First Stage Difficulties (the opening phase) – notes – Gail Hart

Written by FairyDoula. Posted in Midwifery notes

PROLONGED LABOUR RISKS

  • Infection, maternal exhaustion, postpartum haemorrhage, fetal distress, fetal injury or asphyxia, low APGAR scores, separation of mother/baby, difficult recovery, postpartum depression, caregiver exhaustion leading to poor decisions.

* To reduce the risk of infection*

  • Preserve membranes
  • Limit internal exams
  • Avoid internal devices
  • Keep mother hydrated and rested
  • Maintain a clean enviroment

* Risk of distress created by*

  •  Stimulated labour
  •  Artificial rupture of membranes( water bag)
  • Maternal low blood sugar
  • FEAR > TENSION > PAIN!
  • Maternal supine ( laying down) position
  • Coached pushing acidosis
  • Manual extraction ( forceps, suction cup)

* Reduce the risks by*

  • Monitor carefully and unobtrusively
  • Listen to baby> You can hear with your ear from the back as well as the front.
  • Augment labour conservatively
  • Assist all involved to be patient
  • Encourage intact membranes
  • Avoid maternal supine position ( lying down)
  •  Encourage active upright positions and side-lying ( Simms or left lateral)
  •  detect and correct malpositions early
  • Maintain maternal blood sugar with food , liquid or sugar
LOVE > RELAXATION > JOY!

* Assess mother and baby*

DONT DO AN INTERNAL EXAM FOR NO REASON – IF YOU DO ONE , DO A GOOD ONE!

  • Monitor closely for signs or symptoms of infection
  • Elevated maternal temperature
  • Rising pulse
  • Increased uterine or abdominal tenderness
  • Exhaustion
  • Signs of true maternal exhaustion
  • Rising pulse and temperature
  • Is there progress?
  • There must be progress even if there is slow progress
  • Mother and baby must remain in a good position
  • Detect heart decelerations
  • Know when to quit*
  • Signs of disproportion between head and pelvis
  • High head – head not engaged and cant be made to engage
  • Asynclitism ( head off to the side not aligned to the bone of the pelvis) – especially increasing degrees
  • Strong contractions ( rushes, surges) without progress or dilatation( cervix opening)
  • Failure of head to flex and descend with strong contractions and good pushing
  • Large and growing caput ( swelling formed on the baby’s head by pressure from the dilating cervix) but with no descent when measured above the pubic bone

*Signs of potential Uterine ( womb) rupture*

  •  A thinning lower uterine segment( may feel like a balloon
  •  Full bladder
  • Rising contraction ring
  • Formation of Bandl’s Ring ( extreme thickening of the ring of normal labour when labour is obstructed. It is able to be felt with the hands as a hard ridge across the tummy)
* DONT EVER LET THINGS GET THIS FAR! * BE PRUDENT, GET HELP * RULE OUT OBSTRUCTED LABOUR!

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