Week 1-3 Flashcards
Where can you give birth?
- Home Birth
- Midwife Led Derby Birth Centre (with birth pool)
- Hospital Birth
Week 1
Midwife Led Derby Birth Centre
- Situated within the Derby hospital near to the labour wards
- If need a C-section then immediately transferred and midwife will transfer ahead of time without worry
Week 1
Signs of Labour
1. Water breaks
* 1/10 women don’t have waters break but could happen at any point
* If water breaks, wear a pad and monitor colour, smell and how much fluid there is
* Bad sign if bright red blood, report this to midwife immediately
* If water does break then contact midwife immediately.. 60-80% go into labour within 24hrs after water breaks and 90% go into labour within 48hrs
Week 1
Signs of Labour
2. Meconium
* Baby poo which could be leaking from the amniotic sac
* If spot anything brown, report this to midwife immediately
Week 1
Signs of Labour
3. Contractions
* Known as the effacement of the cervix and will be irregular initially
* Contractions can start around 2 weeks before arrival of baby, the lining of the cervix is thinning and moving upwards to the top of the uterus
* Whole contraction lasts around 60 - 90 seconds with the peak lasting roughly 20 - 30 seconds
* 5% of contractions is at it’s peak
* Deep breathing can help with contractions
* Go to the hospital if 3 contractions for 1 minute or more in 10 minutes (get app for counting)
Week 1
Signs of Labour
4. Mucus Plug
* Known as the bloody show
* Should not be bright red but can be pink in colour
* Sometimes large but sometimes a small amount when wiping
Week 1
Signs of Labour
5. Diarrhea
* Hormones change rapidly to prepare your body for delivery, which causes the muscles in your uterus, cervix and even your rectum to loosen
Week 1
Important Points to Note
- Ask for numbers when percentages are given e.g. double increase in risk
- How do you want the midwife to address you? E.g. ask questions? Go through Raj only?
- Be informed and ask questions
- Be cautious when ‘just’ is used
Week 1
Hormones
1. Oxytocin
* Known as the love hormones and needed for contractions
* Building during the latent phase where hormones are building - generally when 0 - 4cm dilated
* E.g. warmth, nice smells (lavendar, rose), dim lights, cuddles, baking, massages (things to help you relax to increase oxytocin)
* When transitioning to hospital, take a blanket and pillow (not white), candles, scan photos
* Breathing exercises - 2 breath (Darth Vader Breath), candle breath
Week 1
Hormones
2. Endorphins
* 200% more powerful than morphine pain relief
* DO NOT want to be obseved, does not help increase oxytocin or endorphins - try stay at home as long as possible
Week 1
First Stage of Labour
* 5 - 10% increase in dilation
* Contractions become more regular and intense
* Have a bath / point shower head on lower back
* Do yoga circles / keep bum wiggling to help with pressure
* Raj and Rosh breathe together, elongate exhale to keep calm
Week 1
Pain Relief
* Gas & Air
* Pethodin
* Epidural - only administered on labour ward
* Labour comb - apply pressure to hands
* Movement
* Homeopathic remedy
* Bachs Rescue Remedy - oral drink
Week 1
BRAIN
Benefits
Risk
Alternatives
Intuition
Nothing
Week 1
Transition
* Oxytocin decrease and adrenaline increases
* Can last up to 20 minutes
* Changes in behavviour or thoughts (might want to come out of bubble)
Ways to navigate transition:
- Change scenery
- Sing
- Dance
- Go for a walk
- Try something that haven’t tried yet
Week 1
Second Stage of Labour
* Oxytocin increases
* Uterus contracts, relax pelvic floor
* More regular contractions with slightly longer rest periods
* Might need to poo (not poo is the baby moving down)
* Crowning - stretching of the vagina, baby’s head
Things to do during the second stage
- Relax jaw and do horse lips to relax the pelvic floor
- Squat and wiggle hips
- Hands and knees - pelvis 30% more open in this position
- (If epidural) stay on side not back
Spinning Babies Method - deep squat / kneeling forward
Week 1
Assisted Birth
* Forceps - tongs to help pull the baby out, gentle tugs on each contraction
* Ventouse - vacuum / suction cup on baby’s head to help pull baby out
* Episiotomy - a cut through the area between the vagina and anus (perineum)
Make a BRAIN decision for above
Try perineal massage from 35 weeks pregnancy to help with stretching of perineum
Week 1
Third Stage of Labour - Placenta Birth
* Usually 30 mins after baby’s birth but can take up to an hour
* Uterus needs to continue contracting
2 types of placenta birth:
- Managed - syntocinon injection (synthetic oxytocin) to allow uterus to continue contracting (usually advised if induced)
- No medical intervention - nothing in the bloodstream and natural birth of placenta
Week 1
Induction
Usually offered when you get to 39 / 40 weeks of pregnancy
Sweep
- Cervical sweep of the membrane where a finger is swept around the cervix
- Can have up to 3 (usually 1 a week)
- Can decline cerival checks
Week 2
Induction
What happens if sweeps don’t work?
1. Pessery called Prostin - inserted in the vagina and softens the cervix
(Will be in the hospital for a couple hours)
2. Syntocinon on drip & fluids - more intense and stronger contractions and more pain as labour usually starts at this point
(Will be kept in the hospital likely for 1 or 2 days)
Week 2
Natural Methods of Induction
- Raspberry Leaf Tea (after 36 weeks)
- Essential Oils - Jasmine, Clary Sage, Rosemary (use during labour)
- Chillis
- Homeopathy - accupuncture
- 4 / 6 dates a day (shortens the first stage of labour)
Week 2
What are the different types of pain medications?
Natural
- Movement - being on hands and knees
- Breathing
- Aromatherapy - Jasmine, Clary Sage, Rosemary & Lavendar
- Water - warm bath or shower running on lower back
- Accupuncture / Reflexology
- Hypnobirthing - deep relaxation, cuddles, sex
Week 2
What are the different types of pain medications?
Medical
1. Gas & Air
2. Pethodin
3. Epidural
Week 2
What are the different types of pain medications?
1. Gas & Air (Laughing Gas & Oxygen) (can have as much as you want)
- Encouraged during contractions only
- Wears of very quickly (within seconds) - feel spaced out but could make you nauseous
- DOES NOT pass to the baby
- Can be used in a birth pool too
Week 2
What are the different types of pain medications?
2. Pethodin (muscle & mind relaxant administered by injection) (usually only given once)
- Lasts up to 6 hours then wears off
- DOES pass to the baby (don’t want it too close to when the baby comes)
Week 2
What are the different types of pain medications?
3. Epidural (injection in the spine) (can be topped up)
- Might be really tired or in a lot of pain
- Docs might be thinking of using assisted birth tools
- Might take time for anesthetist to come (could take up to an hour)
- Takes a while to kick in
- Feel numb from the waist down (stay on side) (kneeling with help)
- Can’t feel anything so may be coached when to push by the midwife
Fetal Rejection Reflex - the body releases a baby involuntarily
Week 2
C-Section
Reasons for a c-section
1. Immediate threat to life (super rare)
2. Maternal / Fetal compromise
3. No compromise but early delivery is necessary
4. Elective
Reasons for a c-section
1. Placenta Previa (the placenta attaches low in the uterus)
2. Twins / multiple births
Week 2
Process of having a C-Section
- Will have an epidural - the anesthetist will keep talking to you and go through the people in the room (8 people roughly)
- Wearing a gown, lying on your back
- Doc will cut through 7 layers to deliver baby
- Mention beforehand if want baby to be put straight on mum’s chest
- Weigh baby on front can cause less stress than weighing on back
- Can ask for the screen to be lowered to see the delivery of baby
- Can request music, aromatherapy or silence if preferred and continue with natural medications
Week 2
Water Birth
- Only 9/100 have water births
- If ‘low risk’ then the benefits in water can outweigh the risks
- Can still do movement, aromatherapy and all natural medications
Week 2
Water Birth
Negatives of a water birth
- Can’t have an epidural
- Don’t like you staying in the water too long, usually get in closer to the time of birth i.e. 7 - 8cm
- Cord avulsion (cord snaps) increase which can happen if baby is brought to the chest too fast - 1.3/1000 not in water vs 4.1/1000 in water
- Uterine infection rate increases - 0.06 increase between in and out of water, usually treated with antibiotics
Week 2
Water Birth
Positives of a water birth
- Rate of epidural & hemorrhage declines
- Might be able to cope without epidural and pethodin but can still use gas & air
- Rate of assisted birth tools declines
- Can lie on your back easier
- Rate of birth satisfaction increases
- Water is kept regulated to body temperature of 37 degrees
- Midwife is generally less involved with the labour
- Dad can also get into the birth pool
Week 2
General Steps
- Stay at home until 3 in 10 for 1 minute contractions or 4cm dilated
- Go to the hospital and wait to be admitted, then checked
- Either go home and wait for longer or stay in hospital at this point
- Taken to a private room if labour is progressing
Week 2
Tips for Dad
- Get onboard, know mum’s mindet so that you can advocate if needed
- Pack the hospital bag
- Work out a gesture together to stop or continue something mid contraction
- Help stay in the bubble and calming mindset - breathe together, affirmations and movement
- Connected - dad groups - FB groups
Week 2
Postpartum Plan
- Batch cook food and freeze roughly 40 days
- Do you want visitors?
- No kissing (especially on face and hands)
- Wash hands before holding baby
- No perfumes - babies learn through touch and smell
Week 3
Postpartum Hormones
- Estrogen and progesterone decrease (can take 5 days to get back to pre-birth)
- Oxytocin increases - uterus is still contracting (let someone know if painful), can take longer for period to come back
- Lochia - bleed for about 6 week with first 3-4 days heaviest
- Prolactin - is a pregnany hormone that promotes breastfeeding
Day 3 - 4 usually the hardest where hormones are up and down
-Consider visitors around this time
-Sometimes want to cry all day (emotional period)
-If feeling low for more than 1 or 2 days could be more
Week 3
Midwife Visits
- Midwife will visit home the day after you get home, she will:
- Check mum’s stomach
- Check how mum and baby are doing
- Check feeding if breastfeeding
Week 3
Lochia
- Usually bleed for about 6 weeks
- Bright red initially then could be brown
- Heaviest at day 3 / 4 - like a heavy period
- Contact midwife if soak a pad in an hour
- If infection - smell different, dizzy, faint, headache, irregular heartbeat, tender stomach and sides, if red and heavy in second week (URGENT call midwife)
- Do same self care as when on period
Week 3
Mental Health
Contact
- Midwife
- GP
- PANDAS
- Perinatal Mental Health (local drop in session)
Week 3
Mental Health
1. Postnatal Depression
- 1 in 10 women are reported with Postnatal depression (low mood, hyperactive thoughts)
2. PTSD (usually from a traumatic birth)
- 1 in 3 women are reported with PTSD (flashbacks of birth, nightmares)
- Related to decision making whilst in labour / mum’s perception of labour
3. Postpartum Psychosis (paranoia, hallucinations)
- Could be persistent so seek help ASAP
Week 3
Postpartum Care
Sleep
- When you sleep your body repairs itself, creates memories and processes birth
Hemorrhoids
- Try a sitz bath (with Epsom salts)
- Eat fibre, use creams and sit on a pillow
Mummy MOT
- See a women’s health professional after birth when you feel ready
Postnatal Yoga and Pilates
- Diastasis Recti (ab separation)
Week 3
Baby Care
Top and tail baby
- For the first few weeks with cotton wool and warm water in the evening as a bedtime routine
- Start from the eyes, use cotton buds on ears and nose, hands and feet, get into all of the rolls and folds
- Clean around the cord stump, falls off in about 2 weeks (no baths before then)
Light and dark isn’t known initially so hard to establish bedtime routine
Speak positively to baby
Baby Positions
- Head by elbow or forward facing floor
- Pat bottom (reminds of inside womb)
- head on shoulder
Week 3
Sleep
- If struggling contact a sleep consultant
- Use sleeping bags
- No mobiles
- Have nothing in the bed / cot
- Look at Lullaby Trust website for tips
Sleep Temperature
- 2 fingers on chest, back or stomach (should be a comfortable temp)
- Baby wears an extra layer than what Mum is wearing
Week 3
Co-sleeping
- Keep all pillows and blankets away from baby
- Do not put baby close to edge of the bed
- No drinking, smoking or taking medications whilst co-sleeping
Week 3
Breastfeeding
- Breastfeed on demand (can be 5 - 40 mins a time)
- If gassy then try and adjust the latch
- Swap sides if baby is getting fussy
- Remove milk reguarly to encourage milk production
- Establish breastfeeding before bottle feeding (6-8 weeks)
- Cluster feeding is devlopmental - can last about a week from day 2-3
- WHO recommends breastfeeding for up to 2 years
- Take dummies away at 1 year old - use at sleeping
Week 3
Breastfeeding Positions
- Ensure nipple is in line with boob (nose to nipple)
- Support neck and ensure baby mouth is wide open
- Chin in contact
- Stomach to stomach
- Check for tongue tie, get privately checked and do exercises if snipped
- Cradle hold, Rugby Hold, On Side, Baby on Shoulder, Koala Hold
Week 3
Feeding straight after delivery
1. Breast Crawl - leave baby on stomach, let baby crawl up Mums body to feed
- Baby may cry and then rest but will repeat and continue crawling up
- Laid Back Feeding - Mum lies at a 45 degree angle and baby lies front facing
NHS Course
CHINS Feeding Technique
- C = Close (tummy to mummy)
- H = Head free (hold the top of babys shoulder)
- I = In line (babys esr, shoulder and hips are in line)
- N = Nose to nipple
- S = Sustainable (relax into the feed)
NHS Course
Formula Feeding
- Boil a litre of water at 70 degrees temperature
- Add appropriate amount of formula
- Swirl bottle to mix (do not shake)
- Cool in cold water
- Keep baby upright, fill half of flange and full teat
NHS Course
Feeding Cues
1. Increased movement - baby turning head from side to side
2. Hand to mouth - tongue sticking out
3. Crying
Knowing if baby has enough
- If baby falls asleep stop feeding
- Massage back downwards
- Offer second boob
NHS Course
