Labour, Birth & Post-Natal Recovery Flashcards
What is the public model of ante-natal & birthing care?
- Mid-wife led care
- Shared with GP or hospital VMO
What is the private model of ante-natal & birthing care?
- Obstetrician-led care
- Midwife/home birth
When is labour normal?
- 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
What is the relationship between maternal age & risk of labour & delivery complications?
<19yo or >35yo associated with increased risk of:
- Postpartum haemorrhage
- Eclampsia
- Cephalopelvic disproportion
- Preterm birth
- Poor fetal growth
- Low birth weight
- Neonatal mortality
What are the 4 stages of normal vaginal delivery/birth (NVD/B)?
- 1-48hrs, early (0-6cm), establised/active (6-10cm)
- 5 mins-2 hours (baby being pushed out)
- Placenta delivered (10 mins-1hr)
- First breastfeed
What should be considered when positioning for routine delivery?
- Parity
- Preference for positioning during
delivery - Progress of labour
- Presentation of the fetus
- Any complications of the labour
What are the guidelines for positioning and pushing during delivery?
- 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
What does evidence suggest about water in labour birth?
- 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
When should a baby be delivered in the lithotomy position (flexion/abduction)?
If significant fetal manipulation may be required (twins, breech, shoulder dystocia)
What instruments can be used to assist birth?
- Vacuum-assisted
- Forceps-assisted
When is an episiotomy considered?
- 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)
What are the grades of perineal injury at birth?
- 1st: Injury to perineal skin only
- 2nd: Perineum but not anal sphincter (AS)
- 3rd: Perineum & AS
- 4th: Perineum, AS & rectal mucosa
What risk factors are associated with women sustaining an obstetric anal sphincter injury?
- 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
What happens to the linea alba during a C section?
Surgeons will tear it, then just place it back together to heal together on its own
What are the surgical complications of a C section?
- Laceration of the uterus, cervix, bladder, vagina or bowel
- Intraoperative blood loss >1000 ml
- Blood transfusion
- Hysterectomy
- Uterine rupture
What are the core roles of a physio in birth?
- Teach Active/“natural” labour & birth
- Non-pharm pain relief
- Post-natal recovery
What are the core roles of a midwife in birth?
- Normal + medicalised labour & birth, hospital procedures
- Intervention/complications
- Pharmacological pain-relief
- Parenting/baby-care
- Breastfeeding
What do birth preparation classes include?
- 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
What should be explained when providing education about non-pharmacological pain relief?
- 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
What does early post-natal recovery education include?
- 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
What are the 2 stages of post-natal recovery?
- First 6 weeks
2. Period up until 1st birthday &/or cessation of breast feeding
What is the anatomy & physiology of the immediate post-natal period (1-6 weeks)?
- 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
What are the functional implications of the immediate post-natal period (1-6 weeks)?
- 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
What physio input is required during the immediate post-natal period (1-6 weeks)?
- Automatic referral for third degree tear
- PN inpatient screen
- PN education
- PN exercise class
- Musculoskeletal treatment
What is the anatomy & physiology of the continuing post-natal period (up to 1yr)?
- Rectus diastasis
- Pelvic floor weakness
- Breast feeding fully to 6 months
- Relaxin decreased but not to pre-pregnancy levels until breast feeding ceases
What are the functional implications of the continuing post-natal period (up to 1yr)?
- May have sub- optimal core stability and pelvic floor
- Stress incontinence
- Possible mastitis with
breast feeding changes - Lifting & carrying 10kg weight all day
What physio input is required during the continuing post-natal period (up to 1yr)?
- 3rd deg tear R/V
- Pelvic floor rehab/stress incontinence treatment
- PN exercise class
- Musculoskeletal
- Mastitis treatment
What does post-op physio care following lower segment caesarean section (LSCS) involve?
Same as for other abdo surgery:
- Prevent resp complications
- Circulation exercises
- Wound support with movement and coughing
- Early mobilisation
- Plus PF/TA activation
What are the RAD management ADL modifications?
- 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
What are the considerations for post natal exercise prescription?
- PF activation & control in good postural positions first
- Care with weight/strength training in relation to vaginal pressures
- Stress test for higher impact exercise
What is mastitis?
- Inflammatory symptoms of the breast that may become infective
- Major cause of breastfeeding cessation
What are the characteristics of non-infective/blocked duct mastitis?
- Red and hot area
- Tender lump in breast
- Milk backs up behind the lump & inflammation develops
- Difficult for baby to attach
- No systemic symptoms
What are the characteristics of infective duct mastitis (5%)?
- 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
What objective measures are used for mastitis?
- Area measure/draw
- Degree of redness, pain,
firmness, lumps - Temp local or core
What physio treatment can be provided for mastitis?
- 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)
