2: Normal labour and peurperium

Question 1

What is a birth plan?

Answer 1

Note of what the woman wants re: labour and post birth

Question 2

Is a woman required to have a birth plan?

Answer 2

No

Question 3

Which hormones

a) encourage
b) discourage

uterine contractions?

Answer 3

a) Oestrogen, oxytocin

b) Progesterone

Question 4

Which chemicals are released in response to oxytocin, inducing labour?

Answer 4

Prostaglandins

Question 5

Stretch of the uterine muscles increases their excitability.

What can therefore trigger labour?

Answer 5

Growth of baby

Multiple pregnancy

Question 6

What is the Ferguson reflex?

Answer 6

Oxytocin release in response to cervical stretch

Encouraging uterine contractions and childbirth

Question 7

Which two hormones trigger prostaglandin formation?

Answer 7

Oestrogen

Oxytocin

Question 8

Which reflex causes oxytocin release in response to the stretching of uterine / cervical muscle?

Answer 8

Ferguson’s reflex

Question 9

What ruptures at the beginning of labour?

Answer 9

Amniotic sac

“floods” of amniotic fluid

Question 10

What is membrane rupture also known as?

Answer 10

Water break

Question 11

When can membrane rupture occur?

Answer 11

Pre-labour (as intended)

Pre-term (bad)

Or baby can be born “in a caul” i.e still in the amniotic sac

Question 12

What happens to the cervix as labour progresses?

Answer 12

Softens and dilates

Question 13

What score is used to determine whether or not a medical induction of labour will be required?

Answer 13

Bishop score

Question 14

What type of labour is advised if a woman’s Bishop score is high?

Answer 14

Spontaneous labour

Question 15

What type of labour is advised if a woman’s Bishop score is low?

Answer 15

Medical induction of labour

manual membrane rupture –> oxytocin

Question 16

How many stages of labour are there?

Answer 16

Three stages

Question 17

As labour progresses, the ___ dilates until expulsion occurs.

Answer 17

cervix dilates

Question 18

How long does labour last on average?

Answer 18

Around 10 hours

Question 19

What diameter does the cervix contract to in the first stage of labour?

Answer 19

3cm

Question 20

What diameter describes complete dilatation of the cervix?

Answer 20

10cm

Question 21

In which stage of labour is the baby actually delivered?

Answer 21

Third stage

Question 22

How long does the third stage of labour last?

Answer 22

10 minutes

Question 23

After how long in the third stage of labour would you consider a caesarean section?

Answer 23

1 hour

Question 24

What is the medical name for false labour contractions?

Answer 24

Braxton-Hicks contractions

Question 25

When do **Braxton-Hicks contractions** occur?

Answer 25

**Third trimester**

Question 26

What increases a woman's chances of having Braxton-Hicks contractions?

Answer 26

**Multiparity**

Question 27

Which **hormone** is primarily responsible for **true labour contractions?**

Answer 27

**Oxytocin**

Question 28

Describe **true labour contractions.**

Answer 28

**Regular rhythm** **Duration = 10 - 45s** **Frequency = 1 - 4 / 10 mins** **Gradually shortening intervals** **Painful**

Question 29

What is the purpose of labour contractions?

Answer 29

**Pushes baby down into the pelvis ready for delivery**

Question 30

The **power** of uterine contractions is dependent on what?

Answer 30

**Uterine muscles**

Question 31

How do **true labour contractions** change over time?

Answer 31

**More frequent** **Longer duration** **Greater power**

Question 32

The **shape** of a woman's ___ will influence the success of natural birth.

Answer 32

**pelvis**

Question 33

What **bony features** can be felt on vaginal examination to figure out the lie and presentation of a baby?

Answer 33

**Sutures** **Fontanelles**

Question 34

What therapy do many women require during labour?

Answer 34

**Analgesia**

Question 35

What **analgesic** drugs are used in labour?

Answer 35

**Paracetamol** **Co-codamol** progressing to **diamorphine** (which is heroin)

Question 36

What **surgical methods** of analgesia can be used in labour?

Answer 36

**Spinal / Epidural anaesthesia** **Pudendal nerve block**

Question 37

What **gas** can be used to temporarily **reduce** labour pain?

Answer 37

**Entonox** 'laughing gas'

Question 38

What is an important effect of **spinal anaesthesia** re: labour?

Answer 38

**Woman can't push** (contractions still present but numb) **Numb from the waist down** (so woman can't walk about)

Question 39

What are the **seven cardinal movements of labour**?

Answer 39

**Engagement** **Descent** **Internal rotation of head** **Flexion of head** **Crowning and extension of head** **Restitution (external rotation of head back in line with body)** **Expulsion** **(release of both shoulders with careful maneouvres)**

Question 40

What is **engagement**?

Answer 40

**Widest part of presenting part descends below pelvic inlet**

Question 41

How many **fifths** of the foetal head needs to pass beneath the pelvic inlet to be described as **engaged?**

Answer 41

**3/5ths**

Question 42

Why is the baby's head externally rotated during engagement?

Answer 42

So **shortest head diameter** (biparietal diameter) and **can fit through largest pelvic diameter** (anteroposterior diameter) **during descent**

Question 43

Why does the baby **flex** its head during an occipito-anterior birth?

Answer 43

**Smallest possible diameter**

Question 44

Does the rotation of the **body** change during birth?

Answer 44

**No** It's all head movements

Question 45

How long after birth should the umbilical cord be clamped and cut? Why?

Answer 45

**3 - 5 minutes** Allows continued transfer of blood between mother and foetus

Question 46

What sort of **contact** improves bonding and breastfeeding success after birth?

Answer 46

**Skin-to-skin contact**

Question 47

How long after birth is the **placenta expelled** on average?

Answer 47

**5 - 10 mins**

Question 48

Which drug is often given during the third stage of pregnancy to encourage expulsion of the placenta?

Answer 48

**Oxytocin**

Question 49

Which hormones are responsible for the **production** and **expulsion** of breast milk?

Answer 49

**Production - prolactin** **Expulsion - oxytocin**

Question 50

What is a mother's first breast milk called? What's special about it?

Answer 50

**Colostrum** **Contains very little fat and loads of immunoglobulins**