nursing symposium may 10,2010

1. PREPARATION FOR LABOURby MONIA ZITOUNI ABDI SENIOR STAFF MIDWIFELABOUR & DELIVERY

3. IT INVOLVES MORE THAN EXPULSIVE MUSCULAR EFFORT OF THE UTERUS.

5. 3.THE TIME DOES NOT EXCEED 24 HOURS 4.NO COMPLICATIONS SHOULD ARISE 5.DIFFICULT OR ABNORMAL LABOUR IS KNOWN AS DYSTOCIA.

6. Causes Of The Onset Of Labour THE ONSET OF LABOUR APPEARS TO BE THE RESULT OF A COMBINATION OF FACTORS : HORMONAL, NERVOUS AND CIRCULATORY. HORMONAL: OXYTOCIN FROM THE POSTERIOR PITUITARY GLAND PLACENTA HAS STIMULATING ACTION ON THE PREGNANT UTERUS WHICH HAS BEEN SENSITIZED BY SOME HORMONAL FACTORS.

7. 2. INCREASED CONTRACTILITY AS PREGNANCY ADVANCES . 3. THE PRESSURE OF THE PRENSENTING PART ON THE NERVE ENDINGS IN THE CERVIX STIMULATES THE CERVICAL GANGLION AND THE WOMAN EXPERIENCES A SHOW LABOUR IS MORE LIKELY TO START ON TIME WHEN THE HEAD IS ENGAGED THAN WHEN IT IS HIGH.

8. THE PREMONITORY SIGNS OF LABOUR DURING THE 3 WEEKS PRIOR TO THE ONSET OF LABOR, CERTAIN CHANGES TAKES PLACE, WHICH ARE USEFUL TO DETERMINE THE APPROACH OF LABOUR: 1. LIGHTENING 2. FREQUENCY OF MICTURATION 3. FALSE PAINS 4. SLIGHT TAKING UP OF THE CERVIX

11. Signs of True Labour: Painful rhythmic uterine contractions. These are now felt by the woman as tightening, discomfort or actual pain. During contraction the uterus feel hard to the touch, slight back pain may also be present. Dilatation of the cervical os. Show – is a blood stained mucoid discharge seen few hours before or within the labor period, the mucous is the thick substance which formed the cervical plug during pregnancy.

12. Stages of Labour First Stage of Labour– the latent phase is prior to the active one, and it may last 6-8 hrs in primi. When the cervix dilates from 0 to 3-4cm and the cervical canal shorten from 3cm long to 0.5cm. The active first stage of labor is the time when the cervix undergo more rapid dilation from 3-4 cm and in the presence of rhythmic contractions is completed when the cervix is fully dilated.

13. 2. Second stage of labour- the second stage is that of expulsion of the fetus it begins when the cervix is fully dilated and the woman feels the urge to expel the baby it is completed when the baby is born.

14. 3. Third stage of labour– is that of separation and expulsion of placenta and membranes, it also involves the control of bleeding.

16. If a multi gravida woman goes into labor during the evening, being busy all day with house hold chores and children she is tired and should be advised to lie down and sleep if she can while there is reasonable interval between contractions.The up

17. The up-right position: There is an advantage in the assumption of the up right position as the fetus sinks into the lower pole of the uterus, and by pressing on the cervical nerve endings stimulates good uterine action. It also facilitates dilatation of the os.

18. In the erect position the anteroposterior diameter of the pelvic brim is enlarged because of certain degree of movement s which takes place at the sacroilliac joints RECUMBENT POSITION – When the intensity of the contraction is higher. The woman should be in the bed so than she relaxes and conserves her energy and analgesics can be given to her to relieve the pain.

19. DIET DURING LABOUR. THIS SUBJECT PRESENTS GREAT DIFFICULTIES, BOTH THE NUTRITIONAL REQUIREMENT OF THE WOMAN IN LABOUR AND THE GRAVE RISK OF ANAETHESIA MUST BE GIVEN DUE CONCIDERATION. THE MODERN TENDENCY IS TO WITHOLD FOOD WHEN LABOUR IS ESTABLISHED AND TO GIVE IVFLUID INSTEAD. DURING EARLY LABOUR, SMALL LIGHT MEALS SHOULD BE GIVEN SUCH AS TEA, BREAD TOAST, FRUIT JELLY, SOUP, ICE CREAM…..

20. PAIN RELIEF IN LABOUR DEFINITION: PAIN IS SAID TO BE A FEELING OF DISTRESS CAUSED BY STIMULATION OF NERVE ENDINGS . PAIN IS A COMPLEX PERSONAL, SUBJECTIVE, MULTIFACTORIAL PHENOMENON WICH IS INFLUENCED BY PSYCHOLOGICAL, BIOLOGICAL, SOCIOCULTURAL AND ECONOMIC FACTORS.

22. TOLERANCE OF PAIN .

23. COPING WITH PAIN.

24. EXPERIENCE OF PAIN : (SILENT OR SHOUTING)

26. THE ENTONOX TAKES EFFECT WITHIN 20 SECONDS . SO ITS IMPORTANT THAT THE WOMAN USES IT AT THE HEIGHT OF THECONTRACTION. THIS METHOD OF PAIN RELIEF IS SIMPLE, USEFUL AND THE PATIENT IS ABLE TO ADMINISTER IT HERSELF.

27. REGIONAL ANALGESIA –EPIDURAL MORE WOMEN ARE NOW REQUESTING A PAIN FREE LABOUR AND ASK FOR EPIDURAL (ibratadhaher) AS SOON AS THE LABOUR IS ESTABLISHED WHEN ADVICING A WOMAN ABOUT ADVANTAGES AND DISADVANTAGES OF EPIDURAL ANALGESIA IT IS IMPORTANT TO USE LOCAL EVIDENCE ABOUT AVAILABILITY AND THE PROCEDURE USED THAT WOMAN CAN MAKE REALISTIC CHOICE FOR HER LABOUR

28. THE WOMAN (AND THE HUSBAND IF AROUND) MUST BE GIVEN A CLEAR EXPLANATION ABOUT THE PROCEDURE AND SECURE HER CONSENT ON THE EPIDURAL ANESTHESIA FORM BLOOD RESULTS FOR CBC, APTT, PT SHOULD BE READY START IV RINGERS/LACTATE AT LEAST ONE UNIT PREPARE THE EPIDURAL TROLEY AND DRUGS AND ALL NECESSARY DOCUMENTS.

29. EPIDURAL ANALGESIA ADVANTAGES: DISADVANTAGES: EFFECTIVE PAIN RELEIF TENDENCY TO LOWER BLOOD PRESSURE USED IN CASES OF PIH DOES NOT DEPRESS RESPIRATORY CENTER OF THE FETUS IF LABOUR IS PROLONGED IT ALLOWS PATIENT TO REST INEFFECTIVE BLOCK MORE FREQUENT MONITORING OF VITAL SIGNES LENGTHENS FIRST STAGE OF LABOUR LESS SENSATION OF EXPULSIVE EFFORTS AND LENGTHENS SECOND STAGE OF LABOUR INCREASES INSTRUMENTAL DELIVERIES

30. EMOTIONAL SUPPORT THIS TERM IS USED TO EMBRACE THE CONCEPT OF MEETING THE EMOTIONAL NEEDS OF THE WOMAN IN LABOUR AS A FEELING, SUFFERING AND PROBABLY APPREHENSIVE BUILDING UP THE WOMANs CONFIDENCE. NOT ONLY MUST THE MIDWIFE GIVE EMOTIONAL SUPPORT, SHE MUST ALL TIMES DEMONSTRATE THIS BY HER WORDS AND HER ACTIONS.

31. ISOLATED FROM HER LOVED ONES, - THE COMFORTING COMPANIONSHIP OF THE MIDWIFE WHO WILL LISTEN, EXPLAIN, ENCOURAGE AND ASSURE THE WOMAN OR KEEP SILENT AS REQUIRED IS OF GREAT VALUE TO THE WOMAN AT THIS TIME TO ADVOCATE COMMUNICATION FOR THE PEACE OF MIND OF MOST WOMEN IT IS ESSENTIAL THAT THEY ARE KEPT INFORMED REGARDING THE PROGRESS THEY ARE MAKING.

32. THE WOMAN RESPONSE S MAGNIFICENTLY TO A WORD OF A PRAISE, EXPLANATION AND REASON (EXAMPLE: PRIOR TO V/E) THE WOMAN IS TOLD WHY THIS IS BEING DONE, THAT THE WOMAN WILL RELAX. THE FINDINGS WILL BE ACCURATE AFTERWARDS SHE IS ASSURED THAT ALL IS WELL AND SHE IS DOING FINE. A WOMAN WHO SCREAMS IN LABOUR DO SO FROM FEAR THAN FROM PAIN. THE MW SHOULD COMMUNICATE CONFIDENCE BY HER CALM, COMPETENT BEARING AND KINDLY ACTIONS, TELLING THE WOMAN NOT TO BE FRIGHTENED AND NOT TO WORRY.

35. Slippers Night gown (one that opens in front if planning for breastfeeding) Nursing bra Clothing for the trip home after delivery Baby’s bag(newborn clothes, blanket, diaper, gentle baby wipes, baby shampoo, lotion, oil, soap. Mittens , (most babies are born with long finger nails and can scratch their faces just to protect them)

36. THANK YOU