Māori Birthing Practices and Cultural Respect
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Questions and Answers

Which type of presentation can birth occur vaginally if mentum is anterior?

  • Vertex Presentation
  • Occiptoposterior Presentation
  • Face Presentation (correct)
  • Brow Presentation
  • What is a key characteristic of Brow Presentation?

  • It involves a fully flexed fetal position.
  • It typically occurs in vertex position.
  • It can always result in vaginal birth due to favorable diameter.
  • The diameter cannot descend into the pelvis. (correct)
  • How long after a stillbirth should remains be buried or cremated?

  • No longer than 5 days. (correct)
  • No longer than 7 days.
  • No longer than 3 days.
  • No specified time limit.
  • What is the position of the occiput in an Occiptoposterior presentation?

    <p>It lies adjacent to the sacro-iliac joint. (A)</p> Signup and view all the answers

    Which statement about the required education for midwives under the Medicines Amendment Act (2013) is true?

    <p>Midwives need specific education to prescribe controlled drugs. (C)</p> Signup and view all the answers

    What is the term for a fully deflexed Vertex Presentation?

    <p>Occipitofrontal (D)</p> Signup and view all the answers

    What is the rotation degree of the occiput during long rotation as descent continues?

    <p>135° (A)</p> Signup and view all the answers

    Which term refers to the dignity of the wahine and her whanau being maintained?

    <p>Mana (C)</p> Signup and view all the answers

    What does Hau Ora encompass in relation to the wahine and her whanau?

    <p>All aspects of wellbeing (B)</p> Signup and view all the answers

    What occurs during the short rotation of descent in fetal birth from the occipito-posterior position?

    <p>The sagittal suture rotates anteriorly. (D)</p> Signup and view all the answers

    Which concept ensures the involvement of others in the birthing process?

    <p>Whanaungatanga (B)</p> Signup and view all the answers

    Which term refers to the holistic model of healthcare developed by Mason Durie?

    <p>Te Whare Tapa Wha (A)</p> Signup and view all the answers

    Which diameters are measured to diagnose fetal position during birth?

    <p>Bisacromial and bitrochanteric diameters (C)</p> Signup and view all the answers

    What defines a first-degree tear during childbirth?

    <p>Injury to the perineal skin and/or vaginal mucosa. (A)</p> Signup and view all the answers

    What is the responsibility of the midwife in terms of Manaakitanga?

    <p>To share the goal of a safe, healthy outcome (C)</p> Signup and view all the answers

    Which of the following correctly describes a third-degree tear?

    <p>Involves both the external and internal anal sphincter. (B)</p> Signup and view all the answers

    What does Pepara refer to in a cultural context?

    <p>Father (C)</p> Signup and view all the answers

    Which of the following describes the role of kaumate?

    <p>Elders (A)</p> Signup and view all the answers

    What is the outcome of deep transverse arrest during labor?

    <p>The occipito-frontal diameter gets trapped in the transverse outlet. (A)</p> Signup and view all the answers

    What must happen within 5 working days following a delivery?

    <p>Notification of birth must be completed by the midwife (D)</p> Signup and view all the answers

    Which muscles are cut during a mediolateral episiotomy?

    <p>Transverse perineal, bulbocavernosus, iliococcygenus, and pubococcygenus. (B)</p> Signup and view all the answers

    What is a characteristic of a midline incision compared to other types?

    <p>It is associated with an increased risk of extension. (B)</p> Signup and view all the answers

    What happens to the occiput during the short rotation phase of birth?

    <p>It rotates 45° or 1/8 of a circle anteriorly. (C)</p> Signup and view all the answers

    Which hormone stimulates growth and the development of LH receptors in granulosa cells?

    <p>FSH (D)</p> Signup and view all the answers

    What is the primary reason for the ovum's limited survival after ovulation?

    <p>It is prone to degradation within hours. (D)</p> Signup and view all the answers

    How does syngamy prevent multiple sperm fertilizing an ovum?

    <p>Through a change in the electrical potential of the ovum. (D)</p> Signup and view all the answers

    How long does the zygote typically remain in the ampulla of the fallopian tube?

    <p>24 hours (C)</p> Signup and view all the answers

    What happens during the cleavage of the zygote as it moves towards the uterus?

    <p>The number of cells increases but not their total size. (A)</p> Signup and view all the answers

    When does the first cell division into the two cell stage occur after fertilization?

    <p>30 hours (C)</p> Signup and view all the answers

    What is the name of the solid cluster of blastomeres formed by day 3 after fertilization?

    <p>Morula (D)</p> Signup and view all the answers

    At what gestation week can fetal breath movements first be detected?

    <p>10 weeks (A)</p> Signup and view all the answers

    What is the separation timing for monochorionic-monoamniotic (MCMA) twins?

    <p>8-13 days (B)</p> Signup and view all the answers

    What is the optimal timing for the MSS1 combined test?

    <p>9-10 weeks (C)</p> Signup and view all the answers

    Which test involves taking 10-15mL of amniotic fluid for testing?

    <p>Amniocentesis (D)</p> Signup and view all the answers

    What is the mortality rate of twin-to-twin transfusion syndrome (TTS) if left untreated?

    <p>80-90% (A)</p> Signup and view all the answers

    What is formed when uterine secretions pass through the zona pellucida into the morula?

    <p>Blastocyst cavity (B)</p> Signup and view all the answers

    Which structure develops into the fetal part of the placenta?

    <p>Trophoblastic layer (D)</p> Signup and view all the answers

    What defines the region beneath the site of implantation?

    <p>Decidua basalis (B)</p> Signup and view all the answers

    During which stage does surfactant production begin in fetal development?

    <p>Weeks 21-25 (A)</p> Signup and view all the answers

    What is the purpose of the trophoblastic layer before the placenta forms?

    <p>Nourish the fertilized ovum (A)</p> Signup and view all the answers

    Which layer of cells develops into the nervous system and skin?

    <p>Ectoderm (D)</p> Signup and view all the answers

    At which day after fertilization does the blastocyst begin implantation?

    <p>Day 6 (D)</p> Signup and view all the answers

    What forms the bilaminar disc around day 7?

    <p>Both hypoblast and epiblast cell layers (B)</p> Signup and view all the answers

    Flashcards

    Whakapapa

    Acknowledging the woman and her family's lineage.

    Karakia

    Spiritual blessings or prayers used by Maori families.

    Cultural Competence (Midwifery)

    Understanding and respecting diverse cultures in midwifery care; acknowledging personal biases and integrating patient cultural preferences into care.

    Manaakitanga

    Kindness, hospitality, and care for others, especially in Maori culture; ensuring a respectful environment for both the birthing person and the wider family.

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    Notification of Birth (BDM9)

    A form completed by the midwife within 5 working days of delivery to report a birth to the relevant authorities.

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    Adoption (Interim/Final Order)

    Legal process for adopting a child, with interim orders signed 12 days from birth and a final order at least six months after; requires birth registration and involvement of social workers.

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    Te Whare Tangata

    Represents the birthing person as a person deserving of respect, nurture, and protection within their community.

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    Mana

    Prestige, respect, and importance in Maori culture.

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    Occipito-posterior position (birth)

    Fetal head's occiput positioned posteriorly during birth, causing persistent occipito-posterior position.

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    Deep Transverse Arrest position

    Fetal head's occipito-frontal diameter gets caught in the transverse diameter of the pelvic outlet.

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    First-degree tear

    A tear affecting only the perineal skin and vaginal mucosa.

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    Second-degree tear

    Tear involving perineal muscles but not the anal sphincter.

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    Third-degree tear

    This involves the anal sphincter, with varying severity.

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    Fourth-degree tear

    Tear including the anal sphincter and anorectal mucosa.

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    Mediolateral episiotomy

    Episiotomy incision beginning in the midline of the vulva and extending backward.

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    Biparietal diameter

    9.5cm- the distance between the two parietal bones of the fetal skull.

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    BDM27 Form

    A birth registration form completed by both parents within 2 months of birth.

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    BDM167 Certificate

    Death certificate required for stillbirths before burial/ cremation, issued within 5 days of death.

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    Vertex Presentation

    Fetal head presentation where the occiput (back of head) portion is prominent and fully flexed.

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    Face Presentation

    Baby's head is presenting with the face first, necessitating specific birth procedures dependent on the face location.

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    Occipitoposterior Position (OP)

    Fetal presentation where the occiput is positioned towards the mother's sacrum.

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    Long Rotation

    Fetal head's rotation that happens as descent continues, aiming the sagittal suture towards the anterior diameter of the pelvic outlet.

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    Controlled Drugs (Intrapartum)

    Midwives can prescribe morphine, fentanyl, and pethidine for labor, birth, and immediate postpartum use.

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    Fetal Positions

    Different ways a baby can position its head and body during birth, which influence the birthing process.

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    Midline Episiotomy

    An incision made from the fourchette directly down to the anus during childbirth, associated with less pain and bleeding, but increased risk of extension.

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    Anterior Episiotomy

    An incision made on the anterior perineum, sometimes necessary for women with specific types of female genital mutilation.

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    Suture Technique

    Suture process: starting above the apex, from vaginal to muscle to subcutaneous layers, with continuous sutures for each layer.

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    FSH and LH

    Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate follicle growth and oestrogen production, with LH particularly targeting theca cells.

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    Sperm Viability

    Sperm can survive 24 hours in the female reproductive tract, needing 4-10 hrs to fertilize. Ovum 12-24 hours.

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    Syngamy

    The process preventing multiple sperm from fertilizing the ovum; zone changes the environment with electrical potential and composition changes.

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    Zygote Movement

    A zygote moves from the fallopian tube to the uterus in 3-4 days after fertilization, undergoing cleavage divisions.

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    Morula and Blastomeres

    A morula is a solid cluster of 12-15 blastomeres formed by cleavage around day 3; enclosed within the zona pellucida.

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    Fetal breath movements

    Can be detected as early as 10 weeks gestation and mature around 28 weeks. These movements are important for lung development.

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    DCDA Twins

    Dizygotic twins, or fraternal twins, who have separate placentas and amniotic sacs. This means they have different genetic makeup.

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    Fetus Papyraceus

    A deceased twin that remains in utero. The body becomes flattened and mummified.

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    Twin-to-Twin Transfusion Syndrome (TTTS)

    A serious condition that affects monozygotic twins (identical twins) where they share the same placenta. One twin receives more blood flow than the other.

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    MSS1 Test

    A maternal serum screening test done between 9-13 weeks and 6 days. It measures two markers (PAPP-A and BhCG) and includes a nuchal translucency scan.

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    Morula

    A solid ball of cells formed after a fertilized egg undergoes several cell divisions.

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    Blastocyst

    A hollow ball of cells that forms from the morula. Contains an inner cell mass and a trophoblast.

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    Trophoblast

    Outer layer of cells surrounding the blastocyst. Develops into the fetal part of the placenta.

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    Inner cell mass

    Inner grouping of cells within the blastocyst. Develops into the embryo, yolk sac, and amnion.

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    Implantation

    The process where the blastocyst attaches to the uterine lining.

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    Syncytiotrophoblast

    Outer layer of the trophoblast. Responsible for releasing enzymes that break down the uterine lining and create spaces for blood vessels.

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    Cytotrophoblast

    Inner layer of the trophoblast. Forms chorionic villi, which connect the fetus to the placenta.

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    Decidua basalis

    Region beneath the site of implantation. Develops into the maternal part of the placenta.

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    Study Notes

    Whakapapa and Acknowledgement

    • Acknowledgement of the woman and her whanau is crucial.
    • Whakapapa provides context and respect.

    Karakia and Te Reo Māori

    • The use of Karakia (prayers) and Te Reo Māori is encouraged during the birthing process.
    • Language and cultural practices should be respected.

    Whanaungatanga

    • The importance of involving whanau in the birthing process.
    • Others involved, such as midwives, should be included.

    Mana, Hau Ora, and Tikanga Whenua

    • Maintaining the dignity of the woman and her whanau is essential.
    • Promoting physical, spiritual, emotional and mental wellbeing is key.
    • Connecting to land, life, and nourishment is a core principle.
    • Knowledge and support from elders are necessary.

    Te Whare Tangata and Mokopuna

    • The woman is acknowledged and respected as a person.
    • Recognizing the role of the mokopuna (future generations)
    • Importance of creating a supportive and healthy environment.

    Manaakitanga and Te Whare Tapa Wha

    • Midwives, as key persons, share the goal of a safe and healthy birth with the woman and her whanau.
    • The Te Whare Tapa Wha model of holistic healthcare provides support.

    Cultural Competence

    • Midwives must recognize the impact of their own culture and beliefs on their practice.
    • Acknowledge different cultures to provide individualized care.
    • Acknowledge and understand the dynamics of power within health care relationships.

    Adoption

    • The interim order is submitted 12 days after birth.
    • The final order occurs at least 6 months later.
    • Social workers and state agencies are involved.
    • Individuals can request birth parent information after 19 years of age and block contact with birth parents after 20 years of age.

    Registration

    • Notification of birth (BDM9) is required within 5 working days of delivery.
    • Both parents complete a registrar of birth (BDM27) within 2 months of birth, including personal details and citizenship.
    • A death certificate (BDM167) is compulsory for stillbirths, registered within 3 days of disposal.
    • Cases reported to the Coroner must be notified to the Registrar.
    • BDM9, BDM167, and BDM27 are legally necessary for stillbirths.

    Prescribing

    • Midwives with the necessary education can prescribe controlled drugs.
    • Morphine and fentanyl are permitted.
    • Pethidine is allowed during labour and immediately postpartum.

    Fetal presentation

    • Descriptions of various fetal presentations (vertex, face, brow).
    • Specific measurements and locations.
    • Descriptions of complications (e.g. occipito-posterior, deep transverse arrest).

    Birth injuries

    • First, second, third, and fourth-degree tears.
    • Specific details about each tear grade.

    Midline and Anterior Episiotomy

    • Descriptions of the surgical incision.
    • Explanation of how to suture the incision.

    Maternal Health Indicators

    • FSH, LH and the functions of the hormones.
    • Ovum and sperm survival in the reproductive tract.
    • Descriptions of stages in the development of the blastocyst.
    • Descriptions of the development of trophoblast & inner cell mass.
    • Descriptions of the decidua and implantation.
    • Pregnancy and gestational weeks.
    • Maternal serum and blood markers for screening
    • Descriptions of amniocentesis and CVS procedures.
    • Assessment of preterm, late preterm, and extremely preterm pregnancies.

    Maternal conditions

    • Complications like preeclampsia, gestational hypertension, diabetes, and anaemia.

    Delivery of the Placenta

    • Latent phase, Detachment phase, and Expulsion Phase.

    Types of Birth

    • Description of different types of birth (vaginal, caesarean) and complications.

    Variations in Pregnancy and Delivery

    • Variations in pregnancy and delivery, such as; complications, infections & diseases that must be understood and addressed in a timely fashion.

    Newborn conditions

    • Neonatal conditions, such as; jaundice, encephalopathy and congenital conditions.

    Infections

    • Causes and management of various infectious diseases in pregnancy and immediately postpartum.
    • Examples of infections, and management.

    Other important conditions

    • Maternal and fetal conditions that must be addressed during pregnancy, and labour, and for immediate follow-up care.
    • Examples, and descriptions.

    Medications

    • List of medications, their dosages, routes of administration, and side effects.

    Variations in newborn conditions

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    Description

    Explore the significance of Māori cultural practices in the birthing process, including the role of whakapapa and whanau. This quiz emphasizes the importance of karakia, te reo Māori, and holistic well-being in maternal care. Delve into the principles of manaakitanga and the supportive environments created for mothers and future generations.

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