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NSE 417 (1)

Labour & Delivery Notes

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Ryerson University
NSE 417
Sharon Paton

GENERAL LABOUR AND DELIVERY INFORMATION Types of Deliveries Spontaneous Vaginal Deliveries (SVD): natural delivery through the vagina; without use of assistive devices Assisted Vaginal Delivery (AVD): Delivery with the use of special instruments such as forceps Vacuum-Assisted Deliveries (VAD): Delivery with the use of vacuum extractor device – such as KIWI or pump C-Section: surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies Vaginal Birth After Cesarean: birthing a baby vaginally after a previous baby has been delivered through c-section; chance of uterine wall reopening from c-section Induced Labour: Where drugs or manual techniques are used to initiate the labour process - Drugs: Oxytocin/Pitocin, prostaglandin suppository - Techniques: Artificial rupture of membranes (AROM), catheterization, nipple stimulation, intercourse Non-stress and stress test must be performed by triage Indication for Induced Labour: - Postterm pregnancy > 42wks - Health risks to the woman in continuing the pregnancy (e.g. pre-eclampsia). - Premature rupture of the membranes (PROM) but labour process does not start - Premature termination of the pregnancy (abortion) - Scheduling concerns - Fetal death in utero - Twin pregnancy > 38wks Stages of Labour: 1 : Onset of regular patterned contractions; longest stage of labour as there are 3 phases Latent – effacement (shortening and thinning of cervix in %), head descends lower into pelvis; dilation (opening of cervix): 1-4 cm Active – rapid dilation: 4cm – 8-9 Transition – Fully dilated: 10 cm – painful contractions; urge to push is strong As labour begins, patient may experience back pain, Braxton Hicks contractions (false), water may break, mucus plug and blood may appear. TRUE vs. FALSE labour True contractions increase in intensity and duration, becoming closer together and continue with walking. Baby presentations and Ease of labour depends on...: Fetus & placenta – size of fetal head, position of shoulders, place of placenta. Head molding Presentation – part of the fetus that enters the pelvic inlet (cephalic – 96%, breech, 5%, shoulder, 1%). Lie – relationship of the long axis of the baby’s spine to the ischeal spine of the mother Attitude – relationship of fetal parts to each other Position – relationship of presenting part to the 4 quadrants of the mother’s pelvis Passageway – size & shape of mother’s bony pelvis, soft tissues of cervix, pelvic floor, vagina GENERAL LABOUR AND DELIVERY INFORMATION Maternal Powers - Primary – contractions (responsible for effacement, dilation & fetal descent) - Secondary – pushing with contractions – responsible for delivering the baby Position of mother – Upright, squat, side lying, over chair – gravity helps labour progress Psych. Response - degree of preparation, support, feelings about the pregnancy Labour Process and Baby Positioning During Delivery: Engagement – baby’s head into pelvic inlet Station – relationship of presenting part to an imaginary line drawn between maternal ischeal spines – cm above or below the spines
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