CHILD BIRTH EDUCATION CLASSES Session 1

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

BRIEF ANATOMY

ANATOMY Uterus

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

Pelvis

Pelvic Floor Muscles Pelvic Floor Muscles

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.

HORMONES PROGESTERONE ENDORPHINS OESTROGEN vs PROSTAGLANDIN ADRENALINE OXYTOCIN

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

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

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)

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

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

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.

CHILD BIRTH EDUCATION CLASSES Session 2

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”

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

Progress of Labour Chart

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

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

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

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

LABOURING Active Labour: Keep ACTIVE

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

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

STAGES OF LABOUR Third Stage Birth of the Placenta

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

Labour Example of baby descent of labour. Animation of labour and birth www.youtube.com/watch?v=B84MewU8h7Y

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

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

Labour Exercises For Home.

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.

Labouring Simple breathing exercises Think of the word relax. In “re” and out “lax”. In 2-3 and out 2-3-4.

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

Active Labour Exercises

Labouring Positions for Back Labour

Resting in Labour

Positions in 2nd stage Labour

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

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

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

CHILD BIRTH EDUCATION CLASSES Session 3

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

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.

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.

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

THE BISHOP SCORE

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

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

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

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.

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

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

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.

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

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.

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

INFORMED CONSENT https://www.matertsv.org.au/assets/files/Maternity%20Services%20Book%202014(1).pdf

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

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

PERINEUM EPISIOTOMY (with anesthetic) TEAR Healing

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.

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

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

CAESAREAN SECTION CONT’D: TED STOCKINGS SCUDS Catheter Drip

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

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

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

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

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

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

CHILD BIRTH EDUCATION CLASSES Session 4

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

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

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

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)

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

Skin to skin

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

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).

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

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.

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)

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

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

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

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

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

ASYMMETRICAL LATCH

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

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.

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

LAST LOOK AT THE LATCH

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

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.

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.

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

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

MASTITIS

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.

INVERTED NIPPLE

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)

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

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.

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

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.

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,

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.

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),

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

COMMUNITY SUPPORT: Postnatal Clinic - 47228866 Community Health – Child Health 47999000 Obstetrician and Paediatrician Centacare - 4772 9000 Beyond Blue- 1300 22 4636 Lifeline – 131114 Family doctor Australian Breastfeeding Association If unsure phone Mater Health Service. We give advice on where to go for assistance

SIDS Sudden Infant Death Syndrome

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.

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