Too Posh To Push Or To Poor To Be cared for - week 2 Flashcards Preview

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Flashcards in Too Posh To Push Or To Poor To Be cared for - week 2 Deck (23)
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1
Q

Labour

A

Sequence of events by which a baby and the afterbirth (placenta) are expelled from the uterus at childbirth which normally occurs spontaneously between 37 and 42 completed weeks gestation

2
Q

Normal birth in a full term pregnancy occurs with …

A
  • spontaneous onset
  • vertex presentation of the foetus
  • low obstetric risk throughout pregnancy and labour
  • a physiological and sequential nature
  • regular painful uterine contractions
  • progressive cervical effacement and dilatation
  • progressive fetal descent
  • strenuous maternal effort
  • maternal movement
  • spontaneous vaginal delivery of the baby , placenta and membranes
3
Q

Normal birth Full term pregnancies occur without …

A
  • induction of labour
  • instrumental assistance
  • operative assistance
  • epidural anesthesia
  • spinal anaesthesia
  • general anaesthesia

Not all vaginal deliveries are normal births

4
Q

Are these things normal and necessary? Medical model of birth

A
  • augmentation/acceleration of labour with oxytoxics or amniotomy
  • electronic fetal monitoring
  • active third stage mangement of labour
  • labouring in bed ?
  • directed pushing it spontaneous pushing ?
  • presenting part
  • maternal ambulation
5
Q

Birth as a social event

A

Birth of a child makes landmark event in the lives of all Involved

Profound physical , mental, emotional and social effect

Invoked pain , emotional stress , vulnerability
Possible physical injury or death , permanent role of change and responsibility

6
Q

Psychophysiological model - ginesi

A

A woman has a baby and her life is literally never the same again

7
Q

Chamberlens midwifery forceps

A

Influential French family
Man midwife who invented midwifery forceps to allow to deliver live infants

Before that craniotomy was used to deliver dead foetus

8
Q

Caesarean section

A

Previously considered to be a life saving procedure

Following tissue layers dissected during surgery in 500 AD

Skin epidermis / dermis 
Subcutaneous layer 
Peritoneum 
Abdominal muscles 
Lower uterine segment muscles
9
Q

Midwifes

A

Midwifes Act 1902

Enshrines normality in child bearing as the midwifed role referring to doctors as soon as abnormality occurs

10
Q

Lying in hospitals for maternity care were innovated in the 18th century

A

Women in institutions who were cared for by doctors and medical students were being at risk of maternal mortality due to cross contamination and lack of hygiene and puerperal sepsis ( child bed fever )

Women cared for by midwifes in institutions or at home were significantly lower risk of contracting child bed fever

11
Q

Peel committee report 1970

A

Recommended that sufficient facilities should be made available for 100% of child bearing women to give birth in hospital

Hospital confinement is inherently safer and preferable for all women

12
Q

Birth rates

A

Normal birth rates have done down in England from 1990 to 2011 so women are 20% less capable of giving birth without intervention in two decades

13
Q

Caesarean section

A

Rates have gone up from 1953 to 2013

NOCE advocate that “ if after discussion and offer of support (incl perinatal mental health support for women with anxiety about childbirth ) , a vaginal birth is still not acceptable option - offer a planned CS

Before 1950’s the CS section was considered high risk due to

  • no general anaesthesia
  • danger of mendelsons syndrome ( aspiration pneumonia )
  • paralytic ileus
  • surgical techniques
  • quite radical abdominal surgery
  • risk to other internal organs from surgical trauma
  • child bearing risks for future births
14
Q

While watching for dystocia ( obstructed labour )

A

You can have a partogram done
Friedmans curve
Alert line / action line

15
Q

Active management of labour

A
  • labour diagnosis at 2cm
  • early artificial rupture of membranes
  • 2 hourly vaginal examination
  • syntocinon when progress is less than 1 cm per hour
  • and in 2nd stage for descent or weak contractions
16
Q

Child birth can only be considered normal in retrospect

A

Cons of that statement :

Turns physiological event into a medical procedure

Interferes with freedom to experience birth hoe and where woman chooses

Leads to unnecessary interventions

Concentrates women to technically equipped hospital - costly and influenced by standardised protocols

17
Q

Intrapartum care guidelines (2007) highlights risk factors

A
  • LSCS
  • psychiatric disorders
  • group B strep
  • multiple pregnancy
  • maternal age
  • prev Pph
  • borderline BMI
18
Q

How does labour start ?

A

Don’t know just hypothesis and theories …

  • onset - PG / incr oxytocin
  • relaxin / calcium / pacemaker potentials / gap junctions
  • myogenic
  • neurogenic - sympathetic and parasympathetic divisions of autonomic nervous system
19
Q

How oxytocin is stimulated naturally

A
Instinctive 
Innate 
Primeval 
( hypothalamus / limbic cortex) 
- eustress - physically stressful 
  • pressure on cervix
  • vaginal fullness
  • pelvic floor pressure
  • crowning

Oxytocin - positive feedback loop stretch / Ferguson reflex

20
Q

Endorphins

A

Beta endorphins may dampen down contractions to modulate coordination

Modulate perception of pain ( gate theory )

Opoid influences to induce euphoria ( exercise )

21
Q

No of interventions decr natural production of oxytocin

A
  • anaesthetic injections ( epidural ? Inhibit Ferguson reflex
  • induction / augmentation flooding receptor sites - less sensitivity to natural oxytocin
    Poor fetal position. - less distension of lower genital tract

Episiotomy - less stretching of perineum

Fear / anxiety - lack of nipple stimulation

Indirect - embarrassment / abuse

22
Q

NMC - nursing and midwifery council

A

To recognise warning signs of abnormality in the mother of infant which necessitate referral to a doctor and assist the latter where appropriate

23
Q

2 incidents of bad clinical management and MDT work

A

1- Furness general morecombe bay 2004/2013

Dominant midwifes over zealous pursuit of natural childbirth let to times of unsafe. Care and poor working relationships between the MDT

2- Manchester general and Royal Oldham hospitals 2016

Death and appalling harm as a result of bad clinical decisions and staff relationships breakdowns