2 Labor & Birth processes

Question 1

Premonitory signs of labor

Answer 1

Lightening
Increased braxton hicks
Cervical effacement/dilation
Loss of mucous plug, bloody show
SROM
Sudden burst of energy (nesting)
Wt loss 1-3lbs
Increased back ache, pressure
Indigestion (N/V)

Question 2

True labor signs

Answer 2

Contractions: regular intervals, increasing frequency, duration, intensity

Discomfort in back (radiates to front of abdomen

Cervical effacement/dilation

Contractions do not decrease with rest

Intensity increases with walking

nothing stops contractions

Question 3

False labor signs

Answer 3

Irregular contraction pattern with no change in intensity,duration,frequency

Discomfort in abdomen

Walking has NO effect or can lessen contractions

No cervical changes

Question 4

Five factors: process of labor and birth
The 5 P’s

Answer 4

Passengers:
Fetus and placenta

Passageway:
Birth canal

Powers:
Contractions

Position (of mother)

Psychological response

Question 5

The passenger

Fetal head

Answer 5

Least compressable/largest

Sutures
fontanels-anterior and posterior

Molding(head shift)
Overriding sutures (bones overlap)

Question 6

Variations in passenger

Fetal attitude

Answer 6

Relationship of fetal parts to eachother:

Flexion(what we want)

Extension

Question 7

Fetal Lie

Answer 7

Relationship between lie of mother and fetal spines

Longitudinal (spines are parallel)

Transverse(baby side ways)

Question 8

Fetal presentation

Answer 8

What part is presenting 1st

Cephalic
-occiput, face (brow/chin)

Breech:
Complete, frank, footling

Shoulder:
Probably transverse

Question 9

Breech types and complications

Answer 9

Complete:chris cross
Frank: feet up in face
Footling: foot coming thru birth canal

Complications:
Prolapsed cord
Passage of meconium (1st stool)

Usually end in c-section

Question 10

Fetal position

Answer 10

Relationship of landmark on fetus to the maternal pelvis

Right or left of maternal pelvis

Landmark presenting:
Vertex: occiput(O), Chin (M), Brow(B)
Breech: sacrum (S)
Shoulder: scapula (SC)

Anterior, posterior, transverse in pelvis

Question 11

engagement

Answer 11

when the widest diameter of the presenting part passes thru the pelvic inlet

Question 12

Descent and station with engagement

Answer 12

0 +1 +2 shows decent of fetus

Anything still in negatives(-) means baby isnt descending yet

Question 13

Powers: contractions
Primary
Secondary

Answer 13

Primary : involuntary, contractions
Effacement (0-100%)
Dilation (0-10cm)

Secondary: voluntary bearing down

Question 14

Descriptions of contractions
Freq,intensity,duration,resting tone
IUPC (intrauterine pressure catheter)

Answer 14

Frequency: start of 1 contraction to start of another

Intensity: test with IUPC, or palpation
Mild(tip of nose) moderate(chin) strong (forehead)

Duration: start to finish

Resting tone: rest between contractions
-lack of this can lead to uterine rupturee

IUPC: has to have ROM to place/can measure intensity

Question 15

Positioning-maternal

Answer 15

Upright(preferred)
Lateral

Changing position and moving around:
Facilitates fetal descent and rotation

Squatting:
enlarges pelvic diameter
Facilitates fetal descent

cant do these if have a epidural

Question 16

Psychological response

Answer 16

Clear info about procedure
Support
Self confidence
Trust staff
Positive reaction to the pregnancy
Personal control over breathing
Preparation for the childbirth experience

Question 17

Process of labor
4 stages

-first stage (3phases)

Answer 17

Onset of regular uterine contractions to full dilation of cervix (longest of all)

-latent phase(0-3cm)- longest phase

-active phase(4-7cm)-more rapid dilation and descent of fetus

-transition phase(8-10cm) shortest phasse:
contraction q2-3minutes

Question 18

Process of labor

-2nd stage

Answer 18

From the time the cervix is full dilated to the birth of the infant (pushing)

Question 19

Process of labor

3rd stage

Answer 19

From the birth of the infant until placental separation and expulsion

-uterus rises upward
-umbilical cord lengthens
-sudden trickle of blood released from vagina
(tells us placenta has deattached)

Question 20

Process of labor

4th stage

Answer 20

Immediate recovery period from delivery of placenta to stabilization of maternal systemic responses and contraction of the uterus

Approx: 1-2hrs

Question 21

Maternal systemic response to birth

Cardiovascular

Respiratory

Answer 21

Cardio:
Increased CO, HR
Increased BP with contractions

Resp:
Increased RR
Hyperventilation d/t anxiety/pain
Increased O2 demand
Diaphoresis

Question 22

Maternal systemic response to birth

Renal

GI

Endocrine

Immune system

Answer 22

Renal:
Full bladder slows fetal descent

GI:
N/V (Gastric emptying is delayed)
Risk of aspiration

Endocrine:
Decreased blood glucose

Immune system:
Increased WBC
Temperature elevation (no greater than 100.4)

Question 23

Fetal response to labor

Baseline FHR
Acceleration and deceleration

Answer 23

Baseline: 110-160

Moderate variation in FHR:
Periodic FHR accells and decels
decels need to be classified by type

Decrease in circulation and perfusion during contractions
-bc uterus clamps down