PRENATAL PART 2

PART 2 OUTLINE

Variations in Labour

Cesarean Sections

Hospital Routines/Inductions

VARIATIONS IN LABOUR

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged >24 hrs

Dysfunctional

Preterm

Cesarean Section

POSTERIOR POSITION

Baby face up instead of face down

A lot of back pain for mom

Coach …rubbing, back massage & hot/cold compresses

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged > 24 hrs

Dysfunctional

Preterm

Cesarean Section

BREECH

Frank, Complete, Incomplete (Footling)

Bum first presentation

Approx. 3 wks before due date, U/S will show babe’s position… usually stays in this position until delivery

May still deliver vaginally – Dr.’s recommendation

BREECH DELIVERY MAYBE…

Umbilical cord not in the way

Baby not too big/small (~5.5-8.5lbs)

Frank or Complete Breech Position

Maternal pelvis adequate diameter

Doctor’s skill/comfort level

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged >24 hrs

Dysfunctional

Preterm

Cesarean Section

RAPID LABOR

Occurs in 1-4 hrs

Difficult to get into a rhythm with contractions

Difficult to prepare self for contraction

DON’T drive self to hospital; call an ambulance

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged >24 hrs

Dysfunctional

Preterm

Cesarean Section

R/t:

Full Bladder

Small pelvis & large babe (CPD)

Bedrest

Dysfunctional labour

Note: Augmentation (getting labour going

with medical intervention) may be necessary.

PROLONGED LABOR (>24HRS)

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged >24 hrs

Dysfunctional

Preterm

Cesarean Section

DYSFUNCTIONAL LABOUR

Ineffective contractions, cervix not thinning or opening & babe not descending

May be related to position of babe

Medication/epidural given too soon

Note: Augmentation (getting labour going with medical intervention) may be necessary.

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged >24 hrs

Dysfunctional

Preterm

Cesarean Section

PRETERM DELIVERY

Delivery <37wks

7.8% of Cdn. deliveries (2012)

Cause is often uncertain

Some risk factors: smoking, overworked, alcohol/drug use, abuse, untreated infections, underweight, premature rupture of membranes.

VARIATIONS IN LABOUR

Posterior position (OP)

Breech

Rapid/Short 1-4 hrs

Prolonged >24 hrs

Dysfunctional

Preterm

Cesarean Section

CESAREAN SECTIONS

Maternal Medical

Conditions:

1. Gestational

Diabetes

2. Severe Toxemia

3. Ruptured

membranes

without labour

>24 hrs

4. Uterine

Dystocia

5. Arrested

Labour

6. Active Herpes

CESAREAN SECTIONS

Low Segment Incision Classical Incision

Only in emergency situations The common method

What to Expect…

PREPARING FOR C/S

Lots of people involved; anesthetist, obstetrician, residents, 2+ RNs, baby team

Don’t forget camera!!

Dad/Support Person changes into “greens” then waits outside OR, while mom goes in to be “prepped”

Mom to OR table, epidural inserted (if not already in place), monitors applied, urinary catheter inserted, abd. washed, draped with sterile green cloths

PREPARING FOR C/S CNT’D

Now Dad/SP called in to OR & sits by mom’s head

Surgery begins, takes approx. 1.5 hrs (start to finish)

Baby out in less than 10 mins

Note: Dad/SP not allowed in OR if mom getting general anesthesia (waits next door)

RECOVERY ROOM

Vital signs taken often

Vaginal flow & dressing monitored

Height of uterus (fundus) measured

Pain meds given

Epidural wears off & sensation returns

Most of the above also done after

vaginal birth

POST CESAREAN DIFFICULTIES

Discomfort d/t: pain at incision, abd. gas, lung congestion

Lack of mobility: IV, catheter, discomfort

Fatigue

Healing of incision

Bonding with Baby

PARTNER’S FEELINGS

Fear for loved one & baby during procedure

Not being needed

Overwhelmed & unsure of how to help loved one

Concerns related to baby

Neglected by family & friends who are concerned primarily about mom & baby

HELPFUL HINTS FOR HOME AFTER A C-SECTION

DON’T feel guilty about asking family for help (cooking, housekeeping, laundry, grocery shopping)

Postpone visitors for 1 week (for much needed rest) & keep visits short as you will find you tire easily

If friends or family offer to help, suggest a ready-made meal

HOSPITAL ROUTINES

INDUCTIONS

MONITORING

Purpose to monitor variations/changes in labour & detect complications

Vital signs; BP, pulse, temp

Vaginal/Pelvic exams

Cervical dilation

Station, presentation & position of baby

Amniotic fluid; odour, color

Fetal heart rate

EXTERNAL FETAL HEART MONITORING

INTERNAL FETAL HEART MONITORING

INDUCTION OF LABOUR

The artificial initiation of labour

Considered when wellbeing of mother or baby makes delivery necessary

High blood pressure (PIH)

Diabetes

Overdue (close to 42 wks)

Decreased fetal movement or other fetal compromises

Rh Incompatibility (rare)

TYPES OF INDUCTIONS

Artificial rupture of membranes (ARM)

Prostaglandins (gel, suppository)

Prostin, Prepidil, Cervidil

Oxytocin/Syntocinon (Pitocin in USA)

ARTIFICIAL RUPTURE OF MEMBRANES

Amniotomy

Use an amnihook

Tear an opening in the amniotic sac

ARTIFICIAL RUPTURE OF MEMBRANES

Speeds up labour (pressure of babe’s head on cervix)

Examine amniotic fluid

Necessary for internal fetal heart monitoring

Doesn’t always work

No more ‘cushion’ of fluid around baby

Cord prolapse (if fetal head not well applied to cervix)

Benefits Risks

PROSTAGLANDINS

Ripens/softens the cervix

Gets labour started

More freedom for mom

May not work

Bring on labour ‘fast and furiously’

Benefits Risks

OXYTOCIN/SYNTOCINON

Increases frequency & intensity of contractions

Helps to dilate cervix & move baby down birth canal

Contractions more difficult to manage ( nature of labour)

Continuous fetal monitoring

Increased risk for more medical interventions

Benefits Risks

POSSIBLE ALTERNATIVES

Nipple stimulation – causes the release of oxytocin, increasing uterine contractions

Sexual intercourse – orgasm stimulates uterus to start contracting

EPISIOTOMY

Enlarge vaginal opening just before baby is born

Fetal distress

Protect pelvic floor

Forceps or vacuum

May tear spontaneously without one

ADVANTAGES OF EPISIOTOMY

Possibly shortens 2nd stage of labour

May prevent severe, uncontrolled tears

AVOIDING EPISIOTOMY/TEARING PRENATALLY

Kegel exercises

Practice the various positions used in labour

Perineal massage

Good nutrition to promote healthy tissues

Avoiding Episotomy/tearing during labour

Relaxing the perineum

Don’t rush ‘bearing down’

Use gravity – neutral positions (squatting, semi-sitting)

Perineal massage, support

Warm compresses

FORCEP & VACUUM EXTRACTION

Fetal distress

Babe not progressing down birth canal

Exhaustion

Anesthetic – mom too ‘frozen’ to push effectively

Vaginal canal too small & mom needs help delivering

FORCEP & VACUUM EXTRACTION DISADVANTAGES

May cause tears

May cause injury to babe

Temporary bruising or changes to shape

of baby’s head

REFERENCES

Slide10 http://www.umm.edu/graphics/images/en/19158.jpg

Slide24 bringbirthhome.com

Slide25 westechinc.com

Slide27 lifeinpain.org

Slide28 yoursurgery.com

Slide39 pregnancy.lovetoknow.com

Slide40 nlm.nih.gov

Slide43 babble.com