Normal Labour Flashcards
what is normal labour?
- Process in which the foetus, placenta and membranes are expelled through the birth canal
- Between 37 and 42 weeks gestation
- Foetus presented by the vertex (head down)
We do not understand the ___________ factors that cause labour to start but there is multiple theories – it is triggered by paracrine and _______- signals generated by maternal, foetal and placental factors which interplay
physiological
autocrine
Key physiological changes must occur to allow for expulsion of the foetus, what are they?
- Cervix softens
- Myometrial tone changes to allow for coordinated contractions
- Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
what are the stages of labour?
- First stage of labour – early/latent phase, active first stage and transition
- Second stage of labour – passive, active
- Third stage of labour – active or physiological
First stage of labour can be split into latent phase/early labour and active first stage:
what is the latent phase?
can be the longest part of labour
Irregular contractions
Cervical changes and dilatation up to 4cm
what is the active phae of the first stage of labour?
length of active labour can vary from 8-12 hours
regular and painful contractions
cervix is 4-10cm
what is the transition phase?
cervix is 8-10cm
may experience physical changes such as shaking, vomiting or the need to empty her bowels
may express that they can no longer cope
Second stage of labour – can have a passive and active element:
what is involved?
- Full dilation to birth
- Passive second stage of labour
- Active stage of labour
- Length vary between 2-3 hours depending on if women is nulliparous (never given birth) or multiparous (given birth before)
what is involed in the third stage of labour?
- Form birth of the baby to the expulsion of the placenta and membranes
- Physiological management
- Active management
what are the 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 foetal lies?
what are the different foetal presentations?
what are the different foetal positions?
what is a foetal skull like?
Assessing foetal wellbeing:
- There is ____ exerted onto the foetus regardless of it being a spontaneous or augmented labour, so monitoring the foetal _____ is important
stress
heart
- Depending on the women’s risk assessment this may be through _________ auscultation or ________ monitoring
intermittent
continuous
- Intermittent auscultation can be done using _______ stethoscope or a handheld ______
- Continuous monitoring is done using a __________
Pinards
doppler
cardiotocograph
- A normal foetal heartrate is between ____-___bpm, with good ________ (>5bpm) and __________ (15bpm)
110-160
variability
accelerations
Monitoring labour - as well as monitoring the baby through labour, we also monitor the women. WHat ways can this be done?
- Maternal observations e.g. BP, pulse, temp, RR
- Abdominal palpation – baby position, where is the head in relation to pelvis
- Vaginal examination
- Monitoring of liquor (how the baby is coping if the it is clear, straw or pink colour)
- Palpation of contraction
- External signs e.g. rhomboid of Michaelis and anal cleft line
what support can be given through labour?
A large part of our role as midwives is to support the women as she progresses through labour – physically, mentally and emotionally
All women will experience labour differently, and there are many non-pharmacological and pharmacological options that they can utilise:
- Maternal position and mobility
- Breathing and hypnobirthing techniques
- Massage
- Aromatherapy
- TENS (machine)
- Oral analgesia
- Water
- Entonox (piped into all birth rooms for mother to use when needed)
- Opioids
- Remifentanil PCA
- epidural
