birth

Question 1

Birth plan

Answer 1

Birth plan is a document completed by the mother which tells the midwives and doctors the kind of labour she would like to have. Information for completing the birth plan can be obtained from midwives, antenatal classes, talking to women who have already given birth and discussions with the person who is with the birthing partner

Question 2

Labour

Answer 2

process of giving birth, describes the period of time from the start of regular painful contractions to the baby and placenta being delivered. Though it is not fully understood how labour begins, it is known to be triggered by hormone changes. when mother is in labour she will have to work hard so contractions open up cervix and baby can be pushed out

Question 3

what is important to note about labour

Answer 3

all births are different and take up to 24 hours from onset of labour
though some take place very quickly it is extremely rare
first babies normally take a longer time to be born

Question 4

signs labour has started

Answer 4

1. Painful contractions start 30 minutes apart( irregular mildly uncomfortable contractions can happen from 32 weeks, known as Braxton Hicks, do not count as labour
2. The waters break- amniotic sac bursts and amniotic fluid comes out either as a slow drip or a sudden gush. Once this happens, the mother should go to hospital due to a risk of infection
3. Women can have a show of bloody mucus from vagina, this is the mucus plug which seals the cervix.
4. The start of labour can also bring on nausea, vomiting, diarrhoea and backache

Question 5

The neck of the uterus opens

Answer 5

regular strong contractions occur- start slowly perhaps every 2 to 3 minutes. become strong, regular and more frequent. During first stage of labour contractions of the muscles in the wall of the uterus gradually open the cervix. The membranes ruptures at some point during this stage, usually at the very beginning of labour and comes to an end when the cervix has opened wide enough for the baby’s head to pass through at 10 centimetres. Different women will find different positions the most comfortable for labour, some lie on their back, on their side and some prefer to crouch or kneel for at least part of the labour( gravity can assist) longest stage of labour

Question 6

The baby passes through the birth canal

Answer 6

baby passes through the birth canal, uterus, cervix and vagina have now become one continuous birth canal. The contractions are very strong and push the baby headfirst through the birth canal. The mother will get the urge to push and must help by pushing When the widest part of the head gradually emerges from the vagina it is called crowning. When the baby’s head has fully emerged, the midwife may clear mucus from the nose and mouth. The baby may start to breath and even cry before the rest of the body slides into the world. Sometimes the opening to the vagina will not stretch enough for the head to pass out.
An episiotomy is something that is carried out under local anaesthetic, this is where a small cut is made between the vagina and anus to widen opening and prevent the skin from tearing

Question 7

Stage 3 the baby becomes a separate person

Answer 7

Once the baby is breathing, the umbilical cord is clamped in two places and a cut is made between them. This separates the baby from the mother. Clamping the cord prevents bleeding. Cutting the cord does not hurt either mother or baby
when baby first appears, the skin is a bluish colour but as soon as breathing starts, the skin turns pink showing o2 has been obtained by air.
contractions continue until placenta has been pushed out through the vagina separated from the wall of uterus. The release of the hormone oxytocin will make the uterus contract and become smaller. making the placenta start to separate from the uterus, some bleeding will occur as placenta is passed. The mother may be given an injection of syntometrine to speed up process and prevent excessive blood loss. If haemorrhage occurs, oxytocin or another drug called ergometrine may be injected which helps the womb contract and stops the bleeding.

Question 8

medical

Answer 8

midwives and anaesthetists in hospital administer these methods of pain relief. The pregnant woman may experience side effects of the medication

Question 9

complementary

Answer 9

different approach to main management

Question 10

Pethidine

Answer 10

morphine-like opioid, helps relieve pain by making the woman more relaxed, midwife will inject pethidine into deep muscle such as the thigh or bottom, takes 20 to 30 minutes to take effect

Question 11

advantages of pethidine

Answer 11

can be administered by a midwife
helps mother relax which enables her to rest during contractions
quick working

Question 12

disadvantages

Answer 12

may cause mum to feel less in control
can cause drowsiness, nausea and dizziness
crosses the placenta to the baby
can effect the babies breathing , may be born drowsy

Question 13

Entonox

Answer 13

mixture of nitrous oxide and oxygen. The pregnant woman inhales it through a mask or mouthpiece when contractions occur to help manage pain.

Question 14

advantages of Entonox

Answer 14

mother is in control over usage
works quickly but wears off when the mother stops breathing in
helps mother take deep breaths/ concentrate on slowing breathing

Question 15

disadvantages of Entonox

Answer 15

may cause mother to feel light headed or nauseous
if used for a long time can cause a dry mouth
does not take away all the pain

Question 16

Remifentanil

Answer 16

powerful morphine type drug offered in labour. It is administered through a drip inserted into a vein in the arm or hand and attached to a patient controlled analgesia (PCA PUMP). the pregnant woman presses the button on pump during every contraction and a small does of remifentanil is given directly into the bloodstream providing pain relief on demand, which reduces severity of labour pains.

Question 17

Advantages of remifentanil

Answer 17

pregnant woman controls when it is administered.
Helps mother to feel relaxed during contractions
pain relief wears off quickly in between use helping mother feel in control

Question 18

Disadvantages of Remifentanil

Answer 18

may experience nausea, vomiting, drowsiness and dizziness.
may not take away all the pain so additional pain relief may need to be used for example gas and air
can pass to the baby and cause them to be drowsy after delivery.

Question 19

Epidural

Answer 19

type of regional anaesthetic which stops a pregnant woman feeling pain from contractions without making her go to sleep by blocking nerves that carry pain sensations to the brain. an anaesthetist carries this out. The anaesthetist uses a needle to put a small plastic tube called a catheter into an area in the spine where nerves of uterus, birth canal and spinal cord meet. An epidural will completely numb the woman from the waist down.

Question 20

advantages

Answer 20

mother will feel calmer and less stressed about labour.
epidural offers complete pain relief so a caesarean section could be given under epidural
Does not cause drowsiness so pregnant woman can make informed decisions about her labour and delivery

Question 21

Disadvantages of Epidural

Answer 21

can take up to 40 minutes to take effect
pregnant woman cannot feel contractions so must rely on the midwife to tell her when to push
the midwife will need to monitor the pregnant woman’s blood pressure regularly as the epidural may cause her blood pressure to fall. Most women will be given an intravenous drip of fluids to prevent this from happening
small risk of headaches.

Question 22

Tens

Answer 22

stands for transcutaneous electrical nerve simulation, form of pain relief that is controlled by a handheld device. It works by sending mild electrical impulses to the sticky pads on the lower back. TENS is thought to work as the electrical impulses stimulate nerves that run to the spinal cord to block the transmission of pain and release endorphins.

Question 23

Advantages

Answer 23

portable-can be used at home
it can be used safely for long periods of time
no lasting side effects
can be used for a home and hospital birth
no drugs that could cross placenta

Question 24

Disadvantages

Answer 24

may only offer pain relief in the early stages of labour
not all hospitals have TENS machines so may need to be hired
cannot be used in a birthing pool
cannot be used by women who have pacemakers or heart conditions as it interferes with heart rhythms.
mum is unable to shower and bath to relax

Question 25

Hydrotherapy

Answer 25

immerse themselves in a birthing pool to chest level during labour. It is thought that warm water helps to relax mother during contractions by reducing adrenaline and promoting release of body's natural hormones to cope with labour pains. Midwives must regulate temperature of water as if it is too hot it may lead to exhaustion, blood pressure problems and contractions may slow down

Question 26

Advantages of Hydrotherapy

Answer 26

water decreases effect of gravity and helps woman to move more freely and change into a comfy position muscles of the back and abdomen relax Encourages endorphin release

Question 27

Acupuncture

Answer 27

derived from ancient Chinese medicine. Fine needles are inserted at certain sites of the body stimulating sensory nerves under the skin and in the muscles, resulting in the body producing natural substances, e.g. pain relieving endorphins

Question 28

Advantages of Acupuncture

Answer 28

helps body produce natural painkillers- endorphins. will not harm the baby can help the woman to relax no drugs, natural birth

Question 29

disadvantages of Acupuncture

Answer 29

Acupuncture is not provided by the NHS so each treatment must be paid for needles in the back may be uncomfortable- unable to lie or sit comfortable need an acupuncturist to put in needles.

Question 30

Homeopathy

Answer 30

natural form of medicine used to treat acute and chronic conditions. it aims to trigger the body' natural healing system. Homeopathic medicines are safe to use and rarely cause side effects

Question 31

Advantages of homeopathy

Answer 31

does not interfere with other medicines non invasive

Question 32

Disadvantages

Answer 32

pregnant women must buy these products from a homeopath

Question 33

Hypnobirthing

Answer 33

method of pain management that can be used during labour and birth, it usually involves a mixture of visualisation, relaxation and deep breathing techniques. Breathing deeply in through or out the nose can help women stay calm and reduce discomfort in labour.

Question 34

Advantages of Hypnobirthing

Answer 34

can help manage the stress hormones such as adrenaline, and reduce anxiety which should lead to a calmer birth may make mother feel more prepared and in control when labour starts. involves birthing partner during labour

Question 35

Disadvantages of Hypnobirthing

Answer 35

will not take away all the pain if mother panics, she will not remember the techniques taught Hypnobirthing classes are taught privately so there will be a financial cost

Question 36

Aromatherapy

Answer 36

use of essential oils. Oils come from plants, such as herbs and flower and they are highly concentrated, containing therapeutic chemicals sending messages to the part of the brain that affects the pregnant woman's mood and feelings. happens when scents are breathed in or when absorbed by the skin through massage. the following are safe to use, ginger, lemongrass and lavender

Question 37

Advantages of Aromatherapy

Answer 37

reduce fear, stress and anxiety, headaches, nausea during labour. will not harm baby can help involve birthing partner to be more involved to be more involved during labour

Question 38

Disadvantages of Aromatherapy

Answer 38

pregnant woman would have to buy essential oils A qualified aromatherapist must mix oils.

Question 39

Physiological birth

Answer 39

baby will present with the head at the cervix and is delivered without assistance. The term normal birth are also used to describe an uncomplicated, straightforward physiological labor and birth but complications can arise.

Question 40

Induction

Answer 40

inductions means use of medications or other methods to cause, or induce labor. It is a procedure where a doctor or a midwife helps pregnant woman go into labor usually when there is a medical reason to do so, only recommended unless health for baby.

Question 41

Reasons for Induction

Answer 41

a baby is overdue(+42) If the mother has pre-eclampsia If the baby is failing to grow If labor doesn't begin after water breaks If the mother or baby have additional complications

Question 42

methods may be used to induce labor

Answer 42

Sweeping the membranes- The procedure involves a healthcare provider inserting a gloved finger into the opening of the cervix and moving the membrane away from the uterus. This separates the fetal membranes from the cervix and stimulates the release of prostaglandin, which triggers the uterus to begin contracting

Question 43

Amniotomy

Answer 43

artificial rupturing of the membranes using an amnihook ( thin plastic hook is pushed against the amniotic sac to puncture it)

Question 44

Prospess pessary

Answer 44

Prostaglandin pessary inserted into vagina to soften the cervix and stimulate contractions

Question 45

Intravenous drip of the hormone oxytocin

Answer 45

Oxytocin stimulates contractions during labor

Question 46

Breech

Answer 46

Some babies lie in a breech position, either with their legs/feet or bottom first. Babies often twist and turn during pregnancy, but most will have moved into the head down position by the time labor begins. If baby is still breech at 36 weeks, an obstetrician or midwife will assess situation and discuss potential options for a safe delivery.

Question 47

Turning a breech baby

Answer 47

The first option which will be offered is an external cephalic version( ECV), where a healthcare professional tries to turn the baby into a head down position by applying pressure to the abdomen. safe procedure but may be uncomfortable. if the EVC doesn't work, there are two options Planned caesarean section Planned vaginal breech birth

Question 48

Planned caesarean section

Answer 48

This is safer for the baby than a vaginal breech birth. Caesarean section carries slightly more risk for the mother than a vaginal birth

Question 49

Vaginal breech birth

Answer 49

carries the least risk for mother but carries small increased risk of the baby dying around time of delivery, may cause short term complications for the baby, no long term effects. A specialist team of medical professionals will need to be present and a hospital birth is necessary in case of an emergency caesarean section is needed. 4 in 10 women planning a vaginal breech birth do not need a caesarean section, induction of labor not usually recommended. The baby's heart rate will be constantly monitored during a vaginal breech birth, if there are concerns about baby's heart rate or labor is not progressing a c section may be necessary,

Question 50

reasons for assisted delivery

Answer 50

concerns about baby's wellbeing during birth Labor is not progressing as would usually be expected mother is unable to, or has been advised not to push during birth. Baby is in an awkward position Obstetrician will examine pregnant women's abdomen and perform an internal exam to confirm that a assisted vaginal birth is safe for mother and baby. Pain relief may be a local anesthetic injection in vagina or an epidural During assisted delivery by forceps and ventose an episiotomy is more likely for baby is to born safely and will repair with stitches After baby is born mother will be given antibiotics through a drip to reduce risk of infections

Question 51

Forceps delivery

Answer 51

Forceps are smooth, curved metal instruments, made carefully to fit around the baby's head. An obstetrician will wait until mother has a contraction and then ask her to push while they pull with forceps to help mother give birth, may happen over several contractions. Some types of forceps are designed to turn the baby to the right position to be born. may cause slight bruising of the baby's head.

Question 52

Ventouse delivery

Answer 52

A ventouse is an instrument that uses suction to attach a plastic or metal cup on to the baby's head. An OB or Midwife will wait until the mother has a contraction and ask her to push while they pull to assist with birth, may happen after several contractions. Sometimes the cup can detach itself. If this happens they may need to reapply the cup to the baby's head before continuing. May cause swelling, bruising or misshaping the baby's head

Question 53

Caesarean section

Answer 53

abdominal operation which opens the abdominal wall and uterus to deliver the baby. The cut is usually made across the abdomen, just above the pubic bone. The baby is removed and the cord is cut, then the placenta is removed before the uterus and abdomen are stitched up . takes about 15 to 20 minutes

Question 54

Elective Caesarean section

Answer 54

An elective caesarean section means the procedure is planned in advance, pregnant woman does not go into labor. Planned caesarean section are usually from 39 weeks. Most commonly an epidural is administered, which makes mother numb from the waist down, means mother will be awake for birth but not feel any pain. A midwife, anaesthetist and obstetrician asses the pregnant woman to ensure they are ready for surgery. A mother can opt for a general anesthetic, however this carries more risk for the mother and baby

Question 55

elective caesarean may be offered or selected if

Answer 55

Medical issues; recommended due to medical issues, certain infections such as first genital herpes infection occurring in late pregnancy or untreated HIV. Personal or psychological reasons positions, baby may be in the wrong position e.g. breech, transverse previous complications with previous pregnancies

Question 56

Emergency Caesarean section

Answer 56

performed if any complications occur before or during labor. A general anesthetic is required if an epidural has not been administered already during the laboring process Progress: the progress of labor slows down or stops Baby showing signs of distress: shown by meconium( fetal stool) in the amniotic fluid, less movement, abnormal heart rate medical conditions; such as raised blood pressure or infection Abruption; placenta starts to come away leading to risk of hemorrhage. Cord Prolapse: very rare, it is when the umbilical cord may slip in front of the baby's heart and into the birth canal Attempted forceps/ ventouse; if not effective an emergency caesarean section is necessary labor is premature; this is discussed on an individual basis

Question 57

Role of a birthing partner

Answer 57

being prepared by reading up on what will happen during the birth and planning how they will get the mother to the hospital and what they need to bring monitor how regular the contractions are. It will be helpful if they keep a record of these contractions and phone the midwife if necessary Keep mother calm and relaxed, this will help retain her energy which will be vital for the later stages of labor. breathing exercises or massages learnt from antenatal classes may help. Reassure the mother throughout, she may feel that she cannot do it, but some encouragement and support goes a long way help the mother feel comfortable by offering her sips of water and cooling her down with a cold facecloth.