Relief
The Midwives at RPAH can give you Pethidine in labour to help with pain relief. True or False
False. Pethidine has a long half life in the baby. We now give Morphine which is better for baby. This is given by injection and usually given with an injection of Maxalon to help with nausea
Name four reasons a woman would have an induction of labour.
Post dates, vaginal bleeding, large or small growth, meconium liqour, SROM with GBS, Diabetes, PET, social reasons, high risk pregnancy, AMA.
An Epidural goes into the spinal cord. True or False
False. An epidural goes into the epidural space. This is the area between the dura mater and vertebral wall. The space is located just outside the Dural sac which surrounds the nerve roots.
Which statement is true
A) 8-13% of births at RPA are assisted by Forceps or a Vacuum
B) 14-17% of births at RPA are assisted by Forceps or a Vacuum
B.
What is the name of the apparatus used to listen to the fetal heart rate?
1) Pinnards
2) Doppler
3) CTG
What is Entonox
Otherwise known as laughing gas or Nitrous oxide, Entonox is a gas available in the Birth Centre and Labour Ward which helps mothers cope with contractions. It takes the edge off the contractions.
What is the difference between an induction and an augment
An Induction starts the process of Labour. The augment is used when labour has started naturally but slowed. An augment may be nipple stimulation, breaking waters or a syntocinon drip
An epidural can not be given between 8-10cm. True or false
False. An epidural can be given at any stage of labour as long as:
1) the woman is able to sit still
2) Labour is not imminent
3) The woman has no medical contraindications like low platelets or previous back injury.
Which product is larger.
A) Forceps
B) Vacuum
A) Forceps.
When the Vacuum was first used it was large and clunky. Now the Vacuum is a small hand held device and the Forceps have been largely unchanged over the years
List four reasons a woman would have continuous fetal heart rate monitoring in labour.
Bleeding
Small growth
Previous abnormal FHR
Meconium Liqour
Syntocinon
Epidural
High Blood Pressure
Previous abnormal HR
Name two types of pain relief that can be used in the bath
Panadeine Forte and Temazepam
Enronox
Morphine with guidelines
What is the role of Cervidil, prostin and a cooks catheter.
List two positive effects of an epidural.
1) Pain relief to the region of the umbilicus and below. The perfect epidural is one that takes away pain but not the ability to move.
2) Lowers blood pressure
3) Safer pain relief option for Caesarian section
4) Can relax the pelvis and help the head descend.
There are many complicating factors that help a doctor decide to use either a Forceps or a Vacuum. Can you explain how the two are different or give an example of when one may be used over the other.
Forceps help by increasing the width of the pelvis and so are better to be used when the head needs to be rotated or if it is high. A Vacuum is quick and easy to use so is better if the baby has come down the pelvis well but delivery just needs to be expedited.
Why would we use a Fetal Scalp Electrode?
A Fetal Scalp Electrode is a FHR monitor placed onto a baby’s scalp to continuously monitor the fetal heart rate. This is used when we are unable to adequately hear the FHR via the abdominal transducer
Sterile water injections are offered in the BC and DW. What part of the body do they affect.
Sterile water injections are injected into the back near the rhomboid processes and help with back pain. While the injections themselves are said to be painful women experience such relief that they elect to have them repeatedly in labour.
Put in order the four different methods of induction.
Syntocinon, Cervidil, Breaking waters, Cooks
Cervidil
Cooks
LARM
Syntocinon
List four negatives of having an epidural.
1) It may not work or only give partial relief
2) Dural Tap and headache
3) Uncontrollable shaking
4) Lowers blood pressure reducing blood supply to the baby
5) Paralysis
6) Can slow down labour if given too early.
For FLO and VXT deliveries a woman must have her cervix fully open (ten cm’s) however a Caesarian can be performed at any dilatation. What is the other difference/factor in deciding between a Caesarian over the Forceps and Vacuum If the woman is ten cm’s
The descent of the fetal head. If the head is above the spines then it is safer to perform a Caesarian section. If the fetal head is below the spines then forceps and Vacuum are safer. Performing a Caesarian section when the fetal head is too far into the pelvis can cause cervical incompetence later on.
What is the purpose of monitoring a baby’s lactate levels in labour?
Lactate levels in a blood supply rise when someone is using anaerobic metabolism. This is a sign that the person or fetus is using up their energy supplies as they are not getting enough oxygen. This is the best indicator we have available to tell us when a baby needs help and it is time for birth.
What is the TENS machine and how does it work in labour.
Often used by physiotherapists to treat chronic pain a TENS machine works by interfering with pain receptors. A TENS machine can be hired for a five week period and for best results should be used from the time of your first contraction. Woman place the electrode pads on their lower back and when they feel a contraction starting they push the button to send impulses to the pads which interrupts the messages of pain sent to the brain from the contractions.
If a woman comes to RPAH at nine am to be induced with her first preganancy when is she most likely to deliver?
1) That evening after six
2) That night between ten pm and eight am
3) the next day by two pm
We find most women having their first child will deliver around lunch time the next day.
When you have an epidural you need to have four other interventions. Can you list three of them?
1) Repeated Blood Pressures
2) IV fluids
3) Urinary Catheter
4) CTG
How many people would typically be in the operating theatre if a woman was having an emergency Caesarian section
A) 5-6
B) 7- 9
C) 10-13
C)
Mum and Dad
Anaesthetics and technician
2 Scrub nurses
2 surgeons
1-2 Midwife
Paediatrician
Porter or Runner
Label the diagram provided. There are four labels required. Baby's heart rate, maternal contractions, Time, Intensity.
1) FHR
2) Maternal Contractions
3) Time (each box is a minute)
4) Intensity