know about: normal labor, effacement, dilation
dilation = size os opening in cx
effacement = length/depth of cx in %, labor starts at 50-60% effaced, 100% at 10cm dilation
if no change in effacement, no labor
station = relative to ischial spines, biparietal diameter of head in relation to spines, 0 when there, neg when not there yet, plus when past there
you'll have a case: normal labor
term woman around 40 weeks (37-42 weeks)
totally normal case, primip
stage overview: 1. dilation, 2. pushing, 3. placenta
2:30pm Friday
afternoon call says she's in labor
contractions last 10-17 sec, variable duration between contractions
when she lies down they go away, feels mainly in cx, no bloody show no water leakage
1cm at last prenatal visit 50% effaced baby's head was high
if you check still same
-->Braxton-Hix contractions
give cramp bark to stop BH contxns
Vitex is amphoteric so will bring on stalled labor or stop premature
(at least 30 sec contractions before labor is really coming on
at least 5 minutes apart and regular)
8pm call
nothing's happening
if water breaks fluid should be clear
meconium in fluid impairs breathing after birth
old vs fresh meconium, thin vs thick, all this matters but covered later
amniotic fluid should smell like eawater
may have white flecks like pond's cold cream, that's vernix that covers babies
vernix caseosa: white cheesy stuff on babies when just born
water breaks, leaks fluid all the time
not many contractions, wants to go for walk
put in tampon?
no dt risk of ascending infx
babe is not protected dt membrane is ruptured
do not check cx oft dt infx risk
risk if membrane ruptured over 24 hours? induce?
yes for the purpose of this class (debatable)
induction of labor with acupx is best way according to Zieman, much in demand
castor oil is great but doesn't always work
induction via acupx about getting aggressive on sacrum and with electrical stim
12:00am, midnight
more regular contxns, 7 mins apart lasting 30-45 secs
she doesn't stop talking while on phone: contractions are not strong
2cm dilated, 60% effaced, head is -2
-->early (1st stage) labor, LATENT is before 4-5 cm
there has been a change but not much of one
this is the beginning of 1st stage, contractions are regular
4:00am
contractions 4 min at INTERVALS, 45-60 duration
ACTIVE labor, can't chat while contracting, whole uterus involved in contraction
cx 5cm, 80% effaced, 0 station
can feel amniotic sac bulging during contraction
babies HR OK
still 1st stage, now ACTIVE labor
know a couple ways to comfort mother:
massage, bath (not before active labor as it can stall labor), being alone, fluids/food, urination, enema, change positions, coaching, talking, visualizations, positive feedback, model relaxation don't order it
she needs to save energy, let her body do what it needs to do
8:00am
moaning, vomiting, spacey, chilly, flushed, emotional
contrx 2-3 mins apart
heart tones excellent
TRANSITION, active labor, 1st stage still but transitioning to stage 2
cx is 7cm dilated, 90% effaced, 0 station (biparietal diameter at ischial spines)
10:00am she's "complete" meaning fully dilated
10cm, +1, 10am
help her focus, she starts PUSHING, stage 2
it's been a while
breathing, pushing, baby not moving, frustrated
suggest ways to push more effectively: hold breath, do valsalva, don't blow air out
know one more thing to do: position: squatting, hands and knees, side lying w/ leg up
person w/ big baby may automatically go to hands and knees, gives more space in pelvis
11:56am
crowning
biparietal diameter at introitus
keep her calm, keep baby there to allow stretching
panting, oil rubbing, avoid violent pushing
11:58am head out
student will catch baby
midwife whispering in her ear
easing head out slowly, FLEX head twd perineum to protect uppper tissues (urethra, clit)
things you can do: perineal support, counter pressure, hot compress
head is out
next find cord
unwrap if around neck
"nuchal cord"
restitution
baby twists to get shoulders out on A-P pole
noon, baby slides out into students hands
chart: viable male/female
end of stage 2
first dry baby
see if breathing, if not, stimulate it by rubbing
bulb syringe mouth then nose
baby crying and pink, mom crying and laughing
when cut cord?
after it stops pulsing
sometimes feel pulse in cord after placenta is out'
don't cut if not in secure/sterile place
APGAR
apgar of 7 or more is normal,
2 points for each of 5 variables is perfect
breathing: screaming = 2
reflexes: responds to touch = 2
color: pink = 2
heart rate: over 100 = 2, palpate cord not baby
movement: squirming = 2
stage 3 after baby is out
waiting for placental delivery
two signs: gush of blood, cord lengthens, uterus rises in abdomen and becomes more globular
300cc blood loss at 12:15 then placenta comes out
hemorrhage is over 5-600cc
hospitals underestimate blood loss to avoid major protocol induction
next
massage uterus to get clots out
this will stop bleeding, allow uterus to shrink and close
woman is stable
get her laying down
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12am 2cm latent stage, some dilation so beginning of stage 1: dilation
4am 5cm beginning of active labor
8am 7cm beginning of transition, last part of stage 1, transitioning to stage 2
10am 10cm complete, stage 2: pushing
noon born, end of stage 2
placenta born 12:15, stage 3 lasted 15 minutes
first dilation change was midnight from 1-->2cm
how long was latent phase?
4 hours
how long active?
6 hours (5cm to )
how long transition?
2 hours
all 1st stage?
10 hours
how long second stage?
2 hours
how long third stage?
15 minutes
whole labor?
12 hours 15 minutes
(this is totally textbook average 1st time mom)
that's the first 4 pages of the test
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feed baby after good long nap? no
feed sooner in 1st hour if possible while mom still awake
because adrenaline and oxytocin are high
optimal for bonding
baby needs blood sugar support, just went through major stress
feeding also helps mom's uterus involute, protects vs ov & breast ca, decr osteoporosis
baby is nursing
no milk?
sitting up, private, drink water, pillows
belly to belly, nose to nipple
latch good?
COLOSTRUM
low in fat and calories compared to later milk
can be expressed from early in preg, when prolactin levels rise
know 3 elements and why good for baby
good bacteria: bifidus, acidophilus needs to get established in baby gut
also high levels of minerals, protein, fat soluble vitamins
antibodies
laxative effect to clear meconium, helps eliminate bilirubin
3 advantages of breastfeeding to mom and baby
protect vs breast ca, loose wt faster
protects vs allergies/asthma in baby
immune protection
helps mom's uterus recover, prevent bleeding
how often should baby nurse in 24 hours?
8-12 times
physiology of nursing
2 fx of prolactin: breast growth, colostrum production
milk composition: contains casein, fatty acids, lactose, enough volume
2 fx of oxytocin
milk ejection
release of hind milk
refilling
how is milk supply managed in body?
supply and demand
a few qs on infert
name 3 parts of sperm analysis:
volume, ph, motility, morphology, fructose content, etc
know other testing to sort out male fert
culture urethral discharge
evaluate gonadotropins, testosterone, PRL
know a couple of botanicals for male fert
panax 5-30 gtts TID-QID
avena 15-30 gtts
serenoa 20-30 gtts
name a couple supplements for sperm:
vitamin C 1-5g
beta-carotene 150,000 IU
also vit E, folate, B3, Zn, Cu, lecihin
know ovulation signs
BBT increase, cervical mucus sticky, palpate cx: soft
how to dx infert in mom
FSH, LH, prog, est, hysterosalpingiogram
post coital test, US, TVUS
clomid
to ripen eggs in ovaries
stimulates FSH
give for 3 cycles
only for women who don't ovulate but have menses at least 1/6mo
SE: lowers est so not for older women
SE: hot flash, HA, moods, insomnia, hair loss, blurry vision