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3A Womens health > Mechanisms of labour management and normal childbirth > Flashcards

Mechanisms of labour management and normal childbirth Flashcards

1
Q

What is normal childbirth?

A

Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth, mother and infant are in good condition’ (WHO DEFINITION)

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2
Q

What is normal birth?

A

Birth without induction of labour, spinal or epidural analgesia, general anaesthesia, forceps or ventouse delivery, caesarean section or episiotomy.

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3
Q

What are the 4 stages of labour?

A

Latent phase
Contractions (may be irregular)
Mucoid plug (‘show’)
Cervix is beginning to efface and dilate (usually between 0cm-4cm)
Can last up to 2-3 days

First stage
Stronger uterine contractions
Cervix is continuing to efface and dilate up to 10cm

Second stage
From full dilatation to the birth of the fetus

Third stage
From the birth of the fetus to the expulsion of the placenta

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4
Q

What are the main hormones of labour?

A

Oxytocin – a surge in oxytocin levels at the onset of labour will contract the uterus

Prolactin – to begin the process of milk production in the mammary glands

Oestrogen – surges at the onset of labour to inhibit progesterone to prepare the smooth muscles for labour

Prostoglandins – to aid with cervical ripening

Beta-endorphins - natural pain relief

Adreneline – released as birth is imminent to give the woman the energy to give birth

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5
Q

What happens during contractions?

A
  • Starts in the fundus (pacemaker)
  • Retraction/shortening of muscle fibres
  • Build in amplitude as labour progresses
  • Fetus forced down causing pressure on cervix
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6
Q

What is the latent phase and what happens in it?

A

Irregular contractions
‘Show’mucoid plug
6 hours-2-3 days
Cervix is effacing and thinning
Encouraged to stay at home
Paracetamol-, position, water, snacks

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7
Q

What is cervical effacement?

A

Cervical effacement (also called cervical ripening) refers to a thinning of the cervix. Prior to effacement, the cervix is like a long bottleneck, usually up to 4cm in length. Throughout pregnancy, the cervix is tightly closed and protected by a plug of mucus.

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8
Q

What is the most common pelvis type in females?

A

Gynaecoid is the most common pelvis type in females. It’s key features for childbirth are;
- The inlet is slightly transverse oval
- Sacrum is wide with average concavity and inclination
- Side walls are straight with blunt ischial spines
- Wide subpubic arch

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9
Q

What happens during cervical effacement and dilation during labour?

A
  1. Cervix is not effaced
  2. Cervix is fully effaced and dilated to 1cm
  3. Cervix is dilated to 5cm
  4. Cervix is fully dilated to 10cm
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10
Q

What happens during engagement?

A

A. Head is mobile above the symphysis pubis = 5/5
B. Head accommodates full width of five fingers above symphysis pubis
c. Head is 2/5 above symphysis pubis
D. Headaccomodates 2 fingers above symphysis pubis

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11
Q

What do we assess during childbirth?

A

Presentation the anatomical part of the fetus which presents itself first through the birth canal

Lie the relationship between the long axis of the fetus and the long axis of the uterus

Attitude presenting part flexed or deflexed

Engagement widest part of the presenting part has passed through the brim of the pelvis

Station relationship between the lowest point of the presenting part and the ischial spines

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12
Q

What happens during active labour?

A

4cms
Regular, frequent contractions
Progressive
Role of oxytocin

Powers
Passage
Passenger

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13
Q

What should be the maternal position during labour?

A

NICE (2007)
Women should be
encouraged and helped to
move and adopt whatever
positions they find most
comfortable throughout
labour

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14
Q

What are the four factors involved in pain and womens satisfaction with labour?

A
  • personal expectations,
  • the amount of support from caregivers,
  • the quality of the caregiver-patient relationship,
  • and involvement in decision making
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15
Q

How can we work with pain during labour?

A
  • Psychological methods-relaxation, imagery, hypnosis, hypnobirthing
  • Sensory methods-position/posture, hydrotherapy, TENS
  • Birth environment-setting, environment
  • Complementary-massage, acupunture, reflexology, aromatherapy, reflexology.
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16
Q

What is the most effective form of pain relief?

A

Associated with:

Less operative births including CS
Less pharmacological analgesia
Shorter labours
More positive experience of childbirth
=continuous support in labour

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17
Q

What is most widely used for pain relief during labour?

A

Entonox-most widely used, high satisfaction levels ?self administration

Side effects-nausea and vomiting

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18
Q

Opiates and labour

A

Pethidine/morphine
Side effects Fetal
Respiratory depression
Diminishes breast-seeking, breast-feeding behaviours
Side effects-maternal
Euphoria & dysphoria
Nausea/vomiting
Longer 1st and 2nd stage labour

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19
Q

What is the most effective form of pain relief?

A

Epidural
Side effects-maternal
Increase length 1st & 2nd stage
Need for more oxytocin
Increase incidence malpositon
Increase instrumental rate
Loss of mobility
Loss of bladder control
Hypotension, pyrexia

Fetal side effects
Tachycardia due to maternal temp
Diminishes breast feeding behaviours

20
Q

What do we look for when looking at maternal observations?

A

BP, Pulse, Temp
Bladder
Contractions
Drugs
Vaginal Examination

Eat & drink as normal

21
Q

How do we monitor the foetal heart?

A

Intermittent monitoring for all low risk women-Term, spontaneous.

Every 15 minutes 1st stage.
After a contraction for 1 minute

22
Q

What happens during the transition stage?

A

SROM-clear liquor
Irritable, anxious,distressed
Start to feel pressure
Contractions can slow/stop
Need good support and reassurance

23
Q

What happens during the 2nd stage?

A

Full dilatation
External signs-head visible
Spont bearing down

Can have a latent phase

Progress-descent

24
Q

What are the 2 types of active phase?

A

Primigravid and Multiparous

25
Q

What happens in primigravid active phase?

A

Primigravid

1 hour suspect delay
2 hours diagnose delay
Baby born within 3 hours of commencement of pushing

26
Q

What happens in the multiparous active phase?

A

Multiparous

30 mins suspect delay
1 hour diagnose delay
Baby born within 2 hours of commencement of pushing

27
Q

What are the advantages and disadvantages of the 2nd stage?

A

Unlikely to beneficial

Directed pushing
Sustained bearing down
Breath-holding
Supine position

Beneficial

Upright posture
Spontaneous pushing
Privacy/dignity
Safety

28
Q

What is the mechanism of labour?

A
  • Descent
  • Flexion
  • Internal rotation
  • Crowning
  • Extension
  • Restitution
  • Internal restitution of shoulders
  • Lateral flexion
29
Q

What happens during labour?

A

The fetus descends into the pelvis

This can occur from 37 weeks gestation onwards, and may not occur until established labour.

It is encouraged by:
Increased abdominal muscle tone
Increased frequency and strength of contractions

30
Q

What happens during flexion of labour?

A

As the fetus descends through the pelvis, uterine contractions exerts pressure down the fetal spine towards the occiput, forcing the occiput to come into contact with the pelvic floor.

When this occurs, the fetal neck flexes allowing the circumference of the fetal head to reduce.

In this position, the fetal skull has a smaller diameter which assists passage through the pelvis.

31
Q

What happens during internal rotation of labour?

A

With each contraction, the fetal head is pushed onto the pelvic floor. Following each contraction, a rebound effect supports a small degree of rotation. Regular contractions eventually lead to the fetal head completing the 90° turn.

32
Q

What happens during mechanisms of labour during extension?

A

The fetal occiput will slip beneath the suprapubic arch allowing the head to extend.

The fetal head is now borm, and is usually facing the maternal back.

33
Q

What happens during restitution/ external rotation during labour?

A

The fetus may naturally align its head with the shoulders. At the point of the head delivery, the shoulders are only just reaching the pelvic floor and negotiating the pelvic outlet.
Visually, you may see the head externally rotate to face the right or left.

34
Q

What happens during mechanisms of labour: delivery of the body?

A

Gentle downward traction may be conducted by the midwife to assist with the delivery of the shoulder below the suprapubic arch.

This then may be followed by gentle upwards traction assisting the delivery of the posterior shoulder.

35
Q

3rd stage of labour

A

Physiological management-increase blood loss

Active management-oxytocic, cut and clamp cord, CCT
Nausea & vomiting

Check placenta and membranes complete

36
Q

What is delayed cord clamping?

A

There is now considerable evidence that early cord clamping does not benefit mothers or babies and may even be harmful. Both the World Health Organization and the International Federation of Gynecology and Obstetrics (FIGO) have dropped the practice from their guidelines.

Benefits
Improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects.

37
Q

What is the anatomy of the fetal skull?

A

The fetal skull is made up of three bones – the frontal bone, the temporal bone and the parietal bone.
The bone is not fully formed at this time, allowing for movement and overlapping to travel through the pelvis.
The sagittal suture and the two fontanels allows midwives/doctors to determine position within the pelvis.

38
Q

What are the two types of rupture of membranes?

A

SROM – Spontaneous Rupture of Membranes

ARM – Artificial Rupture of Membranes

39
Q

What happens during rupture of membranes?

A

Amniotic fluid (liquor) is the fluid between the baby and the amnion (sac), and acts as a ‘cushion’ around the fetus to protect it against any bumps to the mothers abdomen. The fetus can swallow the amniotic fluid, which will help create urine and meconium. It is considerably rich in stem cells. At term (37-42 weeks) there may be between 500mls-800mls.
SROM can happen at any point prior to, or during labour. Rarely, the fetus can be born within the amniotic sac (known as en caul).

40
Q

What is placenta?

A

The placenta is a temporary organ during pregnancy, that is made up of lobes which attach to the uterine wall. It is connected to the fetus via the umbilical cord, which has two arteries and a vein.

Oxygen and nutrients are passed to the fetus via the placenta- and waste products from the fetus (such as carbon dioxide) is passed back to the maternal blood stream for disposal.
The placenta produces hormones that assist with fetal growth and development.
Alcohol and nicotine can be passed to the fetus via the placenta, along with maternal antibodies to protect against infection after birth.

41
Q

What are the 2 membranes of the placenta?

A

2 membranes with the placenta-
The amnion is the bag around the baby
The chorion is the membranes around the placenta

42
Q

What are some options for birth?

A

Immersion in water – pool birth
Analgesic aspects
Promotes calmness
Hands off approach

Upright birth
Increases the diameter of the pelvic inlet
Less risk of compressing mothers aorta
Encourages stronger and longer contractions
Gravity!

43
Q

What are the pros and cons of water immersion?

A

Pros:
None-invasive during labour
Partner can be involved with facilitating
No risk to baby

Con’s
Birthing pool may not be available
Some will work better than others

44
Q

What are the pros and cons of etonox, paracetamol and codeine?

A

Pro’s
Entonox is fast acting (usually taking 20-30 seconds to take effect)
Can be used alongside other analgesia
Does not require any further fetal monitoring
Paracetamol/Co-Codamol can be accessed over the counter and taken at home

Con’s
Entonox can make women feel nauseous and light headed
The effect will wear off quickly (as soon as it has stopped being inhaled)

45
Q

Pros and cons of opioids during labour

A

Pro’s
Can be given by a midwife therefore no delay
Still able to mobilise
Does not slow down labour if established
Can make the woman feel quite drowsy, and allow her to sleep between contractions

Con’s
Remifentanyl can only be given by an anaethetist
Can cause nausea and vomitting
Can cause respiratory depression in both mother and fetus

46
Q

What is an epidural?

A

Epidural analgesia is a mixture of bupivacaine and fentanyl
Epidural catheter is inserted by an anaesthetist, and drugs are administered through this via a pump.

47
Q

Pros and cons of epidural

A

Pro’s
Total pain relief in 90% of cases
Effect will last until the baby is born

Con’s
Reduced mobility
Can take up to an hour to take effect
Will need a urinary catheter
Can slow down labour if not established

3A Womens health (33 decks)

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