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Flashcards in Normal birth & the puerperium Deck (13)
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1

What is a normal birth

-Spontaneous
-No drugs used for induction
-Low- risk at the start of labour and remaining so throughout labour & delivery
-The infant is born spontaneously in the vertex position between 37& 42 weeks of pregnancy
-After birth mother & infant are in good condition

2

What are the characteristics of the early labour stage?

-Irregular contractions
-Bloody mucus show
-Rupture of membranes
-There is some cervical change, including cervical effacement & dilatation up to 4cms
-A period of time, not necessary continuous, when there are painful contractions

3

What are the characteristics of the active first labour stage?

-There are regular painful contractions and progressive cervical dilation from 4cm
-Progress usually considered normal if cervix dilates at least 0.5cm/hour

4

How do we monitor labour?

Maternal:
-contractions
-dilatation
-vital signs
-drugs/fluids
-urine output
-PV loss: liquor, blood
-pain
-emotional state
Fetal:
-Fetal heart activity
-position
-descent

5

How is pain relief provided in labour

Non-pharmacological:
-breathing and relaxation
-massage
-water
Pharmacological:
-Entonox
-Opioids
Regional:
-epidural

6

What are the characteristics relating to transition into the 2nd stage of pregnancy

-uncontrollable urge to push
-holding breath/ grunting
-sweating
-mood changes ( sleepy/more focused)
-external genitals or anus begin to bulge out during contractions
-woman may feel the baby's head begin to move into the vagina
-A purple line between the mother's buttocks as they spread apart from the pressure of the baby's head

7

What are the characteristics of the 2nd stage of pregnancy?

1.) Passive 2nd stage:
-Full dilataation of the cervix prior to or in the absence of involuntary expulsive contractions
-The 'rest and be thankful stage'
-varies in length- usually around 1 hour
2.) Active 2nd stage: the baby is visible-expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation
-Diagnosis of delay should be made for nulliparous women when it has lasted 2 hours and for parous women when it has lasted 1 hour

8

What are the characteristics of the 3rd stage of pregnancy?

-Comprises the phase of placental separation, its descent to the lower segment& its expulsion with the membrane
-The cord and placenta system will contain about 1/3 of baby's blood whilst the remaining 2/3 is in the baby
-After a few mins the cord will stop pulsating. The mother will often feel an urge to push shortly after this
-The contractions may be painful but the placenta usually slides out easily
-The midwife will check it to ensure that it's complete and none is left inside the mother
-Breastfeeding can stimulate a contraction and help the placenta separate from the womb

9

Describe the different types of management of the 3rd stage of pregnancy

1.) ACTIVE MANAGEMENT:
-speeds up the delivery of the placenta
-Routine use of uterotonic drugs
-Deferred clamping and cutting of the cord
-Controlled cord traction after signs of separation of the placenta
2.) PHYSIOLOGICAL MANAGEMENT:
-waiting for the placenta to come naturally, the mum pushes it out
-can take between 10mins to an hour
-No routine use of uterotonic drugs
-No clamping of the cord until pulsation has stopped
-delivery of the placenta by maternal effort

10

What is the puerperium?

-The time from the end of the 3rd stage through the first few weeks after delivery. This period is usually considered to be 6 weeks in duration

11

List some serious post partum complications and their signs/symptoms

Post partum haemorrhage:
-sudden and profuse blood loss
-faintness
-palpitations/tachycardia
Pre eclampsia:
-Headaches accompanied by 1/more of the following symptoms within the 1st 72 hours after birth.. visual disturbances, nausea, vomiting
Thromboembolism:
-unilateral calf pain
-redness/swelling
Infection:
-fever
-shivering
-abdominal pain and/or offensive vaginal loss

12

What is involution of the uterus

-Needs to be monitored during the puerperium
-Shrinkage& the body is sort of reabsorbing it all back

13

What is lochia

-Needs to be monitored during the puerperium
-Vaginal discharge after giving birth