1. CHILD BIRTH
EDUCATION CLASSES
Session 1

3. Overview Session 1
Anatomy & Physiology
Hormones
Blood Groups
What to Bring to hospital –for Mum & Bub
When to seek advice

4. BRIEF ANATOMY

5. ANATOMY
Uterus

6. Pelvis and pelvic floor
Pelvic structure
Pelvic Floor Exercises
The Perineum
Weakness of Abdominal Muscles
Posture & Back Care in Pregnancy
Exercising
Use of TENS in Labour

7. Pelvis

8. Pelvic Floor Muscles
Pelvic Floor Muscles

9. TENS MACHINE Transcutaneous electrical nerve stimulation.
A small machine attached to your clothes that gives out electrical pulses.
The electrical pulses prevent pain signals from reaching your brain, while stimulating endorphins.

10. HORMONES PROGESTERONE ENDORPHINS OESTROGEN vs PROSTAGLANDIN ADRENALINE
OXYTOCIN

11. Blood Groups
Why are these significant?
ABO grouping
Rh Neg/Pos

12. When to Seek Advice. -Waters broken. -Vaginal bleeding or spotting.
-Foetal movements decrease.
-Headaches, seeing spots or visual disturbances, facial swelling
-Sharp constant abdominal pain.
-Frequency and burning when urinating.
-Persistent vomiting/diarrhoea
-If concerned or unsure about what’s happening

13. What to bring to hospital?
Birth Suite
Comfortable night gown/T-shirt
Socks/slippers
Lip balm
Sipper bottle/sport drink
Snacks/Lollies
Music
Toiletries
Oil for massage
Essential oils
Camera
Massager
Ward
Personal toiletries
Comfy sleep wear and day clothes
Comfortable underwear, maternity bras and nursing pads
Maternity pads
Mater Booklet
Current Medications
List of allergies – reactions
Firm fitting bra (if not BF)

14. What to bring for baby ? For Baby Clothes Nappy wipes
Nappies supplied by Mater
Make sure the car capsule is fitted.
Formula if not breast feeding.
Socks/mittens

15. Overview of Labour WHAT IS LABOUR?:
The onset of regular (usually painful) contractions, increasing in frequency, length & strength, causing the baby’s head to descend and the cervix to thin and dilate.
STAGES OF LABOUR
First Stage
Second Stage
Third Stage

16. LABOUR Signs of early labour Lightening (from 36 weeks)
Loss of mucous plug or a ‘show’
Frequency of urine
Mild period type cramps in back & abdomen
Increased Braxton Hicks
Nesting
Diarrhoea
Some of these can last up to a couple of weeks.

17. CHILD BIRTH EDUCATION CLASSES Session 2

18. Overview Session 2 Stages of labour
Comfort Techniques for Pain relief (Self Help – Non Invasive)
Role of Partner/Support person
Positions of the baby
Birth Video: “Understanding Labour”

19. POSITIONING OF BABY: Anterior – baby’s back is facing your front.
Posterior – baby’s back is facing your back.
Breech – baby’s feet or buttocks are in the pelvis
Posterior

20. Progress of Labour Chart

21. STAGES OF LABOUR 1). Early, active, transitional 2). Pushing
3). Delivery of placenta
Cuddling of the baby & rest

22. STAGES OF LABOUR
First Stage – Effacement and dilation of cervix. Early Labour Dilation from 0-3cm Last 8-12hrs or more Contractions 30-45sec : 5-30mins rest Excited but try conserve energy

23. LABOURING Early labour: Have short rests, in a chair or lying down.
If your contractions start at night, try to stay in bed and relax.
Try oral pain relief

24. STAGES OF LABOUR
Active Labour Dilation from 3-8cm, Regular contractions are stronger lasting 60sec

25. LABOURING
Active Labour:
Keep ACTIVE

26. STAGES OF LABOUR
Transitional Labour Dilation from 8-10cm Contractions may be two minutes apart lasting from 60-90sec May feel emotionally overwhelmed

27. STAGES OF LABOUR
Second Stage 10cm fully dilated Contractions can now be five minutes apart lasting 45-90secs,

28. STAGES OF LABOUR
Third Stage
Birth of the Placenta

29. THIRD STAGE Oxytocin injection is given (with your consent)
You may look at the placenta if you wish – please arrange this with the midwife before the birth

30. Labour Example of baby descent of labour.
Animation of labour and birth

31. PAIN RELIEF (NON-INVASIVE):
Breathing and relaxation techniques
Massage
Endorphins
Cold – ice to suck and facial wipes.

32. PAIN RELIEF (NON-INVASIVE)
Positive thinking
Music
Aromatherapy
Heat (hot packs)
TENS
Water\Shower
Hypnotherapy

33. Labour Exercises For Home.

34. Exercises for Early Labour
Sitting on mats straight legs out in front, move toes up and down and around.
Feet in together relax thighs and bounce legs.
Drop your shoulders and stretch
Neck relaxer
Father can be a support if needed.

35. Labouring Simple breathing exercises
Think of the word relax. In “re” and
out “lax”.
In 2-3 and out

36. Labouring Exercises Pelvic circles, tilt and rock
What can the support person do to help?
Discuss

37. Active Labour Exercises

38. Labouring
Positions for Back Labour

39. Resting in Labour

40. Positions in 2nd stage Labour

41. Support person’s role Stay relaxed and calm! Know how to get here!
Take inventory of the room
Encourage relaxation between contractions
Relieve backache by applying firm pressure with the heel of your hand
Massage according to need
Support partner with showers or baths
Ice to suck

42. Assist with comfort Hot packs,
Encourage fluids / refreshments,
Encourage regular visits to toilet (bladder),
Make eye contact,
Communicate between contractions,
Relay midwives instructions,
Question if unsure

43. BIRTH VIDEO Video – “Stages of Labour” Art graphic images
Be prepared for real life images of a birth

44. CHILD BIRTH EDUCATION CLASSES Session 3

45. Overview Session 3
Induction of Labour
Assisted Births – Vacuum (Kiwi Cup)
Forceps
Caesarean Section

46. INDUCTION OF LABOUR: Most labour starts naturally between 37-40 weeks.
Hormones are released that cause:
- cervix to shorten & dilate
uterus to contract
waters to break.
Induction of labour occurs when labour is started artificially.

47. INDUCTION OF LABOUR Maternal health concerns, Fetal health concerns
Pregnancy has gone longer than 41 weeks (Overdue),
Waters have broken but contractions have not started,
Social reasons.

48. INDUCTION OF LABOUR: Making Your Choice Be fully informed - why?
- benefits vs risks,
- procedure involved.

49. THE BISHOP SCORE

50. INDUCTION/AUGMENTATION OF LABOUR:
HOW?
Prostaglandin gel/tape
Artificial rupture
of membranes (ARM)
Syntocinon infusion

51. PAIN RELIEF (MEDICAL OPTIONS):
Nitrous Oxide
Narcotic Injections –(Pethidine or Morphine)
Epidural

52. Pain Relief in Labour GAS
What is it? Nitrous Oxide and Oxygen, “Happy Gas”.
How does it work? Alters pain perception. Strength can be altered by changing the oxygen/nitrous oxide mix.
When can you have it? As soon as you want it, for as long as you want it
Not in 2nd Stage

53. Pain Relief in Labour Positives for the use of gas: easy
under your control
quick acting (10-15sec),
safe for baby,
flexible in strength,
move around,
non drowsy.

54. Pain Relief in Labour Negatives for gas:– mild effect,
Occasional light headed, nauseous,
dry mouth.

55. Pain Relief in Labour Pethidine/Morphine with Maxalon What is it?
Narcotic injection, (morphine family) and maxalon is an antiemetic or anti-nausea medication.
How does it work?
Blocks the pain receptors therefore relaxing the muscle. Injected into the muscle, mostly the thigh or buttock muscle.
It takes 10mins start to work, full effects felt in 30min and lasts 3-4 hours
When can you have it?
Anytime except may not be given within 2 hours of expected delivery

56. Pain Relief in Labour Positives for pethidine and morphine:
strong and works well,
relaxes you,
gives you a rest,
aids dilatation,
great for long labours.

57. Pain Relief in Labour Negatives for pethidine and morphine:
Drowsy and disorientated occasionally
sometimes you may have to lie down,
long acting,
Can cross the placenta
Occasional sleepy baby, with slight delay in breast feeding,
allergy,
light headed,
Vomit (always given with Maxalon)
Maximum of two doses

58. Pain Relief in Labour
Epidural
What is it?
Continuous infusion into the back of a regional anaesthetic.
How does it work?
Local anaesthetic in your lower back.
Hollow needle is guided between the small bones in your spine into the epidural space.
A fine tube, or catheter, is then passed through the needle. Once the tube is in place, the needle is removed. The tube is taped up your back and over your shoulder.

59. Pain Relief in Labour When can you have it? Ideally 4-7cm. Positives -
Very effective pain relief during childbirth.
Enables mother to rest during a long labour.
Long acting.
More emotionally positive birth experience if mother's simply cannot cope with the pain.
Doesn’t affect baby

60. INFORMED CONSENT

61. ASSISTED BIRTHS: VACUUM
A suction cap is applied to baby’s head and gentle traction applied during a contraction and while the mother is pushing

62. Vacuum or Forceps Birth
Need to be fully dilated (10cm).
REASONS:
Delayed second stage.
Maternal exhaustion.
Fetal or maternal distress.

63. PERINEUM
EPISIOTOMY (with anesthetic)
TEAR
Healing

64. CAESAREAN BIRTH: What is it?
Is a surgical procedure in which a bikini line incision is made in the abdomen to birth the baby.
Can occur at any time before or during labour.

65. CAESAREAN SECTION PREPARATION: Theatre attire Possible shave
TED stockings
You will be seen by
the Anaesthetist
prior to surgery

70. CAESAREAN SECTION
The Paediatrician checks baby with the support person and midwife in the holding bay.
Baby is dried and wrapped.
Baby returns to mother.
Once in recovery, “skin to skin”, possibly breast feed
Return to ward
Regular pain relief is given

71. CAESAREAN SECTION CONT’D:
TED STOCKINGS SCUDS
Catheter
Drip

72. CAESAREAN SECTION CONT’D:
DVD:
“Understanding Caesarean Section”
(Mary Pat’s birth story)

73. IMMEDIATE CARE FOLLOWING VIGINAL BIRTH
MUM
Maternal Observations
Check bleeding –
should be like a heavy period.
Nourishment –
if you feel like it
Up to shower
Transfer back to your room

74. IMMEDIATE CARE FOLLOWING BIRTH:
BABY
Immediate skin to skin
First breastfeed.
Observations.
Weight.
Head Circumference.
Length.
Konakion (Vitamin K)
Hepatitis B vacc (consent)

75. GENERAL ROUTINES BABY:
We support rooming-in and have a philosophy of family centred care.
Fathers are welcome to be involved in the baby’s care
The paediatrician will visit during the stay.
Baby’s intake and output will be monitored

76. GENERAL ROUTINES: MOTHER: Daily observations
Assistance with breastfeeding.
Support with caring for baby
Emotional Support
Postnatal education.

77. EVALUATION
Thank you for attending Labour and Birth Sessions Please complete our evaluation form.

78. CHILD BIRTH EDUCATION CLASSES
Session 4

80. FIRST BREASTFEED:
The timing of the first feed and skin to skin contact is important.
Babies natural reflexes and senses (sight, smell, touch, taste, hearing) are heightened immediately after the birth.
Permit uninterrupted skin to skin for the first few hours if possible

81. BREASTFEEDING
If possible the first feed should be within 1 hour of birth. This will mean the following feeds are easier.

82. Sensitive Period
Don’t use oral suction routinely- physical damage and oral aversion
Don’t dry baby's hands-permits transfer of amniotic fluid to breasts-liquor smells similar to breast milk- aids latching
Imprinting time- when they instinctively teach themselves to latch

83. Sequence of Events Crying phase: at birth
Relaxing phase: skin-skin causes oxytocin surges in the mother > chest temperature rises, nipples become erect and anxiety decreases
Awakening phase: stirring, opening eyes
Active phase: limb movements, looking at mother’s face, rooting ( tongue is placed on the floor of the mouth during rooting)

84. Quiet Alert Stage
The best time to initiate breastfeeding- last up to 2 hours then baby may sleep for as long as 24hrs
Ensure baby is well supported on the mother’s chest in the prone position
Avoid contact with family members and midwives > optimal colonization of the baby’s gut by maternal flora
Skin to skin may be provided by the father if the mother is not available

85. Skin to skin

86. LET DOWN REFLEX
When the baby sucks the let down reflex is initiated due to the hormone oxytocin. Oxytocin may also cause after pains.

87. BREASTFEEDING. Supply equals demand.
(What is removed is replaced and what is left provides a feed back mechanism to ensure excess milk does not continue to be produced).

88. HOW IMPORTANT IS HUMAN MILK?
Provides all the nutrients a baby needs for the first six months of life.
Milk components change according to age of the baby ensuring your baby gets what he needs.
Contains antibodies to fight bacterial & viral infections

89. BABY’S BENEFITS - Decreases the risk of allergy & asthma.
Protects your baby from common illnesses such as diarrhoea & ear infections.
Studies found that breast fed babies have a reduced risk of SIDS.

90. MOTHER’S BENEFITS
Helps the uterus return to its pre-pregnant state & aids weight loss
Delays the return of menstruation (NOT a reliable contraceptive method)

91. COMMUNITY BENEFITS Breastfeeding saves food resources, fuel & energy
Breastfeeding is convenient & free
Breastfeeding is environmentally friendly (no long term waste or chemicals) 91

92. Baby led Attachment
Innate- normally happens within the first hour when skin-skin is provided
Self attachment reflexes last beyond the newborn period- use skin-skin for all attachment problems
Semi-reclined )biological nurturing) position is best
Baby between breasts- support but don’t interfere

93. The Latch
Crawling phase: sounds may be emitted; pushing with feet on fundus (stimulates oxytocin)
Familiarisation phase: drooling, sucking on fingers, rubbing nipple with wet fingers, licking with tongue, head bobbing until nipple is located
Suckling phase
Sleeping phase

94. LATCHING The tongue is down and forward Wide Special K gape
Bigger bite at the bottom

95. WHAT TO LOOK FOR When your baby is attached correctly:
It shouldn’t hurt - there may be a stretching sensation for a minute or two
The baby’s mouth takes most of the lower areola in an asymmetrical latch
The baby’s chin is in against the breast; the nose is free; and the baby’s body is wrapped closely around yours

96. ASYMMETRICAL LATCH

97. Attachment Keys
Position - Straight back - Stool - comfort and hydration Baby - chest on chest - nose to nipple - head alignment - Big wide open mouth Aids – Pillows

98. POSITIONING & ATTACHMENT:
When your baby is attached correctly:
It shouldn’t hurt. There is a stretching sensation but not pain.
The baby’s mouth takes most of the areola.
The baby’s chin is well in against the breast, & the baby’s chest is against your chest.

99. GOOD ATTACHMENT Swallowing can be heard periodically
Rhythmic, pain free sucking - stops and starts
Cheeks are rounded – not drawn in
No clicking sounds heard
The areola moves inward with sucking
Baby’s nose is free and the head is tipped slightly back
Movement seen in front of baby’s
ear near the temporal area

100. LAST LOOK AT THE LATCH

101. FEEDING CUES Early cues: Stirring, mouth open
Eye movement under closed eyelids
Fingers around mouth and face
Turning head and searching from side to side
Mid cues:
Sucking on fists and bedclothes
Increased movement
Increased alertness
Making noises

103. HOW LONG DO I BREASTFEED FOR?
Days 1-3
Demand feeding. Can be 8-12 times during a 24 hour period.
Both breasts should be offered each feed, the first breast drained before offering the second.
As breastfeeding establishes itself through supply & demand, the amount of time at the breast shortens.
The WHO recommends exclusive breastfeeding for 6 months and to feed for up to 4 years.

104. GENERAL INFORMATION: FIRST 24 HOURS
Most babies will only receive 5 -20mls colostrum during 24 hours.
Baby has brown fat to break down, extra sodium in colostrum to slow down sweating & urinary output, & often has a stomach full of nutrient-rich liquor to live off for a few days.

105. GENERAL INFORMATION SECOND 24 HOURS – 30mls colostrum.
DAY 3-4 –milk supply is established.
Lifestlyle adjustments may need to be made as babies often feed frequently in the evening

106. Bathing
Delay bathing for at least 24 hours – it retains amniotic fluid odours + as the maternal flora is the main source of bacteria for colonizing the newborn’s gut it is important not to remove this by batching the baby
Prevent thermal loss. Mother’s breasts heat up as required to maintain baby’s temperature
Don’t remove vernix

107. MASTITIS

108. CONDITIONS THAT MAY COMPLICATE BREASTFEEDING
Blocked Ducts Tender swollen ducts may be felt. Usually this will resolve after feeding the baby and/ or massaging and expressing the milk. Mastitis: A breast infection that causes flu like symptoms. The breast will be tender and inflamed and sometimes swollen ducts can be seen Usually it will require antibiotics, but breastfeeding should continue.

109. INVERTED NIPPLE

110. Food for Thought
If normal healthy newborn has not latched or nursed effectively after the first 24hours, stimulation of the breasts and milk removal is crucial to establishing a milk supply
For the mother of a preterm infant, stimulation of the milk production should begin within 6 hours or sooner ( Davis, 2013)

112. NEONATAL SCREENING TEST:
The neonatal screening test is performed by taking blood from the baby’s heel when the baby is at least 48 hours old.
In most cases the test results are normal. Parents are NOT notified of normal test results.
Your Paediatrician will be told of this normal result, which can take up to 6 weeks

113. Immunisations
Baby immunisation involves a series of vaccines that build antibodies against the injected vaccines.
Many infectious diseases have been mostly eradicated in Australia because of national programs of immunisation.

114. POSTNATAL ISSUES & CARE:
EXPECTED LENGTH OF STAY:
Vaginal Birth – 3 days.
Caesarian Section – 4 days.
If there is a variance with your care, ie. Breastfeeding or postnatal complications added length of stay may be necessary.
Usual check-out time on day of discharge is 10am

115. POSTNATAL DEPRESSION (PND):
Up to 80% of women may develop the ‘baby blues’.
Baby Blues last from an hour to 2 days.
PND affects at least 10% of mothers.
Onset can be any time in the first year after birth.
Isolation from social networks & changes in life events are strongly linked to PND.
Other factors : loss of control when usually competent and lack of confidence.

116. PND CONT’D: Signs & Symptoms - Excessive tiredness & Insomnia
- Anxiety or depressed mood,
Tearfy or irritable for no apparent reason
Poor appetite/overeating,
Fear of being alone,
Fear of social contact,

117. PND CONT’D: Obsessive thoughts or activities,
Exaggerated fears about health & safety of self, baby or partner.
Suicidal thoughts, plans or actions.
Remember that it is normal for all mothers to experience times of emotional & physical exhaustion. If your depression or anxiety lasts more than 2 weeks, do not hesitate to seek help.

118. WHAT SHOULD I DO IF I HAVE PND?
Talk to your partner or trusted family/friend.
Seek Help.
Discussing your feelings with your Midwife or your Doctor.
Professional counsellor
PANDA (Post and Ante Natal Depression Association),

119. WHAT HELP WILL I GET? Counseling, Group support,
Help with baby’s needs,
Appropriate medication if needed.
Edinburgh Postnatal Depression Scale

120. COMMUNITY SUPPORT: Postnatal Clinic - 47228866
Community Health – Child Health
Obstetrician and Paediatrician
Centacare - 
Beyond Blue
Lifeline –
Family doctor
Australian Breastfeeding Association
If unsure phone Mater Health Service. We give advice on where to go for assistance

121. SIDS
Sudden Infant Death Syndrome

122. SAFETY & PRACTICALITIES
CAR:
Car seat to Australian Safety Standard
Seat fitted properly with no movement in it
Child is properly harness & blankets over straps
Seat is suitable for child’s weight & height
NEVER leave children unattended in cars
Ambulance Service authorised to check fitting Need to make an appointment.

123. We look forward to seeing you at Mater health Services north Queensland