Week 2
Sarahs' pregnancy was mostly uneventful. On the evening of the 17th October Sarah notices that irregular contractions are occurring. She is 39+1 weeks. Sarah and Bill are very excited. Sarah is coping well with the contractions so decides to stay at home until the contractions are regular. They carry on their normal activities such as eating dinner, having an evening stroll and taking a long bath, until the contractions began coming regularly at 21.00. At 22.00 the contractions are every 5 minutes and she has had a mucous show so they decide to notify the birth centre where Sarah has booked in to have her birth. The Midwife suggested they come to the birth centre. They arrive at the birth Centre at 22.30
On admission the Midwife assesses Sarah’s progress in labour. The Midwife takes Sarah’s vital signs, listens to the fetal heart (130 beats + regular & strong), performs a abdominal examination (cephalic presentation, LOA, 2/5 engaged), feels her contractions (3 moderate contractions in 10 mins) and reassures Sarah and Bill that everything is normal and she is doing a terrific job. Sarah and Bill decide to get into the spa. At 23.00 Sarah’s membranes spontaneously rupture and the liquor is clear. With Sarah’s permission the Midwife decides to do a vagina examination to establish the progress of labour. Sarah’s cervix was fully effaced, and 7 cms dilated. The head was located on her spines at station 0.
At 02.30 on the 18th October Sarah has the urge to push. With each contraction Sarah is encouraged to push. The Midwife takes regular observations of the maternal pulse and fetal heart rate. While Sarah is on all fours for the birth the midwife notices The baby’s head is not progressing with the contractions. The Midwife performs another abdominal examination and discovers that Sarah has a very full bladder. Sarah is encouraged to micturate but is unable to do so. The Midwife decides to perform a catheterisation. (Normally and in-out procedure but for practical purposes here you need to insert an indwelling catheter). Following removal of 900 mls of urine the baby’s head advances with contractions (and Sarah controlled breathing) the baby’s head crowns at 03.00. With the next contraction the head is out and the next contraction a baby girl, Jane, is born at 03.10 on the 18th October. Jane is immediately put onto Sarah belly. The placenta and membranes are pushed out 5 minutes later and they are examined by the Midwife for completeness, which they are.
Tutorial Information
Your tutor will demonstrate the cardinal movements of birth and how to do a placental check
Simulation Laboratory Activities
- Revise the skills you may have missed last week
- Chart the information given on the labour chart supplied
- Practice your palpations to understand the findings of the abdominal examination
- Perform vaginal examinations on the models to establish what 7cms dilated and fully effaced cervix means
- Insert an indwelling catheter for Sarah
- Inspect the placenta and membranes
- Using the models and dolls + pelvis provided go through the cardinal movements the fetus needs to undertake in order to negotiate the maternal pelvis. See what happens when the pelvis is put into different positions (standing, lying and squatting)
- Complete your nursing documentation
Please click on flow chart
