Care of 2nd Stage Labour

Question 1

What are the aims for providing care?

Answer 1

Protecting and promoting physiological processes
Preventing complications
Positive experiences for mother
Detecting deviation from normal and referral when needed

Question 2

What are the principles of care in the 2nd stage?

Answer 2

Maternal observations
Fetal observations
Labour is progressing

Question 3

What are the maternal observation in 2nd stage labour?

Answer 3

Timing contractions every 30 minutes for 10 minutes
Continue; temp, Pulse, Blood pressure, respiration rate
Verbal and non verbal communication

Question 4

What are the fetal observations in 2nd stage labour?

Answer 4

Fetal heart rare every 5 minutes and following a contraction

Question 5

What do you do if no obvious signs of progressing labour?

Answer 5

Perform a VE as per guideline and with consent

Question 6

What are the observations for second stage labour?

Answer 6

Temp 4 hourly
Pulse every 15 min
BP hourly
Abdominal palpation to access decent and progress
Assess per vaginum discharge
Encourage regular bladder emptying

Question 7

What is the passive stage of stage 2?

Answer 7

Full dilation of the cervix in the absence on involuntary explosive contractions

Question 8

What is the active stage of stage 2 labour?

Answer 8

The baby is visible, expulsive contractions with a VE finding of full dilatation or other signs of full dilatation

Question 9

What is the definition of second stage delay in nulliparous women?

Answer 9

Progress of decent of the presenting part is inadequate after 1 hour of active second stage

Question 10

What is the semi- recumbent position?

Answer 10

• Supported sitting
• Most common
• Reduces pelvic outlet

Question 11

Describe left lateral position

Answer 11

Patients lie on their left side, with their left leg straight out on the bed, and the right leg bent up but also lying on the bed

Question 12

Describe upright positions and why are these beneficial?

Answer 12

Squatting, kneeling, all fours, standing, using birthing ball

Reduces second stage, fewer assisted births, fewer episiotomies, reduced pain in 2nd stage

Question 13

Why is lying flat on your back not recommended?

Answer 13

Increased risk of hypertension, reduce placental perfusion and fetal oxygenation, reduced uterine contractions

Question 14

Describe the birth of the head

Answer 14

Supporting perineum
Covering anus with clean pad
Unhurried active phase to safeguard the perineum
Once the head has crowned, gently blowing with contractions to minimise active pushing

Question 15

What can you do to untangle the chord round babies neck if its too tight to pull over babies head?

Answer 15

The Somesault Manoeuvre

Question 16

What do you do with the birth of the shoulder?

Answer 16

Hands on the baby’s head covering ears
Gentle downward tracking to assist the birth of anterior shoulder
Oxytocin agent if active management is the choice
gentle upward traction to deliver posterior shoulder
time of birth is noted and recorded

Question 17

What do you do immediately after the birth?

Answer 17

Dry baby
Start skin to skin
Keep mother and baby warm
Facilitate breastfeeding within the first hour

Question 18

When do you clamp the chord?

Answer 18

Mothers preference, inform and allow to choose
Benefits of delayed cord clamping; facilitates adaption to extra utterine life
placental transfusion prevents anaemia in baby