Labour and Birth Care Fundamentals Flashcards
Factors affecting labour: 5+1 “P”s
- Passenger (fetus and placenta)
- Passageway (bony pelvis and soft tissue)
- Powers (contractions and pushing)
- Position (client)
- Psychologic and People
Emotional Dystocia
• What’s happening in the mind is altering what is happening in the body
Tocophobia
- Fear of labour and contractions; often due to history of varied experiences and/or portrayal of scary stories; the way the media presents labour/birth
- Estimated ` in 10 experiences extreme tocophobia
Psychologic factors of labour and birth
Fear - Pain - Tension
- Moderate to severe anxiety
- Physiologically can have results
- Magnified pain experience can stall labour and decrease confidence
- Clients who come in with a very fixed mindset have a hard time adjusting to needed changes and adapting in situations
- Mind-body connection and tensing can change pain
- GOAL is to minimize or reduce catecholamine secretion
How client anxiety during labour affects the body
- Increases catecholamine secretion
Which causes
- Increased in muscle tension
- Decrease in uterine contractility (reduces blood flow; less oxytocin flow)
- Magnifies pain experience
Which
- Decreases confidence
- Decreases labour progress
How People affects labour and delivery
• Effective caregivers are: respectful, supportive, available, protective, encouraging, kind, patient, professional, calm, comforting, present
• 1:1 nursing care (goal)
• Companion of choice for labour support;
- Not the nurse – ideally not a family/friend, moderate amount of training in labour support and ideally can meet them before (doula); collaborative care and the dynamic/role of the nurse shifts
Factors that influence pain experience during labour and birth
Perception, interpretation and response to pain influenced by various factors:
• Physiologic – number of pain receptors
• Psychologic – expectations and pain thresholds
• Emotional – fatigue and sleep deprivation magnify pain
• Social – previous pain interactions in one’s life
• Cultural – pain perceptions in culture, previous interactions with pain
• Environmental – physical characteristics of one’s environments
Pain and satisfaction in the child birth experience
• Pain control does not equal a positive experience
• Satisfaction
- Caregiver attitudes and behaviours
- Quality of caregiver-client relationship
- Involvement in decision making
- Degree of control
Definition of a positive child birth experience
- Clinically and psychologically safe environment with continuity of practical and emotional support from a birth companion(s) and kind, technically competent clinical staff
- A sense of personal achievement and control through involvement in decision-making
- Frame of mind in which to approach
- Not just a technician for L&D; help guide them through it and make decision to ease their pain and create a positive experience
What is supportive care during labour
•“Non-medical are that is intended to ease a woman’s anxiety, discomfort, loneliness, or exhaustion, to help her draw on her own strengths , and to ensure that her needs and wishes are known and respected”
What does Supportive Care Look Like?
• Continuous presence of a supportive caregiver
• Includes:
- Physical comfort measures – coaching of position changes, reminding of drinking water, etc.
- Emotional support – reassurance, encouragement, praise
- Information and instruction
- Advocacy
- Support for Partner – need to remember partner and companion
Impact of labour support
Increased: • Positive ratings of birth experience • Feelings of competence, confidence • Length of breastfeeding • Maternal assessment of baby’s personality, competence and health
Decreased: • Epidural rate/usage • Use of forceps, vacuum • Analgesia/anesthesia use • Length of labour • Episiotomy rate • Caesarean birth • Postpartum depression
Barriers to supportive care during labour
- Inadequate staffing – no time; admin duties, relieve other nurses and multiple clients, breaks, the way staffing is done (static staffing)
- High tech environment
- Unnecessary medical interventions – routine use of IVs, electro-fetal monitoring that keeps people in bed; more challenging and time consuming to get them into different positions and techniques
- Lack of caregiver education and training
- Lack of management support
- Resistance – it’s hard work!
Passenger in labour
- Vertex presentation
- Depending on the angles, and the ability of the head to mold
- Breach presentations; wider diameters; many are born by C/S
- ECV: externally and physically change the position of the fetus; try and turn the baby
- Skull bone not ossified; can help (if needed) to overlap to accommodate the pelvis; called molding
- Capet; different from molding, it’s a cone shape of the head due to pressure
- Passenger includes the placenta
Passageway: Cervical effacement and dilation
- Cervix is a few cm wide and tight
- During labour it gets softer; it shortens and thins out before it begins to open
- Have to be dilated to 10cm before being able to push
- Palpating cervix; feel membranes; lip of cervix, head of fetus, what’s the baby’s position
Passageway: Station
• When the presenting part, its relationship to the ischial spine
• Palpating for the ischial spine
• Draw an imaginary line from one to the other; zero (0) station; there are cm above and below
- (+) number are below (0) and baby is coming out; (-) numbers are above (0) and baby is farther back
• The widest diameter of the presenting part (of the head) has reached zero station
• The widest part of the head has reached zero; then it is engaged
• Spines also means station = at spine means at zero station
• All based on palpation
Powers (involuntary): Contractions
- Menstrual cramps to tightening to contractions
- Other people can go straight to contractions
- Wave-like; pushes the baby down and pulls the lower part to the uterus and cervix out
- Don’t want labouring people of people past 20 weeks on their back; weight in the uterus causes pressure in the arteries, can cause hypotension and venous pooling
- Wedge client if they need to be on their back
- Some clients you can see contractions
- When EFM is on; assess fetal HR and uterine activity
What to assess contractions on
- Assessing contractions: the pacemaker is in the uterine fundus; intensity and duration of the contraction is palpable in the fundus
- Assessing: duration frequency, intensity
- Duration is how long the contraction lasts; beginning to end in secs
- Frequency is how often; beginning on one contraction to the beginning of the next contraction
- Intensity you let the client rank and palpation
Positions during labour
- Of the labouring client
- All upright positions; labour is about movement (with and in the labouring person’s body)
- Clients upright help with blood flow, reduced pain, perception of pain on back
- Also helps with the mechanics of labour
- Don’t have to be upright all the time; all about positions changes
Examples:
- Walking
- Sitting/leaning
- Tailor sitting
- Semi-recumbent
- Hands and knees
- Standing
- Squatting
- Kneeling and leaning forward with support
Pre-labour vs Labour
Pre-labour: • Irregular uterine activity • Stop with walking or position change • Felt it in back, all over abdomen • Can be stopped with comfort measures • Cervix – may be soft, no significant change in effacement/dilation • No bloody show
Labour:
• Regular uterine activity
• Stronger, longer, closer together
• Become more intense with walking
• Felt in lower back, lower abdomen, don’t stop with rest
• Cervix – cervical change (softening, effacement, dilation)
• + bloody show
Amniotic membranes
- The amniotic membranes rupturing is “water breaking”
- Can released prostaglandins and help progress labour
- ROM; rupture of membranes
- SROM; spontaneous rupturing of membranes
- PROM; premature rupture of membrane
- PPROM; prolonged premature rupture of membranes
- AROM (ARM); artificial rupture of membranes
Assessment of amniotic membranes: COAT
- Colour; clear, meconium stains
- Odour; raw chicken smell, foul smelling (due to infection)
- Amount; copious amounts, small amounts
- Time; what time did the membranes rupture; the longer the membranes are ruptured the increased risk for uterine infection
• Fetal heart fate; one full minute; listening as soon as membranes rupture; ensure cord is okay place
Ferning test
• Ferning tests; put amniotic fluid under slide and dried; creates ferning pattern
Nitrazine test
• + Nitrazine; strip test to determine if membranes have ruptured, interacts positively with membranes
GBS and labour/birth
- Group B Streptococcus (GBS); 35-37 weeks GBS swab done; put on GBS protocol, given IV antibiotics to cover the baby (2 doses minimum 4 hrs apart)
- GBS an cause the baby to have mengitis, sepsis, early and late signs
