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 **************************************** **************************************** * 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 **************************************** ****************************** 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