10: Labor and Post-Partum Flashcards
When does lightening occur with labor?
Within a week prior to delivery
What is lightening with labor?
Increased pressure on the pelvis and bladder causing frequent urination
What is happening with the fetus during lightening?
The head is settling into the pelvis
When are Braxton-Hicks likely?
Beginning of second trimester but more common closer to delivery
What is effacement?
Thinning of the cervix secondary to prostaglandins
What is the length of the normal cervix?
1.5-2” long
What is dilation of the cervix?
Cervix gradually opened from 0-10cm
What is station?
Relationship of the top of the baby’s head or presenting part to the spines of the pelvic bone
If the baby is stationed above the ischial spine, is it a positive or negative value?
Negative
If the baby is stationed below the ischial spine, is it a positive or negative value?
Positive
What does it mean if the station of the baby is “floating”?
-4 above the ischial spine
What does it mean if the station of the baby is “crowning”?
+4 below the ischial spine
What is the function of the mucous plug?
Prevents bacteria from getting to the uterus
What is the “bloody show”?
When the mucous plug is dislodges due to the softening of the cervix
What type of contractions happen with true labor?
Consistent, intensity increases, and contraction interval decreases
What type of contractions happen with false labor?
Inconsistent, intensity and interval does not change
How will walking effect true and false labor?
Tue labor: discomfort stays
False labor: discomfort relieved
Does the cervix dilate with false labor?
No
When is the first stage of labor?
Occurring from the onset of true labor until the cervix is completely dilated
What is early first stage labor?
4 cm dilated, 10-20 minutes between contractions
What is the active first stage of labor?
8 cm dilated, 5 minutes between contractions
What is the transition first stage of labor?
Up to 10 cm dilated, 1-2 minutes between contractions
What is the second stage of labor?
Occurring from complete cervical dilation until delivery
What is the third stage of labor?
Delivery of the placenta
What are some factors that can affect labor?
- Position of baby’s head
- Size of baby
- Pelvic anatomy
- Effectiveness of contractions
- Physical and emotional stage
- Medications
How is this baby positioned, and is it optimal?
Occiput anterior, is optimal
How is this baby positioned, and it is optimal?
Occiput posterior, is not optimal
What is the 7th leading cause of maternal deaths?
Anesthesia
What is the drug of choice for delivery?
Nubain
When is birth recommended after Nubain administration?
Birth not recommended within 4 hours of administration
What are maternal complications with Nubain?
- Decreased respiration
- Nausea and vomiting
- Slowing of labor
- Drowsiness
What are fetal complications with Nubain?
- Decreased fetal activity
- Decreased respiration
- Decreased Apgar
- Respiratory acidosis
Where are local anesthetics injected?
Perineum
Where is a pudendal block administered?
Injected through the vaginal wall blocking the pudendal nerve along each side of the cervix to numb the vaginal walls and perineum
Describe epidurals during pregnancy?
Thin catheter is injected into the epidural space and medication is administered as a bolus or continuous drop
What type of anesthesia is given for c-sections?
Spinal
What are side effects of epidurals?
- Maternal hypotension (fetal compromise)
- Decreased ability to push
- Increase/decrease length of labor
- Spinal block and transient headache
What is the chance of an ineffective epidural?
15%
When is general anesthesia administered?
Never during labor - used via endotracheal tube for emergencies
What are maternal risks for using general anesthesia?
- Aspiration
- Respiratory depression
- Post-partum uterine atony
What are fetal risks for using general anesthesia?
- Respiratory depression
- Hypotonicity
- Hyperbilirubinemia
What is back labor?
Feeling contractions in the low back that can interfere with the mother’s ability to relax
What is a common cause of back labor?
Occiput posterior position
What is coccydnia?
Pain in coccyx related to delivering baby in occiput posterior position resulting in hyperextension of coccyx
What areas are evaluated with Apgar?
- HR
- Color
- Breathing
- Muscle tone
- Reflexes
What values would result in getting 0 Apgar points?
- HR absent
- Blue/pale color
- Absent breathing
- Absent/flaccid dont
- No reflexive response
What values would result in getting 1 Apgar point?
- HR < 100
- Pink body, blue/pale hands/feet
- Irregular breathing
- Some movement
- Grimaces
What values would result in getting 2 Apgar points?
- HR > 100
- Pink
- Crying
- Active movement
- Responds to stimulation
What is an episiotomy?
Incision made into the perineum between vagina and anus
Describe a midline incision episiotomy
4-12x more likely to experience rupture of the anal sphincter, will heal more quickly
Describe a mediolateral incision episiotomy
More painful, increased trauma to PFM, more scar tissue
What is a first-degree episiotomy?
Laceration extends through the skin and superficial structures above the muscles, heals well
What is a second-degree episiotomy?
Laceration extends through the muscles of the perineum
What are the consequences of second-degree episiotomy?
Scarring, incontinence, and difficulty with intercourse
What is third-degree episiotomy?
Laceration extends into the external anal sphincter
What are the consequences of third-degree episiotomy?
May experience difficulty holding back gas or fecal matter
What is fourth-degree episiotomy?
Laceration extends into the anterior wall of the rectum - internal and external anal sphincter involvement
What are the consequences of fourth-degree episiotomy?
Fecal incontinence, unable to differentiate between gas and fecal matter
What are indications to use forceps during delivery?
- Maternal exhaustion, decreased pushing
- Posterior position of baby’s head
- Fetal distress
What are consequences for the mother following use of forceps?
More likely to have pain with intercourse, longer healing time, more scar tissue, 2x as likely to experience fecal incontinence
What are consequences for the mother following use of vacuum extractor?
Pain with intercourse, longer healing time, more scar tissue production
What is shoulder dystocia?
Head is delivered but then shoulders do not fit through pelvic outlet
What are maternal risks during shoulder dystocia?
Post-partum hemorrhage, cervical/vaginal lacerations, ruptured pubic symphysis
What are fetal risks during shoulder dystocia?
Humerus or clavicle fracture, Erb’s Palsy, asphyxia, death
What is CVP?
Cephalopelvic disproportion - baby is too big or pelvis is too small that can lead to fetal distress
What are the four indications for a c-section?
- CVP
- Breech
- Placenta problems
- Cord problems
What is a footling breech?
One foot delivers first with increased risk for cord prolapse
What is a complete breech?
Buttock presents with LE’s crossed
What is a frank breech?
Buttock presents with LE’s extended
What is a transverse breech?
Horizontal position
What are three placenta problems that will indicate a c-section?
- Placenta previa
- Abruptio placentae
- Aged placenta
Describe the effects of an aged placenta
Decreased ability to provide nourishments to the baby after 42 weeks of gestation leading to LBW
What happens with a prolapsed cord?
Cord slides out of the cervix - medical emergency because the pressure on the cord decreases blood flow to the baby
When is a prolapsed cord likely to occur?
- Preterm birth
- Breech
- Head is not well engaged in the pelvic with ROM
What is VBAC?
Vaginal birth after cesarean - recommended
When are you cleared to exercise post partum?
4-6 weeks
Will weight loss impact milk supply?
No
What exercise can you resume after pregnancy?
Gradual return to pre levels, lifting, high impact. PFM training and aerobic
When do the breasts become engorged?
2-3 days post-partum
What can cause a blocked duct?
- Nursing from one breast
- Changes in feeding frequency
- Over abundant supply
- Heavy breast tissue not well supported
- Tight bra or underwire
What is mastitis?
Breast infection of the tissue surrounding the blocked duct
When can mastitis occur?
1-4 weeks post-partum
What are symptoms of mastitis?
- Red, sore, hard areas
- Red streaking
- Fever and chills
- Flu-like
