KATIE ADAMS Midwifery Practice Facilitator / Labour Suite Manager April 2015 Normal Birth The...
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Transcript of KATIE ADAMS Midwifery Practice Facilitator / Labour Suite Manager April 2015 Normal Birth The...
KATIE ADAMS
Midwifery Practice Facilitator / Labour Suite Manager
April 2015
Normal BirthThe Mechanism
of Normal labour
What is Normal?
Normal Birth
Where labour is spontaneous at full term, not induced or augmented and where
normal progress is made without the use of pharmacology. The infant delivers with
maternal effort, no episiotomy or intervention with instruments or
caesarean section
Signs of labour -Latent phase
The body starts to prepare for labour.
Varies between individuals
Irregular painful contractions, period type pain, back pain
Sleeplessness, nausea, hunger / cravings, constipation, diarrhoea
Excitement / Nesting Lasts for several
hours / days Emotional support
and reassurance
When the waters breakorSpontaneous rupture of the membranes
Waters can break at any time – does not mean labour or childbirth is imminent
Clear in colour
Meconium stained liquour
Umbilical cord
Presenting part
Three stages of labour
First Stage:
The onset of regular painful uterine contractions accompanied by progressive dilatation of the cervix through the transitional phase to full cervical dilation of 10 cm.
Second Stage:
Full cervical dilatation to the delivery of the baby.
Third Stage:
Time of birth to the delivery of the placenta and control of bleeding.
Bishops score
Pain Relief
Natural Endorphines Immersion in Water Breathing Techniques Hypnosis Reflexology Massage TENS
N2O+O2 Simple Analgesia (Paracetamol) Narcotics (Pethidine) Epidural Spinal GA
Transitional phase
Occurs towards the end of 1st stage, leads into 2nd stage
the Ferguson reflex: as pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead.
Behavioural changes Loss of control; panic Negative thoughts Nausea and vomiting Slowing of contractions Heavy show, bowels opened Restful stage – don’t jump in! Urge to bear down Purple Line 'Push Off' stage
Expulsive phases
The strength of the pushing urge varies in intensity but will become more consistent
Characteristic grunting noise
Thinks she needs to empty her bowels / bowels open
Signs of full dilatation: heavy show, anal dilatation, perineum bulges and stretches.
The presenting part will become progressively more visible
Labour will progress if
The fetus is of average size With a normally positioned
head In a normal labour In a woman with an average
sized gynaecoid pelvis If contractions are adequate
Mechanisms of Normal Labour
DescentFlexion Internal rotation of headCrowningExtensionRestitution -Internal rotation of the shoulders
External rotation of the headLateral flexion
Descent
The fetal head engages and descends into the pelvis in an OT (occiput transverse) position.
The widest part of the fetal skull into the widest diameter of the pelvis.
Descent
Flexion
As the fetus descends the head flexes so that the fetal chin is touching the fetal chest.
Thereby creating the smallest diameter to pass through the pelvis.
Internal rotation of the head
With good uterine contractions and maternal expulsive effort the occiput reaches the pelvic floor.
As it reaches the resistance of the pelvic floor, it rotates forward through 45 degrees into OA (occiput anterior) position.
The head emerges through the widest diameter of the pelvic outlet – anteroposterior diameter.
Internal rotation
As head descends it meets the muscles of the pelvic floor and rotates anteriorly
Crowning
The occiput escapes under the pubic arch and the head is crowned.
The head no longer recedes between contractions.
Extension
The forehead, face and chin sweep the perineum and the head is born.
Extension
Restitution
When the head is born it will turn right or left righting itself with the shoulders.
The shoulders rotate internally to lie in the AP diameter of the pelvis.
Rotation follows the same direction as restitution.
External rotation
Lateral flexion
The Anterior shoulder is born under the pubic arch first
The posterior shoulder passes over the perineum
The natural curve of the birth canal causes the baby to flex sideways
Complete ExpulsionorDelivery
Placenta
ActiveClamp and cut cord
Oxytocic drugs
Signs of separation
CCTContracted uterus?
Average 5 minutes
Physiological
Do nothingBreast feedObserve blood loss
Maternal observations
Can take one hour or more
Pass urineSit up right
Skin to skin & Breast feeding
4th Stage of labour
Promotes bonding / Feelings of wellbeing
Thermoregulation
Comforts baby
Promotes early breast feeding
Expels placenta
UHCW
Lucina Birth Centre
Division of B2B training
Birthing Pools
Dedicated supervisor of Midwives Team
Specialist Midwives Roles
Birthing outside of Guidance
Low Risk Policies and Guidelines
Large birthing rooms
CAN WE IMPROVE ?
? CEASAREAN SECTION RATE
? NORMAL BIRTH RATE
? WATERBIRTH RATE
? INSTRUMENTAL
AnyQuestions?