normal labour Flashcards
what is normal labour
process in which the fetus, placenta and membranes are expelled via the birth canal
it is spontaneous, 37-42wks gestation, fetus presenting by the vertex, results in a spontaneous vaginal birth (SVD)
physiological changes that allow for expulsion of the fetus
cervix softens
myometrial tone changes to allow for coordinated contractions
progesterone decreases whilst oxytocin and prostaglandins increase to allow labour to initiate
how many stages
3
describe the 3 stages of labour
1st - early/latent, active 1st phase and transition
2nd - passive, active
3rd - active or physiological
what are the stages of the first stage of labour
latent phase/early labour
active 1st stage
describe the latent phase
can be the longest part of labour
irregular contractions
cervical changes and dilatation up to 4cm
describe the active phase
length of active labour can vary from 8-12hrs
regular, painful contractions
cervix is 4-10cm
describe the transition
cervix 8-10cm
may experience physical changes - vomiting, shaking, need to empty bowels
may express that they can no longer cope
describe the 2nd stage of labour
can have a passive and active element
full dilatation to birth
length will vary between 2-3hrs depending on if woman is nulliparous or multiparous
describe the 3rd stage of labour
from birth of the baby to the expulsion of the placenta and membranes
physiological and active management
what are the 7 mechanisms of labour
engagement and descent
flexion
internal rotation of the head
crowning and extension of the head
restitution
internal rotation of the head and external rotation of the head
lateral flexion of shoulders
what are the different types of fetal lie
cephalic
breech
transverse
what are the different types of fetal presentation
face
brow
vertex
breech
shoulder
what are the different fetal positions
right occipitoposterior
left occipitoposterior
left occipitotransverse
left occipitoanterior
right occipitoanterior
right occipitotransverse
whis is it important to assess fetal wellbeing
stress is being exerted onto the fetus - in both spontaneous and augmented delivery
this can be intermittent or continous - depends on the woman’s risk assessment
methods of assessing fetal wellbeing
Pinards stethoscope - intermittnet monitoring
hand held dopplar - intermittent monitoring
cardiotocograph (CTG) - continuous monitoring
what is a normal fetal heart rate
110-160bpm
with good variability (>5bpm) and accelerations (15bpms)
methods of monitoring labour
maternal observations
abdo palpation
vaginal examination
monitoring of liquor
palpation of contractions
external signs e.g. rhomboid of Michaelis and anal cleft line
non-pharmacological and pharmacological support through labour
maternal position and mobility, breathing and hypnobirthing techniques, massage, aromatherapy , TENS, water
oral analgesia, entonox, opioids, Remifentanil PCA, epidural
pros and cons of entonox
widely used, safe, patient in control, works and wears off quickly, patient mobile, can be used with other pain relief systems
dizzy, dry mouth, sick, doesn’t take pain away quickly, timing takes practice
pros and cons of diamorphine
works in 40 mins, lasts 4 hours, relaxes patient, helps patient cope with pain better
sick, sleepy, slows breathing, similar effects on baby
pros and cons of remifentanil PCA (patient controlled analgesia)
patient is in control, works and wears off quickly, strong pain relief
may slow breathing, extra oxygen and monitoring, drowsy, sick, itchy, can’t start if you have had diamorphine in the last 4hrs, not mobile once started
pros and cons of an epidural
most effective pain relief during labour, unlikely to affect baby, you are in control and can be topped up if going for C section
can slow pushing phase of delivery, increased risk of forceps/suction cup, drop in BP, itching, fever, sore area on back, headache
rare but serious complications of epidural
temporary nerve damage - numb area/weakness
nerve damage >6mths
epidural abscess
meningitis
epidural haematoma
accidental unconsciousness
severe injury
