Week 4: The Labour Process Flashcards
What is labour?
Process of moving the fetus, placenta, and membranes out of the uterus and through the birth canal.
What are 4 possible signs which precede labour?
Lightening or dropping, urinary frequency, backache, stronger Braxton Hicks, weight loss (0.5-1.5kg), surge of energy/nesting, increased vaginal discharge, cervical ripening, possible rupture of membranes.
Is the onset of labour attributed to a single cause?
No. Many facets are involved like changes in maternal uterus, cervix, pituitary gland.
What is the function of endorphins in labour?
Help with pain management and lead to a sense of well-being.
Which hormone levels increase with labour?
Estrogen, oxytocin, prostaglandins, prolactin.
Which hormone levels decrease with the onset of labour?
Progesterone, as its goal is to maintain a pregnancy.
What are some key facts about true contractions?
They are regular and remain painful.
What do we want to do when a mother goes into labour?
Reduce stress levels and anxiety. Avoid increases in adrenaline beyond what is normal.
Explain the 5-1-1 rule.
It’s a good time to come to the hospital for contractions every 5’ that last 1’ for the last 1hr.
What are prelabour contractions?
Irregular or temporarily regular, often stop with walking, felt in the back or abdomen, cervix is soft, no dilation or effacement, posterior.
What are true labour contractions?
Regular, strong, last longer, closer together, more intense with walking, felt in the lower back radiating to lower part of abdomen, cervix is soft, effaced, dilated, anterior position, bloody show.
What is effacement?
Shortening and thinning of the cervix during the first stage of labor. Expressed as a %.
What is presentation?
The part of the fetus that enters the pelvic inlet first to lead through the birth canal.
What is dilation?
Enlarging and widening of the cervical canal. 1cm to 10cm (end of first stage of labour).
What is engagement?
Largest transverse diameter of the presenting part has passed through the pelvic inlet into the pelvic cavity.
What is crowning?
Head or the presenting part appears at the vaginal opening.
What does a station of -1 mean?
1 cm above the spine.
What does a station of 0 mean?
At the level of the spine.
What does a station of +4 or +5 mean?
Birth imminent presenting part (+4 out the door).
What are the 5 P’s of labour?
Passenger, passageway, powers, position, and psychological response.
What affects the Passenger in labour?
Size of fetal head, fetal presentation, fetal lie, fetal attitude, fetal position.
What is the ideal position for labour to progress easily?
Well flexed, chin tucked in to neck. If the baby is deflexed, it becomes harder to fit through the cervix.
What is fetal lie?
Longitudinal: Cephalic or breech. Transverse: spine across lateral spine.
What are the 3 types of fetal presentation?
Cephalic, breech, or shoulder.
What is cephalic presentation?
Child’s occiput presents.
Explain the 3 letter abbreviation for fetal position.
R/L: Right or left of mom pelvis. O/S/M/Sc: Occiput, sacrum, Chin, or scapula. A/P/T: Anterior, posterior, transverse.
What are the 2 most favourable fetal lie positions?
ROA, LOA.
What are the 2 least favourable fetal lie positions?
LOP/ROP.
What type of position is most favourable for a breech birth?
Frank breech high longitudinal lie, breeched, sacrum, flexion except for legs at the knees.
Can you deliver a baby in the single footling breech position?
No.
Can you deliver a baby with shoulder presentation?
No.
What head position has the best chance of a successful birth?
Vertex presentation. Brow will be the hardest.
Is the principle of wide, child-bearing hips correct?
No. All that matters is the inner-aspect of the hips. Not the external hip measurement.
What is the Ferguson reflex?
Oxytocin is released, this increases the amount of uterine contractions and this is a positive feedback loop.
What are some examples of primary powers in labour?
Effacement, dilation, Ferguson reflex.
What are some examples of secondary powers?
Bearing down efforts.
How many pushes should you tell a patient to give in one contraction?
3.
Is it good to frequently change position while in labour?
Yes. This relieves fatigue, increases comfort, and improves circulation.
Why is resting important between contractions?
This is important for fetal oxygen. The power is intense/pressure so the baby cannot breathe in a contraction. Perfusion from the placenta to the fetus is reduced so we need to give the baby blood and breath.
