Week 1-3 Flashcards
Where can you give birth?
- Home Birth
- Midwife Led Derby Birth Centre (with birth pool)
- Hospital Birth
Week 1
Midwife Led Derby Birth Centre
- Situated within the Derby hospital near to the labour wards
- If need a C-section then immediately transferred and midwife will transfer ahead of time without worry
Week 1
Signs of Labour
1. Water breaks
* 1/10 women don’t have waters break but could happen at any point
* If water breaks, wear a pad and monitor colour, smell and how much fluid there is
* Bad sign if bright red blood, report this to midwife immediately
* If water does break then contact midwife immediately.. 60-80% go into labour within 24hrs after water breaks and 90% go into labour within 48hrs
Week 1
Signs of Labour
2. Meconium
* Baby poo which could be leaking from the amniotic sac
* If spot anything brown, report this to midwife immediately
Week 1
Signs of Labour
3. Contractions
* Known as the effacement of the cervix and will be irregular initially
* Contractions can start around 2 weeks before arrival of baby, the lining of the cervix is thinning and moving upwards to the top of the uterus
* Whole contraction lasts around 60 - 90 seconds with the peak lasting roughly 20 - 30 seconds
* 5% of contractions is at it’s peak
* Deep breathing can help with contractions
* Go to the hospital if 3 contractions for 1 minute or more in 10 minutes (get app for counting)
Week 1
Signs of Labour
4. Mucus Plug
* Known as the bloody show
* Should not be bright red but can be pink in colour
* Sometimes large but sometimes a small amount when wiping
Week 1
Signs of Labour
5. Diarrhea
* Hormones change rapidly to prepare your body for delivery, which causes the muscles in your uterus, cervix and even your rectum to loosen
Week 1
Important Points to Note
- Ask for numbers when percentages are given e.g. double increase in risk
- How do you want the midwife to address you? E.g. ask questions? Go through Raj only?
- Be informed and ask questions
- Be cautious when ‘just’ is used
Week 1
Hormones
1. Oxytocin
* Known as the love hormones and needed for contractions
* Building during the latent phase where hormones are building - generally when 0 - 4cm dilated
* E.g. warmth, nice smells (lavendar, rose), dim lights, cuddles, baking, massages (things to help you relax to increase oxytocin)
* When transitioning to hospital, take a blanket and pillow (not white), candles, scan photos
* Breathing exercises - 2 breath (Darth Vader Breath), candle breath
Week 1
Hormones
2. Endorphins
* 200% more powerful than morphine pain relief
* DO NOT want to be obseved, does not help increase oxytocin or endorphins - try stay at home as long as possible
Week 1
First Stage of Labour
* 5 - 10% increase in dilation
* Contractions become more regular and intense
* Have a bath / point shower head on lower back
* Do yoga circles / keep bum wiggling to help with pressure
* Raj and Rosh breathe together, elongate exhale to keep calm
Week 1
Pain Relief
* Gas & Air
* Pethodin
* Epidural - only administered on labour ward
* Labour comb - apply pressure to hands
* Movement
* Homeopathic remedy
* Bachs Rescue Remedy - oral drink
Week 1
BRAIN
Benefits
Risk
Alternatives
Intuition
Nothing
Week 1
Transition
* Oxytocin decrease and adrenaline increases
* Can last up to 20 minutes
* Changes in behavviour or thoughts (might want to come out of bubble)
Ways to navigate transition:
- Change scenery
- Sing
- Dance
- Go for a walk
- Try something that haven’t tried yet
Week 1
Second Stage of Labour
* Oxytocin increases
* Uterus contracts, relax pelvic floor
* More regular contractions with slightly longer rest periods
* Might need to poo (not poo is the baby moving down)
* Crowning - stretching of the vagina, baby’s head
Things to do during the second stage
- Relax jaw and do horse lips to relax the pelvic floor
- Squat and wiggle hips
- Hands and knees - pelvis 30% more open in this position
- (If epidural) stay on side not back
Spinning Babies Method - deep squat / kneeling forward
Week 1
Assisted Birth
* Forceps - tongs to help pull the baby out, gentle tugs on each contraction
* Ventouse - vacuum / suction cup on baby’s head to help pull baby out
* Episiotomy - a cut through the area between the vagina and anus (perineum)
Make a BRAIN decision for above
Try perineal massage from 35 weeks pregnancy to help with stretching of perineum
Week 1
Third Stage of Labour - Placenta Birth
* Usually 30 mins after baby’s birth but can take up to an hour
* Uterus needs to continue contracting
2 types of placenta birth:
- Managed - syntocinon injection (synthetic oxytocin) to allow uterus to continue contracting (usually advised if induced)
- No medical intervention - nothing in the bloodstream and natural birth of placenta
Week 1
Induction
Usually offered when you get to 39 / 40 weeks of pregnancy
Sweep
- Cervical sweep of the membrane where a finger is swept around the cervix
- Can have up to 3 (usually 1 a week)
- Can decline cerival checks
Week 2
Induction
What happens if sweeps don’t work?
1. Pessery called Prostin - inserted in the vagina and softens the cervix
(Will be in the hospital for a couple hours)
2. Syntocinon on drip & fluids - more intense and stronger contractions and more pain as labour usually starts at this point
(Will be kept in the hospital likely for 1 or 2 days)
Week 2
Natural Methods of Induction
- Raspberry Leaf Tea (after 36 weeks)
- Essential Oils - Jasmine, Clary Sage, Rosemary (ues during labour)
- Chillis
- Homeopathy - accupuncture
- 4 / 6 dates a day (shortens the first stage of labour)
Week 2
What are the different types of pain medications?
Natural
- Movement - being on hands and knees
- Breathing
- Aromatherapy - Jasmine, Clary Sage, Rosemary & Lavendar
- Water - warm bath or shower running on lower back
- Accupuncture / Reflexology
- Hypnobirthing - deep relaxation, cuddles, sex
Week 2
What are the different types of pain medications?
Medical
1. Gas & Air
2. Pethodin
3. Epidural
Week 2
What are the different types of pain medications?
1. Gas & Air (Laughing Gas & Oxygen) (can have as much as you want)
- Encouraged during contractions only
- Wears of very quickly (within seconds) - feel spaced out but could make you nauseous
- DOES NOT pass to the baby
- Can be used in a birth pool too
Week 2
What are the different types of pain medications?
2. Pethodin (muscle & mind relaxant administered by injection) (usually only given once)
- Lasts up to 6 hours then wears off
- DOES pass to the baby (don’t want it too close to when the baby comes)
Week 2
What are the different types of pain medications?
3. Epidural (injection in the spine) (can be topped up)
- Might be really tired or in a lot of pain
- Docs might be thinking of using assisted birth tools
- Might take time for anesthetist to come (could take up to an hour)
- Takes a while to kick in
- Feel numb from the waist down (stay on side) (kneeling with help)
- Can’t feel anything so may be coached when to push by the midwife
Fetal Rejection Reflex - the body releases a baby involuntarily
Week 2
C-Section
Reasons for a c-section
1. Immediate threat to life (super rare)
2. Maternal / Fetal compromise
3. No compromise but early delivery is necessary
4. Elective
Reasons for a c-section
1. Placenta Previa (the placenta attaches low in the uterus)
2. Twins / multiple births
Week 2
Process of having a C-Section
- Will have an epidural - the anesthetist will keep talking to you and go through the people in the room (8 people roughly)
- Wearing a gown, lying on your back
- Doc will cut through 7 layers to deliver baby
- Mention beforehand if want baby to be put straight on mum’s chest
- Weigh baby on front can cause less stress than weighing on back
- Can ask for the screen to be lowered to see the delivery of baby
- Can request music, aromatherapy or silence if preferred and continue with natural medications
Week 2
Water Birth
- Only 9/100 have water births
- If ‘low risk’ then the benefits in water can outweigh the risks
- Can still do movement, aromatherapy and all natural medications
Week 2
Water Birth
Negatives of a water birth
- Can’t have an epidural
- Don’t like you staying in the water too long, usually get in closer to the time of birth i.e. 7 - 8cm
- Cord avulsion (cord snaps) increase which can happen if baby is brought to the chest too fast - 1.3/1000 not in water vs 4.1/1000 in water
- Uterine infection rate increases - 0.06 increase between in and out of water, usually treated with antibiotics
Week 2
Water Birth
Positives of a water birth
- Rate of epidural & hemorrhage declines
- Might be able to cope without epidural and pethodin but can still use gas & air
- Rate of assisted birth tools declines
- Can lie on your back easier
- Rate of birth satisfaction increases
- Water is kept regulated to body temperature of 37 degrees
- Midwife is generally less involved with the labour
- Dad can also get into the birth pool
Week 2
General Steps
- Stay at home until 3 in 10 for 1 minute contractions or 4cm dilated
- Go to the hospital and wait to be admitted, then checked
- Either go home and wait for longer or stay in hospital at this point
- Taken to a private room if labour is progressing
Week 2
Tips for Dad
- Get onboard, know mum’s mindet so that you can advocate if needed
- Pack the hospital bag
- Work out a gesture together to stop or continue something mid contraction
- Help stay in the bubble and calming mindset - breathe together, affirmations and movement
- Connected - dad groups - FB groups
Week 2
Postpartum Plan
- Batch cook food and freeze roughly 40 days
- Do you want visitors?
- No kissing (especially on face and hands)
- Wash hands before holding baby
- No perfumes - babies learn through touch and smell
Postpartum Hormones
- Estrogen and progesterone decrease (can take 5 days to get back to pre-birth)
- Oxytocin increases - uterus is still contracting (let someone know if painful), can take longer for period to come back
- Lochia - bleed for about 6 week with first 3-4 days heaviest
- Prolactin - is a pregnany hormone that promotes breastfeeding
Day 3 - 4 usually the hardest where hormones are up and down
-Consider visitors around this time
-Sometimes want to cry all day (emotional period)
-If feeling low for more than 1 or 2 days could be more
Midwife Visits
- Midwife will visit home the day after you get home, she will:
- Check mum’s stomach
- Check how mum and baby are doing
- Check feeding if breastfeeding
Lochia
- Usually bleed for about 6 weeks
- Bright red initially then could be brown
- Heaviest at day 3 / 4 - like a heavy period
- Contact midwife if soak a pad in an hour
- If infection - smell different, dizzy, faint, headache, irregular heartbeat, tender stomach and sides, if red and heavy in second week (URGENT call midwife)
- Do same self care as when on period
Mental Health
Contact
- Midwife
- GP
- PANDAS
- Perinatal Mental Health (local drop in session)
Mental Health
1. Postnatal Depression
- 1 in 10 women are reported with Postnatal depression (low mood, hyperactive thoughts)
2. PTSD (usually from a traumatic birth)
- 1 in 3 women are reported with PTSD (flashbacks of birth, nightmares)
- Related to decision making whilst in labour / mum’s perception of labour
3. Postpartum Psychosis (paranoia, hallucinations)
- Could be persistent so seek help ASAP
Postpartum Care
Sleep
- When you sleep your body repairs itself, creates memories and processes birth
Hemorrhoids
- Try a sitz bath (with Epsom salts)
- Eat fibre, use creams and sit on a pillow
Mummy MOT
- See a women’s health professional after birth when you feel ready
Postnatal Yoga and Pilates
- Diastasis Recti (ab separation)
Baby Care
Top and tail baby
- For the first few weeks with cotton wool and warm water in the evening as a bedtime routine
- Start from the eyes, use cotton buds on ears and nose, hands and feet, get into all of the rolls and folds
Light and dark isn’t known initially so hard to establish bedtime routine
Speak positively to baby
Baby Positions
- Head by elbow or forward facing floor
- Pat bottom (reminds of inside womb)
- head on shoulder
Sleep
- If struggling contact a sleep consultant
- Use sleeping bags
- No mobiles
- Have nothing in the bed / cot
