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OB > 6.1b Second Stage of Labor > Flashcards

6.1b Second Stage of Labor Flashcards

1
Q

Second Stage of Labor

A
  • Begins at full cervix dilation and ends at birth of baby
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2
Q

Length of Second Stage Factors

A
  • Age
  • BMI
  • Emotional State
  • Adequacy of Support
  • Level of fatigue
  • Fetal size/position/presentation
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3
Q

Second Stage Labor Time Limit

A

First birth
3 hours without epidural
4 hours with epidural

Multiple birth
2 hours without epidural
3 hours with epidural

Prolonged second stage occurs when limits have been exceeded

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4
Q

Latent Phase

A
  • Passive descent
  • Patient is often quiet and relaxed
  • Not a strong urge to bear down

DELAYED PUSHING

  • Increases duration of second stage of labor
  • Increases risk of hemorrhage/infection
  • Decreases pushing time
  • Reduction in likelihood of operative vaginal birth
  • Improvements in chance of vaginal birth
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5
Q

Active Phase

A
  • Pushing descent phase
  • Ferguson reflex - Strong urge to bear down activated by baby passing through stretch receptors of the pelvic floor
  • Oxytocin is released to produce stronger contractions
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6
Q

Objective Sign of Second Stage of Labor

A
  • Inability to feel cervix during vaginal examination
  • This means that it is fully dilated and effaced
  • Sometimes patients want to bear down prematurely before cervix is fully dilated. Encourage them to breathe through their contractions or assume side lying/hands-knees position to prevent pushing.
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7
Q

Symptoms of Second Stage of Labor

A
  • Increased frequency/intensity of contractions
  • Urge to push (feels like need for bowel movement)
  • Vomiting
  • Increased bloody show
  • Uncontrolled shivering
  • Verbalization of inability to cope
  • Involuntary bearing down efforts
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8
Q

Physical Assessment during 2nd stage of labor

A
  • BP, Pulse, RR every 5-30 minutes
  • FHR every 5-15 minutes (depending on risk)
  • Assess vaginal show, signs of descent, changes in appearance/mood/energy/partner involvement every 10-15 minutes
  • Assess every contraction and bearing down effort
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9
Q

Latent Phase Interventions

A
  • Help patient rest to conserve energy

- Promote fetal descent by encouraging position change, pelvic rock, ambulation and showering

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10
Q

Active Phase Interventions

A
  • Do not leave patient alone
  • Help patient change positions and encourage bearing down
  • Help patient relax between contractions
  • Provide comfort/pain relief
  • When head is emerging patient should pant during contractions and gently push between
  • Inform patient regarding progress
  • Offer mirror to watch birth
  • Encourage patient to touch fetal head when visible
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11
Q

Labor Positions

A
  • Important to help baby navigate through pelvis
  • Changing positions provides relief and pain management
    POSITIONS
  • Standing/walking (gravity)
  • Sitting (gravity)
  • Squatting (relieves pressure off back)
  • Hands-Knees (takes pressure off spine)
  • Leaning/Kneeling Forward (relieves pressure of back)
  • Stay active in early active labor
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12
Q

Latent Phase

A
  • Passive descent, not too intensive contractions
  • Station 0-2
  • No urge to bear down
  • Patient is quiet
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13
Q

Active Phase

A
  • Contractions become overwhelmingly strong/expulsive
  • Contractions happen every 2-3 minutes and eventually every 1-2 minutes
  • Contractions last around 90 seconds
  • Fetal station is at 2-4
  • Significant increase in dark red bloody show
  • Increased urge to bear down
  • Patient may start grunting
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14
Q

Bearing Down

A
  • Ferguson Reflex

- Prolonged breath holding

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15
Q

Bearing Down Techniques

A
  • Valsalva maneuver (closed glottis pushing) is discouraged. Causes intrathoracic and cardiovascular pressure which reduces cardiac output and perfusion to placenta
  • Open glottis pushing for 6-8 seconds is encouraged
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16
Q

FHR

A
  • Concern if baseline slows, minimal variability or late/prolonged
  • First action is to turn patient to their side
  • Second action administer oxygen at 10L/min through non-rebreather mask
  • If these do not help, notify provider
17
Q

Supporting Normal Labor

A

Step 1 - Allow labor to begin on its own
Step 2 - Encourage freedom of movement
Step 3 - Provide support and decrease use of epidural anesthesia
Step 4 - Avoid routine implementation of interventions
Step 5 - Support non-directed pushing in non-supine positions to shorten labor
Step 6 - Encourage skin to skin contact after birth and foster early breastfeeding

18
Q

Vertex Position Phases

A
  1. Birth of head
  2. Birth of shoulders
  3. Birth of body/extremities
19
Q

Crowning

A
  • Biparietal diameter (widest pat of head) distends the vulva before birth.
  • When the babies head becomes visible
20
Q

Episiotomy

A
  • Incision to enlarge the perineum

- Done around the time you see crowning

21
Q

Hands-On Birthing Approach

A
  • Prevents fetal intracranial injury and protects maternal tissue
22
Q

Ritgen Maneuver (modified)

A
  • Apply pressure from coccygeal region to extend head during birth
23
Q

Nuchal Cord

A
  • Umbilical cord encircles the neck.

- Either untangle the cord or clamp the cord twice and cut between the clamps

24
Q

Time of Birth

A
  • Precise time when entire body is out of the mother
  • Allow immediate skin to skin contact and delay cord clamping if conditions allow for it.
  • Do not clamp umbilical cord for 1-5 minutes after birth (or when cord stops pulsating)
  • Optimal time is around 3 minutes
25
Q

Lotus Birth

A
  • Cord is never clamped or cut

- Cord and placenta remain attached until cord naturally separates a few days after birth

26
Q

Post-Birth Care

A
  • Focuses on assessment and stabilizing the baby
  • At least 2 nurses should be present
  • 1 nurse focuses on newborn while the other nurse helps physician with placenta delivery
  • Assessment is done immediately even if during skin to skin contact
  • Priorities include maintaining patent airways, supporting respiratory effort, preventing stress by drying the baby and covering in a warm blanket.
27
Q

Perineal Trauma

A
  • Warm compress, perineal massage, and stretching may decrease trauma
  • Massage during last month of pregnancy has shown to work for first time vaginal births
  • Usually nulliparous patients have more pronounced trauma
28
Q

Perineal Trauma Risk Factors

A
  • Maternal Nutritional Status
  • Birth position
  • Pelvic anatomy
  • Fetal presentation
  • Fetal position (breech, occiput)
  • Large babies (macrosomic)
  • Use of forceps or vacuum
  • Prolonged 2nd stage of labor
  • Rapid labor
29
Q

Perineal Laceration Degrees

A

1st degree - Superficial skin/structures
2nd degree - Extends through muscle
3rd degree - Extents through anal sphincter
4th degree - Extends through anal sphincter and rectal mucosa

30
Q

Vaginal Vault Lacerations

A
  • Circular

- Results from forceps use, rapid fetal descent, or precipitous birth (rapid birth)

31
Q

Cervical Injuries

A
  • Most are shallow with minimal bleeding

- If there are extensive lacerations, surgeon may artificially enlarge the cervix or deliver before full dilation

32
Q

Episiotomy

A
  • Procedure to enlarge the vaginal outlet
    Midline Episiotomy - Higher incidence of 3-4 degree lacerations
    Mediolateral Episiotomy - More painful
  • Should be avoided if possible

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