Los Olivos Classes Part 1

Question 1

What is the role of Oxytocin (OT) in labor?

Answer 1

Causes labor progression

Question 2

What hinders OT during labor?

Answer 2

Fear and stress

Question 3

How can you re-frame pain in childbirth?

Answer 3

Childbirth pain is from physical effort; different from pain being indication of something wrong (a warning).
Pain signifies labor is progressing

Question 4

9 Factors that Decrease Pain

Answer 4

Well-fed
Well-rested
Well-hydrated
Relaxed, not stressed
Have knowledge - no fear of unknown
Feeling empowered and supported (good team!)
In the present moment: not dwelling on thoughts of pain to come, anticipating
Staying active and trying different positions
Stimulate pleasurable senses instead: acupressure, massage, music, aromatherapy, heat, cool, environment temperature

Question 5

How do you re-think pain? PAIN Acronym

Answer 5

P - purposeful, helping labor progress
A - anticipated
I - intermittent. contractions aren’t constant. relax the body during this time
N - normal. not indicating injury

Question 6

How do you evaluate an intervention? BRAIN acronym

Answer 6

Benefits
Risks
Alternatives, if any
Intuition
Need time: what happens if we wait?

Question 7

What are the “stations” of the baby?

Answer 7

The position of the head relative to the ischial spines.
0 station is at the spines
Up above is negative. -4, -3, -2, -1
You don’t push when it’s up high
Past spines is +1, +2, +3, +4 (crowning, right at perineum)

Question 8

How to relieve feeling of heaviness? (position)

Answer 8

Lie on left side, knee up, feet elevated

Question 9

What are the cervical dilations and stages of labor?

Answer 9

0cm to fully dilated at 10cm
1-3 cm early labor
3-7cm active labor
You need to be 10cm before you start pushing

Question 10

What things might happen before labor late in pregnancy?

Answer 10

Bloody show, loss of mucus plug, dilation, and cervical effacement

Question 11

What 911 emergency is associated with the placenta? What symptoms?

Answer 11

Placenta abruption. Around 1% of pregnancies where the placenta partially or completely separates from the uterine wall.

Symptoms: Continuous severe abdominal pain: intense tightness
Lower back pain more than normal
Tender abdomen
Constant tightening of uterus
Bleeding

Question 12

In what percent of pregnancies does the water break before labor starts?

Answer 12

10-15%

Question 13

How soon after water breaking need you deliver?

Answer 13

24 hours (to avoid infection)

Question 14

What do you tell the Dr. when your water breaks? Acronym COAT

Answer 14

Color (clear or milky is normal)
Odor (amonia-y or odorless is normal. foul indicates infection)
Amount - trickle or gush tells low or high break
Time - when did this happen?

Question 15

What 911 emergency is associated with the water breaking? What do you do?

Answer 15

Gushing low break can sometimes take the umbilical cord out with it - this is a prolapse cord. Get on all fours with your butt higher in the air than the rest of you. Takes the pressure of the cord so blood keeps flowing.

Question 16

What hormones soften the cervix?

Answer 16

Prostaglandins

Question 17

What hormones induce contractions?

Answer 17

Oxytocin

Question 18

When does the baby “drop”?

Answer 18

Usually 3-4 weeks before delivery

Question 19

What “call the doctor” urgency is associated with swelling? What else can indicate this urgency?

Answer 19

Sudden increase in swelling (or sudden increase in weight gain or pitting edema under the eyes) can indicate pre-eclampsia. BP is too high.

Other symptoms: persistent headache, spots in eyesight, pain in shoulder or upper abdomen

Question 20

How to practice kegles? (just a practice note)

Answer 20

Tighten all the way back to the rectum to help avoid hemorrhoids.

Question 21

What massage tip helps with back pain?

Answer 21

Press on lower back, fingers reaching around sides of soft abdomen, just above hip bones

Question 22

What is the 25-35-lb weight gain of pregnancy made of?

Answer 22

6-7lb baby
2lb placenta
1-2lb fluid
2-3lb blood
Breasts 2-3 lb
Uterus 2-3 lb
Fat 4-8 lb

Question 23

What is the single most important thing to remember from these classes? (about relaxation)

Answer 23

Relaxation = Dilation. So practice relaxation ahead of time with breathing exercises and meditation.

Question 24

What are the four stages of labor and delivery? (big picture)

Answer 24

1. Labor
2. Pushing and Delivery of baby
3. Delivery of Placenta
4. Postpartum period

Question 25

What are the three stages of labor (small picture)? What are the typical time-scales, dilations, and markers?

Answer 25

1. 1 Early / Prodromal Labor - 12hrs + - Contractions starting, not so intense - -30-60s in duration - -5-20mins apart - 0-6cm dilation 1. 2 Active Labor - 6hrs+ - Contractions frequent and stronger - -45-60s in duration - -2-5mins apart - 6+cm dilation - Water might break - THIS is when you go to the hospital - Epidurals can start from here on out at any point 1. 3 Transition to delivery - 0.5-2hrs - Contractions different and much stronger - -1-1.5min in duration - -2-3min apart - 10cm fully dilated Then pushing and delivery (separate flashcard)

Question 26

What marks pushing and delivery? What do you do?

Answer 26

``` Lasts 30-45mins 10cm fully dilated Contractions -45-90s in duration -3-5min apart ``` Now it's okay to push, especially when you feel the urge. Pushing can be hard Push WITH the contractions and rest between contractions. Keep pushing THROUGHOUT the contraction with just little tiny breaths in. Mostly about pushing.

Question 27

What are you going to have on hand for when Autumn goes into labor?

Answer 27

``` Cushy floor mat and green cushion as knee pads Her water bottle with straw Ice water Tea Udon Heating pad Bath ```

Question 28

What are the signs of pre-labor 3-4 weeks before labor begins?

Answer 28

``` Lightening: baby lower, breathing a little easier Bloody show or loss of mucus plug Flu-like symptoms or diarrhea Nesting Weight loss of a couple pounds Braxton-hicks “practice” contractions. Feel real but not progressing the cervix dilation Cramping and pain in groin area Loosening of joints ```

Question 29

What is false labor?

Answer 29

Some effacement and dialation but not progressing Water doesn’t break (though doesn’t always break in true labor either) Contractions not getting longer, stronger, closer together Walking can make contractions go away

Question 30

What to do if Braxton-Hicks contractions are becoming a little too real?

Answer 30

More than 5 contractions/hr can cause cervix to start dialating If that happens: Lay down on left side Rest for hour or so Do kick counts Drink 1-2 glasses of water to avoid dehydration-caused contractions

Question 31

What should you do to avoid early labor leading up to the 37 week mark?

Answer 31

``` No nipple play Sit somewhat more often Don’t carry heavy things Limit stairs and stooping and bending Keep exercise moderate Regular exercise will help prevent preterm labor Minimize stress as much as you can Have a good weight, get your nutrients Avoid raw meat, raw fish Limit caffeine, 2 cups coffe/day max or less if you can Keep up with dental work ```

Question 32

What are the definitions of duration and frequency of contractions?

Answer 32

Duration: from beginning of contraction to end. Might take 30s at the beginning. Frequency: from the BEGINNING of one contraction to the BEGINNING of the the next.

Question 33

When do you go to the hospital? (mnemonic)

Answer 33

5-1-1 5 minutes -- Contractions are about 5 minutes apart or less 1 minute -- They last 45-60 seconds 1 hour -- This pattern is holding for 1.5-2 hours. A nice consistent active labor pattern

Question 34

What is "back labor"? What can you do to avoid it?

Answer 34

When the baby's occiput is on the back side. This happens in 25% of labors and brings some serious bone-on-bone action and pain. Ideally you want the baby's nose facing mom's butt (big part of he head is on mom's anterior). To reduce risk, MOVE A LOT DURING LABOR and the baby will more likely turn into the good position. So swaying, going to the bathroom every hour, slow dancing position, etc.

Question 35

As a labor coach, what things should you think about doing/providing? (Acronym PURE)

Answer 35

Position Urination Relaxation Environment Change position every 30 minutes Go pee once per hour. Toilet-sitting is also a fine laboring position. Relaxation = dilation Environment -Music. Body goes with the tempo. Maybe find some stuff around 120 beats per minute -Lighting -Temperature -Having the right people around -Location: couch, tub, bed, rocker, floor, etc. -Aromatherapy options -Heat pads, cold pads