KATIE ADAMS

Midwifery Practice Facilitator / Labour Suite Manager

April 2015

Normal BirthThe Mechanism

of Normal labour

What is Normal?

Normal Birth

Where labour is spontaneous at full term, not induced or augmented and where

normal progress is made without the use of pharmacology. The infant delivers with

maternal effort, no episiotomy or intervention with instruments or

caesarean section

Signs of labour -Latent phase

The body starts to prepare for labour.

Varies between individuals

Irregular painful contractions, period type pain, back pain

Sleeplessness, nausea, hunger / cravings, constipation, diarrhoea

Excitement / Nesting Lasts for several

hours / days Emotional support

and reassurance

When the waters breakorSpontaneous rupture of the membranes

Waters can break at any time – does not mean labour or childbirth is imminent

Clear in colour

Meconium stained liquour

Umbilical cord

Presenting part

Three stages of labour

First Stage:

The onset of regular painful uterine contractions accompanied by progressive dilatation of the cervix through the transitional phase to full cervical dilation of 10 cm.

Second Stage:

Full cervical dilatation to the delivery of the baby.  

Third Stage:

Time of birth to the delivery of the placenta and control of bleeding.

Bishops score

Pain Relief

Natural Endorphines Immersion in Water Breathing Techniques Hypnosis Reflexology Massage TENS

N2O+O2 Simple Analgesia (Paracetamol) Narcotics (Pethidine) Epidural Spinal GA

Transitional phase

Occurs towards the end of 1st stage, leads into 2nd stage

the Ferguson reflex: as pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead.

Behavioural changes Loss of control; panic Negative thoughts Nausea and vomiting Slowing of contractions Heavy show, bowels opened Restful stage – don’t jump in! Urge to bear down Purple Line 'Push Off' stage

Expulsive phases

The strength of the pushing urge varies in intensity but will become more consistent

Characteristic grunting noise

Thinks she needs to empty her bowels / bowels open

Signs of full dilatation: heavy show, anal dilatation, perineum bulges and stretches.

The presenting part will become progressively more visible

Labour will progress if

The fetus is of average size With a normally positioned

head In a normal labour In a woman with an average

sized gynaecoid pelvis If contractions are adequate

Mechanisms of Normal Labour

DescentFlexion Internal rotation of headCrowningExtensionRestitution -Internal rotation of the shoulders

External rotation of the headLateral flexion

Descent

The fetal head engages and descends into the pelvis in an OT (occiput transverse) position.

The widest part of the fetal skull into the widest diameter of the pelvis.

Descent

Flexion

As the fetus descends the head flexes so that the fetal chin is touching the fetal chest.

Thereby creating the smallest diameter to pass through the pelvis.

Internal rotation of the head

With good uterine contractions and maternal expulsive effort the occiput reaches the pelvic floor.

As it reaches the resistance of the pelvic floor, it rotates forward through 45 degrees into OA (occiput anterior) position.

The head emerges through the widest diameter of the pelvic outlet – anteroposterior diameter.

Internal rotation

As head descends it meets the muscles of the pelvic floor and rotates anteriorly

Crowning

The occiput escapes under the pubic arch and the head is crowned.

The head no longer recedes between contractions.

Extension

The forehead, face and chin sweep the perineum and the head is born.

Extension

Restitution

When the head is born it will turn right or left righting itself with the shoulders.

The shoulders rotate internally to lie in the AP diameter of the pelvis.

Rotation follows the same direction as restitution.

External rotation

Lateral flexion

The Anterior shoulder is born under the pubic arch first

The posterior shoulder passes over the perineum

The natural curve of the birth canal causes the baby to flex sideways

Complete ExpulsionorDelivery

Placenta

ActiveClamp and cut cord

Oxytocic drugs

Signs of separation

CCTContracted uterus?

Average 5 minutes

Physiological

Do nothingBreast feedObserve blood loss

Maternal observations

Can take one hour or more

Pass urineSit up right

Skin to skin & Breast feeding

4th Stage of labour

Promotes bonding / Feelings of wellbeing

Thermoregulation

Comforts baby

Promotes early breast feeding

Expels placenta

UHCW

Lucina Birth Centre

Division of B2B training

Birthing Pools

Dedicated supervisor of Midwives Team

Specialist Midwives Roles

Birthing outside of Guidance

Low Risk Policies and Guidelines

Large birthing rooms

CAN WE IMPROVE ?

? CEASAREAN SECTION RATE

? NORMAL BIRTH RATE

? WATERBIRTH RATE

? INSTRUMENTAL

AnyQuestions?