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Normal and Abnormal Birth

ByDr Nur Azurah Abdul Ghani

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How do I know that I am in labour?

• Painful uterine contractions

• Show• Rupture of the

membrane• Shortening of the

cervix and dilatation of os

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Other signs and symptoms

• Reduced foetal movement

• Diarrhoea• Nausea/vomiting• ‘Nesting’ behaviour• Lightening

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Braxton-Hicks contractions are:

~ irregular contractions that are painless

~ occur throughout the pregnancy

Labour contractions are:

~ regular, start from the back

~ increase in frequency

~ increase in intensity

How do I know that it is not false labour?

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What do I need to bring?

• Patient’s clothing• Towel• Toiletries• Sanitary pads• Panties (disposable)

• Baby’s clothing• Diapers• Blankets• Cotton balls• Baby wipes• Towel for baby

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Stages of labour

• First stage~ latent phase~ active phase

• Second stage ~ pelvic phase (passive)~ perineal phase (active)

• Third stage

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First stage of labour(onset of labour till full dilatation of the os):

Longest phase of labour

i) Latent phase ~ from 0 till 3cm

~ primid – 8 hours

~ multip – 6 hours

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What will happen to me when I come to deliver?

• Patient will be assessed to determine the stage of labour

• If still latent phase, patient will be managed in the ward

• Nurse will check BP, PR, T, urine ketone• Encouraged to have food and drinks to

ensure hydration

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• Patient is encouraged to walk around• CTG is performed to assess the baby• Mother is reassessed every 4 hours• Once her os is already more than 3cm, her

membrane will be ruptured, and she will then be transferred to the labour ward

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First stage of labour(onset of labour till full dilatation of the os):

ii) Active phase ~ from 3cm till full dilatation

~ primid – 1cm/hr

~ multip – 1.5cm/hr

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What will happen to me in the labour ward?

• Will be given enema• NO MORE FOOD• Put on CTG monitoring• BP, PR, T and urine check• Husband will be allowed to

stay with the patient

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• Patient will be offered analgesia• Intraveneous fluid infusion• If poor contractions, pitocin

will be started• Patient will be reviewed regularly

by doctors and nurses

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Second stage of labour(full dilatation till delivery of baby):

Primid ~ 1 hour; Multip ~ 30mins

May be longer with the use of epidural

How will I know how to push?•Advise patient to remain calm and listen to instructions

•Help patient with breathing techniques in between contractions

•Teach patient proper techniques of pushing

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Perineum is guarded properly

Episiotomy is performed if required

Once the head is delivered, allow restitution then external rotation

Check for any cord around the neck

Apply gentle downward and upward traction to deliver the shoulder and whole body

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Third stage of labour(from delivery of baby till expulsion of placenta):

Usually 5-10 mins

Signs of separation:~ uterus contracted

~ gushing of blood

~ lengthening of cord

Active management:~ early clamping, give syntometrine/syntocinon, CCT

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What happens after delivery?

• Baby will be shown to the mother and will be allowed to be breastfed

• Episiotomy repaired• Check uterus for contractility• Observe for BP, PR and T (at least 1hr)• Check pad • Will be given food and drinks• Will be given analgesia• Baby will be weighed and measured

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Final result

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ABNORMAL BIRTH

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Abnormal Birth

• Induction of labour• Vaginal breech delivery• Instrumental delivery• Caesarean section

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What is induction of labour?• Labour is induced for either obstetric

reasons or maternal medical conditions• Methods used to promote labour• Two ways of inducing:

i) surgical – sweeping membrane amniotomy

ii) medical – Prostiniii) combination

INDUCTION OF LABOUR

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Common indications for induction of labour:

• Post-date• Pre-eclampsia• Gestational diabetes• Prelabour rupture of membrane• Intrauterine death• Intrauterine growth restriction

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Is it more painful than natural labour?

Actually, no

Is it safe?

Generally, yes. But associated with complications:

~ failed induction

~ foetal distress

~uterine rupture

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BREECH DELIVERYWhy is my baby in breech presentation?

Most of the time unknown.

Need to be assessed by doctor.

Could be due to prematurity, abnormal baby, oligo/ polyhydramios, placenta praevia, abnormal uterus, pelvic mass, contracted pelvis, abdominal laxity

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What are my options for the delivery?

After assessment by doctor, generally there are three options: assisted vaginal breech delivery, external cephalic version or elective Caesarean section.

Is assisted vaginal breech delivery safe?

If criteria is fulfilled, yes. However, associated with some complications such as femur fracture, hip dislocation, head entrapment, etc

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Breech DeliveryCriteria for assisted vaginal breech delivery:~ EBW 2.5-3.5kg

~ adequate pelvimetry

~ flexed neck

~ extended/flexed breech

~ no medical illness

~ positive attitude of couple

~ skilled staff

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Is it safe?

Yes. Prior to procedure, patient is kept NBM in case there is a need to do LSCS if complications arise. Complications: abruptio placenta, PROM, cord accident, foetal distress, uterine rupture, transplacental haemorrhage

What is ECV?

Baby is turned to cephalic position. Usually done after 37 weeks.

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External cephalic version

Contraindication for ECV:~ placenta praevia, pre-eclampsia, oligo/polyhydramios, previous LSCS or myomectomy, multiple gestation

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INSTRUMENTAL DELIVERYWhat is instrumental delivery?

When a doctor needs to use an additional instrument to help deliver the baby’s head (forceps or vacuum). Reasons for this: delayed second stage, foetal distress, to shortened second stage, aftercoming head

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INSTRUMENTAL DELIVERYIs it safe?

With correct application, yes. However, associated with maternal and foetal injury.

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CAESAREAN SECTIONCan I request LSCS?

Need to discuss with doctor. If no risk factor, best is to try vaginal delivery. LSCS is not without complications such as anaesthetic cx, surgical cx such as bleeding, injury to bladder and haemorrhage, infection and thromboembolism.

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When is LSCS indicated?Foetal distress, cord prolapse, obstructed labour, malposition, malpresentation, multiple pregnancy, placenta praevia, maternal illness eg pre-eclampsia, previous LSCS

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THANK YOU