Management of Normal Birth and Labour Flashcards
What are the features of normal birth?
1) Spontaneous onset, low-risk at the start of labour and remaining so throughout labour and delivery
2) The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy
3) After birth, mother and infant are in good condition
Aside from women whose labour starts spontaneously, progresses spontaneously without drugs, and who give birth spontaneously what other women does the normal delivery group include?
Women who experience…
1) Augmentation of labour - slow natural progress but membranes are ruptured artificially to speed up process
2) Artificial rupture of the membranes (ARM) if not part of medical induction of labour
3) Entonox (gas and air)
4) Opioids
5) Electronic fetal monitoring
6) Managed third stage labour
7) Antenatal, delivery or postnatal complications incl. PPH, perineal tear, repair of perineal trauma, admission to SCBU or NICU
Why is encouraging normal birth important?
1) Safety
2) Physical - easier to recover from than C section, iatrogenesis
3) Psychological - reduced incidence of PTSD in normal birth
4) Financial
5) Natural bonding process
6) Colonisation of baby - when passing through the birth canal, the baby is colonised through maternal gut which improves feeding and gut health of infant long into childhood
7) Higher rates of successful breastfeeding
What maternal features do we monitor during labour (on a partogram)?
1) Contractions - marked wider lines if mild and v thick if stronger, and can see number of contractions in 5 mins
2) Cervical dilation - crosses on second chart down
3) Vital signs
4) Drugs/fluid
5) Urine output and input
6) PV (per vaginum) loss
7) Pain - coping? pain relief?
8) Emotional state
What maternal vital signs do we monitor and how often?
Maternal temp hourly and maternal pulse and BP half hourly
What are the types of PV loss?
1) Liquor - clear, comes if membranes have gone, distinct smell
2) Blood - a little bit is normal
3) Meconium - think black tarry stuff passed by baby in utero - if they are distressed they may open bowels
When will the baby pass meconium if they don’t pass it in utero?
- If they don’t pass it in utero they will pass it in the first few days of life
What does the type of meconium indicate?
- Look at consistency, thickness and colour
- Straw colour = baby has been stressed at some point but probably ok
- Thick and brown = baby is stressed
Why do we monitor maternal urine output and input in labour?
A distended bladder will delay progress of descent of baby’s head or cause problems passing urine post birth
What fetal features do we monitor during labour?
1) Fetal heart activity (FHR)
2) Position
3) Descent of baby’s head -circles on partogram
How does position of the fetus affect labour?
- If the baby is lying with its back against its mum’s back this can cause lots of back ache and slower labour
- The baby should rotate before it is born (short or long way)
- Or it can stay as persistent occipito-posterior - back of baby’s head is against mum’s back
How does the descent of the baby’s head affect affect affect labour?
OP position (wider diameter coming down) descent will be slower than in vertex position
What are non-pharmalogical methods of pain relief in labour?
1) Breathing and relaxation
2) Massive
3) Water - although most women end up wanting to actually deliver out of the pool
4) Hypnobirthing
5) Aromatherapy
6) Music therapy
7) TENS (transcutaneous electrical nerve stimulation) machine
Describe use of TENS for pain relief in labour
Very effective if pads are placed low down either side of maternal spine and really stimulates endorphins which helps pain esp. in early first stage of labour
What are pharmacological methods of pain relief in labour?
1) Entonox
2) Opioids e.g. pethidine
What is regional analgesia given as pain relief in labour?
Epidural - can walk around as lower dosage but often tired
Describe treatment with Entonox for pain relief in labour
- Usually with mouth piece
- Well controlled
- Breathed in as they feel contraction coming therefore peaks when contraction peaks and as they breathe out it is expelled from the system v quickly afterwards
What is the problem with opioids for pain relief in labour?
- If given too close to time of the delivery, the baby may need narcan to reduce its effects as it stays in the system
- Half life
When do you clamp the umbilical cord?
When pulsation has stopped
Why do you delay cord clamping until the cord has stopped pulsating?
- The cord and placental system will contain about ⅓ of the baby’s blood (remaining ⅔ is in baby)
- Therefore want to wait for the cord to stop pulsating so that the baby gets as much blood out of the placenta as it needs
What needs to be done once the placenta is delivered?
- The midwife will check it to ensure that it is complete incl. all the membranes
- They will also check that none is left inside the mother as this can lead to postpartum infection and haemorrhage
What can be done to induce the third stage of labour?
Breastfeeding
- It can stimulate a contraction and help the placenta separate from the womb
What are parts of active management of the third stage of labour recommended by WHO?
1) Routine use of IM uterotonic drugs e.g. syntometrine
2) Deferred clamping and cutting of the cord
3) Once the placenta is in the lower segment, the midwife will guard the uterus and apply gentle downward traction to deliver placenta - controlled cord traction after signs of separation of the placenta
What is the benefit of active management of the third stage of labour?
- Active management reduces (immediate) blood loss but overall blood loss is similar in active and physiological management
- However if have PPH likely to be around time of delivery in first 24h (remains a killer of women)