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Physio in Specific Groups > Labour, Birth & Post-Natal Recovery > Flashcards

Labour, Birth & Post-Natal Recovery Flashcards

1
Q

What is the public model of ante-natal & birthing care?

A
  • Mid-wife led care

- Shared with GP or hospital VMO

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2
Q

What is the private model of ante-natal & birthing care?

A
  • Obstetrician-led care

- Midwife/home birth

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3
Q

When is labour normal?

A
  • Spontaneous onset
  • Low risk at the start & throughout labour & birth
  • Baby born in vertex position between 37-42 weeks
  • Baby & mother in good condition after birth
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4
Q

What is the relationship between maternal age & risk of labour & delivery complications?

A

<19yo or >35yo associated with increased risk of:

  • Postpartum haemorrhage
  • Eclampsia
  • Cephalopelvic disproportion
  • Preterm birth
  • Poor fetal growth
  • Low birth weight
  • Neonatal mortality
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5
Q

What are the 4 stages of normal vaginal delivery/birth (NVD/B)?

A
  1. 1-48hrs, early (0-6cm), establised/active (6-10cm)
  2. 5 mins-2 hours (baby being pushed out)
  3. Placenta delivered (10 mins-1hr)
  4. First breastfeed
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6
Q

What should be considered when positioning for routine delivery?

A
  • Parity
  • Preference for positioning during
    delivery
  • Progress of labour
  • Presentation of the fetus
  • Any complications of the labour
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7
Q

What are the guidelines for positioning and pushing during delivery?

A
  • Avoid supine & semi-supine in second stage
  • Adopt any other comfortable position
  • Be guided by own urge to push
  • Birth in a position where treatment can be delivered rapidly in case of unexpected complications
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8
Q

What does evidence suggest about water in labour birth?

A
  • Water immersion during the first stage of labour reduces the use of epidural/spinal analgesia
  • Associated with low risks
  • Minimise risks & hazards associated with unplanned delivery occurring in water
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9
Q

When should a baby be delivered in the lithotomy position (flexion/abduction)?

A

If significant fetal manipulation may be required (twins, breech, shoulder dystocia)

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10
Q

What instruments can be used to assist birth?

A
  • Vacuum-assisted

- Forceps-assisted

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11
Q

When is an episiotomy considered?

A
  • Severe laceration
  • Shoulder dystocia
  • Requirement to accelerate the birth delivery of a compromised fetus
  • A need to facilitate opertive vaginal delivery
  • A history of Female Genital Mutilation (FGM)
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12
Q

What are the grades of perineal injury at birth?

A
  • 1st: Injury to perineal skin only
  • 2nd: Perineum but not anal sphincter (AS)
  • 3rd: Perineum & AS
  • 4th: Perineum, AS & rectal mucosa
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13
Q

What risk factors are associated with women sustaining an obstetric anal sphincter injury?

A
  • Nulliparity (first baby)
  • Asian or indian sub-continent ethnicity
  • Female Genital Mutilation (FGM)
  • Baby is large in relation to maternal size (> 4kg)
  • Previous history of perineal trauma requiring repair or obstetric anal sphincter injury
  • Precipitate or faster than expected second stage
  • Instrumental birth
  • Active second stage >1 hour
  • Inappropriate maternal position (e.g. lithotomy position)
  • Midline or inadequately angled mediolateral episiotomy
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14
Q

What happens to the linea alba during a C section?

A

Surgeons will tear it, then just place it back together to heal together on its own

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15
Q

What are the surgical complications of a C section?

A
  • Laceration of the uterus, cervix, bladder, vagina or bowel
  • Intraoperative blood loss >1000 ml
  • Blood transfusion
  • Hysterectomy
  • Uterine rupture
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16
Q

What are the core roles of a physio in birth?

A
  • Teach Active/“natural” labour & birth
  • Non-pharm pain relief
  • Post-natal recovery
17
Q

What are the core roles of a midwife in birth?

A
  • Normal + medicalised labour & birth, hospital procedures
  • Intervention/complications
  • Pharmacological pain-relief
  • Parenting/baby-care
  • Breastfeeding
18
Q

What do birth preparation classes include?

A
  • Biomechanics of labour
  • Non-pharmacological pain relief & skills
  • Protective strategies during 2nd stage to minimise risk (upright positions, spontaneous relaxed breathing)
  • Early post-natal recovery
19
Q

What should be explained when providing education about non-pharmacological pain relief?

A
  • Explain pain (neurophysiology)
  • Contraction pain is good/drugs have disadvantages
  • Fear/stress increases pain perception
  • Manage adrenalin/ oxytocin
  • Calm & supportive carers & environment
  • Movement, massage, water, relaxation, heat, TENS, diaphragmatic breathing
20
Q

What does early post-natal recovery education include?

A
  • PF RICE + exercise
  • Bladder and bowel function
  • PF+TA activation and functional use
  • Backcare/wrist care with babycare & breastfeeding
  • Advice re graded return to exercise/sport
  • When to see physio
21
Q

What are the 2 stages of post-natal recovery?

A
  1. First 6 weeks

2. Period up until 1st birthday &/or cessation of breast feeding

22
Q

What is the anatomy & physiology of the immediate post-natal period (1-6 weeks)?

A
  • Uterus involuting & bleeding
  • Abdomen ‘deflated’
  • Rectus diastasis
  • Perineum healing
  • Establishing lactation breast engorgement, high prolactin &
    progesterone
  • Relaxin decreased but not to pre-pregnancy level
  • Sleep deprivation
23
Q

What are the functional implications of the immediate post-natal period (1-6 weeks)?

A
  • Abs and pelvic floor sub-optimal
  • Poor posture while learning breastfeeding
  • Baby care: lifting and carrying a 3-4kg weight for up to 1 hr every 4 hrs 24/7
  • Fatigue
24
Q

What physio input is required during the immediate post-natal period (1-6 weeks)?

A
  • Automatic referral for third degree tear
  • PN inpatient screen
  • PN education
  • PN exercise class
  • Musculoskeletal treatment
25
Q

What is the anatomy & physiology of the continuing post-natal period (up to 1yr)?

A
  • Rectus diastasis
  • Pelvic floor weakness
  • Breast feeding fully to 6 months
  • Relaxin decreased but not to pre-pregnancy levels until breast feeding ceases
26
Q

What are the functional implications of the continuing post-natal period (up to 1yr)?

A
  • May have sub- optimal core stability and pelvic floor
  • Stress incontinence
  • Possible mastitis with
    breast feeding changes
  • Lifting & carrying 10kg weight all day
27
Q

What physio input is required during the continuing post-natal period (up to 1yr)?

A
  • 3rd deg tear R/V
  • Pelvic floor rehab/stress incontinence treatment
  • PN exercise class
  • Musculoskeletal
  • Mastitis treatment
28
Q

What does post-op physio care following lower segment caesarean section (LSCS) involve?

A

Same as for other abdo surgery:

  • Prevent resp complications
  • Circulation exercises
  • Wound support with movement and coughing
  • Early mobilisation
  • Plus PF/TA activation
29
Q

What are the RAD management ADL modifications?

A
  • Avoid doming/peaking (may be a sign of increased stretch on the LA)
  • Modified transfers
  • Avoidance of heavy lifting, use correct technique.
  • Avoid excessive abdominal muscle straining
  • Management of constipation/avoid straining at stool
  • Engage PF/TA for cough or sneeze
30
Q

What are the considerations for post natal exercise prescription?

A
  • PF activation & control in good postural positions first
  • Care with weight/strength training in relation to vaginal pressures
  • Stress test for higher impact exercise
31
Q

What is mastitis?

A
  • Inflammatory symptoms of the breast that may become infective
  • Major cause of breastfeeding cessation
32
Q

What are the characteristics of non-infective/blocked duct mastitis?

A
  • Red and hot area
  • Tender lump in breast
  • Milk backs up behind the lump & inflammation develops
  • Difficult for baby to attach
  • No systemic symptoms
33
Q

What are the characteristics of infective duct mastitis (5%)?

A
  • Milk stasis leaks out of blocked ducts into surrounding tissue
  • High vascularity results inflammation++
  • Dx based on ‘flu-like’ symptoms
  • Doesn’t improve with conservative management in 24-36 hours
34
Q

What objective measures are used for mastitis?

A
  • Area measure/draw
  • Degree of redness, pain,
    firmness, lumps
  • Temp local or core
35
Q

What physio treatment can be provided for mastitis?

A
  • Therapeutic PUS
  • Feed baby asap after treatment
  • Heat and massage of lump before feed (toward nipple)
  • Ice and lymphatic drainage after
    massage after feed (toward axilla)

Physio in Specific Groups (12 decks)

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