The stages of labour and birth

Question 1

Changes to cardiovascular system during pregnancy

Answer 1

-circulating blood volume will increase by 30-40%
-HR increases by 20bpm
-cardiac output increases
-BP lowers due to increase progesterone
-heart shifts upwards due to enlarged uterus

Question 2

Changes to respiratory system

Answer 2

-uterus presses on diaphragm
-reduced capacity to take deep breaths
-may be slightly tachypnoea
-ligaments that join ribs to sternum relax to increase tidal volume

Question 3

Anatomy changes

Answer 3

-increased spine curvature (lordosis)
-reduced bladder and rectal capacity
-uterus can grow 5-6x
-joints in pelvis widen (sacroiliac, pubic symphysis)

Question 4

Fundus

Answer 4

-height of the bump
-gradually increases during pregnancy
-until around 40 wks where the bump will drop as the babies head engages with pelvis

Question 5

Stages of labour

Answer 5

First
-cervix opens fully over several hours
-comprises latent phase, early labour, active labour and transition
Second
-from full dilation to birth of baby
Third
-from birth of baby to delivery of placenta

Question 6

Pre labour
Cervix shape, baby location

Answer 6

-cervix long and closed but starts ripen/ soften
-head sitting in pelvis
-baby facing side

Question 7

Latent phase
Contractions, cervix, how long, what to do

Answer 7

-contractions irregular, short and painful
-cervix shortens and starts open
-woman is fine and can stay at home
-can last 20 hours
-‘show’- mucus and blood, sign of cervix softening
-cervix dilate from 0-3cm

Question 8

Early labour
contractions, cervix, changes to woman

Answer 8

-contractions more regular, longer, more intense
-cervix thins and continues to open
-baby starting to push down through pelvis
-woman fine at home

Question 9

Active labour
contractions, cervix, baby

Answer 9

-contractions strong, 3-5 mins, intense
-cervix open 3-6cm
-baby descending
-woman likely to want to be in place where she wants to give birth

Question 10

Transition stage
contractions,

Answer 10

-contractions every 3-5 mins very intense
-woman needs lots of encouragement as often feels she can’t cope
-rectal pressure at peak of contractions
-membrane bulging if not already broken
-if not 1st baby, birth imminent

Question 11

Full dilation

Answer 11

-contractions every 60-90secs
-urge to push with peak of contraction
-blood stained ‘show’
-may open bowels, reassure her its normal
-head moulding and starting to rotate

Question 12

Assessment of woman in labour

Answer 12

-observe and listen to woman
-history- parity (no. times given birth), gravidy (no. times pregnant), gestation, complications
-count contraction rate
-set of obs
-any loss per vaginum eg. ‘show’ etc.

Question 13

Communication with other professionals

Answer 13

-call midwife
-discuss with staff at booked place of birth
-if any complications, they will advise transfer
-if birth imminent, remain on scene, midwife will be called
-request second ambulance
-get informed consent for everything

Question 14

Preparation for birth

Answer 14

-entonox
-warm room, towels and blankets
-allow woman choose comfortable position
-cover areas with sheets/ towels/ inco pad
-prepare neonatal resus area
-open delivery pack
-put on gloves when birth imminent
-prepare medications we might need

Question 15

Medications we need to prepare

Answer 15

Carbetocin
Misoprostol
TXA
-all for post partum haemorrhage

Question 16

What you see when birth imminent

Answer 16

-anal dilation
-perineum bulging
-top of head visible when pushes
-head will go back between contractions (1st baby)
-reassure that what she is feeling is normal

Question 17

What affects birth of baby

Answer 17

Power- strength of push
Passenger- foetus size, head size, angle of head
Passage- pelvis, inlet not stretched wide enough, baby may not have rotated

Question 18

Multip
Premip

Answer 18

-mum given birth before
-first birth

Question 19

Crowning

Answer 19

-most of head out
-head won’t retreat after this contraction
-ask woman to breathe and not push
-consider gentle pressure on top of head to slow it down

Question 20

Head born

Answer 20

-note time
-shoulders rotate in pelvis
-if multip, body may follow quickly
-if premip, wait for next contraction to deliver body

Question 21

After birth

Answer 21

-pass baby to mum
-skin to skin, dry and cover warm towels
-place hat on baby head
-observe blood loss
-don’t pull on cord
-observe baby’s condition, if crying no further action
-if not crying after 15secs stimulate with towel
-if not responding, cut cord and take to resus area

Question 22

Effects of oxytocin

Answer 22

-encourage production of breast milk
-bonding and attachment
-inhibition of stress
-decrease BP

Question 23

Delivery of placenta

Answer 23

-up to 20mins after
-placenta separates from uterus wall, causing small gush of blood and lengthening of cord
-may become uncomfortable in lower back/ rectum
-ask to push placenta out
-uterus then contracts to prevent haemorrhage
-afterpains may start in multip
-collect placenta in bowl or bag for inspection by midwife

Question 24

Cut umbilical cord

Answer 24

-cord continues pulse to deliver oxygen during transition to extra-uterine life
-don’t clamp earlier than 1 min after birth unless has HR less than 60bpm and isn’t increasing
-leave 10cm to put first clamp, 5cm next clamp then cut in between

Question 25

After care

Answer 25

-clean sanitary towel for mum
-keep bloodied linen to be weighed
-keep mum and baby covered, skin to skin, encourage breast feeding
-observe blood loss
-record set of obs
-if midwife hasn’t arrived liaise with delivery suite for advice

Question 26

Assessment of baby

Answer 26

-colour- not blue or waxy white
-tone- want some flexion, not floppy limbs
-breathing- yes/no, crying or not
-HR- below 60= bad
-temp