositioning baby
• Stair climbing, lunge, double hip squeeze, and knee press are all helpful in repositioning baby
• Open knee-chest position can aid in freeing baby’s position so it can realign in pelvis
• Rock the baby position can also aid in repositioning baby

Question 6

Conditions Affecting Labor - Emotional stress

Answer 6

• Previous birth trauma
• Fears, anxiety
• Lack of support

Question 7

Onset of labor - primarily determined by baby

Answer 7

• Multiple hormonal changes occur starting with baby’s pituitary gland releasing hormone CRH, ACTH and cortisol all begin final stages of lung maturity in baby
• These hormones alone with other cause changes in estrogen, progesterone, and prostaglandin levels in mother’s body
• These changes lead to a significant increase in oxytocin receptors in uterine muscle making it responsive to increasing levels of oxytocin that mother’s body secretes during labor
• Additional changes occur with levels of relaxin, prostaglandin, and endorphins which contribute to progression of labor and birth

Question 8

CRH

Answer 8

• Corticotrophin releasing hormone

Question 9

ACTH

Answer 9

• Adrenal corticotrophin hormone

Question 10

Progression of labor

Answer 10

• Contractions generally begin sporadic, they are usually mild, and of short duration
• As levels of oxytocin rise, contractions become stronger, last longer, and become more frequent
• Mother often needs to use relaxation/pain relieving techniques
• Remaining in comfortable environment such as home can be very helpful in progress in labor

Question 11

Labor and Birth Transition

Answer 11

• Often referred to as most difficult or intense part of labor
• Contractions are usually very intense occurring every 2-3 minutes

Question 12

Laboring Down

Answer 12

• Process of allowing natural descent of baby when urge to push in not yet present regardless of whether mother is medicated or un-medicated

Question 13

Laboring Down - Advantages

Answer 13

• Less maternal fatigue
• Fewer fetal heart rate decelerations
• Less perineal trauma
• Less potential nerve damage for mother form improper potential of her knees and hips, especially with use of epidural
• Less use of instrument delivery - forceps or vacuum

Question 14

Laboring Down - Disadvantages

Answer 14

• Lack of control by medical staff

- Potential increased time from complete dilation to birth

Question 15

Laboring Down - Techniques

Answer 15

• Allow mother to assume position of comfort
• Allow baby to stimulate Ferguson’s reflex, ejection reflex
• Encourage mom to push only when urge is present
• Mom should hold her breath for 5-8 seconds with pushing and encourage mom to change positions every 30-40 min
• Squatting position is most effective for increasing intrauterine pressure and opens pelvis to maximum dimensions

Question 16

Prolonged Pushing - Valsalva Maneuver

Answer 16

• Prolong breath holding while pushing

Question 17

Prolonged Pushing - Valsalva Maneuver Side Effects

Answer 17

• Increased chest and abdominal pressure in mother resulting in decreased blood flow, vasoconstriction, and decreased blood flow to organs
• Baby’s normal physiological responses to pushing to be altered and leads to decrease oxygen in baby
• Distress in baby becomes apparent in decreased heart rate, babies are often born with low APGAR and may be in need of resuscitation
• Mom also becomes significantly fatigued and risk of assistance with forceps or vacuum increases
• Poor initiation of breastfeeding also may occur

Question 18

Self-directed pushing

Answer 18

• Mom pushes only with urge to bear down
• Each contraction should have 2-3 adequate pushes
• Mom often use moaning, groaning, and grunting sounds
• Birth is less traumatic on mother’s tissues and easier for baby

Question 19

Delivery of placenta

Answer 19

• Spontaneous
• Normal separation occurs in 5-30 min after birth
• Tugging or pulling on cord should not be done
• Placenta has not separated reposition mom
• Place baby to breast to aid in placenta separation

Question 20

Oxytocin

Answer 20

• Contributes to contractions in labor, to ejection reflex, and to letdown reflex in breastfeeding

Question 21

Endorphins

Answer 21

• Natural morphine like substance produced by body that increases during stress, fear, and pain
• When birth occurs, endorphins also cause euphoric state for mother

Question 22

Catecholamine

Answer 22

• Hormones that are secreted during times of fear, stress, and pain which signal body of potential dangers and may trigger “fight or flight” response

Question 23

Physical causes of pain in labor and birth

Answer 23

• Effacement and dilation of cervix
• Thinning of lower uterine segment
• Decreased blood flow to uterine muscles during contractions
• Pressure in pelvis from heavy uterus and as baby descends
• Vaginal and perineal pressure during pushing and birth
• Position of baby in uterus resulting in pressure on structures

Question 24

Emotional causes of pain in labor and birth

Answer 24

• Increased stress and/or fear in mother
• Physical tension leading to decreased blood supply to muscles
• Lack of effective support for mom
• Pressure from family/friends that is inconsistent with her birth plan

Question 25

Signs of potential suffering and birth trauma

Answer 25

• Crying, screaming, and/or intense moaning
• Hyperventilation
• Feeling of total despair
• Sense of foreboding
• Pressure of family/friends that’s inconsistent with her birth plan

Question 26

Gate control theory - Pain transmission

Answer 26

• Pain travels rapidly on very small nerve fibers

- Brain interprets pain and response in formed

Question 27

Water injections

Answer 27

• Sterile
• Effective in back pain
• Acupuncture

Question 28

Gate control theory - Pain control

Answer 28

• When larger nerve fibers are stimulated they partially block transmission of pain to brain on tiny nerve fibers
• Stimulating large nerve fibers normally reduce pain for 1-2 hours
• Changing techniques frequently increases pain relief and techniques can be used multiple time
• Examples of techniques that stimulate large nerve fibers include massage, hot and cold packs, slow breathing, music, changing positions, lunge, and knee press