Normal birth

Question 1

What happens in/what are the markers of First Stage?

Answer 1

• Painful regular contractions
• Cervix 4cm – 10cm dilated
• Foetal head descends and rotates through pelvis
• Encourage mother to lie on left side or sit upright, discourage lying flat on back
• Entonox for pain relief

Question 2

What happens in/what are the markers of Second Stage?

Answer 2

• Cervix fully dilated up until birth of baby
• Birth imminent if regular contractions every 1-2 minutes, urge to push and baby’s head visible
• Ask for maternity notes
• If birth imminent, request a midwife and second crew
• If en-route to hospital, pull over and park if birth occurs
• Call obstetric unit for advice

Question 3

What are the signs that birth is imminent?

Answer 3

• Strong regular contractions every 1-2 minutes
• Second babies will come quicker than first
• See part of the baby
• Mother having contractions she’s not talking through, focused, less interactive with you
• Labia parting
• Woman saying I can’t do it – transition phase
• Woman starts to make lower frequency noise, like a moo
• Waters and mucus plug slightly less relevant

Question 4

What should you do to prepare for birth?

Answer 4

• Reassurance
• Get and unpack Maternity Pack, Prepare resus area
• Blankets and towels for baby
• Ensure modesty
• Support mother in comfortable position
• Entonox, ask mother to breathe and pant through contractions. Pant when the baby’s head is coming out.

Question 5

What should you do as the baby is born?

Answer 5

• Encourage panting and allow head to come out slowly, can support the head/apply gentle pressure so it comes out slowly
• If cord is around neck, allow baby to be born with cord around neck, unravel it after birth
• Support baby as it is born, and lift towards mother’s abdomen
• Wipe mucus from baby’s mouth and nose

Question 6

What do you do to assess the baby at birth?

Answer 6

• Dry baby with warm towel then discard wet towel
• Skin to skin with mother, blanket over the top, hat for baby
• If baby isn’t crying, assess baby
• Assess APGAR score

Question 7

What do you do to cut the cord?

Answer 7

• No rush, wait for it to stop pulsating
• Act quicker if there are concerns
• 2 umbilical cord clamps 15cm away from umbilicus, 3cms apart. Cut cord between clamps.

Question 8

What happens during the third stage?

Answer 8

• Placenta may take 15-20 mins and there may be 200-300ml blood loss
• Allow spontaneously expulsion, do not pull on cord
• Place placenta in bowl or plastic bag along with blood and membranes. There is bag for it in mat pack
• If it hasn’t come out on its own in 20 minutes, go to consultant-led obstetric unit
• Consider breast feeding
• Encourage mother to urinate
• May be requested to insert large bore cannula as mother is at increased risk of haemorrhage

Question 9

What should you do following the third stage?

Answer 9

• Keep baby warm
• Check mother’s uterus – place hand at the top of the uterus and it should be firm,
• Observe blood loss
• Document actions

Question 10

How do you manage/what are the considerations in a water birth?

Answer 10

• Ask to get out if possible, make sure baby isn’t suddenly born as stepping out
• If baby born in pool, allow full birth before removing baby from water
• Water babies can initially be quiet and may not cry immediately: check colour and tone
• Stimulate with towel and dry
• Can become cold quickly, encourage to exit pool to deliver placenta, ensure do not slip
• Have neonatal resus equipment ready. Babies usually do not gasp until they reach the surface of the water, but be prepared.