Labour and Birth Flashcards
What is a normal birth
- when does this happen
- how do the proportions of normal births change with age
- what are the benefits of a normal birth
37-42wks, spontaneous labour and delivery
Proportion of natural births decrease with age
Proportion of CSections increase with age
- avoid surgical risks
- colonisation of baby
- increase success breastfeeding
- increased bonding
How does the cervix get prepared for birth
- quiescent stage
- activation
- stimulation
Quiescent
- membranes (elastic, SM) intact => closed cervix
- mucus plug
Activation
-inflammation increases => membrane weakens, can rupture (collagen fibre breakdown to soften cervix)
Stimulation
-cervix dilates
How does the myometrium get prepared for birth
- quiescent
- activation
- stimulation
Quiescent
- low [Ca]
- downregulation of contractile proteins
Activation
- high [Ca]
- increase in contractile protein synthesis/gap junctions
Stimulation
-increase in oxytocin, PG => augument contractions
Describe the pathway that leads up to birth
- fetal HPA
- fetal movements
- placenta
What contractile proteins are synthesised
Fetal HPA
-CRH => ACTH
Triggers 2 pathways
1. DHEA, DHEAS =(aromatase)=> increased O
2. Cortisol => lung maturation, surfactant prod => proinflammatory
2. Cortisol => increased placental PG
Fetal movement => maternal pituitary oxytocin increase
Placenta
-CRH, oxytocin production
All these pathways increase production of contractile proteins
- connexin
- PG2, Ca, OXY receptors
What are the key inflammatory markers
iNOS, COX2 =>NO, PG2
Increased cytokines, immune cells
Matrix metalloproteinases
What are the 2 key urotonins
What do they do
OXY
-increase receptors => increased sensitivity
PG2
-increase COX protein => increased OG prod
Describe the build up to birth
What increases
Uterine contractions increase in frequency for several nights prior
+ve feedback loop
increased OXY => increased PG synth
Describe the 1st stage of labour
- latent
- active
Latent (can last for days, on and off)
- painful contractions
- some cervical effacement, dilation
Active - 4cm onwards
-regular painful contractions
Describe the transition phase of labour
10cm dilated
More frequent contractions
Mood changes, sweating
Greater urge to push
Describe the 2nd stage of labour
- passive
- active
Passive
- frequency of contractions falls but v strong
- no urges
Active
- expulsive contractions
- delivery of head, ant, post shoulder, lower body
Describe the 3rd stage of labour
- describe active management
- describe physiological management
Placental separation
- expulsion of membrane
- uterine contraction (limit blood loss)
Active management
- Uterotonic drugs
- deferred cord clamping, cutting
- controlled cord traction after placental separation
Physiological management
- no routine drugs
- clamped when pulsation stops
- maternal delivery
What is the benefit of skin to skin contact
- maternal
- fetal
Maternal
- successful breastfeeding
- latching
- feed longer and exclusively
Fetal
- maintain temp, HR, RR, BP, glucose
- less likely to cry
What are the 2 forms of pain relief that you can use
Non drug
- breathe, relax
- massage
- water
Drugs
- entonox (gas and air)
- opioids (diamorph)
- epidural
What forms of social support and care would be useful
How can the location benefit the mother
Family friend, doula
Receive care from a known midwife
Home (small increase in AE)
Birth center (feel safer, decreased adrenaline => decreased pain, AE)
Hospital
