ch 16 - intrapartum Flashcards
5 factors affecting labor and birth
passageway (bony pelvis, soft tissues)
passenger (fetus)
powers (contractions and pushing)
position (mom)
psyche
3 physical considerations of maternal pelvis
-size of pelvis (petite women, adolescents)
-shape of pelvis
-ability of soft tissue to permit passage of fetus
4 pelvic shapes
-gynecoid (most common, wide)
-anthropoid (narrow)
-android (flares in)
-platypelloid (flares out)
3 regions of pelvis (top to bottom)
-inlet
-midpelvis
-outlet
3 changes that must happen in soft tissue of cervix and vagina for birth
-cervix must efface
-cervix must dilate
-vaginal canal must distend
(+pelvic floor muscles facilitate fetal rotation)
major bones of fetal skull (4)
-frontal bone (2)
-parietal bone (2)
-occipital bone
-temporal bone
sinciput
forehead
4 sutures of fetal skull
-sagittal suture (down the middle to left and right)
-coronal suture (crown dividing front and back)
-frontal suture (between two frontal bones)
-lambdoid suture (inverted V by occiput)
3 possible presentations
-cephalic
-breech (sacrum or foot)
-shoulder
best presentation for baby to be in for birth
vertex = cephalic with occiput presenting
preferred fetal attitude
chin on chest
fetal position: R/LOP, R/LOT, R/LOA
ROP: right occipitoposterior
ROT: right occipitotransverse
ROA: right occipitoanterior
downsides of R/LOP
-back pain
-slower labor
fetal station (cm)
-5 to +5
0 = ischial spines (engaged)
-5 = at pubic symphysis
+5 = perineum
fergusons reflex
when baby is at +2
irresistible urge to push
benefits to frequent changes of maternal position during labor (4)
-relieve fatigue
-increase comfort
-improves circulation
-facilitates fetal descent and labor progress
factors impacting woman’s psyche during labor (5)
-her perception of the process (negative attitude, fear)
-psychologic and physical prep for childbirth
-sociocultural heritage
-previous childbirth experience
-support from significant others
S+S true labor (5)
-pain in lower back radiates to abdomen
-pain with regular rhythmic contractions
-regular rhythmic contractions
-contractions that intensify with ambulation
-progressive cervical dilation and effacement
S+S false labor (3)
-discomfort localized in abdomen
-no lower back pain
-contractions decrease in intensity or frequency with ambulation
S+S impending labor (10)
-lightening
-braxton hicks contractions
-cervical changes
-loss of mucus plug (bloody show)
-sudden burst of energy (nesting)
-greater frequency urination
-weight loss 1-3 lbs
-increased backache and SI pressure
-possible N/V/D
-ROM
4 stages of labor
stage 1: cervical change and contractions
stage 2: fetal descent and pushing
stage 3: placental
stage 4: recovery
describe current way of describing phase 1 of labor
early/latent: 0 cm - 5.9 cm. effacement, some dilation
active: 6 cm - 10 cm. finish dilation and fetal descent
describe the old way of describing phase 1 of labor
early/latent: 0 cm - 3.9 cm. slight discomfort
active: 4 cm - 7.9 cm. serious “labor”
transition: 8 cm - 10 cm. intense, painful, loss of control
maternal physiologic adaptations to labor
CARDIAC:
-cardiac output (increases 10-15% 1st stage, 30-50% in 2nd stage, peaks 10-30 mins after birth)
-increased HR, RR, temp
-increased bp during contractions
GI:
-N/V
-slowed motility, absorption, stomach-emptying time
RENAL/URINARY:
-decreased awareness of full bladder
-inability to void
-protineuria
OTHER:
-increased WBC
-increased blood glucose
-increased O2 consumption
what degrees C/F represent a fever
100.4 F
38.0 C
fetal physiologic adaptation to labor
-molding of head
CIRCULATORY:
-preferential streaming through shunts
RESPIRATORY:
-production lung fluid stops and absorption starts
-pressure on fetal thorax during birth helps clearance of fluid from airways
-O2 decreases
-CO2 increases
-pH decreases
-fetal resp movements decrease
ability of fetus to compensate for periods of stress (decreased O2)
fetal reserve
4 things that help fetus maintain adequate oxygenation during labor (Fetal reserve)
-fetal oxyhemoglobin
-increased RBCs
-increased CO (heart rate)
-preferential streaming (shunts)
