Birth is a normal, healthy part of a woman’s life. This unexplainable happiness is usually accompanied by severe pain due to contractions.
Labour is a health state that most women aspire to, at some point in their lives. The first thought that comes to the mind of an expecting woman regarding her delivery is the pain of labour.
Labour is a normal physiological process, which while should be an occasion for rejoicing
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
Help the medical students to know about the fetal clinical parameters. Very rarely material present in the books. I prepared this for the little bit help from my side.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
complementary therapies in labour ..different types of therapies at the time of pregnancy , water birth and their advantages and disadvantages , different types of messages while pregnancy
Help the medical students to know about the fetal clinical parameters. Very rarely material present in the books. I prepared this for the little bit help from my side.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
complementary therapies in labour ..different types of therapies at the time of pregnancy , water birth and their advantages and disadvantages , different types of messages while pregnancy
Normal Labour & Nursing Management of First stage of LabourNeha Parmar
Definition of normal labor, Terminology , events of labour, causes of labour, signs , stages of labour , signs and symptoms of labour, diagnosis in first stage of labour, Partograph, difference between true labour and false labour ,nursing management of first stage of labour.
Pain relief in labor is complex and often challenging.
Effective management of labor pain plays a relatively major role in a woman's satisfaction with childbirth.
Labor contractions usually cause discomfort or a dull ache in the back and lower abdomen, along with pressure in the pelvis.
Contractions move in a wave-like motion from the top of the uterus to the bottom.
Some women describe contractions as strong menstrual cramps.
support measure during childbirth
Reduction of fear and anxiety by providing information and support.
Facilitation of appropriate rest, sleep and for ambulation.
Provision of a labor companion.
If you are an expectant mother,
you should talk with your obstetrician and your anesthesiologist to develop a plan on
Pain management during labor and delivery
that ensures the safest possible pregnancy, childbirth, and recovery.
a detail study on normal labour ( definition, stages of labour, management ,p...martinshaji
The World Health Organization (WHO) defines normal birth as follows: The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. this is study on detailed study on physiology and stages of normal labour .
please comment
thank u
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
"Nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs." – Abdellah
ORGANIZATION: According to L. White, "Organization is the arrangement of personnel for facilitating the accomplishment of some agreed purpose through allocation of functions and responsibilities.“
Definition of Professional Organization:
A professional Organization is an organization, usually nonprofit that exists to a particular profession, to protect both public interests and the interests of professionals.
The whole number of people or inhabitants in a country or region” -(Webster’s dictionary)
In sociology, population refers to a collection of human beings.
Scaled down teaching used by a student teacher in a controlled condition of a teacher in order to attain proficiency in a particular teaching skill is called micro teaching
The research approach indicates the basic procedure for conducting research.
Research approach is the technique which the researcher uses to structure a study in order to gather and analyze information relevant to the research question .
A disruptive condition that occurs in response to adverse influences from the internal or external environments
A condition in which the person responds to changes in the normal balanced state
A biological, psychological, social or chemical factor that causes physical or emotional tension and may be a factor in the etiology of certain illnesses.
Most of us have probably become angry on occasion. Let us hope the moment passed quickly, we apologized and moved on. However, anger that is not under control can be extremely harmful, even lethal. It is vital to learn early how to control this emotion.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. FROM THE HOLY QURAN
IN THE NAME OF ALLAH THE
MOST BENEFICIENT THE MOST
MERCIFUL
“AND THE PAINS OF CHILDBIRTH DROVE
HER TO THE TRUNK OF A DATE PALM.
SHE SAID “ WOULD THAT I HAD DIED
BEFORE THIS, AND HAD BEEN
FORGOTTEN AND OUT OF SIGHT”.
3. Introduction
Birth is a normal, healthy part of a woman’s
life. This unexplainable happiness is usually
accompanied by severe pain due to
contractions.
Labour is a health state that most women
aspire to, at some point in their lives. The
first thought that comes to the mind of an
expecting woman regarding her delivery is
the pain of labour.
Labour is a normal physiological process,
which while should be an occasion for
4. CONTD…
The amount of pain a woman experiences is
influenced by many individual, physical,
emotional and environmental factors.
Most pain during childbirth results from
normal physiologic events.
If nurses understand the nature and effects of
pain during the labour process, they will be
better prepared to provide supportive care
physical comfort includes offering a variety of
Non-Pharmacologic and Pharmacologic
5. The Debate…
“Labor results in severe pain for many women.
There is no other circumstance where it is
considered acceptable for a person to
experience untreated severe pain, amenable to
safe intervention, while under a physician’s
care… Maternal request is a sufficient medical
indication for pain relief during labor.”
ACOG & ASA
6. What is labor?
• Labor = the act of uterine contractions
combined with cervical change
• Fetus is gradually pushed through the birth
canal (consisting of the cervix, vagina and
perineum)
• Placenta is extruded and uterus involutes
9. How does the uterus contract?
• The uterus is made from a weave of smooth
muscle (myometrium) covered by a smooth
cellular surface (serosa) – all formed by the
joining of the two original mullerian horns
• The cavity is hollow and lined by
vascular/stromal bed that is responsive to
hormonal stimulation (i.e. menstrual cycle)
11. What does the myometrium need
to contract?
• CALCIUM!
• Calcium channels allow influx which
through a cascade of events activates
myosin
• Smaller calcium supply comes from other
organelles (i.e.. Sarcoplasmic reticulum)
• These all play a part in how we can
manipulate labor!
14. Physiology of labour
Series of events that take place in the
genital organs to expel the viable products of
conception out of the womb through the
vagina into the outer world is called normal
labour.
15. STAGES OF LABOUR: divided into
4 stages.
First stage of labour – true labour
contractions
Second stage starts from full
dilatation of cervix till expulsion of
fetus.
Third stage begins after the
expulsion of fetus and ends with the
expulsion of placenta and
membranes.
Fourth stage is the stage of
20. The second stage of labor usually lasts about 90 minutes.
During this stage, the cervix opens sufficiently and the baby
begins to move down the birth canal. The mother pushes,
or bears down, in response to pressure against her pelvic
muscles. The crown of the baby’s head becomes visible in
the widened birth canal.
21. Nature of Labor Pain – 2nd
Stage
• Somatic pain
– Perineum
•Sharper and more
continuous
• Pressure or nerve entrapment
(caused by the fetus’ head)
– May cause severe back or leg
pain
22. Following the exit of the infant, the third stage of labor
occurs. The uterus continues to contract, expelling the
severed umbilical cord and placenta, called the afterbirth.
The third stage occurs within ten minutes of the baby’s birth.
23. As the head emerges entirely (left) the physician turns the
baby’s shoulders (right), which emerge one at a time with the
next contractions. The rest of the body then slides out
relatively easily, and the umbilical cord is sealed and cut.
24. Fourth Stage of Labor
• Stage 4
– Immediate period after placental delivery
– Uterus contracts to close off venous sinuses
and slow bleeding
– Watch for signs of post-partum hemorrhage
25. • The Apgar score is a score given at one, five and ten
minutes after the birth of a child. A score of 7-9 is
normal.
• Bonding is the closeness (caring and concern) for
another.
• Feeding, touching and playing are the three basic
elements of bonding.
• Factors that negatively affect bonding are: very
expensive child, very cross or colicky child, wife is
sick, mother refuses sexual advances of father, if
child looks like someone the parents do not like.
26. PHYSIOLOGY OF LABOUR PAIN
The first symptom to appear in first stage of labour
is painful intermittent contractions. This pain is felt
anteriorly with simultaneous hardening of the
uterus. Initially the pain is not strong enough and
come at various intervals of 15-30 min with duration
of about 30 sec. The pain starts from the abdomen,
back and then radiates to thigh.
27. Causes of Pain in Labor
Stage One
Stretching of the cervix
during dilation & effacement
Uterine Anoxia/ Myometrial hypoxia
Stretching of the
uterine ligaments
28. Causes of Pain in
Labor
Stage
Two
Distention of the vagina and
Perineum
Compression of the nerve
ganglia in cervix & lower uterus
Pressure on urethra, bladder,
rectum during fetal descent
Traction on and stretching of
the perineum
29.
30.
31. PAIN RELIEF MEASURES
Normal labour may be easy and trouble free
provided a rational approach is made with
the beginning of pregnancy. Pain can be
relieved by various measures:
Sedatives and analgesics.
Epidural analgesia.
Inhalation agents.
Alternative and
contemporary modalities.
32. Methods of Pain Relief
• Non pharmacologic
– Childbirth methods
• Breathing Techniques
• Relaxation Techniques
• Touch
• Focusing attention on one object
– Effleurage
35. CONTD…
There are several measures used for
relieving pain during labour.
Alternative and contemporary
modalities are one among them; it
refers to all those therapies not
provided by the conventional
methods. These modalities boosts up
the confidence of the women, hence
36.
37.
38. CONTD….
Alternative and contemporary
modalities are simple, safe and
inexpensive.
It considers the human body as the sum
total of its physical, mental, social and
spiritual dimensions. It has no side
effects.
Remedies are based on natural
ingredients thereby advocating a
drugless cure. Alternative modalities
40. GATE CONTROL THEORY
• It implies that a non-painful stimulus can
block transmission of a noxious stimulus.
• It is based on the premise that the gate
modulates the pain impulses.
• There are three types of nerve fibres: A-
Delta fibres(sharp pain), C fibres(dull pain),
A-Beta fibres(light touch).
• The substantia gelatinosa acts as the
modulating gate.
• A-Delta and C firbres open the gate and A-
Beta fibres close the gate.
• Alternative modalities activate the A-Beta
43. AROMA THERAPY
Aromatherapy is the science of using highly
concentrated essential oils or essences distilled from
plants in order to utilize their therapeutic
properties.
stimulates the chemoreceptor sites in the naso-
pharynx and directly affects the hypothalamic-
pituitary, adrenal axis.
Administration includes putting drops in a pillow, in
a bath.
Important essential oils
(1) Lavender Oil
(2) Neroli Oil
(3) Rose Oil
46. TOUCH AND MASSAGE:
Therapeutic touch in labour is to communicate
caring and reassurance.
Painful uterine contractions can be treated by the
application of pressure with the hands to the
women’s back, abdomen, hips, sacrum etc.
Touch and massages stimulates the body to release
endorphins which are natural pain killing and mood
lifting hormones.
Massage is thought to have physiological basis,
blocking pain impulses by increasing A-fiber
transmission or by stimulating large diameter nerve
fibers to close a gate of pain, stimulating circulation
with resultant increased oxygenation to tissues and
facilitating the excretion of toxins through the
47.
48. Latent Phase:
In a 10ml bottle =pour 4drops of lavender+ 2 drops
of neroli +add vegetable oil.
Massage temples, forehead and chest and advice to
take deep breaths.
Active Phase:
In 10ml bottle pour 6 drops lavender+ 1drop
neroli+1drop rose oil + add vegetable oil.
Massage and advice to breathe and relax.
50. BREATHING EXERCISES
The theory behind breathing patterns is that the
thought process is redirected from the painful
response. Breathing exercises should be done at
the beginning and at the end of each contraction.
Some of the breathing exercises are:
(1)Slow breathing
(2)Light accelerated breathing:
(3)Variable transition breathing:
(4)Slow relaxed abdominal breathing
51. Procedure:
Fill a small tuberculin syringe with sterile water
Identify the posterior superior iliac spine and
mark them.
Approx. 3 to 4 cm down and 1 to 2 cm in
identify other two points and mark them.
During a contraction inject a small amount of
sterile water into the skin raising a bleb
Repeat at the other three sites as quickly as
possible.
During the injection the woman will feel a
sharp stinging pain.
The stinging will fade in 10 to 15 sec.
Avoid back massage after the water block as it
could shorten the duration of action.
Procedure:
Fill a small tuberculin syringe with sterile water
Identify the posterior superior iliac spine and
mark them.
Approx. 3 to 4 cm down and 1 to 2 cm in
identify other two points and mark them.
During a contraction inject a small amount of
sterile water into the skin raising a bleb
Repeat at the other three sites as quickly as
possible.
During the injection the woman will feel a
sharp stinging pain.
The stinging will fade in 10 to 15 sec.
Avoid back massage after the water block as it
could shorten the duration of action.
INTRA-DERMAL WATER BLOCKS
52. INTRA-DERMAL WATER BLOCKS
It is a new technique for non-narcotic pain relief.
With slight modifications it can be used in labour,
especially for posterior positions.
.
59. HYDROTHERAPYOne of the safest and most effective forms of
pain relief in labour is the immersion in deep
water or a warm shower.
Hydrotherapy has been used for relaxation,
healing and pain relief for centuries. It relieves
the stretching sensations of ligaments and areas
associated with posterior presentation.
Mode of action
There are three factors that contribute to the
benefit of hydrotherapy: heat, buoyancy and
massage.
Immersion in water results in increased
circulation.
The buoyancy of water creates a weightless
feeling and promotes relaxation
One of the safest and most effective forms of
pain relief in labour is the immersion in deep
water or a warm shower.
Hydrotherapy has been used for relaxation,
healing and pain relief for centuries. It relieves
the stretching sensations of ligaments and areas
associated with posterior presentation.
Mode of action
There are three factors that contribute to the
benefit of hydrotherapy: heat, buoyancy and
massage.
Immersion in water results in increased
circulation.
The buoyancy of water creates a weightless
feeling and promotes relaxation
60. CONCLUSION
Alternative and contemporary modalities
are the techniques which imparts a sense
of well being in an individual with the
desired effect. The main advantage is that
it can be discontinued at any time without
any side effects. Midwives should possess
adequate knowledge about these
modalities.
61.
62.
63. Bishop Score
ParameterScor
e
0 1 2 3
Position Posterior Intermediat
e
Anterior -
Consistency Firm Intermediat
e
Soft -
Effacement 0-30% 40-50% 60-70% 80%
Dilation <1 cm 1-2 cm 2-4 cm >4 cm
Fetal station -3 -2 -1, 0 +1, +2
64. Cervical Ripening
• Mechanical
– Stripping (or sweeping) of the fetal membranes
– Placement of hygroscopic dilators within the
endocervical canal
– Insertion of a balloon catheter above the
internal cervical os (with or without infusion of
extra-amniotic saline)
• Pharmacologic
– Prostaglandins
• Prostaglandin E2-cervidil
• Prostaglandin E1-misoprostil
65. After the initiation of labor…
• Factors responsible for the ongoing labor
process include:
– Oxytocin
– Prostaglandins (PGF2-alpha, thromboxane,
PGE1,E3)
– Endothelin (by receptor-PLC coupling via
nifedipine sensitive channels)
– Epidermal Growth Factor
67. Stages of Labor
• First stage – Latent and active labor
• Second stage – Descent with pushing to
delivery of baby
• Third stage – Delivery of placenta
• Fourth stage – involution of the uterus
69. Stages of Labor
• Stage 1 (Latent Phase)
– Uterus and cervix prepare for active labor
– Dilatation up to 4 cm
– Variable length of time
70. Stages of Labor
• Stage 1
– The “Active” Phase – rapid cervical dilatation
from 4 centimeters to 10 centimeters (or
complete dilatation). Varies for nulliparous vs.
multiparous patients
• Nulliparous – 1.2 cm/hr
• Multiparous – 1.5 cm/hr
71. Stages of Labor
• Stage 2 “Pushing”
– Starts from complete dilatation to delivery of
the fetus
– Variable depending on parity maternal forces
– Fetus has to make it’s way through the curves
of the pelvis
72. Third Stage of Labor
• Stage 3
– From delivery of the fetus to delivery of the
placenta
– Variable amounts of time for placental
extrusion but generally within the first 20-30
minutes
– Medications can be used to augment placenta
delivery and post-partum bleeding
74. Occiput posterior (OP) presentation
• Approximately 10% of
deliveries
• Face is looking up
towards the ceiling
versus the floor
• Fetus must perform
opposite
flexion/extension
maneuvers to navigate
the birth canal
76. What can we do when labor is
not progressing?
• Natural methods
– Rupture of membranes
– Walking
– Nipple stimulation
– Position change
– Herbs (used as abortifacients)
77. Medical treatments for protracted
labor
• Augmentation of contractions with Pitocin
• Anesthesia
• Repositioning of fetal head
• Assistance with vacuum or forceps
78. Considerations for Operative
Vaginal Delivery
• Maternal Criteria
– Adequate analgesia
– Lithotomy position
– Bladder empty
– Clinical pelvimetry must be adequate in
dimension and size
– Consent
79. Considerations
• Fetal criteria
– Vertex presentation
– Fetal head engaged in the pelvis
– Position of fetal head must be known
– ? Presence of caput or molding
80. Considerations
• Other criteria
– Cervix fully dilated
– Membranes ruptured
– No placenta previa
– Experienced operator
– Capability to perform an emergent cesarean
delivery if needed
81. How far we’ve come…
• Addition of
anesthesia, antisepsis
and sterile technique
• Closure of uterine
incisions vs.
hysterectomy
• Significant reduction
in mortality after
1940’s –Why?
What are the characteristics of contractions and how these related to labor progress?
What are the causes of pain during the first stage of labor?
What are the causes of pain during the second stage of labor?
What are methods of non-pharmacologic pain relief in providing general comfort?
Several midwifery pearls involve the use of non-pharmacologic approaches to pain management in labor. These include ambulation and freedom of movement, hydrotherapy during the active phase of labor, and continuous support of the woman in labor. All of these approaches are supported by research (ACNM, 2014).
Hydrotherapy is beneficial and safe for laboring women.
Historically hydrotherapy was not used in labor due to the concern that it would increase the risk for maternal and/or fetal infection in the setting of ruptured membranes. However, the use of a warm tub bath to soothe the pain of labor has become a common practice in the past two decades and has been extensively studied.
In a review of 8 randomly controlled trials involving 2939 women, researchers demonstrated that immersion in water during labor was associated with a statistically significant decrease in the use of anesthesia and a decrease in reported pain. No adverse maternal or neonatal outcomes were reported.
Water immersion can facilitate the neuro-hormonal interactions of labor, alleviate pain, improve uterine perfusion, and enhance labor progress (Ginesi & Niescierowicz, 1998a, 1998b).
If you don’t have a tub, you can always use the shower.