Too posh to push Flashcards
What is the history of childbirth?
Local women or family members that had given birth and developed experience over time. Surgeons and gynaecologists attended when labour was obstructed to perform C-section to retain baby’s life.
Development of forceps from delivering dead foetus -> live baby
1902 Midwife Act was established for midwife managing childbearing and doctor’s intervening when abnormality occurred.
What is the midwifery model of childbirth?
Pregnancy is an altered state of health with birth being a normal, unassisted physiological process that can be enhanced. There is low intervention through watchful waiting for women to have an unassisted physiological birth, providing support and their prescence which improves safety and satisfaction of women and babies.
What is the medical model of childbirth?
—>Labour and birth are dangerous and only normal in retrospect so there is a low threshold for intervention is important to prevent maternal or foetal compromise.
—>Women’s bodies are ineffectively designed for birth so requires intervention, that may be pre-emptive.
—>Clinician delivers the baby.
—>Directed pushing, with labour occurring in obstetrics unit.
How is normal birth classified?
Based on presence of factors such as spontaneous onset, cervical effacement and delivery of baby and placenta spontaneously.
Also based on absence of labour induction, anaesthesia and assistance.
How has birth changed over time?
Birth rates have declined and there is an increasing rate of interventions such as elective C-section.
How has pregnancy been medicalised?
Caesarean section
Pre-natal screening
Electronic foetal monitoring
Induction of labour
Instrumental assistance of birth
Artificial membrane rupturing
How has childbirth been managed?
Labour is diagnosed at 2cm cervical dilation with hourly vaginal examinations. Syntocinon (oxytocin) is administered when labour progression has slowed. Dystocia is also monitored.
What is dystocia?
Obstructed labour through slow cervical dilation, slow foetal descent or entrapment of foetal shoulders during labour.
What are the risk factors for intrapartum (term) labour?
Mother with:
Psychiatric disorder
Multiple pregnancies
Higher maternal age
Previous post-partum haemorrhage
Borderline BMI
What is the labour hypothesis?
The production of prostaglandin production will increase the expression of oxytocin receptors.
How is oxytocin stimulated?
—> Foetal head pressing against cervix causes an increase in cervical and pelvic pressure
—> Vaginal fullness which creates a positive feedback loop called the Ferguson Loop. This stimulates oxytocin release.
How can oxytocin levels be reduced in labour?
Anaesthetic injections inhibit the Ferguson reflex
Induction of labour with synthetic oxytocin reduces the sensitivity to endogenous oxytocin
Poor foetal position
Fear and anxiety
Episiotomy
How is labour tracked?
Monitored with a partogram to provide foetal heart rate, cervical dilation, vital signs
->Alert line: Average dilation rate per hour
->Action line: where the curve crosses this, C-section or amniotomy must be performed
Friedman Curve: expected rate of cervical dilation and labour duration in primiparous moth
What is the legislation for childbirth?
Midwives Act 1902, which states that enriching normality of childbearing is part of the midwives’ role, and abnormality in childbearing is the role of the doctor, to ensure equal access of doctors and midwives to childbearing women.
