Information evening

Information evening
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The Dutch system
Preparing
Where to deliver
Start of labour
Midwife arrives
Stages of labour
Contractions
Support from your partner
Being in control
Coping with the contractions
Hormones
Episiotomy or rupture?
The birth
Film
FILM
•
•
•
•
•
•
Coping with the pain
Vacuum extraction or forceps?
Aftercare (“kraamzorg”)
The midwife
Breastfeeding
Questions
Dutch System
• Selection
• Medical
Dutch system
• A pregnant woman is essentially healthy, not a
patient
• Risk assessment:
• Midwife: Normal pregnancy and delivery,
no complications
• Gynaecologist: Pregnancy and delivery
with medical indication
Preparations
•
•
•
•
•
•
•
•
Environment
Bed
“Kraampakket”
Telephone numbers
Sanitary facilities
Rest
Warmth
Bag packed and ready
Home delivery
• Spotlight
• Toothbrush
• 2 buckets and rubbish
bag
• Cotton diapers
• Bath towels
Where to deliver.
• Home or hospital?
• Make your choice during labour!!
Start of labour
– Contractions (more later)
– Rupture of membranes
– Blood loss
– Mucus (show)
Contractions
• Abdominal
• Early contractions
• Dilation
• The real thing
The beginning of labour
• False labour (Braxton-Hicks)
• Start of the real thing
• Early contractions
– To prepare the uterus
– Reaction to moving baby or full bladder
– Engaging
– Menstruation-like pains
– Weak and irregular, not continuous
– Warmth helps, also shower or bath
– Cervix dilates 1-2 cm max
Dilation contractions
•
•
•
•
•
Regular, more frequent
Duration 60-80 seconds
Strong and painful
Loss of blood and/or amniotic fluid
Nausea, vomiting possible
The midwife
What can you expect?
Support from your partner,
postures
•Comfort
•Massage
•Breathing
assistance
•Warmth
•Stimulates the creation of Oxytocine
•Stimulates the creation of Endorphins
•Reduces Adrenaline levels
relax
oxytocine
endorfine
krachtige
weeën
How to cope with
contractions?
• Stimulate Oxytocine
• Stimulate Endorfine
• Reduce de Adrenaline
• HOW??
Natural pain relief
•
•
•
•
Relaxation excercises
Breathing excercises
Positive but realistic expectations
Warmth: hot water bottle, socks, shower,
bath
• Massaging helps!
• Keep moving!
Not coping with the pain
Pain relief
Epidural
Pethidine
Remifentanyl
•
Positive
- Pain free
- Relax
- Rest
• Positive:
- Relax
- Improves delivery
•
Negative
- Half an hour CTG
- Theatre
- Low blood pressure
- Can’t move
- Catheter
- Extra medication
- Extended pushing
- Vacuum delivery
- Temperature
• Negative
- CTG
- Not that effective
- Only 4 hours
Effect on baby
• Positive
- Controle it yourself
- Fast
- Never too much
- Relaxes
- Faster
• Negative
- CTG
- IV
- Limited
TENS
•
•
•
•
Transcutanic Electro Neuro Stimulation
Elektrical currents
Nerves influenced reduces pain
Insurance pays (incl. Agis, achmea/zilverenkruis)
Sterile water injections
•
•
•
•
•
•
New pain relief method (1 juli 2013)
4-6 injections in de lumbar area during contractions
Feels like a bee sting
May be repeated every 1,5 to 2 hours
Influences nerve transmission
No negative effects on mother or baby
Epidural Anaesthesia
Anaesthetic introduced into epidural
space between vertrebrae with a
rubber tube
Tube remains in place, connected to a
pump, dosage can be adjusted
Anaesthetic blocks transfer of pain
through nerves in and around the
spinal column
Epidural anaesthesia
Advantages
• No pain below the waist
• Control of dosage
• You remain awake and
alert
• 95% feel no pain
Disadvantages
•Less mobile, not vertical
•Catheter
•Weaker urge to push, slacker muscles
•Extra hormones
•Greater chance of vacuum/forceps/epi
•5% ineffective
•Headache (1%), back pain, shaking, itching
•Spectator own delivery
•Possibility of fever for mother / baby may
require antibiotics
Being in control
• By knowing what is happening and why
(dilation, rupture of membranes, contractions, etc.,
but also in case of transfer)
• Good communication with us
• Good breathing technique helps manage pain,
prevents panic, requires less energy
• Know that pain relief is always possible
The midwife is on the way –
what to expect?
•
•
•
•
•
See how you are doing
Observe contractions
Tips and advice
Determination of pain limit
Check baby
Internal examination
• Cervix: tight/soft
• Dilation
• Membranes
• Engagement and facing
Changes in the Cervix
Dilation
Labour
• Has it all started?
• Latent phase
- 4 cm
• Active phase
- Dilation 4 -10 cm
• Birth
2nd phase
• Urge to push
• Possibilities: Bed, bath, birthing chair
• Duration: 5 min to 2 hours
Birth (1)
https://www.youtube.com/watch?v=Xath6kOf0NE
Birth (2)
• Engagement of head
• 10 cm dilation
• Pushing
Episiotomy or rupture
Episiotomy
Rupture
• Foetal distress
• Insufficient progress
• Not enough space
•
•
•
•
Happens at times
Listen to instructions!
Heals faster than episiotomy
Less discomfort
Vacuum extraction
•
•
•
•
•
•
Kiwi
If the “uitdrijving” does not progress
If the baby can’t emerge spontaneously
Inconvenient facing
Foetal stress
Tired
Hormones
• Oxytocine ↑
• Adrenaline ↓
• Endorfine ↑
Aftercare
Spoiled
Care
Observations
Advise
Help
Post Partum
•
•
•
•
•
•
8 days:
Big change!!
Intense
Fantastic
Tiring
Confused
“Kraambed” (postnatal care)
•
•
•
•
•
•
Blood loss
Stitches
Contractions
“Stuwing”
Limited mobility
Interrupted sleep
Advice
•
•
•
•
Baby close to you
Take time to get to know your baby
Follow your instinct
Advice
Breastfeeding
Breastfeeding clinic
Questions?
Wishing you a good
pregnancy and delivery.