Labour and Maternity Flashcards
What is the Definition of Labour?
Woman’s Perspective - From the first contraction until her baby is born.
Midwifery/Obstetric Definition - From the onset of regular (1:3-5 minutes) painful contraction until the expulsion of the Placenta and Membranes.
What are the Paramedic Decision making aids?
History - this Pregnancy, Previous Pregnancies, Medical and Surgical History, Reason for call, Current labour history.
Observation - Vital Signs, Ruptured Membranes - colour of the Amniotic Fluid, Bleeding, Birth Behaviour.
“Scoop and Run”?
Call the Midwife?
2nd Crew?
How to Recognise the Stages of Spontaneous Labour?
1st Stage - Contractions increasing in Intensity, Duration and Frequency.
During this stage, the Cervix softens and dilates. Full dilation is considered to be around 10cm.
What are the 1st Stages of Labour?
The Contraction starts at the ‘pacemaker’ found at top of the Uterus. Each Contraction moves in a wave-like pattern downwards towards Cervix (neck of the womb) which Dilates from Closed to 10cms to allow the baby to enter the Vagina. Mothers may perceive Contractions as backache —> Period like twinges —> strong cramping pain and increasing back ache.
How to Recognise the 2nd Stages of Spontaneous Labour?
Second Stage - This stage is from Full Dilation of the Cervix to the Birth of the Baby.
Spontaneous or directed Maternal ‘pushing’ efforts aid the power of the Contractions to Deliver the Baby.
Contraction may become slightly more spaced out, but they will be Stronger, Longer and Expulsive.
Mother may make a guttural ‘mooing’ sound.
How to Recognise the 3rd Stages of Spontaneous Labour?
Third Stage - The Period from the Delivery of the Baby to the Delivery of the Placenta and Membranes.
A Gush of Blood followed by the Delivery of the Placenta and Membranes due to ‘emptying’ of the Uterus which is aided by uterine Contractions, Gravity and some Maternal effort.
Not Usually Painful.
Most Dangerous part of Labour for the Mother.
What is the Duration of Labour?
Primigravida (1st Baby) 12-18 Hours
Multipara (2nd+ Baby) < 8 Hours
Labour is often Faster Second Time around.
Labour and Birth can also be precipitated even for 1st Labours - lasting minutes from start to finish.
What are the 3 Phases of the 1st Stage of Labour? 0-10cms
Latent 1st Stage (Minutes-8hrs) (0-4cm) - Onset of Irregular but Painful Contraction when Cervix is effacing (Shortening) and Dilating. Contractions 1 in 6-20 Minutes lasting 10-20 seconds. Woman can usually speak through these contractions.
Active 1st Stage (Minutes - 12 hours) (4-8 cms) - Contracting 1 in 2-5 Minutes lasting 30-60 Seconds. Women usually unable to speak through these Contractions.
Transition (Usually Minutes) (8-10cms), very strong Contractions, the mother becomes very distressed and vocal, difficult to calm, may Hyperventilate - Requesting an Epidural and Caesarean or demanding that the Baby is Delivered. The Membranes usually rupture spontaneously at this Stage —> ‘The baby/he/she is coming!’
How to Attend to a Woman in Labour?
Decision Making Aids:
- Estimate the Frequency of Contractions
- Estimate the Duration of Contractions
- H/O ‘show’ - Thick mucus discharge in early labour or jelly-like bleeding in late first stage, bleeding or ruptured membranes (Record colour/time)
- H/O Pregnancy Problems and Previous Labours and Births.
Observe Change in Behaviour/Birthing behaviour - is the Birth Imminent.
Transport Decision
- When would you ‘Scoop and Run’ or call for Midwifery Assistance and 2nd Crew?
What to do if Birth is Imminent?
Inform nearest Maternity Facility and Call for Midwifery backup.
Do not Move the Woman
In Transit - Pull up and Park in Safe Location.
Ensure Privacy; Warmth; Calm Support, Guiance and Reassurance.
Support Woman in Suitable position, Avoid the Supine Poisition;
- Left Lateral lying position
- Upright sitting with knees bent and spread apart
- Kneeling on all-fours.
Encourage Woman to ‘push’ spontaneously when she gets the urge.
Prepare Maternity/Normal Delivery Pack.
How to Manage Pain - Analgesia?
Maternal and Family Support/Reassurance
Massage/Mobility
Birth Balls
Water
Entonox
Hospital (Consultant Unit)
Pethidine
Epidural
What is the L-Lateral Side Lying Position?
Left-Sims Position.
Ensures that the Uterus and the Fetus do not compress the Inferior Vena Cava and Abnominal Aorta - better Fetal Perfusion.
Allows the Woman to hold Knees together between Contraction and part them when ‘pushing’.
Reduces Back Pain
Can Slow a precipitated (Rapid) Birth.
What is the Semi-Recumbent Position?
Dorsal Position with the Woman’s torso propped up to a High Recumbent position.
Seems to help some Women with Pushing.
Exploits Gravity to help Fetal Descent.
What is the Standing Birth/Half Squatting Position?
Ancient Practice
Used in Home Environments in the Developing World
Used in the Developed World in Home or Midwife only Birthing Facilities.
Maximum use of Gravity
Allows Widening of Pelvic Outlet.
Ensure the Baby is Received and held as it is born.
What are the Mechanisms of Labour?
When Negotiating the Birth Canal the Fetus Undergoes a Series of Passive Manoeuvres or Cardinal Movements.
As the Fetus Descends through the different planes of the Pelvis it needs to be Manipulates into the position of best fit.
