Labour & Birth Care Fundamentals Flashcards
What are the 5+1 P’s that affect labour?
Passenger (fetus and placenta) Passageway (bony pelvis and soft tissue) Powers (contractions and pushing) Position (client's position) Psychologic \+ People
Emotional Dystocia
psychological stress that can cause labour to stall or slow down
- extreme fear of labour pain, not feeling safe, lack of privacy, trauma from prior sexual abuse
Tocophobia
Intense fear of pregnancy and childbirth
1 in 10 people
How does anxiety affect labour?
Anxiety causes increased secretion of catecholamine. Muscles become tense - decreased blood flow and oxygen flow, affecting uterine contractility.
What are the 3 elements in the mind-body connection cycle?
Fear
Tension
Pain
Explain the 6th P: People
An effective and trained caregiver that supports the birth parent (such as doula or midwife)
OR
One to one nursing care
What are some factors that affect one’s pain experience?
- Physiologic (health condition or variation in pain tolerance)
- Psychologic (abuse or past experience)
- Emotional (sleep deprivation or fatigue)
- Social (other’s experience?)
- Cultural (expression and understanding of pain)
- Environmental (mood/atmosphere of birthing setting)
Sources of labour pain
a. uterine contraction
b. back (baby’s head putting pressure)
c. pelvic nerve pressure
d. stretching of perineum
What contributes to satisfaction or a positive experience?
- caregiver attitudes and behaviour
- quality of caregiver-client relationship
- involvement in decision making
- degree of control
How does WHO define “Positive Childbirth Experience”
…one that fulfils or exceeds woman’s personal expectations
- giving birth to healthy baby
- safe environment
- continuity of practical and emotional support
- kind and competent companion/staff
- sense of achievement and control
What is Supportive Care?
“Non-medical care 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 he needs and wishes are known and respected.”
What does Supportive Care look like?
- continuous presence of caregiver
- physical comfort measures
- emotional support (encouragement)
- information and instruction
- advocacy
- support for partner
Labour Support increases..
a. positive ratings of birth experience
b. feelings of competence, confidence
c. length of breastfeeding
d. maternal assessment of baby’s personality, competence and health
Labour Support decreases..
a. epidural rate/usage
b. use of assistive devices (forceps, vacuum)
c. analgesia/anesthesia use
d. length of labour
e. episiotomy rate
f. caesarean birth
g. postpartum depression
What are some barriers to Supportive Care?
a. inadequate staffing
b. high tech environment (reduced interaction?)
c. unnecessary medical interventions
d. lack of caregiver education and training
e. lack of management support
f. resistance from staff
Moulding
overlap of skull bones to accommodate fitting through the birth canal, causes cone shaped head
Breech presentation
baby’s buttocks and/or feet positioned to be delivered first (sacrum)
Cephalic presentation
head first enters pelvic inlet (occiput)
Shoulder presentation
Scapula (shoulder bone) lies closest to the cervix
Cervical effacement
Shortening and thinning of the cervix during the first stage of labour
Dilation
Enlargement or widening of the cervical opening and the cervical canal that occurs once labour has begun
What does vaginal assessment reveal?
a. dilation and effacement
b. status of membrane
c. fetal positioning
Station
- relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines
- a measure of the degree of descent of the presenting part of the fetus
Engagement
when the largest transverse diameter of the presenting part has passed through the maternal pelvic brim (station 0)
- often occurs in the weeks just before labour begins
Gate control theory of pain
non-painful input closes the nerve gates to painful input, which prevents pain sensation from travelling to the CNS
Contractions
Involuntary powers
- wavelike
- measured by duration, frequency and intensity
Why shouldn’t labouring people be on their back?
- venous return issue
- hypotension in the adult (decreased cardiac output from compressed major vessels)
- fetal distress
What positions are recommended and why?
upright positions (walking, sitting, kneeling or squatting)
- promote the descent of fetus
- stronger contractions
- more efficient in effacing and dilating the cervix
- shorter labour
- increased cardiac output
- prevent compression of vessels
What is the significance of positions in labour?
Frequent position changes relieve fatigue, increase comfort and improve circulation