CH 13 - Labor & Birth Process Flashcards
Factors Influencing the Onset of Labor (4):
- uterine stretch
- progesterone withdrawal
- increased oxytocin sensitivity
- increased release of prostaglandins
Premonitory Signs of Labor
-cervical changes: softening, dilation
-lightening: baby is coming down & mom can breathe better
-increased energy level: nesting
-bloody show
-braxton hicks contractions: false labor contractions
-SROM: spontaneous rupture of membranes aka time to deliver
True v False Labor
- timing
- strength
- discomfort
- change in contraction activity - true labor will not go away
- change in cervical dilation - key
- stay or go - depending on dilation
5 P’s Affecting Labor & Birth
- passageway (birth canal - pelivs and soft tissues) can be tight and still be ready to deliver
- passenger (fetus and placenta) is baby breached? sideways?
- powers (contractions) need to be good to deliver
- position (maternal) squatting? laying down flat? birth ball?
- psychological response - the more relaxed, the faster the birth will go. if pt is relaxed, cervix will relax, and she will dilate faster
Additional Factors Affecting Labor Process
-philosophy (low tech, high touch) walking around
-partners (support caregivers) can make labor better or worse, rub mom, get ice chips etc
-patience (natural timing)
-pt preparation (childbirth knowledge base) no unknown = less fear
- pain control (comfort measures) epidural etc
Passageway: Soft Tissues
Cervix: thins thru effacement to allow presenting part to descent into vagina
-pelvic floor muscles - need to be soft and relaxed to allow baby to come thru
-vagina - if pts 1st baby then it has to stretch a lot
Passenger: Fetus
- fetal skull (size, fontanelles, sutures)
- fetal attitude (flexion or extension) want flexion
- fetal lie (position of long axis) vertex = head down, breached = butt 1st, transverse = side lying, longitudinal = up and down
- fetal presentation (cephalic, breach, shoulder)
- fetal position (O= occiput, L - left, R - right, A= anterior, P = posterior, T = transverse) Ex: ROA, LOP
- fetal station (relation to level of the ischial spines) +2, -1, etc
- fetal engagement - movement into pelvis, when the baby drops down
Passenger: Fetal Skulls Details
-largest and least compressible structure
-sutures: allow for overlapping and changes in shape (molding) ; help identify position of fetal head
Fontanelles: intersections of sutures
-baby can come out conehead (shape of vagina)
-don’t want to deliver breached baby bc we want head to come out 1st since its the biggest
Passenger : Fetal Presentation
- Cephalic (vertex):
-military = up and down
-brow
-face = wont be getting the baby out, doing c section - Breech
-frank = legs are up by the face - check hips to make sure everything ok
-full or complete breech = just sitting there
- footling or incomplete = single or double - 1 ft out first or 2 feet coming out - usually c section but may do vag for 2 feet only - shoulder
Passenger: Fetal Position
Landmarks:
OMSA - what comes out 1st
O = occipital bone - vertex presentation
M= mentum - chin - face presentation
S = sacrum - buttocks - breech presentation
A = acromion process - scapula - shoulder presentation
Passenger: Fetal Station
the higher the (-) negative # = the higher up the baby
the higher the (+) positive # = the lower the baby
-4
-3 – baby up higher
-2
-1
0 — baby in the middle
+1
+2
+3 – baby coming down, deliver
+4
Passenger : Fetal Engagement
-presenting part reaching 0 station
-floating: no engagement, presenting part freely movable about pelvic inlet ; not a good thing
- if we help the delivery then baby needs to be at least at +2
Cardinal Movements of Labor
Extension & Rotation
Decent & Engagement
Flexion & Expulsion
Powers
-uterine contractions = main powers
-bearing down = mom at 10 cm
-contractions are involuntary - they thin & dilate cervix
-measure from the beginning to the beginning of each contraction
3 parameters:
-frequency -every 2-4 minutes
-duration - 60-80 seconds
-intensity - mild, moderate, strong
Physiologic Responses to Labor: Maternal
-slight temp elevation (100s +)
-muscle aches/cramps
-increased BMR
-decreased blood glucose levels - mom not eating anything so give NS or LR. Diabetics will have blood sugar checks every hour.
