194 HAPTER 12 What happens during stage 2 of labor Help the mother have a safe birth Watch for warning signs Watch for signs that stage 2 is near or starting Help the mother give birth Baby is breech ID: 147531
Download Pdf The PPT/PDF document "In this chapter:Pushing: stage 2 of labo..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
194 HAPTER 12 In this chapter:Pushing: stage 2 of labor What happens during stage 2 of labor Help the mother have a safe birth Watch for warning signs Watch for signs that stage 2 is near or starting Help the mother give birth Baby is breech............................................................................................................... Delivering twins............................................................................................................ Baby is very small or more than 5 weeks early 195 ƒ \b† \b ‚ Watch for signs that stage 2 is near or starting‚ \b† ‡ \b \b \b† † ˆ ‰ † \b \b \b ‚ † \t †\bƒ \b †‚ †ƒ ‚ ƒ I have to push! I have to push! 196 Pushing too early‚ \b† ƒ \b \b \b \b† \b Œ \b \b† ‡ Ž \b† ƒ \b Œ ‚ †ƒ \b ‚ \b†ƒ ‘\b ‡ \b† \b ƒ \b† \b \t \b† ƒ \b What happens during stage 2 of labor… ƒ ƒ \b \b \b ˆ \b \b ƒ †Ž\b \b \b \b ˆ \b \b ƒ † \b \b \b ‹ ƒ \b \b \b \b ‡ \b ‰ ƒ ƒ \b \b Genitals bulge during contractions. Genitals relax between contractions. During a contraction, the baby’s head shows. Between contractions, the baby’s head the vagina. A little more of the baby’s head shows with each contraction. The head slips back before. Each contraction brings the baby closer to birth. What happens during stage 2 of labor \t \b ’ ƒ “ \b \b ‡ \b \b ”\b ƒ \f How the baby moves through the vaginaˆ \b ‡ \b ƒ \b crowns, the vaginal opening is a bit larger hand. First the baby tucks his head down, chin to chest. This makes it easier for the head to t through the mother’s pelvis. The baby’s head is squeezed and through the mother’s pelvis. The baby turns his face toward the mother’s back. The baby begins to lift his vaginal opening. This is called extension. This is what happens This is what you see The baby lifts his chin more his head crowns 198 The baby continues lifting his chin until his head is born. At rst, the baby’s face is still toward the mother’s back, while his shoulders are turned at an angle. Soon the baby’s head turns toward the mother’s . Now the baby’s face is lined up with his shoulders. Then the baby’s whole body . The baby’s shoulders are now straight up and down. The baby faces the mother’s leg. The rest of the baby slips out easily. shoulders shoulders shoulders Note: ˆ ‘•ƒ \b ˆ \b \b ƒ \bƒ \t\b \b \b The baby continues to lift his head comes outThis way the head is born smoothly. 199 Help the mother have a safe birth Help the mother have a safe birthCheck the mother’s and baby’s physical signsThe mother’s physical signs \b ‘\bƒ \b ƒ \t \b ‚ \f– ‘\b \f„ ‚ \f ƒ \f„ ‚ \f \b \b ƒ \f ƒ \b \f\n ƒ \f„ The baby’s physical signs‡ \b ‹ †\b — \b \b ˜ \b ƒ \b ‚ ”™ \n \b \b ˆ \b \b \b \b ‚ \b \b \fƒ \f ƒ ‹ \b † ƒ \b\b ‚ ƒ \b \b š ƒ \f\n • ‚ ƒ \f\n 200 Support the mother’s pushing\t \b† ƒ \b †\b ‡ ƒ ›Œœ Œœž ˆ \b ‡ ƒ \b ƒ • Let the mother choose the position that feels good to her Note: ‚ Ÿ \b ¡ Ÿ \b —’ ƒ \b ˆ \b ƒ ”™ \b or birth chair Hands-and-knees Squatting or sitting on a pillow StandingLying on the side This position may be the most comfortable, and makes it easier for the midwife to guide the birth of the baby’s head. These 3 positions can help bring the baby down when the birth is slow. This position is relaxing and helps prevent tears in the vagina. This position is good when the woman feels her labor in her back. It can also help when the baby’s shoulders 201 Help the mother have a safe birth Pant pushing: ‡ ƒ \b \b \b … \b ƒ † ƒ \b \bƒ ‡ Œ Ž\b † \b ‘‘ Hold-the-breath pushing: ‡ ƒ \b ƒ \b \b ƒ \b \b \b ‡ \b Moan or growl pushing:‡ ‡ ƒ \b \b aaarrrg! nnnn................ If the mother needs help pushing‹ ˆ \b \b† \b “ ‡ \b ” ‰ uunnh! uunh! This mother is bottom down. This mother is lifting her bottom up. YES NO! 202 202 Support the mother’s pushing‚ •\b ƒ \b ‹ ¢ \b ‚ƒ † Ž\b \b \b \b\b Œ ‡ Ž† \b \t ƒ \b ‡ Watch for warning signsWatch the speed of the birth\t\b \b \r\f \n \n\t \b \b ‡ \b Keep pushing. ‚ ƒ ‰ Put a gloved nger about 2 centimeters into her vagina and press straight down towards her bottom. (Do not rub the vagina.) uuunhh! Ask the mother to change positions. Ask the mother to open her mouth and relax her jaw. Apply clean, warm, wet cloths to her genitals. Ask the mother to pull her knees up towards her body. Watch for warning signs £ \b \b \b \f \t\b \b ‹ \b ƒ ƒ ƒ ‡ \b \b ˆ \b \b ƒ \b • \n ƒ ƒ ‚ ƒ \bƒ \b ‚ \f ƒ Baby is not born after 1 or 2 hours of strong contractions and good pushing ‚ \b ƒ \bƒ • \b \b \b ‰Œ \f \f \b †‹ \b \b ¡ \b • ƒ \bƒ \b Mother needs to change positions‚ ƒ ‡ —— ƒ ‡ £ †ƒ \b \bƒ Squatting can help bring the baby down. Š •\b Š • 204 Baby is in a di cult or impossible birth position \f \b •\b ‚ \b \bƒ ‘‘ — ‡ \b \b \b \b \b\b ‚ ƒ “ ‚ \b • •ƒ •\b ‚ ƒ \b \t ƒ \nBaby is unable to t through the mother’s pelvis‚ ƒ ƒ ‡ ’ ‚ ƒ ƒ • \n ƒ † ‚ \b • ƒ • If there is no progress — get medical help‚ “ ƒ ƒ ƒ ƒ \bƒ “ \f ƒ \b \b ‚ ‚ \b \bƒ \f “ \b \f \b \n \b \n We should not wait any more. Let’s go to the hospital. I’ll get I’ll carry her over. Watch for warning signs Watch for bleeding during pushing‹ ƒ \b \bƒ ‚ ˆ \b \b \b \f„Detached placenta (abruption)‚ \b \b ƒ ƒ ƒ \b \b \b ‚ \b \b \bƒ \b ¤ “ ‚ \bƒ \b \b \b ‚ ƒ \b ˆ œ ‡ † \fƒ ¤ \b \b \b Torn womb‚ ƒ \b \b ƒ \b ‡ ‚ ƒ \b \b \t \f \f WARNING! Œ \b \b ƒ ‡ \b œ \t ƒ \n Œ ‘\b Push hard! baby must come quickly! 206 Help prevent tears in the vaginal opening‡ \b ‡ \b\b \b \b \b \b ƒ ¥ƒ ˆ ” Cutting a circumcision scar‚ \b ƒ \b\b\b \b \b \b £ \b £¤ \b \b \b ‚ \b\b\bƒ \b \b \b\b\b \b Œ €\n † \bƒ \b \b\b\b \b Help the mother give birth upport the vaginal opening‡ \b \b \b “ \b \b \b \n \f \n \t \b \n \b \f \b \b Help the mother give birth Use very warm cloths \t \b ƒ \b‰low the birth of the head ‚ ƒ \b ‡ ƒ ƒ ƒ \b To help the mother stop pushing‡ \b ƒ ‚ \b \t ƒ ‚ •\b ”ƒ \b \b \b ƒ \b \b “ \b \b ‡ \b Ž\b \f \b \b ‰‹ \b ƒ \b This mother should stop pushingThe baby’s head is about to crown. 208 Whooo. Here WARNING! \f \f‚ \bƒ —\b If necessary, clear the baby’s nose and mouth \t ƒ \b ƒ \b ‚ \b ƒ \b \b \b • ˜ \b ‹ ƒ Ÿ \b Is the contraction over? Take a rest. The Gently! Yes! stop pushing! And here is the head! How Blow! Blow! Blow! Blow! Okay. Give a stopblow! Keepblowing. In a minute give another gentle Help the mother give birth ‚ \b ˜ \b \b \b ˆ \b \b \b \b ” \b \b \f \fCheck for a cord around the baby’s neck‚ ƒ \b \b‚ \b \bƒ \b ‚ \b ƒ \b \bƒ ‚ \b \b ƒ \b ‹ ƒ \b ¦ ƒ ¦ ”\b ƒ \b \b Ÿ \b ‚ \b ‚ ƒ \b ‚ ¦ \b ƒ \b \f \f‚ \b \b ƒ \b † ƒ \b \b ‚ \b \b \b ƒ \b ‘ \b \b \b \b ‚ ƒ \b ’ ’ ˆ \b \b \b WARNING! \r\f \b \b \f \f \t \n \f \t \b ƒ \b † medical hemostats blunt-tipped scissors 210 Deliver the baby’s shoulders‹ \b ƒ †\b \b ‹ \b \b ¢ƒ Bring out the rst shoulder by gently moving the baby’s head towards the mother’s bottom. Bring out the second shoulder by moving the baby towards the mother’s belly. WARNING! Do not bend the baby’s head far. Guide the head — do not pull it. To prevent tearing, try to bring out 1 shoulder at a time. If the mother is in the hands-and-knees position If the mother is in the Baby gets stuck at the shoulders \b ” \b \b ˆ ƒ ƒ \b \b ‡ \b — \b \b ƒ ƒ ‡ \b Ž € \b \n‚ ‡ \b ‡ ƒ ‹ ƒ ‡ \b ‚ ƒ Help the mother give birth What to do˜ \b \b \b ƒ\b ‹ † \b ‡ ƒ 1. Try the hands-and-knees position. \b \b \t ƒ ‚ ƒ † 2. Try pressure above the pubic bone.‹ ¥ \b “ ‡ ‹ \b \b \b \b \t ƒ ‚ ƒ † 3. Try pushing the baby’s shoulder from the inside. Œ … ƒ \b \b ‚ ƒ † 212 4. Try pulling the baby’s arm out of the vagina. š ƒ ƒ Œ \b \b ‡ •\b ˆ \b \b \b \b ¥ ‡ \b ¤ \b ‚ ƒ \b ¨\b •ƒ \b ƒ ƒ ˜ WARNING! „ \b\t \f ˜ \b ˆ \b \b ˆ \f Deliver the baby’s body and give the baby to the mother‹ ƒ ¨ ˆ \b œ … \b \b ”™ƒ ƒ ‡ ˜ \b \b \b \b \b ƒ ¦ \b ˆ ‹ \b ‹ ƒ Help the mother give birth Stool in the amniotic waters (green or yellow)‚ ƒ ‚ \b ˜ \b \b ‚ \b \b ‰‚ ƒ \b ‰ ‡ \b \b ƒ \b † \t ’ To make a suction trapYou need a small jar, a stopper that ts snugly into the top of the jar, and some very thin, soft tubing that can be cleaned easily. Sterilize the tubing before and after you use it. Push one tube through below the stopper. Push the second tube through until it almost touches the bottom of the jar. Make 2 holes in the stopper. The holes should be just big enough to push the tubing through. To use a suction trap £ ¥ ‚ \f\b \b \b • ‡Ÿ ¥ ‹ \b ƒ \b 214 Cut the cord when it turns white and stops pulsingš ƒ \b \b ¡ \b \b ‚ \t ¥ ƒ \b ‚ • ƒ ‡ † \t \b ƒ \b © \b \b \bƒ \b \b \b ‡ \b How to cut the cord¢ \b \b \b • ‡ \b \b ‡ — Œ \b \b Wait! OK to cut. square knotsquare knot To tie a square knot Right over left, left over right, makes a square knotsecure and tight. Squeeze the syringe. Gently put the syringe in the baby’s throat.The bulb mucus. (Do not squeeze the syringe while it is in the Squeeze out the mucus. Release the syringe as you wiggle it around. To use a bulb syringe’ \b \b \b ‡ \b Œ\b\b \b Help the mother give birth WARNING! \n \b ‚… \b “ \b \b Œ \b \b Baby is breech‡ \b ‰ ‹ \b \b Dangers of breech birthsˆ\b \b ƒ ‡ \b • ƒ \b ‡ \b ‰ ‚ ƒ \b \b \bƒ \b \b ‚ \b ƒ \b \b ƒ †\b \b complete breech (folded legs) frank breech footling breech (feet rst) \b \b ƒ ’ ƒ \b ‹ \b \b ƒ ’ €\n¡ \b \b “ • 216 Delivering a frank or complete breech \b \b Ž ƒ \b \b \t \b† ƒ \b Ž\b ƒ ‡ ¡ \b ‚ ƒ \b \b \b \t \b \b ‚ \b ƒ ƒ • Ÿ ™ ‡ \b \b ¦ ‡ \b ‚ \b ƒ • … Help the mother give birth ˜ \b ‡ \b ƒ … \b \f † \b \b „ ‚ \b ƒ • ‡ ƒ Œ \b \b … ¡ ‡ \b ƒ • Œ ƒ • \b \b ‡ \b \b \b \b • 218 Delivering a footling breech‹ \b \b \b£ \b \b\b \b \b \b ‚ \b \b \b \b ‡ \n Œ ‘\b \b ™ \b \b ¡ \b ‡ †ƒ ƒ ¡ \b \b \f ‚ \b ƒ \b ¡ \b ‚ \b ‡ \b ‚ Delivering twins It is very dangerous to try to deliver them at home. If the head-down baby is born rst, the other baby may turn. But a breech twin will have the same dangers as all breech babies. When both babies are sideways, they cannot be born through the vagina. down, it is a little less dangerous to deliver at home. It is even better if both babies are up and down. It is best if both babies are down — but it is still more dangerous than a single birth. ‚ \b ƒ \b† ‹ “ \b ¢ \b \f€ \f„ \b \bDelivering twinsDangers of twin births‡ ƒ \b •\b ‡ ƒ ‰£ ƒ \b \b ‚ ¥ •\bƒ • ‡ †\b 220 Delivering twins ‚ ƒ Possible problems when delivering twinsNo contractions within 2 hours of the birth of the rst twinŽ\b • ‚ ƒ „ ‚ \b ƒ ˆ \b ‚ ƒ \b \b \n \b \n \n ‚ \b ƒ \b \b ƒ \b† \b ƒ \b \b The second baby is sideways‚ \b \b ƒ ‚ ƒ †\b ƒ ‰ NO! Baby is very small or more than 5 weeks early The mother bleeds before the second twin is born (or the rst placenta is born before the second twin is born)ˆ \b \b \f„ \b \f \b ƒ ƒ Baby is very small or more than 5 weeks early ‹ ƒ \b ‰£ ƒ \b \b ‚ ƒ \b \b ‚ ƒ \b‰ … \b \b \b ¨ƒ ™ ‡ ‡ \b \b \b \b \b \b € \b ‚ \b ‘ ƒ \b ‚ \b A Book for Midwives (2013) Chapter 12: Pushing – Stage 2 of labor A Book for Midwives (2013)