Labor and Birth Final Exam Flashcards
(202 cards)
1
Q
True or False: Fetal presentation refers to the direction towards which the back of the baby’s head (or other presenting part) lies within the mom’s body.
A
False
2
Q
The back of the baby’s head is toward mom’s right back
A
ROP–Right occiput posterior
3
Q
The back of the baby’s head is toward mom’s left front
A
LOA–Left occiput anterior
4
Q
The back of the baby’s head is toward mom’s left back
A
LOP–Left occiput posterior
5
Q
The back of the baby’s head is directly toward mom’s front
A
OA–occiput anterior
6
Q
The back of the baby’s head is towards mom’s left side, or facing her right thigh
A
LOT–left occiput transverse
7
Q
The back of the baby’s head is toward mom’s right front
A
ROA–right occiput anterior
8
Q
The baby’s tailbone, or sacra is toward mom’s right front
A
RSA–right sacrum anterior
9
Q
The back of the baby’s head is directly toward mom’s back
A
OP–occiput posterior
10
Q
What position is halfway between a posterior and anterior position and can indicate positive movement towards an anterior position if the baby has previously been known to be posterior?
A
LOT–left occiput transverse
11
Q
Which position would describe a breech position?
A
RSA–right sacrum anterior
12
Q
True or false: During labor, the presentation of the baby rarely changes; however, the position of the baby usually does change.
A
True
13
Q
Station refers to the location of the ? ? ? in ? , in relation to (which pelvic anatomy) ?
A
baby's Presenting part centimeters Ischial spines
14
Q
If the baby’s head is assessed at a +2 station, it is where anatomically?
A
2 centimeters below the ischial spines
15
Q
List in proper order the 4 cervical changes that take place before and/or during labor?
A
Moves forward
Softens (ripens)
Effaces (thins/shortens)
Dilates (opens)
16
Q
List in proper order the 3 categories of the signs of labor
A
Possible
Preliminary
positive
17
Q
List 3 signs experienced in each “signs of labor” category
A
Possible: 1. backache such as before menstruation 2. abdominal cramping 3. nesting urge Preliminary 1. Braxton Hicks contractions 2. Bloody Show 3. Leaking of amniotic fluid Positive 1. Cervical dilation 2. Rupture of membranes with a gush 3. Progressive contractions of the uterus
18
Q
What are the phases of the first stage of labor?
A
Latent, early phase
Active labor
Transition
19
Q
Give 3 points of advice for a first time mom calling you to say she is in early labor.
A
Keep your normal routine (sleep if night, stay busy if day)
Do something fun like a walk or movie
Eat easy to digest foods
20
Q
What is the reason why mom should be encouraged not to arrive at the hospital too early in labor?
A
She may become exhausted if the unfamiliar environment of the hospitals slow her progress. She may also become subject to the time table hospitals expect for labor.
21
Q
List 3 signs that might convince you a mom has entered active labor.
A
Contractions become more noticeable, stronger, and closer together.
Mom’s focus moves more inward as she copes with contractions.
Mom may begin weeping in active labor because she realizes she can’t turn back.
22
Q
List 2 helpful tips you might suggest to mom or dad during active labor:
A
Try different positions that feel best to your body.
Use massage and other comforting touch to help cope with contractions
23
Q
Explain 2 keys to coping with transition.
A
Recognition: When you recognize you are in this phase you can be encouraged by your progress and see the pain as challenging, because baby is coming rather than discouraging.
Understanding the signs as normal: can help parents cope with transition and not become afraid or worried by what is experienced.
24
Q
What are the phases of the second stage of labor?
A
Latent
Descent
Crowning/birth
25
Explain 2 keys concepts that should help guide mom during second stage of labor.
Listen to your body: find positions that are most comfortable to you and push when you feel the urge.
Push with contractions: push when you feel the urge to push rather than rushing
26
Describe what it means for a mom to bear down spontaneously during second stage and what are the advantages of a mom using spontaneous pushing as opposed to the very popular directed pushing during a natural second stage.
When a mom bears down spontaneously she will likely push for 5-7 seconds and take deep breaths in between. She will probably have 3 sets of these per contraction. A mom who pushes in this way is more likely to push her baby out without tearing and more comfortably than when directed. She also will not waste her energy.
27
Why do they refer to directed or Valsalva pushing as "Purple pushing?"
The mother has to push so hard that her face turns purple. This pushing occurs without contractions and requires a lot of strength and energy from mom.
28
What are the six reasons why it is not beneficial for mom to have a prolonged maximal pushing stage?
1. exhausting mom
2. Tearing the perineum
3. Failure of baby to rotate
4. Arrest of descent
5. Over stretching of pelvic ligaments and muscles
6. Decreasing oxygen to the baby, causing HR to drop.
29
According to several large studies, evidence says that not clinging to Friedman's Curve and allowing labor to continue for a longer period before ?? centimeters of cervical dilation may reduct what rate in the united states?
6
| c-section
30
In 5 lines, write how you might explain the Rule of 10 to a group of expecting parents as well as why such information is important for them to know during their birth and what they can proactively do about it?
The rule of 10 is a popular way of talking about when many caregivers consider the mom ready to begin pushing--10cm dilation of the cervix becomes the goal, then you can push. However, recent studies are showing that when a woman has the urge to push before 10cm, doing so can help to rotate the baby and fully dilate the cervix. In contrast, most mothers who try to resist this urge experience considerable discomfort and slowing of progress. You should feel the freedom to listen to your body, and respond in the way that is most comfortable. If that means you want to push before 10, be encouraged that you will not push so hard that you will rupture your cervix, as an unmedicated woman will stop in response to that kind of pain.
31
List 2 ways mom can best protect her perineum during birth:
1. Panting or blowing through the burning sensation of crowning.
2. Choose a caregiver who prefers to avoid episiotomy.
32
More than ?? in 10 women who had Cesareans for failure to progress had not even reached 5cm dilation before they were taken to surgery.
4
33
Explain what it means for a mom to "hold back" during second stage of labor and list 2 reasons why she might be holding back?
Holding back occurs when a mom resists the urge to push and does not follow the urges of her body. She may be afraid of the pain or have a psychological reason, such as issues with her partner, that keep her from wanting to surrender and let the baby come.
34
What is something you might tell a mom in labor who you know is holding back?
It is time to get your baby out. You need to let go so that your body can do this and you can meet your baby! You are almost done.
35
What kind of position should mom be encouraged to assume if her baby seems to be descending too quickly?
side-lying position
36
According to midwife and author Lydi Owen, the phase of maximum slope is defined as dilation occurring most rapidly from ?? to ?? centimeters.
6 to 8
37
Why are squats the new kegel?
The goal of your pelvic floor in labor is to stretch and open as the baby moves down and out. Kegels, though popularly recommended to prevent pelvic floor trauma during and after labor, actually serve to tighten and shorten the pelvic floor. Squats, on the other hand, help lengthen and strengthen your pelvic floor, making it more flexible and able to stretch as the baby comes out, an return to normal after delivery. Doing squats rather than keels, especially during pregnancy, is a much more effective way of preparing your pelvic floor to withstand and bounce back from labor and birth. Kegels can be done to tone while not pregnant, but should be avoid during pregnancy and replaced with squats.
38
The gate control theory states that the balance of ?? and ?? stimuli reaching your consciousness determines the ?? of pain and its severity.
painful
nonpainful
perception
39
What three coping mechanisms are a description of the essential, universal, and instinctual behaviors of women who sole well in labor?
relaxation
ritual
rhythm
40
What are three benefits to relaxation in labor?
Helps to relieve the stress of labor
Helps women cope with the pain of labor
Conserves energy throughout the labor process.
41
Why is it important for an expecting mom to practice and learn what muscle tension feels like?
This enables her to identify where she holds tension and prepare herself to be able to relax well during labor. Practicing this technique will equip her to do it more easily in the stress of labor.
42
Draw the charge that explains the power of the mind body connection in birth and then provide a word example next to the chart
```
idea/word/thought about birth
feeling
belief
behavior
positive or negative experience
```
```
favorite moment
happy,excited
birth will be fun
relaxed, accepting, happy
positive experience
```
43
The release of hormones necessary for the birth process is accompanied by a reduction of what part of her brain ?? This part of the brain enables women to do what two things?
neocortex
think scientifically and rationally
communicate through language
44
According to Odent, a main component of protecting the mother and birth process is assuring what does NOT happen to a woman in labor?
She should not be asked any questions or spoken to rationally.
45
Complete the Labor tools acrostic
```
Encouragement
Massage
Position
open mind
Walking
Empty bladder
Refreshments
```
```
Breathing
Imagery
Relaxation
Trust
Honor the process
Surroundings
```
46
?? coupled with pressure for more than two minutes will anesthetize a body surface area?
Vibration
47
List the 4 different touch relaxation techniques that may help mom cope in labor?
Still touch
firm touch
stroking
massage
48
Describe 5 different comfort measures that can assist a woman to cope better with labor.
1. utilizing water, such as a bath or shower, to help her relax and folate the pain.
2. Touch--massage and other methods of touch are important comfort measures.
3. Music that relaxes and distracts the mother
4. Utilizing hot and cold such as heating pads or cold rags.
5. Visualization of the process internally or through use of an external focal point
49
Describe 3 benefits provided to mom when using a birth ball during labor?
It can relieve pressure on her arms when in the hands and knees position.
It can support her perineum and encourage descent of the baby.
It is helpful to use in situations for addressing the diagnosis of failure to progress.
50
Why should a mom be encouraged to empty her bladder every ?? minutes during labor?
45
| A full bladder can slow progress and increase the pain of labor.
51
Why should mom be encouraged to alternate positions every ?? minutes during labor
30
This can change the shape of her pelvis, encouraging good position of the baby. It can also utilize gravity, encouraging descent. An added benefit is distraction provided to mom.
52
Why are breathing techniques important for mom to practice and master before birth?
Breathing is a very effective way to relax during labor. Mastering this before will help a woman know what technique works best for her and enable her to utilize it more efficiently during labor because she is familiar with it.
53
If hyperventilation does occur in labor, you can help a mom correct it by suggesting she:
Rebreathe her own air through cupped hands, paper bag, or surgical mask. Hold her breath in between contractions. Take a long deep breath. Also implementing relaxation methods such as touch or a warm shower can help calm her down.
54
What cycle tends to happen when a laboring mom chooses to only breathe with her chest and why?
Tension-->fear-->chest breathing-->pain
Chest breathing increases tension, which leads to fear and pain. this shallow breathing doesn't get as much oxygen into the body and can result in hyperventilation
55
List two benefits of abdominal breathing for a birthing mother?
1. It is natural
| 2. It uses less energy
56
What are two things you will teach women about vocalization in birth?
1. Vocalization in birth is empowering and can enable you to feel a sense of control during your birth.
2. Choose a poem or chant and practice it while utilizing other relaxation techniques in order to prepare for labor.
57
True or false: A widely accepted notion is that all women should respond to labor pain calmly and quietly
true
58
Every mom should come to expect and accept that she will probably lose ?? at some point during labor.
control
59
How might you encourage a mom that feels like she is 'losing control' in labor?
You can encourage her to surrender and give into the process because by doing this her baby will come. This moment often comes at a time that signals the process will be over soon if she can embrace the moment.
60
What 3 variables make each woman's perception of labor pain unique?
Frequency of contractions
Freedom to move around
Size and position of baby
61
What are 2 purpose for pain in birth?
The pain signals the process to continue by releasing more hormones (oxytocin, adrenalin, endorphins, prolactin)
The pain signals to those around you what is going on in the labor process
62
List 2 factors that can increase or decrease the degree of labor pain a woman feels
What she has been told about birth
| Her past experiences with birth
63
List 3 functional sources of labor pain
1. pressure of baby on nerves in cervix and vagina
2. pressure o baby on bladder, rectum, and perineum.
3. stretching and opening of the cervix (dilation)
64
The birth process is a ?? process
brain
65
What is the more accurate meaning of the word "sorrow" in the Genesis 3:16 context?
"work" or "labor"
66
In 5 sentences, explain what God's intended purpose is for women to experience pain or hard work in childbirth.
God gave childbirth to women as a directive, not as a corrective. Women are able to participate with God in the labor, or hard work, that he also endured in creation. This process bonds women to their children as it bonds God to his. It teaches women their appropriate gender roles and disciplines us as we interact with our husbands. This process is what creates a healthy family, society, and ultimately world!
67
Write the 4 basics of the sphincter law.
Sphincters function best in situations of familiarity, intimacy, and privacy.
Sphincters do not open at will and do not respond well to commands such as "open" "relax" "stop it"
A sphincter in the process of opening may suddenly close if interrupted.
The degree of relaxation of the mouth and jaw is directly related to the ability of the cervix, vagina, and anus to open.
68
Liste and explain the Law of the 3Ps
Passenger
Passage
Power of contractions
Labor is often described in terms of the passenger, or baby, the passage, or mom's pelvis, and the power of contractions to move the baby down and out.
69
What are 3 benefits for mother when she is able to change positions and move around during labor and birth?
It provides distraction
It changes the position of her pelvis so the baby can get in better position
It utilizes gravity to encourage descent.
70
Describe 2 ways the baby benefits when a mother is mobile and changing positions in labor and birth:
The baby is able to maneuver into a better position for birth.
The baby remains oxygenated well.
71
Leaning forward on a birth ball, partner, or bed
Relives pressure on back when there is a lot of back labor while also supporting mom so she doesn't tire as easily.
Helpful to use this position if mom is feeling a lot of back pain at any time in labor
72
Sitting on the toilet
relaxes the perineum
| This is a good position to utilize when labor has stalled and mom needs to relax.
73
Knee-chest
Encourages the baby's head out of the pelvis and can relieve pressure on a swollen cervix
This is helpful to use when mother needs to lower the intensity of contractions or slow progress down.
74
Side-lying
Helpful to slow labor that is going too fast or a very large baby.
This is a good position to try when pushing, if pushing is going too fast.
75
Hands and Knees
Relieves pressure on mother's back in case of an OP baby
| Good to use anytime in labor that a mother is experiencing a lot of back pain.
76
Squatting
Helps push the baby down as it provides little room for the baby
This position is useful at any time in labor to encourage progression and descent.
77
What are 3 beneficial position for a woman to use during 2nd stage labor?
Side lying, in order to slow a fast 2nd stage, especially with a very large baby
Hands and knees, in order to relieve back pain and pressure of an OP baby
Squatting, in order to open the pelvis to its greatest diameter (1-2cm larger)
78
What does a woman learn when she births without drugs, anesthesia, or medical intervention?
```
She is strong and powerful.
Self confidence
trusting herself
realizes her own strength and power
Gives her a different attitude about pain and difficult situations
```
79
What is one of the issues that creates the need for childbirth education classes?
The breakdown of family, no longer any stories told about childbirth.
The cognitive matrix surrounding birth is that it is a chaotic bewildering and terrifying experience.
80
Who founded Lamaze and when?
Elizabeth Bing and Marjorie Karmel in 1965
81
What are key points about Lamaze?
Women should be encouraged to respect her doctor's word as final.
Stresses that the doctors job and her are completely separate.
Doctor is responsible for her physical wellbeing and that of her baby
She is responsible for controlling herself and her behavior.
82
How does Lamaze believe self control is achieved?
Practice use of complex and precisely sequenced breathing techniques.
Techniques are to be practiced frequently during the six weeks of Lamaze training
Husband was supposed to practice these techniques with his wife so that he could coach her during labor.
83
What are lamaze breathing techniques and what are they based on?
Rituals based on a cognitive matrix that insists that labor is not a terrifying unknown but a fully understandable mechanical process with specific stages.
84
What is a common misconception about Lamaze?
That it is nothing more than patterned breathing.
85
What do today's Lamaze classes include?
Instruction on normal birth, labor, and postpartum care, birth planning, common medical procedures, patient doctor communication skills, labor support techniques, doulas, positioning, anesthesia, comfort measures, and c-section.
They no longer teach the patterned breathing because women were hyperventilating.
86
What is the Read Method?
His philosophy is that ignorance produces fear which leads to tension and pain.
This is the oldest method and is usually associated with relaxation classes.
87
What did Read believe about medication?
That drugs were sometimes necessary for a woman to have a satisfying birth experience. He believed medication was a useful tool for pathologic situations or when some were unable to relax adequately.
88
What is the Bradley Method?
Husband coached natural childbirth.
89
What were Dr. Bradley's goals?
To make the hospital soothing and safe and to teach women to relax fully in labor.
Making the environment more conducive to a woman's preferences.
He wanted to focus on the joy of birth rather than the pain.
90
Who was instrumental in getting fathers into the delivery room?
Bradley
91
What percentage of Dr. Bradley's patients had intervention-free, unmedicated births?
94% of the over 14,000 births he attended.
92
What percentage used medication and what had c-sections?
3% and 3%
93
What do Bradley teachers recommend?
That women respond in the moment in a way that is right for them.
94
What is the fundamental difference between the lamaze and bradley methods?
The Lamaze is grounded in the technocratic model and the Bradley in the wholistic model.
95
Who founded Birthing from Within?
Pam England in 1998
96
What is the purpose of birthing from within?
To encourage women to explore themselves and embrace the natural pain of the birthing process. It teaches women to approach their birth experience and see any outcome as positive because it is connected to their process of becoming a mother.
97
What are the 6 beliefs of women who birth from within?
1. Pregnancy and birth is a rite of passage, not a medical event.
2. Connecting with other mothers and women for support is an essential part of preparation for birth and mothering.
3. The power to birth comes from within them, from their strong bodies and commitment to do whatever it takes to birth their child.
4. Primitive self expression, including making noise and losing control, are a natural part of birth.
5. Protecting their birth space so that it is conducive to birth is critically important to how their birth will unfold.
6. For Western women, birthing from within requires preparation and practice during pregnancy.
98
How does this method encourage panic oping techniques?
Through the examination of fears.
99
What is the most notable strategy of birthing from within?
The construction and interpretation of birth art. Paper tigers: fears that are threatening your birth experience.
100
What can birth art be in the form of?
Paintings
sculptures
drawings
writings
101
What is the purpose of birth art?
An exploration of the woman's inner thoughts, worries, and dreams.
102
What is the birthing from within method of education?
It is not about following procedures or proven techniques, but instead finding what works for the mom as an individual.
103
What are the most popular forms of hypnosis during birthing?
Hypnobirthing and Hypnobabies
104
Who inspired this technique?
Dick Read
105
Who founded Hypnobirthing?
Marie Mongan
106
What is Hypnobirthing based on?
The fear-tension-pain syndrome and how understanding leads to relaxation and a painless birth.
107
How is pain eliminated in labor?
By substituting fear with understanding (90% of women)
108
What is hypnosis?
It is like running a virus scan on your computer--it finds corrupt programs or those that need to be upgraded and replaces them with positive suggestions about birth.
109
What is the goal of hypnobirthing?
Getting rid of fear and allowing bodies and minds to relax so we can birth babies gently.
110
Does the hypnobirthing practitioner have control over the mom?
no. Mom decides to accept the suggestion that birth can be gentle and easy. Nobody can make her do something she wouldn't normally do. All hypnosis is self-hypnosis.
111
What do couples learn in hypnobirthing?
That severe pain does not need to accompany normal labor.
112
What alternative language does this method use?
Surges or waves instead of contractions
113
What is a misconception about hypnobirthing?
That it teaches disassociation or distraction. The method believes that pain does not need to exist in a normal labor, but when it does you listen to the body because pain communicates that something is not quite right.
114
What percentage of hypnobirthing moms need no pain medication?
About 70%
115
How long has hydrotherapy had its place with women in labor?
Since 1803
116
Why labor in water?
Increases relaxation
natural form of pain relief
can help labor progress
contractions hurt less and less need for pain relief medication
Increased oxygenation for mother and baby
Less energy expended by the mother
Decreased pain and anxiety
Endorphin and oxytocin levels increase
Feels most of her weight is gone.
Assuming different positions that allow for the widening of her pelvis.
Helps pelvis floor muscles relax and stretch more easily.
117
What temperature should the water be?
Between 99 and 101 degrees.
118
What inhibitory factors prevent the baby from inhaling water at the time of birth?
First: 24-48 hours before the onset of spontaneous labor, the fetus experiences notable increase in the prostaglandin E2 levels from the placenta which causes a slowing down or stopping of the fetal breathing movements.
Second: Babies are born experiencing acute hypoxia, or lack of oxygen.
Third: the temperature differential is another factor thought by many to inhibit the newborn from initiating the breathing response while in water
Fourth: Water is a hypotonic solution and the pun fluids present in the fetus are hypertonic.
Fifth: the dive reflex that is associated with the larynx
119
How does the increase of the prostaglandin E2 help the baby not breathe in water?
Helps the baby prepare for birth. The oxygen they need comes from the umbilical cord. The "breathing" they do in the womb is practice that helps develop their lungs.
120
How does acute hypoxia matter in water birth?
It is a build in response to the birth process that causes apnea and swallowing, not breathing or gasping.
121
What is the importance of the temperature of the water?
The temperature of the water is so close to maternal temperature that it prevents any detection of change for the newborn.
122
What is the importance of the hyper and hypotonic solutions?
Even if water were to travel past the larynx, it could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.
123
What is the dive reflex?
When a solution hits the back of the throat and crosses the larynx, the taste buds interpret what the substance is and the glottis automatically closes so that the fluid is swallowed, no inhaled.
124
What initiates the baby's first breath?
When the baby senses a change in the environment from water into air, a complex chain of chemical, hormonal, and physical responses initiate the baby's birth breath.
Water born bbies are slower to initiate this response because their whole body is exposed to the air at the same time, not just the head.
125
How long does it take for all the lung fluids to disappear?
About 6 hours
126
When should women enter the water?
Many hospitals use the 5cm rule.
127
Why do some women find a bath in early labor useful?
Calming effect and to judge if labor has actually started.
128
Why can water be a good litmus test for labor?
The uterus can become aggravated due to different things. If labor has actually started, it isn't likely to stop, even if a woman enters a bath.
129
Why shouldn't water be entered too early?
It can slow or stop labor
130
Why might a bath in early labor be good?
If contractions are strong and regular with little to no dilation, a bath might help the mother relax enough to dilate.
131
How should a bath be tried out?
It has been suggested that a bath be used in a trail of water for at least one hour, allowing the mother to judge its effectiveness.
132
What is the key factor in water birth?
Deep immersion, up to the breast level and completely covering the belly.
133
What is the most notable physiological response to full immersion?
The redistribution of blood volume, which stimulates the release of oxytocin and vasopressin.
134
What does vasopressin do?
It can increase the levels of oxytocin.
135
What is another benefit to water birth?
A woman is more easily able to refuse a vaginal exam.
The control they have by being able to move freely in the water often helps them assess their own progress.
Water intensifies their connection with baby while at the same time reducing pain
Mothers have the ability to assume more and more responsibility for the birth.
136
What effect does water have on perineal trauma?
Slows the crowning and offers its own perineal support.
It is reported to be less severe, with more intact perineums for multips.
One of the best benefits of water is the zero episiotomy rate.
137
What are protocols surrounding water birth?
1. The presence of meconium requires that you leave the pool so that the baby can be suctioned when born. (this requirement has relaxed some)
2. Tight nuchal cords were once cause for women to stand, but not the universal practice is not to feel for a cord in a water birth except for a very slow second stage or fear of cord compression.
3. Breech position.
4. Shoulder dystocia
5. prematurity
138
What is the cascade of interventions?
Many interventions have unintended side effects that cause new problems that must be solved with further intervention. many woman and their partners are often unaware that many routine interventions can lead to a cascade of unplanned experiences and unwanted side effects.
139
What are interventions?
Using various medications to induce labor
artificially breaking the membranes surrounding the baby and releasing amniotic fluid before or during labor.
using synthetic oxytocin to hasten labor
giving medications for pain relief
using back-lying positions for labor and birth.
140
Why do interventions cause problems?
They disrupt the normal physiology of pregnancy, labor, and birth by interfering with the hormones that move labor and birth along, creating opportunity for infection, having undesirable effects on mom or baby, interfering with mom's ability to push the baby out.
141
How can a doula help?
Encourage mom to accept only those interventions that cause more benefit than harm
142
What is electronic fetal monitoring?
An ultrasound device held in place by a belt around your abdomen, sends and receives sound waves to detect fetal heart rate. Another belt holds a pressure sensate device in place over mom's funds to detect uterine contractions.
Monitoring can be intermittent (10-20 minutes ever hour) or continuous.
On the fetal monitoring strip, bottom is the contractions, heart rate is on the top.
143
What are the benefits of EFM?
Enables an assessment of how contractions affect fetal heart rate.
Enables assessment of fetal well being when
Pitocin or other interventions are used.
Provides frequency of contraction
Provides continuous printed record of FHR and contraction pattern
Helps labor partner know when a contraction begins
Doesn't require AROM
144
What are the Risks/disadvantages of EFM?
Needs frequent readjustment when mom or baby moves
May be uncomfortable and restrict mom's movement
Decreases mom's ability to use abdominal or back massage
Doesn't provide accurate strength of contractions
May keep labor partner watching monitor instead of mom
May lead to less personal contact between mom and nurse
145
What are gleanings from the medical literature regarding EFM?
Few cases of cerebral palsy arise from events in labor.
The baby's heart rate during labor correlates poorly with measures of the baby's conditions at birth
Measures of the baby's condition after birth correlates poorly with long-term outcomes
The baby's heart rate during labor correlates poorly with the incidence of cerebral palsy
Comparison of EFM and intermittent listening show that EFM offers no long-term benefits, but may have short term benefits when oxytocin is used.
Comparisons of EFM and intermittent listening show that EFM increases the likelihood of c-section, vaginal instrumental delivery, infection, and cerebral palsy in premature babies.
146
IFM (Internal Fetal monitoring)
Reads the baby's heart rate more accurately because it is inside the baby's presenting part. This is usually done if the baby is in distress. Water must be broken.
The fetal heart rate is measured by a scalp electrode inserted into the skin of the fetal presenting part.
147
What are the benefits to IFM
More accurate than EFM
| Provides information needed to determine if further medical assistance of intervention is needed.
148
What are the risks of IFM
Requires rupture of membranes
| Restrict free movement, especially walking during labor
149
What is an IUPC (intrauterine pressure catheter)
A pressure catheter inserted into the uterus that measures contractions.
More accurately measures the strength and pressure of contractions which can be necessary when interventions like Pitocin are used.
Pressure catheter may need frequent readjustment with the mother's change of position.
150
What are IV fluids and NPO?
A needle is inserted into a vein in the forearm or back of hand. A thing plastic tube is inserted through the needle and the needle is removed. Fluids are then dripped continuously from the IV bag into the vein.
151
What are the risks of fasting in labor?
May cause a rise in maternal ketone levels
Does not guarantee an empty stomach
hunger and thirst are a source of considerable discomfort and laboring women
Eating and drinking does not increase the risk of vomiting, avoids hazard IV-fluid overload, and may have beneficial effects on labor progress.
152
What are the benefits to IV fluids?
Maintains hydration when a mom is not allowed to drink liquids or is unable to keep anything down.
Helps maintain BP is regional anesthesia is used or if mom bleeds too much
Allows immediate access to the vein if medication or a blood transfusion is necessary
Needed for the administration of Pitocin
Provides some calories for energy
153
What are the disadvantages to an IV?
Restrict easy movement during labor
May result in infiltration
Fluid overload which can cause blood chemistry disturbances and excessive swelling in early postpartum
If mother receives large amounts of fluids containing dextrose the baby may become hypoglycemic at birth and need special care.
154
AROM (Amniotomy)
Artifically rupturing the membranes using an amniotomy hook.
155
Can AROM shorten labor?
Yes, but a modest amount (1-2 hours) and is a minor variable in determining the length of labor (baby needs to be in optimal position, best to use at 9-10cm)
156
What adverse effects can amnio have?
May not prevent or correct poor progress.
Can cause fetal heart rate patterns indicative of fetal distress
Can increase the risk of c-section
Increases the risk of maternal infection
May cause umbilical cord prolapse is presenting part is high.
Increases the use of interventions like Pitocin if labor doesn't start or speed up
Often increases discomfort of contractions
157
When do caregivers want women to give birth after having an amnio?
They prefer that mothers be in active labor or give birth within 24 hours after AROM
158
How can the likelihood of infection be lowered after AROM?
Keeping vaginal exams to a minimum
159
What percentage of births were induced in 2005?
22.3%, a 50% increase since 1990
160
What is traditional wisdom in rural France concerning when babies are ready to be born?
Babies are like fruit on a tree. Not all fruit is ripe at the same time. A fruit that has been picked before it is ripe will never be fit to eat and will quickly go bad.
We must accept that some babies need a longer time than others before they are ready to be born.
161
When is induction recommended?
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When pregnancy has continued at least 1-2 weeks because EDD.
High BP or preeclampsia
SROM without labor
Infection
Gestational diabetes
Baby has abnormal heart rate pattern
Doctor's convenience
Chronic medical conditions of mother or baby
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162
What are induction methods?
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Nipple stimulation
Sexual intercourse
Castor Oil
enema
Acupuncture or TENS
Herbs (don't recommend as a doula)
Stripping/sweeping the membranes
Mechanical dilators (foley bulb)
Prostaglandin gel (cervadil)
Amniotomy
Pitocin
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163
What percent of women report that their caregiver tried to induce labor?
4 out of 10, 41%
164
What is the WHOs recommendation for induction rates?
Induction rates in any geographic region should not exceed 10 percent
165
When should induction be performed?
Only when the benefits outweigh the risks
166
What interventions does induction multiply the chance of?
c-section, forceps delivery, shoulder dystocia, hemorrhage, fetal distress, meconium aspiration
167
What are questions to ask your caregiver is induction is suggested?
Why are you scheduling an induction?
What are the risks of inducing my labor?
What precaution will you take to make sure my baby is not born too early?
How do you plan to induce my labor?
How will induction affect my labor and the health of my baby?
What measures would you take to reduce my odds for a c-section?
What is my bishop score? (see handout)
168
Castor oil
May work by stimulating prostaglandin induction.
The woman takes 2oz of castor oil mixed with 2 oz of orange soda and sherbet.
Repeats with 1oz of castor oil 2 hours labor.
According to midwives, the entire dose taken at once is more effective.
169
What are the benefits to castor oil?
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Hastens the ripening of the cervix
May start labor within 2-8 hours
Empties bowels
Best if started early in the morning
Notify caregiver before using this intervention
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170
What are the risks/disadvantages to castor oil?
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Causes intenstinal cramps and diarrhea for several hours
Frequently does not succeed
Can dehydrate the mom
Has a bad taste
Can stress the baby out
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171
What is cytotec?
a tablet that is placed in the vigain, behind the cervix, or given orally.
172
What are the benefits to cytotec?
Low cost
easy to administer
can be repeated every 3 hours
Has a lower rate of failed induction than other methods.
173
What are the risks/disadvantages to cytotec?
excessive, frequent contractions
requires repeated vaginal exams for repeated doses
Most recently introduced drug for cervical ripening
The FDA has not approved it for use in pregnancy and labor
Few scientific studies have been done to establish optimal dose, effectiveness, and safety for mother and baby
It is not to be used in women who have had a previous cesarean.
174
What is prostaglandin Gel (cervadil)
A controlled release vaginal insert; a soft pouch is placed just behind the cervix that release prostaglandins stealing over 12 hours. Can be removed easily by a string attached to the insert.
175
What are the benefits of prostaglandin gel?
Hastens ripening of cervix
May trigger onset of labor
Easiest to administer and least invasive for mothers
Women may be able to go home between doses of gel, after being observed and monitored for 1-2 hours
Improves success of induction with pitocin
176
What are the risks of prostaglandin gel?
uterine hyperstimulation
fetal distress
possible nausea, vomiting, or diarrhea
Pain at site of insertion
Requires caution if used in women with asthma, glaucoma, liver, or kidney disease
Cervadil is easily expelled, which may not be noticed by the woman.
177
What is Amnioinfusion?
When amniotic fluid is lower from ruptured membranes or from diminished production, sterile saline solution may be injected into the uterus via an IUPC.
178
What are benefits to amnioinfusion?
Reduces fetal distress
Allows labor to continue when csection might be the only solution
Dilutes meconium in the fluid and helps avoid problems from the newborn inhaling meconium
If there is cord compression it can cushion and protect against fetal distress
179
What is pitocin?
Administered via IV with an infusion pump to control dosage, increased every 30 minutes
180
What are Pitocin's benefits?
Causes uterine contractions and dilation of the cervix
181
What are risks/advantages to Pitocin?
Uterine hyperstimulation
Fetal distress
Longer labor in hospitals
Possible greater pain
Excessive fluid rentention
Requires continuous EFM
Does not succeed if the cervix is unripe; failed induction leads to cesarean
Early induction without clear due date may cause prematurity
When done for convince, benefits may not outweigh risk.
182
Does the fetus get pitocin?
Yes, the baby's blood/brain barrier is not mature because the ductus arterioles is still open the high amounts via maternal blood to fetus is probably reaching the fetal brain directly
183
What conclusions were made at the Primal health conference in 2012?
Infusion of Pitocin in labor produces ineffective levels of natural oxytocin in mom.
The more and longer a mom receives, the less her own oxytocin is produced
Synthetic oxytocin is the most common intervention with the most collateral damage
Newborn feeding behavior is depressed by the use of pitocin
Pit can alter the duration of lactation
Has an effect on the psychological development of children.
184
How can you avoid unnecessary induction?
Choose a caregiver who has a low induction rate, doesn't induce for large baby, allows you 24 hours to begin labor on your own if membranes rupture, doesn't consider you overdue until at least 42 weeks
Refuse an elective induction for convenience
Refuse an ultrasound to estimate fetal weight
Refuse an induction for suspected large baby
Don't permit due date to be changed based on ultrasound scan unless done within the first 13 weeks and has more than a 10 day difference
Consider requesting or refusing BPP before 40 weeks
Make sure you have had plenty of fluids before an US measured for amniotic fluid.
If the fetal test is positive, ask for another
185
What are issues with pain medications?
If given within a few hours or delivery, then the baby may be very sleepy when born.
Nitrous can make mom nauseous or feel too loopy
186
When should an Epidural be given?
Prior to a c-section
| As early as 2cm, but most wait until 4-5 cm
187
What are benefits and purposes of an epidural?
Provides good pain relief without impairing mental awareness
Allows sensations other than pain to be felt (temp, pressure, touch)
Mom can self dose with the push of a button
More pain relief with less medication
188
What are the risks and side effects to epidural?
Usually causes itching all over body
Nausea and or vomiting
Inability to urniate, requiring a catheter
Weakness in legs and loss of balance
Spinal headache
Effects on newborn are less than systemic narcotics
Delay in fetal rotation
impaired labor progress
Drop in blood pressure
decreased bearing down reflex and effectiveness when pushing
postpartum backache
fetal distress from drop in mom's blood pressure
newborn fever
restriction of food and fluids by mouth
IV fluids
various devices involved to closely monitor mom's vitals
Oxygen often needed by mask
Pitocin sometimes needed to speed up labor
Assisted delivery may be necessary
189
What is an episiotomy?
A surgical incision made into the perineum from the vagina toward the rectum just before the birth of baby's head.
190
What are the benefits and purposes to episiotomy?
Enlarges the birth canal
May speed delivery of the baby by a few minutes
Provides a straight incision which is easier to repair
Provides more space for applications of forceps
Decreases the likelihood of spontaneous tear in front of vagina
191
What are the risks to episiotomy?
Causes discomfort in postpartum period
Sometimes performed routinely when unnecessary
May delay mother-baby bonding and interaction as perineum is repaired
Site of incision may become infected or bleed
May cause pain with intercourse for several months after birth
More likely to extend a serious tear
192
What is the likelihood of an intact perineum when an episiotomy is not done?
25-60%
193
What are benefits to a vacuum extractor?
helps descent of the babies head
Requires less space in vagina than forceps
Less need for episiotomy
194
What are the risks to the vacuum?
May cause bruising or swelling of babies soft call tissue or mothers perineum
Not as helpful with baby's rotation as forceps
195
What are the benefits to forceps?
Helps rotate baby's head to an anterior position
Helps bring baby down when epidural is used or bearing down efforts are insufficient
May be used to facilitated birth of head with a breech vaginal birth
Speeds delivery if baby is in trouble
196
What are the risks to forceps?
Usually requires an episiotomy
May bruise soft tissues of babies head or face
Usually requires regional anesthesia
May bruise or tear vaginal tissues
197
What are the benefits of c-section?
More convenient, faster, and more predictable than a vaginal birth
Usually not a painful procedure because mom is under epidural anesthesia
198
What are the risks to c-section?
possible problems with anesthesia
Increased incidence of infection
more blood
postoperative pain that lasts of reeks or months
problems with scar tissue
possible injury to other organs
blood clots in leg or pelvic area
increased risk of breathing or temp problems with baby
higher rate of subsequent infertility than women with vaginal births
increased risk of placenta pre via, retained placenta, and like hood for another c-section
199
What are reasons for a c-section?
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failure to progress
malpresentations or position
CPD
fetal distress
fetal defects
prolapsed cord
placenta previa
placental abruption
maternal disease
elective
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200
What are advantages to a VBAC?
Babies are born when ready
babies receive catecholamines during birth
babies are more likely to breastfeed
babies have higher apgar scores
201
What are risks to a VBAC
Increased risk of scar separating
Scar dehisence occurs in 1-2% (does not have any symptoms and is harmless to mother and baby)
Uterine rupture (prolonged deceleration of FHR, abdominal pain different in nature from contracting pain)
Uterine rupture is around .09-.8% for women with a horizontal scare, 2.2% for vertical scar
Hysterectomy is required in 6-20% of uterine bleeding
Uterine rupture accounts for 5% of maternal deaths.
202
What is the Bishop score?
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Criteria:
Dilation
Effacement
Station
Consistency
Position
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0 Bishop Score: 0 Dilation, 0-30% effaced, -3 Station, firm, Posterior
It is recommended that the Bishop score be greater than 7 to have an induction
