HEART AND HANDS MIDWIFERY PREP PART 1 Questions and Answers

HEART AND HANDS MIDWIFERY PREP PART 1 Questions and Answers What are the components of prenatal care? NutritionnExercisenNon-allopathic healingn herbologyn homeopathynMind body integrationn yogan meditationnTests and screeningnRoutine UrinalysisnVitalsnPalpationn fetal heart monitoringn fundal height n fetal growth What information should be discussed during the initial phone call? Why home birth?nWhat are you looking for in a midwife?nRule out risknCurrent health, partner, and pregnancy historynpersonal philosophy of care and back up plan What is the most important task of the initial interview? to determine compatability Social insincts Lead us to make socially recognized choices Biological instincts survival and self realization: deeply rooted When may HIPAA be broken? 1. If it is believed that the care provider's life is in danger or someone else's life, safety or property are in dangern2. Evidence or suspicion of child, disabled or elderly person abuse or neglectn n3. court order What are you required to disclose in the initial visit? insurance and legal status What two serious complications should be discussed early in care? PP hemorrhage and possible need for resuscitation (procedure and indications) What preexisting conditions are contraindicated for home birth? DiabetesnHypertensionnHyperthyroid disordernChronic lung diseasenSevere asthmanClotting disordernEpilepsynCongenital heart diseasenKidney diseasenExtreme obesity What conditions that may arise during pregnancy are contraindicated for home birth? Rh-/ with antibodiesnSevere anemianCancernAcute viral infections: Rubella, CMV, Toxoplasmosis, Chicken pox, Herpesnor any of the preexisting conditions listed What lifestyle factors and conditions may be contraindicated for home birth? Unresolved STInChronic malnutritionnDrug addictionnModerate/Frequent alcohol usenSmoking What abortion method is least traumatic to the uterine lining? Suction What two abortion-related factors may effect placental implantation? D&C, post abortion sepsis What is the rate of uterine rupture for VBAC with low transverse scar and stimulant induction? 1% What labor stimulant is associated with uterine rupture? Misoprostol/Cytotec (6% rate) What are the risks of Cesarean section? Sepsisnperforation of organsnScarring of the uterine liningn increased risk of future abnormal placental implantationnHemorrhagenIncreased risk for adhesionsn3.6X greater chance of death What factors decrease risk of rupture and increase chances for successful VBAC? Double layer suturingnLow transverse incision (uterine layer)nNo other uterine surgeriesnAt least 18 months since cesareannUS of placenta is favorable nClient lives less than 20 min from hospital What therapeutic options may be effective for healing emotional VBAC scars? HypnotherapynEye movement desensitization and reprocessing (EMDR)nSupport groups and Organizations (ICAN) List the main symptom of fibroids Painless bleeding with intercourse What are fibroids? How can they effect pregnancy? Fibroids are benign uterine masses. Fibroids experience considerable growth during pregnancy. If inside the uterus, may cause IUGR by restricting space, or cause abnormal placental implanation What is one treatment option for fibroids? Green tea How can cervical scarring be softened near term? Evening primrose oil massaged into the tissue List the gynecoligical surgeries that may effect pregnancy Cervical cone biopsynCervical cauterization or cryosurgerynLEEP (correlation w/ incompetent cervix and preterm labor) Concerns to consider for client with a history of IUD use AnemianScarring (Predisposes for ectopic pregnancy or irregular implantation or the placenta, and hemorrhage PID and IUD use have two similar effects on pregnancy AnemianUterine scarring History of hormonal contraception may cause deficiency of what nutrient? Folic acid What is the window for rupture of ectopic pregnancy? 10-13 weeks What are the main symptoms of ectopic pregnancy? Bleeding, non-rhythmic pain unaffected by position change In the third trimester, bleeding and non-rhythmic pain amy indicate what serious complication? Placental abruption What conditions should be ruled out if a client is experiencing chronic brown bleeding? Molar pregnancy, missed abortion/incomplete miscarriage What is varicella? Chicken pox What may be indicated by repeated episodes of painless bleeding? placenta previa Generalized edema may indicate ...? Diet concernsnPossible preeclampsia (after 26 weeks)nif before 24 weeks, refer for consultation What should be done to treat generalized edema? Eliminate processsed foodsninclude high quality proteinninclude fresh veggiesnsalt food to taste What are some preeclampsia warning signs? headaches, visual disturbances, epigastric pain The normal fluctuations of what substances may cause headaches in pregnancy? Hormones Why is a history of flu-like symptoms important? May indicate a dangerous viral infection By trimester, what is the fetal risk of being infected with toxoplasmosis? 1st: 15%n2nd: 30%n3rd: 60% How can a pregnant woman avoid contracting toxoplasmosis? Avoid uncooked meat and fishnAvoid changing the litter boxnWear gloves when gardening and wash produce Toxoplasmosis "Toxoplasmosis is known to cause severe neurological damage to the fetus, but only if contracted after 10 wks. Mothers can minimize their chances of contracting toxoplasmosis by avoiding uncooked meat and any contact with cat feces," (p. 16) What is varicella? Varicella is chicken pox and can be extremely dangerous in pregnancy. p. 16 What is cytomegalovirus? "Cytomegalovirus is a farily common infection--60% of the general population has antibodies--and is most damaging in the 1st trimester," p. 16 Define hyperemesis gravidarium. Nausea and vomiting that is chronic and self perpetuating. May be unable to retain food or liquid and may require IV therapy. Theories of causes include emotional issues or elevated estrogen levels irritating the liver. Hyperemesis gravidarium: herbal remedy Ginger Root. Three times daily. Fresh grated in tea or ground in capsules. Common complaints of early pregnancy: Fatigue. List 2 possible causes. 1. elevated hormone levelsn2. anemia, esp. if combined with dizziness or nausea beyond the 1st trimester. (p. 17) Urinary Tract Problemsn(list symptoms) Symptoms of UTIn1. stingingn2. urgencyn3. pain after urinationnmay be nearly absent in pregnancy due to progesterone's softening effect on the urethra (p. 17) PyelonephritisnDefine and Describe Consequences on Pregnancy Pyelonephritis is a kidney infections. Kidney infections can lead to premature labor. (p. 17) Teratogen. Define "Any substance that can harm the fetus or cause fetal anomalies is called a teratogen," (p. 17) Describe Continuity of Care and it's importance to midwifery practice. "Midwives typically provide comprehensive, continuous prenatal care. By doing so, they get to know clients well enough to have some sense of what to anticipate at the birth. Careful prenatal assessement is the cornerstone of effective midwifery practice...Every mother's condition is unique and can only be appreciated by regular contact," (p. 17) Health History: History of Abortion. Describe potential implications for pregnant woman and this pregnancy/birth. --type of procedure(suction less traumatic than D &C, D&C more likely to cause scarring.n--emotional effects?n--any issues with bleeding or infection?n--did she receive rhogam if rh neg? Gynecological Surgeries: cervical procedures used to remove abnormal cells may result in scarring that retards dilation. List 3 such cervical procedures 1. cone biopsyn2. cervical cauterizationn3. cryosurgeryn(p. 15) Gynecological Surgeries: cervical procedures. List something a midwife can suggest to a client to help with scar tissues. "Scar tissue can be softened by evening primrose oil massaged gently onto the cervix during the last few weeks of pregnancy," (p. 15) Gynecological Surgeries: List the two problems with pregnancy/labor that are correlated with the LEEP procedure. 1. incompetent cervixture labor Gynecological History: Fibroids: Describe the impact of Fibroids on childbearing. "These benign uterine masses vary in size but tend to grow considerably during pregnancy...pregnancy may be affected by reduced intrauterine space or disrupted placental implantation and the immediate postpartum may be complicated by hemorrhage," ( p. 15) Family History: List two conditions the midwife should ask about. 1. hypertensionn2. diabetes Herpes: What is the most dangerous trimester for the fetus for an initial outbreak of herpes? The first trimester is the most dangerous time for an initial outbreak, (p. 16) Herpes: True or False. Some midwives permit vaginal birth. True. "If lesions are present externally, but not in the immediate path of the baby some midwives permit vaginal birth. Lesions must be covered with surgical adhesive film or spray on bandage," (p. 16). Obstetrical History: List 9 things the midwife should ask about a woman's obstetrical history. abruption, fetal distress, prior transports, hemorrhage, shoulder dystocia, neonatal asphyxiation, previous stillbirth, perceived losses/disappointments, child spacing (p. 14) Contraceptive History: "If the mother used oral contraception immediately prior to pregnancy, she may be deficient in ___________ and should be advised to begin supplementation at once." folic acid (p. 16) Naegele's Rule Naegele's Rule is a formula for calculating estimated date of delivery. Take the first days of her last menstrual period, count back three months and add one week. (p. 18) Define LMP the first day of a woman's last menstrual period. List medical and high risk factors for pregnancy. (13) diabetes, thyroid disease, active tuberculosis, chronic lung disease, sever asthma, epilepsy, clotting abnormalities, rh neg with antibodies, severe anemia, acute viral infection, congenital heart disease, renal disease, extreme obesity (pp. 19-20) List lifestyle and personal factors that are high risk in pregnancy. (5) 1. tobacco usen2. Malnutritionn3. Drug addictionn4. Moderate to heavy alcohol use.n5. Heavy caffeine use. (p. 20) Define the dangers associate with diabetes to the fetus and woman. "Fetal demise after 36 weeks, 5 x the normal incidence of fetal abnormalities, increased polyhydramnios, 30-50% higher incidence of preeclampsia, increased incidence of prematurity and newborn respiratory difficulties. (p. 19) Describe the impact of active tuberculosis on childbearing. 1. slightly higher risk of premature laborn2. slightly higher risk of miscarriagen3. after birth: baby must be separated from the mother if the mother is infectious High risk factors in pregnancy: epilepsynDescribe the impact of epilepsy on pregnancy. "Dangers: Anticonvulsant drugs may cause folic acid deficiency, which when treated with folic acid may cause seizures. the infant may develop deficiency of coagulation factors,"(p. 19) Afibrinogenemia, hypofibrinogenemia, excessive fibrinalytic activity are examples of __________________. clotting disorders (p. 19) High Risk Factors in Pregnancy: Clotting Disorders. Describe the impact of clotting disorders on pregnancy. "Dangers: can lead to maternal bloodl loss, shock or death," (p. 19). List two dangers to the fetus/baby when the mother is rh - with antibodies. 1. hemolytic anemian2. fetal or neonatal deathn(p. 20) Name 5 dangers to the mom or baby associated with severe anemia, including hereditary anemia like Thalassemia B or sickle cell, or nutritional anemia (iron, B12 or folic acid.) 1. maternal infectionn2. prolonged laborn3. IUGRn4. hemorrhagen5. fetal hypoxia during labor List 4 dangers to the fetus associated with more than 10 cigarettes daily. 1. IUGRn2. miscarriagen3. congenital heart diseasen4. fetal hypoxia in labor Risk Factors: Lifestyle and Personal: Drug Addiction. List up to dangers to fetus or mother associated with drug addiction. 1. IUGR, 2. fetal hypoxia, 3. respiratory distress syndrome, 4. maternal malnutrition, 5. infection, 6. preeclampsia, 7. dysfunctional labor, 8. hemorrhage, 9. baby withdrawal from cocaine, crack or amphetamines, (p. 20) High Risk Factors: Lifestyle and Personal: Heavy Caffeine Use. nWhat are the impacts of heavy caffeine use (in excess of 10 cups a day)? "Dangers: Fetal malformations, heart defects, reproductive problems," (p. 20) True Pelvis and False Pelvis. Describe the difference between the True and False Pelvis. "The true pelvis includes all dimensions from the inlet downward and the false pelvis includes the illiac crests or hip bones, above. Though disconcerting, this terminology serves to illustrate that hip size is unreliable in predicting pelvic capacity," (p. 25). Describe how you would do a bimanual exam to size the uterus and confirm EDD. 16 wks or less. "Press up firmly on the cervix while using your other hand to palapate the fundus. As you bring your hands together, you will get an idea of how large the uterus has grown. 10wks: around pubic bone, 12 wks: a few cms above pubic bone., 16 wks: midway between pubic bone and umbilicus (p. 23) Prenatal care: check her urine: Ketones. What does the presence of ketones signal? Ketones in the urine "signal inadequate food intake or dehydration," (p. 21) Establishing baseline reflexes is suggested early in prenatal care. nWhy? "Since heightened reflexes can be a signal of preeclampsia, it's wise to establish baseline reflexes as soon as possible," ( p. 21)/. Name the five steps/assessments that made when performing pelvimetry. 1. assess the depth of the sacral curves the size of the pelvic inletn3. assess the contours and distance between the ischial spinesn4. assess the angle or width of the pubic archn5. assess the outlet dimension or the intertuberous diameter. Name the four basic pelvis types gynecoidnandroidnplatypelloidnanthropoidn(p. 24) Describe the android pelvis. "prominent close set spines,tapering sidewalls, narrow pubic arch (less than 80 degrees), and close set tuberosities," (p. 25). Name the four pelvic joints. 1. symphysis pubis jointn2. sacrococcygeal jointn3 and 4. two sacroiliac joints Name and describe the "3 Ps" 1. passage is defined as the bony pelvis and musculature, 2. the passenger is the baby and how it is presenting, 3. the powers refer to uterine activity during labor (p. 25). During a typical prenatal a midwife may make the following 4 physical assessments of the mother. 1. check her weightn2. check her urinen3. check her blood pressuren4. check her pulse Fetal Lie. Define fetal lie and list the three possible fetal lies. "Fetal lie--the relationship of the baby to the long axis of the mother's body,"nlongitudinal, oblique or transverse (p. 28). Define denominator Whatever the presentation, the denominator is the part of the baby's body that is used to determine the position of the baby. (p. 28) List the denominator for each of the following presentations:ncephalic, breech, shoulder cephalic--occiputnbreech--sacrumnshoulder--scapula Define presentation. Presentation describes part of the baby that is in the pelvis. In a longitudinal lie the presentation is either cephalic or breech. In a transverse lie the shoulder presents. (p. 28) Define attitude. Attitude describes the degree of fetal head flexion. Define fetal position. Fetal position describes the location of the denominator within the mother's pelvis. For example, a head down baby with it's occiput on the mother's right size is right occiput transverse (ROT) p. 30 What is the norma rate ofl Fetal Heart Tones? 120-160 beats per minute, in younger babies the FHT may be up to 170, (p. 30) Check for variability: Variability typically occurs in response to _________(3) and is considered a sign of _____________ health. FHR accelerates in response to palpation, uterine contractions or the baby's own movements and is a sign of neurological health. What does a Complete Blood Count, or CBC comprise? CBC typically test for red blood cell count, hemoglobin, hematocrit, white blood cell count (leukocytes) and platelets among other things. Define hemoglobin. A woman's hemoglobin should be above _____ when pregnant. Hemoglobin enables the transport of oxygen. Hemoglobin should be above 11. Define Hematocrit. Hematocrit is the precentage of red blood cells per total blood volume. Hematocrit values on the CBCshould be 33 or more, (p. 35). Lab work: Syphilis Screen: describe the risk of syphilis to the pregnant woman and her fetus. "Syphilis can casue miscarriage, prematurity, neonatal infection, fetal malformation or death," (p. 36). Lab work: Syphilis Screen: A woman who does not have syphilis will have a ____ test result. nonreactive or (NR)