9TENS 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.
10HORMONES PROGESTERONE ENDORPHINS OESTROGEN vs PROSTAGLANDIN ADRENALINE OXYTOCIN
11Blood GroupsWhy are these significant?ABO groupingRh Neg/Pos
12When 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
13What to bring to hospital? Birth SuiteComfortable night gown/T-shirtSocks/slippersLip balmSipper bottle/sport drinkSnacks/LolliesMusicToiletriesOil for massageEssential oilsCameraMassagerWardPersonal toiletriesComfy sleep wear and day clothesComfortable underwear, maternity bras and nursing padsMaternity padsMater BookletCurrent MedicationsList of allergies – reactionsFirm fitting bra (if not BF)
14What to bring for baby ? For Baby Clothes Nappy wipes Nappies supplied by MaterMake sure the car capsule is fitted.Formula if not breast feeding.Socks/mittens
15Overview 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 LABOURFirst StageSecond StageThird Stage
16LABOUR Signs of early labour Lightening (from 36 weeks) Loss of mucous plug or a ‘show’Frequency of urineMild period type cramps in back & abdomenIncreased Braxton HicksNestingDiarrhoeaSome of these can last up to a couple of weeks.
34Exercises 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 stretchNeck relaxerFather can be a support if needed.
35Labouring Simple breathing exercises Think of the word relax. In “re” andout “lax”.In 2-3 and out
36Labouring Exercises Pelvic circles, tilt and rock What can the support person do to help?Discuss
41Support person’s role Stay relaxed and calm! Know how to get here! Take inventory of the roomEncourage relaxation between contractionsRelieve backache by applying firm pressure with the heel of your handMassage according to needSupport partner with showers or bathsIce to suck
42Assist 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
43BIRTH VIDEO Video – “Stages of Labour” Art graphic images Be prepared for real life images of a birth
46INDUCTION OF LABOUR: Most labour starts naturally between 37-40 weeks. Hormones are released that cause:- cervix to shorten & dilateuterus to contractwaters to break.Induction of labour occurs when labour is started artificially.
47INDUCTION 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.
48INDUCTION OF LABOUR: Making Your Choice Be fully informed - why? - benefits vs risks,- procedure involved.
50INDUCTION/AUGMENTATION OF LABOUR: HOW?Prostaglandin gel/tapeArtificial ruptureof membranes (ARM)Syntocinon infusion
51PAIN RELIEF (MEDICAL OPTIONS): Nitrous OxideNarcotic Injections –(Pethidine or Morphine)Epidural
52Pain 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 itNot in 2nd Stage
53Pain Relief in Labour Positives for the use of gas: easy under your controlquick acting (10-15sec),safe for baby,flexible in strength,move around,non drowsy.
54Pain Relief in Labour Negatives for gas:– mild effect, Occasional light headed, nauseous,dry mouth.
55Pain 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 hoursWhen can you have it?Anytime except may not be given within 2 hours of expected delivery
56Pain Relief in Labour Positives for pethidine and morphine: strong and works well,relaxes you,gives you a rest,aids dilatation,great for long labours.
57Pain Relief in Labour Negatives for pethidine and morphine: Drowsy and disorientated occasionallysometimes you may have to lie down,long acting,Can cross the placentaOccasional sleepy baby, with slight delay in breast feeding,allergy,light headed,Vomit (always given with Maxalon)Maximum of two doses
58Pain Relief in LabourEpiduralWhat 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.
59Pain 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
70CAESAREAN SECTIONThe 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 feedReturn to wardRegular pain relief is given
73IMMEDIATE CARE FOLLOWING VIGINAL BIRTH MUMMaternal ObservationsCheck bleeding –should be like a heavy period.Nourishment –if you feel like itUp to showerTransfer back to your room
74IMMEDIATE CARE FOLLOWING BIRTH: BABYImmediate skin to skinFirst breastfeed.Observations.Weight.Head Circumference.Length.Konakion (Vitamin K)Hepatitis B vacc (consent)
75GENERAL ROUTINES BABY: We support rooming-in and have a philosophy of family centred care.Fathers are welcome to be involved in the baby’s careThe paediatrician will visit during the stay.Baby’s intake and output will be monitored
76GENERAL ROUTINES: MOTHER: Daily observations Assistance with breastfeeding.Support with caring for babyEmotional SupportPostnatal education.
77EVALUATIONThank you for attending Labour and Birth Sessions Please complete our evaluation form.
80FIRST 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
81BREASTFEEDINGIf possible the first feed should be within 1 hour of birth. This will mean the following feeds are easier.
82Sensitive PeriodDon’t use oral suction routinely- physical damage and oral aversionDon’t dry baby's hands-permits transfer of amniotic fluid to breasts-liquor smells similar to breast milk- aids latchingImprinting time- when they instinctively teach themselves to latch
83Sequence of Events Crying phase: at birth Relaxing phase: skin-skin causes oxytocin surges in the mother > chest temperature rises, nipples become erect and anxiety decreasesAwakening phase: stirring, opening eyesActive phase: limb movements, looking at mother’s face, rooting ( tongue is placed on the floor of the mouth during rooting)
84Quiet Alert StageThe best time to initiate breastfeeding- last up to 2 hours then baby may sleep for as long as 24hrsEnsure baby is well supported on the mother’s chest in the prone positionAvoid contact with family members and midwives > optimal colonization of the baby’s gut by maternal floraSkin to skin may be provided by the father if the mother is not available
86LET DOWN REFLEXWhen the baby sucks the let down reflex is initiated due to the hormone oxytocin. Oxytocin may also cause after pains.
87BREASTFEEDING. 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).
88HOW 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
89BABY’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.
90MOTHER’S BENEFITSHelps the uterus return to its pre-pregnant state & aids weight lossDelays the return of menstruation (NOT a reliable contraceptive method)
91COMMUNITY BENEFITS Breastfeeding saves food resources, fuel & energy Breastfeeding is convenient & freeBreastfeeding is environmentally friendly (no long term waste or chemicals)91
92Baby led AttachmentInnate- normally happens within the first hour when skin-skin is providedSelf attachment reflexes last beyond the newborn period- use skin-skin for all attachment problemsSemi-reclined )biological nurturing) position is bestBaby between breasts- support but don’t interfere
93The LatchCrawling 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 locatedSuckling phaseSleeping phase
94LATCHING The tongue is down and forward Wide Special K gape Bigger bite at the bottom
95WHAT TO LOOK FOR When your baby is attached correctly: It shouldn’t hurt - there may be a stretching sensation for a minute or twoThe baby’s mouth takes most of the lower areola in an asymmetrical latchThe baby’s chin is in against the breast; the nose is free; and the baby’s body is wrapped closely around yours
97Attachment KeysPosition - Straight back - Stool - comfort and hydration Baby - chest on chest - nose to nipple - head alignment - Big wide open mouth Aids – Pillows
98POSITIONING & 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.
99GOOD ATTACHMENT Swallowing can be heard periodically Rhythmic, pain free sucking - stops and startsCheeks are rounded – not drawn inNo clicking sounds heardThe areola moves inward with suckingBaby’s nose is free and the head is tipped slightly backMovement seen in front of baby’sear near the temporal area
101FEEDING CUES Early cues: Stirring, mouth open Eye movement under closed eyelidsFingers around mouth and faceTurning head and searching from side to sideMid cues:Sucking on fists and bedclothesIncreased movementIncreased alertnessMaking noises
103HOW LONG DO I BREASTFEED FOR? Days 1-3Demand 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.
104GENERAL 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.
105GENERAL 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
106BathingDelay 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 babyPrevent thermal loss. Mother’s breasts heat up as required to maintain baby’s temperatureDon’t remove vernix
108CONDITIONS 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.
110Food for ThoughtIf 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 supplyFor the mother of a preterm infant, stimulation of the milk production should begin within 6 hours or sooner ( Davis, 2013)
112NEONATAL 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
113ImmunisationsBaby 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.
114POSTNATAL 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
115POSTNATAL 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.
116PND CONT’D: Signs & Symptoms - Excessive tiredness & Insomnia - Anxiety or depressed mood,Tearfy or irritable for no apparent reasonPoor appetite/overeating,Fear of being alone,Fear of social contact,
117PND 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.
118WHAT 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 counsellorPANDA (Post and Ante Natal Depression Association),
119WHAT HELP WILL I GET? Counseling, Group support, Help with baby’s needs,Appropriate medication if needed.Edinburgh Postnatal Depression Scale
120COMMUNITY SUPPORT: Postnatal Clinic - 47228866 Community Health – Child HealthObstetrician and PaediatricianCentacare - Beyond BlueLifeline –Family doctorAustralian Breastfeeding AssociationIf unsure phone Mater Health Service. We give advice on where to go for assistance
122SAFETY & PRACTICALITIES CAR:Car seat to Australian Safety StandardSeat fitted properly with no movement in itChild is properly harness & blankets over strapsSeat is suitable for child’s weight & heightNEVER leave children unattended in carsAmbulance Service authorised to check fitting Need to make an appointment.
123We look forward to seeing you at Mater health Services north Queensland