Labour & Birth Refresher Course · Web viewLocate and review the intrapartum guidelines for normal birth that apply to your place of work, taking particular note to the care of women

Labour & Birth Refresher Course

Module 7: Second Stage Labour

Australian College of Midwives (ACM) www.midwives.org.au | https://learn.midwives.org.au

Labour & Birth Refresher CourseModule 7: Second Stage Labour

Questions for Reflection: Passive and Active Stages

Discussing these questions with colleagues will bring depth to your learning experience.

1. Do you think these definitions of passive and active second stage have been introduced as intrapartum care guidelines?

Click or tap here to enter text.

2. Would you be confident to work this way with women?


3. How would these definitions be useful when aiming to increase the likelihood of the woman having an unassisted birth in the following situations:

a. A woman labouring with an effective epidural block?


b. A woman with pre-eclampsia labouring with an effective epidural block with some motor blocking effects?

© Australian College of MidwivesLast Updated: 11/09/2023 Page: 1



c. A woman labouring after a previous caesarean section?


Questions for Reflection: Intrapartum Guidelines



1. Locate and review the intrapartum guidelines for normal birth that apply to your place of work, taking particular note to the care of women in the second stage of labour.

2. We also recommend reviewing the following guidelines:Queensland Health: Guideline on Normal Birth can be found in the

Maternity and Neonatal Guidelines at https://www.health.qld.gov.au/qcg/publications

SA Health: Clinical Guideline on Normal pregnancy, Labour and puerperium management can be found in the Perinatal Practice Guidelines at http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/perinatal/perinatal+practice+guidelines

The NICE guidelines on Intrapartum Care for Healthy Women and Babies can be found at https://www.nice.org.uk/guidance/cg190/

3. Is there anything that you did not expect in your local guideline?


4. When was your local guideline developed and were there any midwives identified on the team?



https://www.nice.org.uk/guidance/cg190/

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/perinatal/perinatal+practice+guidelines

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/perinatal/perinatal+practice+guidelines

https://www.health.qld.gov.au/qcg/publications


Tip: You may want to consider joining the review team when the guideline is next up for review, as a professional development activity.

Questions for Reflection: Birth Spaces

1. Does the layout of your birthing room(s), and the positioning of the bed, offer women privacy when people enter or leave the room? If not, why not?


2. How does the layout of your birthing room(s) meet the: a. Privacy needs of the woman?


b. Assessment and clinical care needs of the care providers?




3. Can you identify any ways you could affect changes in your birthing room(s) to see that both the woman and care provider’s needs are met?


Questions for Reflection: Flexion of Fetal Head

1. Reflect on the VE Touch Pictured activity from Module 2: First Stage Labour.



2. How does decreased flexion of the fetal head affect progress in labour?


3. Draw a ‘touch picture’ of findings on VE of a woman with her cervix fully dilated and her baby in the following positions with a deflexed head.

Right Occiput Transverse

R.O.T.Left Occiput Posterior

L.O.P.Left Occiput Transverse

L.O.T.

4. Draw a ‘touch picture’ of findings on VE of a woman with her cervix fully dilated and her baby in the following positions with a deflexed head when the examination is attended with the women in an all fours position.



Right Occiput Transverse

R.O.T.Left Occiput Posterior

L.O.P.Left Occiput Transverse

L.O.T.

5. Can you describe any midwifery tools you may use to encourage the baby to adopt a greater degree of flexion and decent in labour?


Questions for Reflection: Managing Second Stage Labour

1. What do you consider to be the appropriate duration of the second stage of labour?


2. Does this duration differ with different clinical situations? If yes, what are the differences?




3. Are you familiar with working with the definitions of passive and active second stages of labour?


4. How would you assess without attending a vaginal examination when a woman was in either passive or active second stage?


Questions for Reflection: Directed Pushing



1. Consider your own experiences as a midwife.

2. Are you familiar with directed pushing in second stage?


3. Do you currently use this style of direction with women in second stage?


4. When and why would you use this style of direction with women?


5. What do you see as the positive influence/outcome of directed pushing?




Questions for Reflection: The Urge to Push


2. Having read this section on management of the second stage, would you change your practices with regard to guiding women through late second stage of labour? If yes, what would these changes be?


3. How would you advocate for women being enabled to experience a spontaneous urge to push in the second stage of labour in your practice setting?




4. How might incorporating the definitions of active and passive second stages minimise the use of directed pushing?


5. Can you identify the aspects of the culture of your current practice setting that may adversely affect the ability for women to give birth following their own body’s signals?




Questions for Reflection: Management of the Second Stage

1. Can you identify factors that promote traditional management of the second stage in your setting?


2. Considering these factors, can you identify any strategies you could implement to reduce the barriers to effecting change in the care offered to women in the second stage of labour?




Questions for Reflection: Assisted Vaginal Birth

1. Refer back to Strachan’s (2005) research.


3. Why and how does each of Strachan’s factors reduce the need for assisted vaginal birth?


4. In the past, have you worked with these factors as a means of protecting women from assisted vaginal births?


5. What resources would you need to be able to work with these factors in the future?




Questions for Reflection: Maternal Indicators for Assisted Vaginal Birth

1. Consider your own experiences as a midwife and your current practice context.

2. Do the RANZCOG (2016) recommendations fit with the maternal indications for assisted vaginal births that you know of?


3. If not, can you identify which do not fit? Can you describe the factors that explain why women are treated differently in your practice context?


4. Can you identify the importance of passive and active second stage in determining the need for assisted vaginal delivery?




5. Can you identify the PEARLS of intrapartum care that may reduce the proportion of women requiring assisted vaginal delivery?


Questions for Reflection: Women Experiencing Assisted Vaginal Birth

1. There are four key elements describing the dimensions of support in labour which women evaluate positively. Using this list of four key elements, record how you would meet each of these support needs for women experiencing an assisted vaginal birth.

a. Emotional support: encouragement, praise and reassurance.




b. Informational support: explanations, advice and information.


c. Physical support: comforting measures.




d. Advocacy: to represent the woman’s wishes to other f needed and to act on her behalf if this is requested or indicated by her.


Questions for Reflection: Respectful Maternity Care in the Second Stage of Labour

1. This module has explored some of the routines that are used to manage second stage of labour. How could the use of routines impact a woman’s human rights? Think back to ‘The Seven Rights of Childbearing Women seeking and receiving maternity care’.

2. Do you use routines regularly or as part of your collection of tools for providing individualised care?




3. Can you think of an example when a technique to support the physiology of labour was used as a routine instead of individualised care?


4. How might liberal use of episiotomy relate to the freedom from harm and ill treatment?


5. What challenges does the right to informed consent and refusal of treatment raise for the process of performing an episiotomy?





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Labour & Birth Refresher Course · Web viewLocate and review the intrapartum guidelines for normal birth that apply to your place of work, taking particular note to the care of women