Obstetrics (Normal Birth) Flashcards
Recite the normal birth CPG (part 1)
Recite the Normal Birth CPG (Part 2)
Can you give opioid analgesics in the late second stage of labour?
No they are contraindicated
What do you do in the normal birth - not imminent?
- reassure
- monitor regularly for change
- transfer to appropriate maternity service facility using a left lateral tilt position
- provide analgesia
How do you prepare for the imminent normal birth?
- reassure including cultural considerations
- prepare equipment for normal birth
- provide a warm and clean environment
- provide analgesia
What do you do in the normal birth - birth of the head?
- as the head advances, encourage the mother to push with each contraction
- if head is birthing too fast, ask mother to pant with an open mouth during contractions instead
- place fingers on baby’s head to feel strength of descent of head
- apply gentle pressure to the perineum to reduce risk of perineal tears
- if precipitous, apply gentle backward and downward pressure to control sudden expulsion of the head
- do not hold back forcibly
- note the time once the head is delivered
what do you do in the normal birth - umbilical cord check?
- following the birth of the head, check for umbilical cord around the neck
- if loose and wrapped around neck - slip over babies head with appropriate traction
- if tight - mother should be encouraged to push
- where the baby does not descent and cord still cannot be loosened, clamp and cut cord
what do you do in the normal birth - head rotation?
- with the next contraction the head will turn to face one of the mothers thighs (restitution)
- this indicates internal rotation of shoulders in preparation for birth of the body
What does restitution indicate?
- internal rotation of shoulders in preparation for birth of the body
what do you do in the normal birth - birth of shoulders and body?
- may be a passive or guided birth
- hold baby’s head between hands and if required apply gentle downwards pressure to deliver the anterior (top) shoulder
- once the babys anterior shoulder is visible, if necessary to assist birth, apply gentle upward pressure to birth posterior shoulder - the body will quickly follow
- support the aby
- note the time of birth
- place the baby skin to skin with mother on her chest to maintain warmth unless baby is not vigorous/requires resuscitation
- Manage the vigorous newborn as per Newborn Baby
- Manage the non vigorous baby as per newborn resuscitation
- If body fails to deliver in <60 seconds after the head manage as per Shoulder dystocia
- following delivery of baby - gently palpate abdomen to ensure second baby is not present
What do you do if the baby is vigorous?
- manage as per newborn baby
What do you do if the baby is non-vigorous
- manage as per newborn resus
What do you do if the babys body does not deliver within 60 seconds of delivery of head?
- manage as per shoulder dystocia
what steps are required in clamping and cutting the cord?
- there is no immediate urgency to cut the cord
- wait for the cord to stop pulsating, which commonly tkes one to two minutes.
- allow birthing partner to cut the cord if they wish
- ideally cord cutting should be taken prior to extrication
- to cut the cord, apply first clamp 10 cm away from baby and second clamp 5cm after that. then cut the cord between the two clamps
- for uncomplicated births, a parental birthing preference where mother and abby are transported to hospital still attached is permissable (lotus birth)
How long does it take for the cord to stop pulsating?
1-2 minutes
