Ch 13-14 Labor & Birth Processes Flashcards
Factors Influencing Labor Initiation
- Uterine stretch
- Progesterone withdrawal- pregnancy mx hormone
uterus gets crampy and then goes into labor - Increased oxytocin sensitivity
- body’s natural hormone that is UTERUS specific and makes it contract
- nipple stimulation is #1 method to increase oxytocin
Pro: When done in moderation, it can get labor going
Con: no control on amount of oxytocin you produce. Can hyperstimulate uterus
- Increased release of prostaglandins
- softens cervix and thins it out, effaces
Premonitory signs of labor
cervical chgs lightening (relief) increased energy (nesting) bloody show (mucus plug) braxton hicks spontaenous rupture of membranes (water break)
Regular Stronger over time Increasing discomfort UC’s continue despite position 5 min apart x2 hours
true labor
Irregular No increase in intensity Localized pain (front) UC’s come and go with position changes Fluids helps
false labor
5 p’s
Passenger - this is where position of baby is covered
Passageway
Powers
Position - most confusing - of the MOTHER, not of fetus
Psyche (psychological response)
Passenger (fetus)
size (macrosomia) presentation lie attitude position placenta
what can you ask mom to do if baby is LOT?
positioning
If diamond is closer to anterior and triangle is posterior, it is …
OP
If diamond is L and triangle is R, it is …
LOT
most desirable position & presentation
cephalic, OA
the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
(longitudinal vs transverse)
Lie
which is most subjective
station
is true cephalopelvic disproportion common or rare?
COMMON
who would have problems w/ cervical dilation?
those w/ a leap
anyone w/ HPV w/ tissue removal
anyone w/ D&C or D&E (scar tissue)
what is a good indication that someone’s pelvic msks are strong?
good shape
effacement
shortening
dilation
opening of cervix
Cardinal movements
EDFI
ExExEx
entering of the biparietal diameter (widest) into the pelvic inlet.
Engagement
The baby’s head (presenting part) moves deep into the pelvic cavity and is commonly called lightening. – greatest at deceleration phase of 1st stage and during 2nd stage of labor
descent
occurs during descent, brought about by resistance felt by the baby’s head against the soft tissues of the pelvis. Smallest diameter of the baby’s head presents into the pelvis
flexion
head reaches pelvic floor & rotates to accommodate for changes in diameter of the pelvis. Baby must move from sideways to facing posterior
internal rotation
head passes through pelvis at nape of neck and there is a rest. Occurs as head, face, and chin are born
extension
after baby’s head comes out, it sucks back in a little & rotates to face down
external rotation
last big relieving push which results in baby
expulsion
Involuntary uterine contractions
primary powers
PUSHING
Bearing-down efforts
Augment the primary powers
secondary powers
responsible for effacement and dilation
divided into frequency
duration
intensity
primary
not letting the patient push so that primary powers can work baby down further into pelvis
effective for only 1 hr
longer the labor, the greater the risk of infx.
laboring down
epidurals before what CM increases csection rate?
3 cm
during transition, what position should they not be in? what postition should they be in?
NOT lithotomy. OK to have counterpressure and squatting, hands & knees = takes weight off back (can deliver baby on hands & knees)
What affects psyche?
Maternal exhaustion Length of labor Labor support Fear Chronic illness Pregnancy related illness
Lightening Braxton Hicks contractions Increased vaginal mucous Weight loss (0.5-1.5kg) Energy surges Diarrhea N/V Indigestion Loss of operculum
preceding labor
Uterine distention
Increasing intrauterine pressure
Regular, rhythmic contractions
Loss of operculum
onset of labor
Stage 1 labor - from _____________ to __ cm
3 sub stages & their cm
onset of labor to 10 cm
Latent- 0-3 cm
Active- 3-7 cm
Transition- 7-10 cm
Stage 2 labor - from ____ to _________
10 cm through delivery of fetus
Latent- passive descent and rotation
Active- active expulsion efforts
Completed within 2-3 hours
Stage 3 labor: delivery of ______ through ______
delivery of fetus through placenta
Completed within 30 minutes
Stage 4 labor: first _____ of postpartum recovery.
what is a big complication in stage 4?
first 1-2 hours of postpartum recovery; reestablishment of homeostasis - big thing right now b/c hemorrhage
little cuts around periurethral area and skin. biggest problem: getting them to void - give warm soapy bottle for periurethral - may not require repair b/c vag is vascular and heals quickly. may heal b/c it’s bleeding + cosmetic
1st degree
goes through skin, portion of vag wall & anal wall
3rd degree
goes through perineal skin & msk - always gets repaired
2nd degree
tear between vag floor & rectum - must be repaired through each layer of muscle.
4th degree
biggest fear in 4th degree tear?
interventions
going to the bathroom
Give them sitz bath, medications, stool softener, hydrate, ice packs, tucks, foley
greatest risk in 3rd/4th degree tears?
risk of infection
- -good hygiene
- -wipe front to back
- -NOTHING in the vagina for at least 6 weeks (tampons, penises, etc)
What can you do to prevent perianal tearing?
stretch
mineral oil/baby shampoo
