Normal birth & the puerperium Flashcards
What is a normal birth
- Spontaneous
- No drugs used for induction
- Low- risk at the start of labour and remaining so throughout labour & delivery
- The infant is born spontaneously in the vertex position between 37& 42 weeks of pregnancy
- After birth mother & infant are in good condition
What are the characteristics of the early labour stage?
- Irregular contractions
- Bloody mucus show
- Rupture of membranes
- There is some cervical change, including cervical effacement & dilatation up to 4cms
- A period of time, not necessary continuous, when there are painful contractions
What are the characteristics of the active first labour stage?
- There are regular painful contractions and progressive cervical dilation from 4cm
- Progress usually considered normal if cervix dilates at least 0.5cm/hour
How do we monitor labour?
Maternal: -contractions -dilatation -vital signs -drugs/fluids -urine output -PV loss: liquor, blood -pain -emotional state Fetal: -Fetal heart activity -position -descent
How is pain relief provided in labour
Non-pharmacological: -breathing and relaxation -massage -water Pharmacological: -Entonox -Opioids Regional: -epidural
What are the characteristics relating to transition into the 2nd stage of pregnancy
- uncontrollable urge to push
- holding breath/ grunting
- sweating
- mood changes ( sleepy/more focused)
- external genitals or anus begin to bulge out during contractions
- woman may feel the baby’s head begin to move into the vagina
- A purple line between the mother’s buttocks as they spread apart from the pressure of the baby’s head
What are the characteristics of the 2nd stage of pregnancy?
- ) Passive 2nd stage:
- Full dilataation of the cervix prior to or in the absence of involuntary expulsive contractions
- The ‘rest and be thankful stage’
- varies in length- usually around 1 hour - ) Active 2nd stage: the baby is visible-expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation
- Diagnosis of delay should be made for nulliparous women when it has lasted 2 hours and for parous women when it has lasted 1 hour
What are the characteristics of the 3rd stage of pregnancy?
- Comprises the phase of placental separation, its descent to the lower segment& its expulsion with the membrane
- The cord and placenta system will contain about 1/3 of baby’s blood whilst the remaining 2/3 is in the baby
- After a few mins the cord will stop pulsating. The mother will often feel an urge to push shortly after this
- The contractions may be painful but the placenta usually slides out easily
- The midwife will check it to ensure that it’s complete and none is left inside the mother
- Breastfeeding can stimulate a contraction and help the placenta separate from the womb
Describe the different types of management of the 3rd stage of pregnancy
- ) ACTIVE MANAGEMENT:
- speeds up the delivery of the placenta
- Routine use of uterotonic drugs
- Deferred clamping and cutting of the cord
- Controlled cord traction after signs of separation of the placenta - ) PHYSIOLOGICAL MANAGEMENT:
- waiting for the placenta to come naturally, the mum pushes it out
- can take between 10mins to an hour
- No routine use of uterotonic drugs
- No clamping of the cord until pulsation has stopped
- delivery of the placenta by maternal effort
What is the puerperium?
-The time from the end of the 3rd stage through the first few weeks after delivery. This period is usually considered to be 6 weeks in duration
List some serious post partum complications and their signs/symptoms
Post partum haemorrhage: -sudden and profuse blood loss -faintness -palpitations/tachycardia Pre eclampsia: -Headaches accompanied by 1/more of the following symptoms within the 1st 72 hours after birth.. visual disturbances, nausea, vomiting Thromboembolism: -unilateral calf pain -redness/swelling Infection: -fever -shivering -abdominal pain and/or offensive vaginal loss
What is involution of the uterus
- Needs to be monitored during the puerperium
- Shrinkage& the body is sort of reabsorbing it all back
What is lochia
- Needs to be monitored during the puerperium
- Vaginal discharge after giving birth
