Labour Flashcards
Stages of labour :
Latent phase 0-3cm
Active phase 3-7cm
Transition 7-10cm
Second stage
Pushing 10cm - birth
Third stage
Until placenta
Fourth stage
One hour after birth
Established Labour
What dilatation?
What starts?
4cm
IAP
MgSO4
4 hourly VE
WHO Labour Care guide changes
1)Active phase 5cm
2)Evidence based time limits at each cm of cervical dilatation
3)Intensified monitoring of 2nd stage.
4) Explicit recording of labour companionship, pain relief, oral fluid intake, posture
5) duration and frequency of uterine contractions
Requires deviation to be highlighted and corresponding response to be recorded by the provider
First stage of labour
Latent - some cervical change, some contractions. Irregular <4cm remember
Established first stage of labour
Regular contractions
Progressive dilatation from 4cm
Pain relief first stage of labour
Breathing exercises
Water immersion
Massage
Do not offer aromatherapy, yoga, acupressure for pain relief
Initial assessment
Review antenatal notes
Record any vaginal loss
Length, strength, frequency of contractions
Pain , pain relief options
HR, BP, temperature and urine
Transfer to obstetric led care if any of the following observations in woman -
.HR > 120 on 2 occasions 30 minutes apart
.Any vaginal blood loss other than a show
.Single reading raised diastolic BP > 110 or raised systolic BP > 160
.A reading of 2+ protein on urine and single reading of either raised diastolic BP > 90 / raised systolic BP > 140
.Temperature of 38 on a single reading or .37.5 on 2 consecutive readings 1 hour apart
Transfer to obstetric led care if any of the following observations in woman -
.Rupture of membranes more than 24 hours before the onset of established labour
.The presence of significant meconium
.Pain reported by the woman that differs from the pain normally associated with contractions
Any risk factors recorded in the woman’s notes that indicate the new for obstetric led care
Does meconium need CTG and CLU?
YES
Transfer to obstetric led care if any of the following observed in unborn baby :
.Any abnormal presentation (including cord)
.Transverse / oblique lie
.High (4/5 - 5/5 palpable) / free floating head in P0
.Suspected FGR / Macrosomia
.Suspected anhydramnios or polyhydramnios
.Fetal HR <110 or >160bpm
.Deceleration in FH heard on IA
.RFM last 24 hours reported by mum
If birth is imminent in MLC setting but risk factors are observed :
Whether birth in current location is preferable to transferring
D/W coordinating midwife
Intermittent auscultation
1) offer FHR at first contact and at each further assessment
Immediately after a contraction for at least 1 minute and record as a single rate - at least every 15 minutes
Record Accs / decels if heard
Palpate maternal pulse to differentiate between maternal and fetal heart rates
Transfer to obstetric led unit :
Confirmed delay 1/2nd stage
Requesting additional pain relief using regional analgesia
Obstetric emergency : APH, cord prolapse, PPH, maternal seizure or collapse, need for advanced neonatal resuscitation
Retained placenta
3/4th degree tear / complicated perineal trauma that needs suturing
Meconium requires
Obstetric led care
HCPs trained in advanced neonatal life support readily available for birth
Fetal blood sampling
Labour care
1:1
No routine H2A/ PPIs
Opioids/ other RFs > consider H2AS as GA mah be more likely
Isotonic drinks may be more beneficial than water
Light diet unless she has had opioids / develops RFs that make GA more likely
Pain relieving strategies
Breathing and relaxation techniques
Massage
Labour in water
Water temp - 37.5, check hourly
Support music
Do not offer TENS, acupuncture, acupressure, hypnosis
Do not use injected water papules
Remifentanil PCA 40mcg
More likely to have SVD or need O2 than with Pethidine
Needs continuous presence of midwife
Continuous CTG
Continuous RR
o2 available
Immediate anaesthetic support if any respiratory depression
Sterile water injections
10 minutes to 3 hours pain relief
Initial stinging
0.1ml intracutaneously
0.5ml subcutaneously
Around the Rhombus of Michaelis
Pethidine cannot be used…
With epilepsy , SCD, IUFD
Water birth eligibility
Low risk pregnancy
Single time pregnancy
>37/40
Cephalic presentation
Clear amniotic fluid (if meconium present, may labour , in tub but bed birth required
Normal FHR tracing
Nursing staff member present at all time while tub in use
Water birth contraindications
Preterm labour
Communicable blood / skin infection
Maternal fever 100.4 +
Excessive vaginal bleeding
Indeterminate HR
Suspected macrosomia with history of shoulder dystocia
(May labour in tub, but bed birth required)
Previous CS birth x 2
Sedation
Malpresentation or multiple births
Water birth and opioids
Should not enter the water within 2 hours of opioids
Regional anaesthesia is NOT associated with
Long term backache
Longer 1st stage of labour
Increased chance of caesarean birth
Regional anaesthesia IS associated with
More effective pain relief than opioids
Longer 2nd stage of labour
Increased chance of AVD
