Normal labour Flashcards
Is labour normally induced or spontaneous?
Spontaneous
When does birth normally take place?
37-42 weeks gestation
What are some key changes we know must occur for normal spontaneous birth?
Cervix soften
Myometrial tone changes to allow coordinated contractions
Progesterone decreases while oxytocin and prostaglandins increase to initiate labour
What are the 3 phases of the first stage of labour?
Latent
Active
Tansition
What are some characteristics of the latent phase?
First
Can be longest
Irregular contractions
Cervical dilation up to 4cm
Name some characteristics of the active phase.
8-12 hours
Regular painful contractions
Cervix 4-10cm
What are some characteristics of the transition phase?
Cervix 8-10cm
Possible physical changes like shaking, vomiting or need to empty bowels
May express inability to cope
During which stage does the cervix dilate fully to birth?
Second
What may indicate second stage?
Fully dilated
See presenting part visible
Expulsive contractions or maternal effort after encouragement
What categorises the third stage?
From birth of baby to expulsion of placenta and membranes
What does Nulliparous mean?
Woman has not experienced live birth
What does multiparous mean?
Given birth multiple times
What is the function of flexion in the mechanism of labour?
Smaller diameter presenting to aid navigation through the pelvis
What is internal rotation?
Leading part is pushed down towards pelvic floor and diaphragm resists, causing rotation
Describe crowning and extension.
Head is guided by pelvic floor, turns 45*, comes under pubic arch and extends, does not recede
What is restitution?
Baby turns back to face position it was in utero
Describe external rotation of the head and internal rotation of shoulders.
Shoulders catch up with way head is facing.
Cranium lateral
Describe cephalic fetal lie.
Head pointing to birth canal
Basically upside down to us
Describe breech fetal lie.
Arse pointing towards birth canal
Describe transverse fetal lie.
Head and arse point laterally
How is the fetal heart monitored?
Intermittent auscultation
Continuous monitoring
Which devices are used to auscultate the fetal heart?
Pinards stethoscope
Hand held dopplar (amplifies)
What is used for continuous fetal heart monitoring?
Cardiotocograph (CTG)
Paddles put on woman’s abdomen
Measure fetal heart and contractions
What is a normal fetal heart rate?
110-160
High variability and accelerations
What are some ways the mother is monitored during birth?
Abdominal palpation Vaginal exam Monitoring of liquor Palpation of contractions External signs
What are 2 external signs used to monitor the mother?
Rhomboid of Michaelis
Anal cleft lign
How is liquor used to monitor labour?
Clear, straw colour or slightly pink all normal and good indication
Look out for meconium or bloods
What is the rhomboid of michaelis?
Rhomboid shape obvious at tail bone
Displaced pelvic bone making way for baby’s head
What are some good non-pharmacological options for support through labour?
Position and mobility Breathing and hypnobirthing Massage Aromatherapy TENS
What is multiple gestation?
Pregnancy with more than one embryo
What are dichorionic diamniotic twins?
Each baby has a separate placenta and amniotic sac
What are monochorionic diamniotic twins?
Both babies share a placenta but have separate amniotic sacs
What are monochorionic monoamniotic twins?
Each baby shares amniotic sac and placenta
