Mechanism of Labour

Question 1

How would you introduce yourself to ana

Answer 1

Confirm name and id with band
Introduce yourself - student midwife
Wash hands - 5 moments and 7 steps of hand hygiene
Or hand gel
Gain consent

Question 2

Discuss the approach you would take to delivering antenatal education

Answer 2

Assists based approach- discuss and correct knowledge if pre existing and build on it

Question 3

What is the definition of the mechanism of labour

Answer 3

Widest of the diameter of the fetus successfully goes though the widest diameter of the pelvis
Can use doll to demonstrate

Question 4

Discuss the basic anatomy of the pelvis

Answer 4

Formed in tow parts - false pelvis and true pelvis
False pelvis is everything from the brim up
True is everything from the brim and below
Trust pelvic constantly of the outlet the cavity and the brim
Fetus had to negotiates the way through

Question 5

Beginning with the pelvis brim describe the anatomy and the dematerialised- 8 landmarks

Answer 5

Pelvis prim is at the start- Ovoid shape- bounded by the sacrum and the sacred promontory is at the back ( effects the shape of the pelvis brim as it sticks out) Symphysis pubis is at the from
8 Landmarks;
Sacral promontory
Sacral ala
Sacral iliac
ileopectineal line
Ileopectineal eminence
upper border of the superior pubis rami
upper border of the pubic arch
Symphysis pubis
Helps to determine the position of baby during labour and antenatal
Diameters of the brim -
the anterior posterior diameter is 11cm
oblique is 12cm
transverse is- 13cm

Question 6

Describe them pelvis cavity and the diameters

Answer 6

Inner part of the pelvis, almost circular however shorter at the front as borders by the symphysis pubis, longer at back as bordered by the sacrum
as circular all diameters are the same - 12cm
curve of carries

Question 7

Describe the pelvic outlet and diameters

Answer 7

Outlet is partially border by ligaments- diamond in shape (formed by the coccyx, lower part of symphysis pubis and the ligaments)
diameters
anterior posterior- 13cm
oblique - 12cm
transverse -11cm
Last part the baby had to get though before its born

Question 8

Describe and demonstrate the mechanisms of labour in a logical manner
Decent

Answer 8

Happens differently depending on if tryout first (Prim) or a paras woman
Decent can happen after 36 weeks on a prim (Due to having good tone and brakton hicks can push the uterus down)
Can sometimes only happen when in labour from paras woman
Descending towards the pelvic brim- widest part of the fetal head has entered the pelvis- This would be described as being engaged

Question 9

Flexion

Answer 9

Happens due to increased decent- with good contractions and with some fundal dominance- top of uterus pushing down through fetus using axis pressure
Pushed down and starts to meet the resistance of the pelvis- baby will tuck his head down onto chest- which presents smaller diameters
Smaller diameters makes it easier for baby to get through and progress

Question 10

Internal rotation

Answer 10

Due to head hitting of pelvis floor, causing resistance and make the fetal head rotate from transverse into anterior position

Question 11

Crowning

Answer 11

With continuing decent- when largest part of the head is passed through the vulva and locks there (stops the rocking back and forth)
Ring of fire

Question 12

Extension

Answer 12

Babies head is born- neck pivots of the sub pubic arch
Head is born by the sweeping of the forehead off the perineum
Then the nose and and chin
Finally the whole head is born

Question 13

Restitution

Answer 13

If baby has entered the pelvis is the right occipital anterior position the head and neck needs to realign towards maternal right about and 8th of a circle

Question 14

External rotation of the head and internal rotation of the shoulders

Answer 14

Once there has been a few more strong contractions we will except to external rotation the head
At the same time as this there should be internal rotation of the shoulders
Shoulders are trying to get into the largest part of the pelvis to mak it easier to get through
The head will turn fully to the maternal right thigh

Question 15

Lateral Flexion

Answer 15

If midwife is using hands on approach- she will help this last part
This is when the baby follows the curve of caries
Either use a chin occipital grip or hold the side of the babies head and pull down until the anterior shoulder pops out, the using an upward pull the posterior shoulder will pull up and out and glides over the perineum
Babies deliver
Placed on woman’s abdomen
Skin to skin
Commence golden hour