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Labour and birth
In this chapter, you’ll learn:
♦
types of foetal presentations and positions
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ways in which labour can be stimulated
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signs and symptoms of labour
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stages and mechanisms of labour
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midwifery responsibilities during labour and birth,including ways to provide comfort and support.
 Just the facts
The midwife’s role
 The midwife has a huge part to play in providing individualised,holistic care for the labouring woman and her partner. She must:•act as an advocate for the woman•empower the woman to believe that she is capable of deliveringher baby •facilitate the mother through the stages of labour and thedelivery •do her best to make sure that the mother has as normal alabouring experience as possible with minimal intervention ormedicalisation•provide physical and psychological care at all times•utilise all of her skills and knowledge in making sure that birthfor mother and baby is safe.
A look at labour and birth
Labour and birth is physically and emotionally straining for a woman. As the woman’s body undergoes physical changes to helpthe foetus pass through the cervix, she may also feel discomfort,
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282LABOUR AND BIRTHMeditate on this: Relaxation iskey during labourand birth.
pain, panic, irritability and loss of control. To ensure the safestoutcome for the mother and child, you must fully understandthe stages of labour as well as the factors affecting its length anddifficulty. With an understanding of the labour and birth process, you’ll be better able to provide supportive measures that promoterelaxation and help increase the woman’s sense of control.
Foetal presentation
Foetal presentation is the relationship of the foetus to the cervix. Itcan be assessed through abdominal inspection and palpation, vaginalexamination and sonography. By knowing the foetal presentation, you can anticipate which part of the foetus will first pass throughthe cervix during delivery.
How long and how hard
Foetal presentation can affect the length and difficulty of labouras well as how the foetus is delivered. For example, if the foetus isin a breech presentation (the foetus’s soft buttocks are presentingfirst), the force exerted against the cervix by uterine contractions isless than it would be if the foetus’s firm head presented first. Thedecreased force against the cervix decreases the effectiveness of theuterine contractions that help open the cervix and push the foetusthrough the birth canal.
Presenting difficulties
Sometimes, the foetus’s presenting part is too large to pass throughthe mother’s pelvis or the foetus is in a position that’s undeliverable.In such cases, caesarean birth may be necessary. In addition to theusual risks associated with surgery, an abnormal foetal presentationincreases the risk of complications for the mother and foetus.The primary factors that can affect foetal presentation duringbirth are foetal attitude, lie and position.
Foetal attitude
Foetal attitude (degree of flexion) is the relationship of the foetalbody parts to one another. It indicates whether the presenting partsof the foetus are in flexion or extension.
Complete flexion
 The most common foetal attitude is
complete flexion
. This attituderesults in a vertex (top of the head) presentation of the foetusthrough the birth canal. Commonly called ‘the foetal position’,
Hail Caesar!Caesarean birthmay be necessarywhen the foetus’spresenting partis too large topass through themother’s pelvis.
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FOETAL PRESENTATION283Hey mum!For once, I bet youwon’t mind megiving you someattitude.
complete flexion is the traditional attitude referred to whendescribing a foetus in utero.
Tucked, folded and crossed
In complete flexion, the head of the foetus is tucked down onto thechest, with the chin touching the sternum. The foetus’s arms arefolded over the chest with the elbows flexed. The lower legs arecrossed, and the thighs are drawn up onto the abdomen. The calf of each leg is pressed against the thigh of the opposite leg.
All about attitude
Complete flexion is the ideal attitude for gestation and birthbecause the foetus occupies as little space as possible in the uterus.Birth of a foetus in complete flexion is easier because the smallestanteroposterior diameter of the foetal skull is presented to passthrough the pelvis first.
Moderate flexion
 Moderate flexion
(military position) is the second most commonfoetal attitude. It tends to result in a sinciput (forehead) presentationthrough the birth canal. Many foetuses assume this attitude early inlabour but convert into complete flexion as labour progresses.
Ten-hut!
In moderate flexion, the head of the foetus is slightly flexed butheld straighter than in complete flexion. The chin doesn’t touchthe chest. This attitude is commonly called the
military position
 because the straightness of the head makes the foetus appear to be atattention.
Low rank of difficulty
 The birth of a foetus in moderate flexion usually isn’t difficultbecause the second smallest anteroposterior diameter of the skullis presented through the pelvis first. Hopefully further flexion willoccur during labour, decreasing the diameter of the foetal skull.
Partial extension
 Partial extension
is an uncommon foetal attitude that results in abrow presentation through the birth canal. The head of the foetus isextended, with the head pushed slightly backward so that the browbecomes the first part of the foetus to pass through the pelvis duringbirth. Partial extension of the foetus can make birth difficult becausethe anteroposterior diameter of the skull may be the same size as orlarger than the opening in the woman’s pelvis.
Give a salute to the militaryposition – moderate flexion where the foetal head looks asif it’s at attention.
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