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Samenvatting Blok 2 - Ouders en kind in de hoofdrol
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,Table of ContentsHet Benige Baringskanaal .............................................................................................................................................................................................................................. 9
Anatomie – Bekken .......................................................................................................................................................................................................................................................................... 9
Anatomie – Ligamenten van bekken.............................................................................................................................................................................................................................................. 10
Anatomie – Bekkensoorten............................................................................................................................................................................................................................................................ 10
Anatomie – Benige Baringskanaal .................................................................................................................................................................................................................................................. 11
Afmetingen – Benige Baringskanaal .............................................................................................................................................................................................................................................. 11
Vlakken van Hodge......................................................................................................................................................................................................................................................................... 12
Anatomie – Foetale Schedel .......................................................................................................................................................................................................................................................... 12
Afmetingen – Foetale schedel........................................................................................................................................................................................................................................................ 13
Het Weke Baringskanaal .............................................................................................................................................................................................................................. 13
Anatomie – Weke Baringskanaal ................................................................................................................................................................................................................................................... 14
Innervatie – Weke Baringskanaal ................................................................................................................................................................................................................................................... 14
Anatomie – Bekkenbodemspieren ................................................................................................................................................................................................................................................. 15
Anatomie – Buikspieren ................................................................................................................................................................................................................................................................. 15
Standen & Baringsmechanismen .................................................................................................................................................................................................................. 16
Baringsmechanismen – Definities ............................................................................................................................................................................................................. 16
Notatie (stand) – NL ....................................................................................................................................................................................................................................................................... 16
Notatie (stand) – ENG .................................................................................................................................................................................................................................................................... 16
Posities van kind............................................................................................................................................................................................................................................................................. 17
Spildraaifactoren ............................................................................................................................................................................................................................................................................ 18
Baringsmechanismen – Hoofdliggingen..................................................................................................................................................................................................... 18
Achterhoofdsligging (voor) ............................................................................................................................................................................................................................................................ 18
Achterhoofdsligging (achter) ......................................................................................................................................................................................................................................................... 20
Kruinligging .................................................................................................................................................................................................................................................................................... 22
Voorhoofdsligging .......................................................................................................................................................................................................................................................................... 23
, Aangezichtsligging .......................................................................................................................................................................................................................................................................... 25
Wandbeenligging ........................................................................................................................................................................................................................................................................... 27
Hoge rechtstand ............................................................................................................................................................................................................................................................................. 28
Diepe dwarsstand .......................................................................................................................................................................................................................................................................... 30
Incidentie ....................................................................................................................................................................................................................................................................................... 31
Spierweefsel ................................................................................................................................................................................................................................................. 31
Anatomie – Skeletspier .................................................................................................................................................................................................................................................................. 31
Fysiologie – De Contractie.............................................................................................................................................................................................................................................................. 33
Fysiologie – Contractiecyclus ......................................................................................................................................................................................................................................................... 35
Soorten Spierweefsel ..................................................................................................................................................................................................................................................................... 36
Glad Spierweefsel (unitair)............................................................................................................................................................................................................................................................. 37
Het Myometrium .......................................................................................................................................................................................................................................... 38
Uterus tijdens de zwangerschap .................................................................................................................................................................................................................................................... 38
Anatomie & Fysiologie – Myometrium .......................................................................................................................................................................................................................................... 39
Het begin van de baring ............................................................................................................................................................................................................................... 40
Hormonen – vóór de baring ........................................................................................................................................................................................................................................................... 40
Hormonen – tijdens de baring ....................................................................................................................................................................................................................................................... 40
Het op gang komen van de baring ................................................................................................................................................................................................................................................. 42
Het verloop van de (fysiologische) baring ..................................................................................................................................................................................................... 42
Belinstructies.................................................................................................................................................................................................................................................................................. 42
Het eerste tijdperk – de ontsluiting ........................................................................................................................................................................................................... 43
De latente fase ............................................................................................................................................................................................................................................................................... 43
De actieve fase ............................................................................................................................................................................................................................................................................... 44
De overgangsfase ........................................................................................................................................................................................................................................................................... 45
Baringshoudingen .......................................................................................................................................................................................................................................................................... 45
Het tweede tijdperk – de uitdrijving ......................................................................................................................................................................................................... 46
De persfase .................................................................................................................................................................................................................................................................................... 46
, Het derde tijdperk – de nageboorte .......................................................................................................................................................................................................... 47
Loslaten van de placenta ............................................................................................................................................................................................................................................................... 47
Fysiologie – Geboorte placenta ..................................................................................................................................................................................................................................................... 48
Medicatie (actief beleid) ................................................................................................................................................................................................................................................................ 49
Het vierde tijdperk – de postplacentaire fase ............................................................................................................................................................................................ 49
Controles postpartum .................................................................................................................................................................................................................................................................... 49
Voorlichting – “pasgeboren” ouders .............................................................................................................................................................................................................................................. 50
Verslaglegging .......................................................................................................................................................................................................................................... 51
Het Partogram................................................................................................................................................................................................................................................................................ 51
Het Partusverslag ........................................................................................................................................................................................................................................................................... 52
VIL – Verloskundige Indicatie Lijst .................................................................................................................................................................................................................................................. 53
De Kraamperiode ......................................................................................................................................................................................................................................... 53
Hormonale veranderingen ............................................................................................................................................................................................................................................................. 53
Lichamelijke veranderingen – Voortplantingsstelsel ..................................................................................................................................................................................................................... 55
Lichamelijke veranderingen – Overige Orgaanstelsels .................................................................................................................................................................................................................. 56
Normaalwaardes – 6 B’s ................................................................................................................................................................................................................................................................ 57
Kraambed – Verhoogde risico op infecties .................................................................................................................................................................................................................................... 58
Kraambed pathologie - Beleving .................................................................................................................................................................................................................................................... 58
Kraambed pathologie – Borsten .................................................................................................................................................................................................................................................... 60
Kraambed pathologie – Urinewegen & Maagdarmstelsel ............................................................................................................................................................................................................. 62
Kraambed pathologie – Uterus & Perineum .................................................................................................................................................................................................................................. 63
Kraambed pathologie – Vaatstelsel ............................................................................................................................................................................................................................................... 65
Kraamvisites & Nacontrole – Maternale controles ........................................................................................................................................................................................................................ 66
Psychologische & Sociale veranderingen....................................................................................................................................................................................................... 68
Bevallingstrauma............................................................................................................................................................................................................................................................................ 68
Het Ouderschapsmodel ................................................................................................................................................................................................................................................................. 69
Seksualiteit ................................................................................................................................................................................................................................................... 70
, Seksuele responscyclus .................................................................................................................................................................................................................................................................. 70
Seks – Zwangerschap ..................................................................................................................................................................................................................................................................... 70
Seks – Post Partum......................................................................................................................................................................................................................................................................... 71
Anticonceptie ............................................................................................................................................................................................................................................... 71
Overzicht Anticonceptie Methodes ............................................................................................................................................................................................................................................... 72
Hormonale Anticonceptie – Hormoonwerking .............................................................................................................................................................................................................................. 73
Anticonceptie Methoden ............................................................................................................................................................................................................................................................... 74
Borstvoeding – Anatomie & Fysiologie ......................................................................................................................................................................................................... 78
Anatomie – Mammae .................................................................................................................................................................................................................................................................... 78
Ontwikkeling van de Mammae ...................................................................................................................................................................................................................................................... 79
De Lactogenese .............................................................................................................................................................................................................................................................................. 80
Fysiologie – Lactatie ....................................................................................................................................................................................................................................................................... 81
Moedermelk - Samenstelling & Soorten ........................................................................................................................................................................................................................................ 82
Borstvoeding vs. Kunstvoeding ...................................................................................................................................................................................................................................................... 84
Borstvoeding geven ...................................................................................................................................................................................................................................... 86
Fysiologie – Drinken aan de borst .................................................................................................................................................................................................................................................. 86
Fysiologie – Aanhappen ................................................................................................................................................................................................................................................................. 87
Borstvoeding geven ....................................................................................................................................................................................................................................................................... 88
Leefstijl moeder ............................................................................................................................................................................................................................................................................. 88
Borstvoedingshoudingen ............................................................................................................................................................................................................................................................... 89
Kolven ............................................................................................................................................................................................................................................................................................ 91
Verloskundige begeleiding ............................................................................................................................................................................................................................................................. 92
De WHO ......................................................................................................................................................................................................................................................................................... 93
De Nederlandse bevolking ............................................................................................................................................................................................................................................................. 93
Borstvoeding & Werken ................................................................................................................................................................................................................................................................. 94
Pijn ............................................................................................................................................................................................................................................................... 95
Soorten pijn .................................................................................................................................................................................................................................................................................... 95
, Soorten zenuwvezels ..................................................................................................................................................................................................................................................................... 95
Soorten Nociceptoren & Neuronen ............................................................................................................................................................................................................................................... 96
Fysiologie – Pijn .............................................................................................................................................................................................................................................................................. 96
De Poorttheorie ............................................................................................................................................................................................................................................................................. 98
De Pijnbeleving .............................................................................................................................................................................................................................................................................. 99
Pijn tijdens de baring .................................................................................................................................................................................................................................... 99
Baringspijn ..................................................................................................................................................................................................................................................................................... 99
Ei van Loeser ................................................................................................................................................................................................................................................................................100
Pijnbestrijding ..............................................................................................................................................................................................................................................................................100
Verloskundige begeleiding ...........................................................................................................................................................................................................................................................103
Wondgenezing ........................................................................................................................................................................................................................................... 104
Fysiologie – Hemostase ................................................................................................................................................................................................................................................................104
Fysiologie – Coagulatiefase ..........................................................................................................................................................................................................................................................105
Fysiologie – Wondgenezing..........................................................................................................................................................................................................................................................106
Soorten Wondgenezing................................................................................................................................................................................................................................................................107
Complicaties – Bloedstolling & Wondgenezing............................................................................................................................................................................................................................107
Beïnvloeding – Bloedstolling & Wondgenezing ...........................................................................................................................................................................................................................108
Letsels – Weke baringskanaal ..................................................................................................................................................................................................................... 108
Rupturen – Weke baringskanaal ..................................................................................................................................................................................................................................................108
Het hechten .................................................................................................................................................................................................................................................................................109
Hechtmateriaal ............................................................................................................................................................................................................................................................................109
Perineumrupturen hechten .........................................................................................................................................................................................................................................................110
Wondbeoordeling en adviezen ....................................................................................................................................................................................................................................................111
Astma......................................................................................................................................................................................................................................................... 112
(Intrinsieke/Extrinsieke) Asthma Bronchiale................................................................................................................................................................................................................................112
Zwangerschap & Astma ...............................................................................................................................................................................................................................................................114
De Nederlandse Geboortezorg .................................................................................................................................................................................................................... 116
, Organisatie van de geboortezorg ............................................................................................................................................................................................................ 116
Landelijk .......................................................................................................................................................................................................................................................................................116
Regionaal......................................................................................................................................................................................................................................................................................117
Individueel....................................................................................................................................................................................................................................................................................118
Bekostiging geboortezorg ....................................................................................................................................................................................................................... 119
Soorten bekostiging .....................................................................................................................................................................................................................................................................119
Zorgverzekeraars..........................................................................................................................................................................................................................................................................120
De Integrale geboortezorg ...................................................................................................................................................................................................................... 120
Geboortezorgvernieuwing ...........................................................................................................................................................................................................................................................120
Integrale bekostiging – voor- en nadelen ....................................................................................................................................................................................................................................121
Evaluatie van de geboortezorg ................................................................................................................................................................................................................ 121
Perined .........................................................................................................................................................................................................................................................................................121
Gegevensverwerking....................................................................................................................................................................................................................................................................122
Tevredenheid - verloskundige zorg ..............................................................................................................................................................................................................................................123
Klachten - verloskundige zorg ......................................................................................................................................................................................................................................................123
VT – Capillaire bloedafname ....................................................................................................................................................................................................................... 125
Vingerprik .....................................................................................................................................................................................................................................................................................125
Hielprik .........................................................................................................................................................................................................................................................................................126
VT – Baring ................................................................................................................................................................................................................................................. 127
Het eerste tijdperk – de ontsluiting ......................................................................................................................................................................................................... 128
Algemene beoordelingen .............................................................................................................................................................................................................................................................128
Vulvair toilet .................................................................................................................................................................................................................................................................................128
Vaginaal toucher ..........................................................................................................................................................................................................................................................................128
Strippen ........................................................................................................................................................................................................................................................................................129
Amniotomie .................................................................................................................................................................................................................................................................................130
Het tweede tijdperk – de uitdrijving ....................................................................................................................................................................................................... 131
, Geboorte neonaat ........................................................................................................................................................................................................................................................................131
Geboorte neonaat – Badbevalling ...............................................................................................................................................................................................................................................132
Afnavelen neonaat .......................................................................................................................................................................................................................................................................133
Navelstreng “complicaties” ..........................................................................................................................................................................................................................................................133
Het derde tijdperk – de nageboorte ........................................................................................................................................................................................................ 134
Geboorte placenta .......................................................................................................................................................................................................................................................................134
Controles Postpartum ..................................................................................................................................................................................................................................................................135
EBM – Descriptieve statistiek ...................................................................................................................................................................................................................... 136
Introductie – Descriptieve Statistiek ............................................................................................................................................................................................................................................136
Evidence Based Midwifery ...........................................................................................................................................................................................................................................................137
Gebruik Richtlijnen .......................................................................................................................................................................................................................................................................137
WCC & SDM ................................................................................................................................................................................................................................................ 139
Woman Centred Care ..................................................................................................................................................................................................................................................................140
Shared Decision Making ...............................................................................................................................................................................................................................................................140
Vertrouwensrelatie ......................................................................................................................................................................................................................................................................142
Geboortewensen .........................................................................................................................................................................................................................................................................143
Communicatie Trainingen – Blok 2.............................................................................................................................................................................................................. 144
ISBARR-methode ..........................................................................................................................................................................................................................................................................144
Informeren & Adviseren ..............................................................................................................................................................................................................................................................145
,Het Benige Baringskanaal
Anatomie – Bekken
12
12
1
1
3
3
4 2 2
5 5
4
8
10
10
6 6
9
7
7 11
11
• Os sacrum - heiligbeen Os ileum 1 spina iliaca anterior superior = sias 7 foramen obturatorium
• Os coxae - heupbeen Os pubis 2 spina iliaca anterior inferior = siai 8 acetabulum
• Os coccygis - staartbeen Os ischium 3 spina iliaca posterior superior = sips 9 linea arcuata
• Symphysis pubica - symfyse 4 spina iliaca posterior inferior = sipi 10 spina ischiadica
• Promontorium 5 incisura ischiadica major 11 tuber ischiadicum
o Linea innominata/terminalis 6 incisura ischiadica minor 12 christa iliaca
• Articulatio sacroiliaca - sacro-iliacale (SI) gewricht
• Articulatio sacrococcygea - sacro-coccygeaal gewricht
Grote bekken – pelvis major Kleine bekken – pelvis minor
, Anatomie – Ligamenten van bekken
Anatomie – Bekkensoorten
Gynaecoïd bekken Vorm bekkeningang - dwars-ovaal
Arcus pubis - wijd, 90° of groter
Vorm kleine bekken - cilinder-vormig
Spinae ischiadicae - stomp
Sacrum - biconcaaf (rond)
Androïd bekken Vorm bekkeningang - driehoekig
Arcus pubis - nauw, 90° of kleiner
Vorm kleine bekken - trechter-vormig
Spinae ischiadicae - steken in
Sacrum - minder concaaf (recht)
Anthropoïd bekken Vorm bekkeningang - voor-achterwaarts ovaal
(verder gelijk aan androïd bekken)
Platypelloïd bekken Vorm bekkeningang - dwars-ovaal en voor-achterwaarts vernauwd
(verder gelijk aan gynaecoïd bekken)
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