Doula Training Class 5: Complications & Interventions PDF

Doula Training & Mentorship Class 5: Complications & Interventions Interventions Interventions generally occur due to one of the following: Risk/complication management Induction Augmentation Pain management Interventions Snapshot Typically only occur in hospital settings! Comm...

Doula Training & Mentorship Class 5: Complications & Interventions Interventions Interventions generally occur due to one of the following: Risk/complication management Induction Augmentation Pain management Interventions Snapshot Typically only occur in hospital settings! Common Complications About Pregnancy Complications Certain conditions and diagnoses may deem a pregnant woman high risk. High risk pregnancies are typically required to be followed by an MD (either OBGYN or MFM – maternal fetal medicine). It is always recommended that any client seeking to have a vaginal delivery first consult with a certified nurse midwife (CNM). In the event that the patient has a condition that must be monitored by an MD, the midwife may still be able to collaborate in providing care. Hyperemesis Gravidarum (HG) Increases likelihood of: dehydration | perinatal depression | nutritional imbalances What is it? Extreme nausea and vomiting which does not resolve after the 14th week of pregnancy, and typically persists until the delivery of the infant. What causes it? Recent studies have shown that it is caused by hormones. Studies are linked in the course resources. What cures it? Typically, there is no cure, and symptoms subside once the woman is no longer pregnant. Traditional remedies for nausea are ineffective in reducing the symptoms associated with HG.  Increases likelihood of: Placenta Previa hemorrhage | cesarean What is it? A condition where the placenta either partially or fully covers the cervix (the neck of the uterus). Can present early in pregnancy and is usually detected by 20 weeks. What causes it? The placenta implants seemingly randomly. It can attach to any wall of the uterus. Past cesarean births, scar tissue and other issues with the uterine lining/walls can cause the placenta to attach in a less-than-ideal location. What cures it? If the placenta is low-lying and only partially covering the cervix, it will likely move out of the way as the uterus expands. Some (severe) cases, however, do not resolve, and thus make a vaginal delivery dangerous. Placental Abruption Increases likelihood of: hemorrhage | preterm delivery| cesarean | NICU What is it? When the placenta prematurely separates (either partially or fully) from the wall of the uterus, causing extreme bleeding. This puts the fetus at risk as it eventually no longer receives oxygenated blood or nutrients from the placenta. Most commonly occurs during third trimester. What causes it? Severe physical trauma, high blood pressure and uterine infection are common causes. What cures it? In cases of partial separation, the pregnancy may continue to progress as normal with additional supervision. In cases of full separation, the infant will likely need to be delivered urgently. Intrauterine Growth Restriction Increases likelihood of: low birth weight | What is it? preterm delivery | NICU When fetal growth is limited during pregnancy. Typically, fetuses measuring in the 10th percentile or lower are considered at risk for IUGR and require more frequent appointments and additional imaging. What causes it? Issues with placental function prevent the fetus from receiving adequate nutrients. What cures it? Delivering the baby early is typically recommended so that nutrition can be addressed and improved outside of the uterus via breastmilk or formula. Gestational Diabetes Increases likelihood of: macrosomia | cesarean | NICU What is it? Diabetes that develops during pregnancy in a mother who did not previously have diabetes. What causes it? The body’s inability to make enough insulin during pregnancy. Risk factors include lack of exercise, obesity/overweight, unhealthy diet, family history of diabetes, history of gestational diabetes in prior pregnancy. What cures it? In most cases, gestational diabetes is monitored with frequent glucose testing and dietary maintenance. In severe cases, medication may be prescribed. Preeclampsia Increases likelihood of: preterm delivery | cesarean | What is it? NICU A condition in pregnancy that is characterized by severely high blood pressure, fluid retention and protein in the urine. What causes it? The exact cause is not known. Chronic hypertension, obesity and family history of preeclampsia are risk factors. The occurrence is higher among the black community. What cures it? The only cure is to delivery the fetus, which ends the pregnancy. In most cases of preeclampsia, induction is recommended. Low dose aspirin is recommended for patients who have at least one risk factor. Let’s discuss! Additional Pregnancy Complications Rh incompatibility Insufficient cervix Recurrent UTIs or kidney infections Low amniotic fluid (can also occur during labor) Additional Labor Complications The most common labor complication is hemorrhage. Communicable diseases such as genital herpes, HIV, etc. Chorioamnionitis Cord prolapse Shoulder dystocia Stillbirth Common Interventions  Clinical Induction Jumpstarting or expediting labor Method Purpose Pros Cons Dinoprostone (cervidil) To soften the cervix Is topical and generally Can be painful “the tampon” does not affect baby Causes bleeding Misoprostol (cytotec) To soften the cervix Can sometimes be given in May cause fetal heart “the abortion pill” outpatient setting, can decelerations cause contractions to begin Foley bulb To open the cervix Is manual and generally Is typically painful “the balloon” does not affect baby, can be administered in outpatient setting Pitocin To start or augment Can cause a pattern of The contractions are “synthetic oxytocin” contractions strong, consistent significantly more painful contractions Can cause fetal distress Manual rupture of To augment Can relieve pressure in the Will put the client on a membranes contractions/engagement uterus and cause baby to timeclock “breaking the water” descend further Increased risk of infection Less Invasive Induction Scientifically Proven Not Scientifically Proven Nipple stimulation Pineapple Sex Spicy food Membrane sweep (or even Eggplant cervical checks) Castor oil/midwives brew (only to be used under the direction of a midwife) Let’s discuss!  Medication Type Reason Pros Cons Antibiotics To treat an infection in the Rids the birth canal of bacteria May require monitoring mother such as GBS or chorio so a vaginal birth is still May be associated with infant possible digestive issues IV NSAIDs To reduce pain Offers temporary relief in early May not be effective in labor, safe for the baby reducing pain Ineffective in the later stages of labor IV narcotics To reduce pain May offer some temporary Crosses the placenta relief from contraction pain and Baby needs to be monitored pressure postpartum Epidural To minimize the sensation of Client is typically more Can stall labor contractions comfortable and sometimes Reduces mobility able to sleep Does not reduce pressure General To put patient in a state of full Quickest way to ensure the Risk of aspiration anesthesia sedation in emergency patient will tolerate surgery Does not allow patient to (cesarean only) situations experience the birth Standard Interventions During Labor There are various “recommendations” during labor that are part of protocol at most hospitals. These recommendations are interventions in disguise. Though they are “standard practice”, they are not necessary practice, and can lead to additional interventions. We refer to this as the cascade of interventions. “Starting an IV” – why? Is the client dehydrated? Did the client request it? Can lead to pushing fluids  narcotic pain meds  epidural Fetal monitoring – why? Has the fetus shown signs of distress? Can lead to too much information  provider anxiety  maternal anxiety Can also lead to stationary labor  lack of maternal mobility  lack of progress Cervical exams – why? Has the client requested to be examined? Can lead to rupture of membranes  being rushed  augmentation Pitocin to help deliver placenta/early postpartum – why? Does the client have risk of or show signs of hemorrhage? Assisted Deliveries Forceps Vacuum Excessive force Episiotomy Occasionally, in order to prevent a cesarean delivery, a clinician may recommend as assisted delivery. This is a delivery that utilizes one or more tools or physical maneuvers to successfully deliver the baby. Avoiding Intervention: Labor Preparation Throughout Pregnancy Stretching/prenatal yoga throughout pregnancy Regular care with the prenatal care network Chiropractic care, pelvic floor therapy, acupuncture Beginning at 36 Weeks Miles Circuit Curb walking Prostaglandins/cervical ripeners 6 dates a day Semen Evening primrose oil (oral and suppository) Let’s discuss! Let’s discuss! Until Next Class… Things to think about Things to do How might your biases show Review and memorize the up when educating clients on Miles Circuit: interventions? www.milescircuit.com Research shoulder dystocia and the role of the doula in this type of delivery