Anatomy and physiology of birth 2
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- Created by: Ruby waterhouse
- Created on: 24-11-20 10:47
NICE guidance on the stages of labour-
Latent
Latent
-Not necessarily continuous
-Painful contractions
-Some cervical change including cervical effacement
-Dilation up to 4cm
-Painful contractions
-Some cervical change including cervical effacement
-Dilation up to 4cm
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NICE guidance on the stages of labour-
Established
Established
-Regular painful contractions
-Progressive cervical dilation from 4cm
-May want pain relief at this stage
-Monitor both mum and baby at this time
-Progressive cervical dilation from 4cm
-May want pain relief at this stage
-Monitor both mum and baby at this time
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NICE guidance on the stages of labour-
Duration of the first stage
Duration of the first stage
-length of established labour varies from between women
-first labours last on average 8 hours unlikely to last over 18hours
-second and subsequent labours last on average 5 hours unlikely to last over 12hours
-first labours last on average 8 hours unlikely to last over 18hours
-second and subsequent labours last on average 5 hours unlikely to last over 12hours
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WHO guidance on the stages of labour (2018)
-onset of an active first stage commences from 5cm
-latent and first stage of labour varies from woman to woman
-Duration of first stage does not usually extend beyond 12 hours
-Usually does not extend beyond 10hours in subsequent labours
-latent and first stage of labour varies from woman to woman
-Duration of first stage does not usually extend beyond 12 hours
-Usually does not extend beyond 10hours in subsequent labours
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First stages of labour-
what happens to the cervix ?
what happens to the cervix ?
-Active first stage is monitored following from the onset of regular contractions- this process is monitored through VE's
-Woman will start to experience painful contractions waters may break.
-Women are asked to only come into hospital when they are e
-Woman will start to experience painful contractions waters may break.
-Women are asked to only come into hospital when they are e
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what happens to the uterine contractions during the first stage of labour?
-within this stage of labour cervical effacement, dilation and fetal descent are all aided by uterine contractions
-Each uterine contraction starts at the fundus near one of the cornua then it spreads across and downwards.
-Each uterine contraction starts at the fundus near one of the cornua then it spreads across and downwards.
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Pain management
what is it?
What is labour pain caused by?
what is it?
What is labour pain caused by?
-Labour pain is not caused by a pathological event (not abnormal) normal physiology of the contractions
-Pain and pain management is the interaction between physiological and psychological factors
-Pain and pain management is the interaction between physiological and psychological factors
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how is using a sautogenic approach essential in the management of labour ?
what does this involve?
what does this involve?
-involves a discussion of labour and advises women what to expect in the antenatal period
-Explaining to them what is normal
-explaining about cervical changes and fetal decent
-gives women the sense of coherence and
manageability
-Explaining to them what is normal
-explaining about cervical changes and fetal decent
-gives women the sense of coherence and
manageability
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what changes may the painful stimulus induce by the sympathetic nervous system?
-increased blood pressure
-increase of adrenaline into bloodstream
-increased blood glucose levels
-decrease in gastric mortality
-reduction of blood supply to the skin (causing sweating)
*Monitoring is essential*
-increase of adrenaline into bloodstream
-increased blood glucose levels
-decrease in gastric mortality
-reduction of blood supply to the skin (causing sweating)
*Monitoring is essential*
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what should be monitored to ensure fetal and maternal well being throughout labour?
-Maternal vital signs
-strength, length and frequency of contractions
-cervical dilation and effacement - through VE's
-Amniotic fluid colour (clear liquor ideally)
-Meconium stained liquor needs continuous monitoring of baby heartbeat
-Regular monitori
-strength, length and frequency of contractions
-cervical dilation and effacement - through VE's
-Amniotic fluid colour (clear liquor ideally)
-Meconium stained liquor needs continuous monitoring of baby heartbeat
-Regular monitori
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What is a partogram?
-used to document all the findings from vital signs
-not commenced on a partogram until labour is defined as established (4cm)
-From 4cm midwives will start to monitor progress of labour
-not commenced on a partogram until labour is defined as established (4cm)
-From 4cm midwives will start to monitor progress of labour
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Membranes
(SCROM) meaning ?
(SCROM) meaning ?
- Spontaneous rupture of membranes - can occur at any time
- can occur before the labour starts and when the waters break
- can also occur at the first stage of pregnancy
- can occur before the labour starts and when the waters break
- can also occur at the first stage of pregnancy
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(ARM)- what does this mena
why might this need to happen?
why might this need to happen?
- artificially ruptured membranes
- could be needed in labour where it is having slow progress
- and there are concerns about the baby's wellbeing
- could be needed in labour where it is having slow progress
- and there are concerns about the baby's wellbeing
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Why is it important that the midwives asses when the membranes have ruptured?
-for the colour of the liquor
- this can change throughout the labour which is why it is vital that intermittent monitoring is done.
- ideally we would want clear liquor
- if meconium stained liquor is picked up it can indicate fetal distress and would n
- this can change throughout the labour which is why it is vital that intermittent monitoring is done.
- ideally we would want clear liquor
- if meconium stained liquor is picked up it can indicate fetal distress and would n
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transition into the second stage of labour
what is this described as ?
what is this described as ?
- the stage between dilation and active pushing
- eg end of the first stage and start of the second stage
- eg end of the first stage and start of the second stage
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what are the 2 ways in which a woman may enter the second stage of labour?
- passive second stage of labour
- active second stage of labour
- active second stage of labour
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what is the passive stage of labour (resting)
why can it occur?
what is this known as ?
why can it occur?
what is this known as ?
- the finding of full dilation of the cervix before or in absence of full contractions
- no urge to push could be due to analgesia eg epidural - they may be fully dilated but have no urge to sensation to push
- "resting period"
- no urge to push could be due to analgesia eg epidural - they may be fully dilated but have no urge to sensation to push
- "resting period"
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active second stage of labour
what is this ?
what might the woman be experiencing?
what is this ?
what might the woman be experiencing?
- experiencing expulsive contractions
- full dilation of the cervix and reporting urge to push
- in some cases the baby may be visible
- active maternal effort following the confirmation of full dilation of the cervix if no expulsive contractions
- full dilation of the cervix and reporting urge to push
- in some cases the baby may be visible
- active maternal effort following the confirmation of full dilation of the cervix if no expulsive contractions
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Timings of the second stage of labour
according to NICE guidelines
primiparous (first baby)
according to NICE guidelines
primiparous (first baby)
- within 3 hours of the active pushing second stage
- diagnose delay if it has lasted 2 hours and refer to doctor to discuss an instrumental delivery eg forceps
- or if observations are fine set a plan in place to allow pushing to go on for longer
- diagnose delay if it has lasted 2 hours and refer to doctor to discuss an instrumental delivery eg forceps
- or if observations are fine set a plan in place to allow pushing to go on for longer
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Timings of the second stage of labour
according to NICE guidelines
multiparous women
when does it start ?
how long does it last ?
according to NICE guidelines
multiparous women
when does it start ?
how long does it last ?
- within 2 hours of the start of the active stage of labour in most women
- diagnose delay in active second stage when it has lasted 1 hour and refer to a doctor to undergo a operative vaginal birth and birth is not imminent
- diagnose delay in active second stage when it has lasted 1 hour and refer to a doctor to undergo a operative vaginal birth and birth is not imminent
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Physiology of the second stage of labour
what happens with this stage?
what happens with this stage?
- contractions change in character and become more intense this is due to Fergusons reflex - a surge in oxytocin which can aid in the contractions
- membranes can rupture in this stage if they haven't already this is because the baby is descending into t
- membranes can rupture in this stage if they haven't already this is because the baby is descending into t
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other changes that can occur in the second stage of labour
- soft tissue displacement can occur as the head is descending down and putting pressure on the rectum
- this then causes the woman to have an urge to go to the toilet and may even pass faeces
- this then causes the woman to have an urge to go to the toilet and may even pass faeces
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What is the Rhombus of Michaelis ?
what is it ?
why does it occur?
what is it ?
why does it occur?
- a kite shaped area in the lower spine that includes the sacrum and three lower lumbar vertebrae
- as the second stage of labour begins the rhombus of Michalis moves backwards increasing the diameter of the pelvis.
- as the second stage of labour begins the rhombus of Michalis moves backwards increasing the diameter of the pelvis.
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Anal cleft line
what is this when can it be seen?
what research was done on this?
what is this when can it be seen?
what research was done on this?
- a temporary change of skin discoloration
- can be seen above the anal cleft as the woman progresses throughout labour
- research showed that the was a correlation between the length of the line and the woman's dilation and decent of the fetal head
- can be seen above the anal cleft as the woman progresses throughout labour
- research showed that the was a correlation between the length of the line and the woman's dilation and decent of the fetal head
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Factors that can impact the second stage of
labour
labour
- parity (previous baby)
- analgesia eg epidural & potential "resting stage"
- uterine contraction activity
- infection
- fetal position
- type of pelvis
- size of pelvis
- maternal weight
- analgesia eg epidural & potential "resting stage"
- uterine contraction activity
- infection
- fetal position
- type of pelvis
- size of pelvis
- maternal weight
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Changes within the cardiovascular system during labour and why does this happen
- increased respiratory rate - due to pain
- cardiac output increase up to 20-50% due to the return of uterine blood to the maternal circulation
- pain and fear may also cause a sympathetic response which produces a greater cardiac output
- cardiac output increase up to 20-50% due to the return of uterine blood to the maternal circulation
- pain and fear may also cause a sympathetic response which produces a greater cardiac output
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digestive system changes within labour
- hospital polices vary on nutrition in labour
- previously a lot of focus on restricting nutrition in labour to prevent gastric aspiration during anaesthia
Mandelson's syndrome - if the woman needed an epidural later on in labour or emergency C section
- previously a lot of focus on restricting nutrition in labour to prevent gastric aspiration during anaesthia
Mandelson's syndrome - if the woman needed an epidural later on in labour or emergency C section
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Changes within the renal system in labour
renal - the bladder rises into the abdominal cavity causing the retention of urine
- a full bladder may increase pain and reduce the efficiency of uterine contractions and delay the descending part
- may need to assist the emptying of the bladder throug
- a full bladder may increase pain and reduce the efficiency of uterine contractions and delay the descending part
- may need to assist the emptying of the bladder throug
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changes within the endocrine system during labour
- progesterone increases up to full term
- fetal cortisol production increases at term - this then increases oestrogen production and the formation of oxytocin receptors on the uterine muscles
- as oxytocin is released the uterus begins contractions
- fetal cortisol production increases at term - this then increases oestrogen production and the formation of oxytocin receptors on the uterine muscles
- as oxytocin is released the uterus begins contractions
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flight or fight response
what is this?
what is this?
- a physiological response that promotes survival of the endangered or frightened animal or human
- initiated by the outpouring of stress hormones and catecholamines
- triggered by danger, fear, anxiety, distress
- has the potential to slow labour
- initiated by the outpouring of stress hormones and catecholamines
- triggered by danger, fear, anxiety, distress
- has the potential to slow labour
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what can catecholamines have an affect on ?
- they can counteract the affects of oxytocin - this is why it is important to reduce stress and anxiety and creating a calm and relaxed environment for the woman in labour eg low lighting, music, quiet room
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what are the 7 Mechanisms of labour
do - frogs - in - Essex - really - eat - sugar - beans
do - frogs - in - Essex - really - eat - sugar - beans
- Decent
- Flexion
- internal rotation
- extension
- restitution
-external rotation
- shoulders
- birth
- Flexion
- internal rotation
- extension
- restitution
-external rotation
- shoulders
- birth
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Decent
of what?
when and why does this occur?
what does it provide a measure of and
how can it be assessed?
of what?
when and why does this occur?
what does it provide a measure of and
how can it be assessed?
- decent of the fetus to the pelvis
- occurs throughout labour due to the force of gravity and pressure from contractions
- decent of the head provides a measure the progress of labour, using ischial spines as a marker which can be assessed through VE'
- occurs throughout labour due to the force of gravity and pressure from contractions
- decent of the head provides a measure the progress of labour, using ischial spines as a marker which can be assessed through VE'
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Flexion
of what?
when does it occur?
of what?
when does it occur?
- flexion of the head occurs as it descends and meets the pelvic floor this brings the chin into contact with the fetal thorax
- as the fetus descends the chin touches the chest and the arms begin to cross this is then increased further the head meets th
- as the fetus descends the chin touches the chest and the arms begin to cross this is then increased further the head meets th
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internal rotation
when does this occur ?
when does this occur ?
- occurs when the occiput (head) reaches the resistance of the pelvic floor and rotates 45 degrees
- the slope of the pelvic floor aids in the rotation forward and allows the head to emerge in the longest diameter of the pelvis
- the slope of the pelvic floor aids in the rotation forward and allows the head to emerge in the longest diameter of the pelvis
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extension
what is this?
how does this occur?
what is this?
how does this occur?
- the crowing of the head
- occurs with a slight extension the face, forehead, bregma and chin will then pass over the perineum and the head is then born
- occurs with a slight extension the face, forehead, bregma and chin will then pass over the perineum and the head is then born
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Restitution
what happens at this stage
?
what happens at this stage
?
- when the head is born it will turn left or right to be in line with the shoulders that are still in utero
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external rotation
what happens at this stage ?
what happens at this stage ?
- this is when the shoulders rotate and go underneath the pubic arch
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delivery of the shoulders - what happens at this stage?
- restitution and external rotation allow the smooth birth of the shoulders
- the anterior shoulders appears though maternal effort gentle traction may be applied if needed
- the posterior shoulder is born following the curve of the pelvis followed by t
- the anterior shoulders appears though maternal effort gentle traction may be applied if needed
- the posterior shoulder is born following the curve of the pelvis followed by t
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Other cards in this set
Card 2
Front
NICE guidance on the stages of labour-
Established
Established
Back
-Regular painful contractions
-Progressive cervical dilation from 4cm
-May want pain relief at this stage
-Monitor both mum and baby at this time
-Progressive cervical dilation from 4cm
-May want pain relief at this stage
-Monitor both mum and baby at this time
Card 3
Front
NICE guidance on the stages of labour-
Duration of the first stage
Duration of the first stage
Back
Card 4
Front
WHO guidance on the stages of labour (2018)
Back
Card 5
Front
First stages of labour-
what happens to the cervix ?
what happens to the cervix ?
Back
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