Ch. 16 Labor and Birth Process Flashcards
1
Q
What five factors affect the birth process? (Five P’s)
A
- Passenger (Fetus and placenta)
- Passageway (Birth canal)
- Powers (Contractions)
- Position of mother
- Phsychologic response
2
Q
Are the first four of the five P’s the basis for the physiologic process of labor?
A
Yes
3
Q
What is included under the category passenger?
A
- Fetal head
- Fetal attitude
- Fetal lie
- Fetal presentation
- Fetal position
4
Q
What is fetal attitude?
A
Attitude is relationship of fetal body parts to each other
5
Q
What is fetal lie?
A
the relationship of the fetal spine to the maternal spine
6
Q
What is fetal presentation?
A
the part of the fetus that enters the pelvic inlet first
7
Q
What is fetal position?
A
relationship of the presenting part to four quadrants of the mothers pelvis
8
Q
Is the fetal head composed of bony parts?
A
Yes
9
Q
What is molding of the fetal head?
A
Overlapping of cranial bones
10
Q
What are sutures of the fetal head?
A
Membraneous spaces between cranial bones
11
Q
What are the fontanels of the fetal head?
A
Intersection of cranial suture
12
Q
Are the anterior and posterior fontanels used as landmarks for assessment before and after birth?
A
Yes
13
Q
What does the front of a fetal head close?
A
Around 18 months (diamond shaped)
14
Q
When does the posterior of the fetal head close?
A
Around 8 weeks (triangular)
15
Q
What make the skull flexible to accommodate the growing fetal brain?
A
Sutures and fontannels
16
Q
Are infants born with a cone head?
A
Yes
17
Q
What are the three main fetal presentations?
A
96% cephalic / vertex (head)
3% breech (butt)
1% shoulder
18
Q
How do we determine fetal presentation?
A
Internal exam, ultrasound, or palpation
19
Q
Do babies who present with a face presentation usually end up being delivered vaginally? Why or why not?
A
No due to potential trauma
20
Q
What fetal presentation is most common?
A
Cephalic
21
Q
What is the presenting part in a cephalic presentation?
A
Occiput
22
Q
Why is cephalic presentation called “sunny side up”?
A
Baby looking up (or down)
23
Q
What does vertex presentation mean?
A
Head completely flexed on chest
24
Q
What does a complete breech presentation mean?
A
Knees and hips flexed
25
What are the presenting parts if a baby is complete breech?
Buttocks and feet
26
What does a frank breech presentation mean?
Hips flexed, knees extended
27
What are the presenting parts if baby is frank breech?
Buttocks
28
What does a footling breech presentation mean?
Hips and legs extended
29
What are the presenting parts of a footling presentation?
One or two feet first
30
Can the fetal lie mean being transverse or longitudinal?
Yes
31
Can a vaginal birth occur if there is a transverse lie?
No
32
In regards to fetal attitude, can deviations from morn cause difficult labors?
Yes
33
What does a normal fetal attitude mean?
Moderate flexion of head, arms on chest, leg flexed on abdomen
34
What is fetal attitude often referred to as?
"Chin up in air"
35
Can babies adapt to birth canal as they move through it?
Yes
36
What are the most common fetal positions?
LOA or ROA (delivery positions)
37
What is the first step in determining fetal position?
1st letter= side of maternal pelvic: left (L) or right (R)
38
What is the second step in determining fetal position?
2nd letter= presenting part of fetus:
- occipital (O)
- mentum (M)
- sacrum (S)
- acromion process (A)
39
What is the third step in determining fetal position?
3rd letter= means in relation to front or back of pelvis:
- anterior (A)
- posterior (P)
- transverse (T)
40
Why is posterior fetal position often the cause of a difficult labor?
Baby is hitting mom's spine causing back pain
41
What is the measurement of the degree of descent of the presenting part through the fetal pelvis?
Station
42
Does the station include the relationship of presenting part to ischial spine in pelvis?
Yes
43
What does -5 station mean?
floating and not engaged (don't feel baby with vaginal exam)
44
What does +5 station mean?
Ready to deliver
45
Is station measured in cm?
Yes
46
What anatomical parts are included in the passageway?
- Bony pelvis
- Lower uterine segment (soft tissue)
- Cervix
- Pelvic floor muscles
- Vagina
47
What does the frequency of contractions mean?
beginning of one to beginning of next
48
What does the duration of a contraction include?
timing of each contraction
49
What does the intensity of a contraction include?
strength as mild, moderate or strong (intrepreted by palpation, what a woman describes with external monitoring)
50
What is the primary powers: forces of labor?
Uterine muscular contractions
51
All contractions include what cycle?
- Increment (building up)
- Acme (peak)
- Decrement (letting up)
52
Does a contraction consist of the frequency, duration, and intensity?
Yes
53
Is the duration of a contraction counted in seconds?
Yes
54
Upon palpation what does a mild contraction feel like?
Tip of the nose
55
Upon palpation what does a moderation contraction feel like?
a chin
56
Upon palpation what does a strong contraction feel like?
Forehead
57
Can a contraction intensity be measured by palpation?
Yes
58
May moms with an epidural not feel involuntary uterine contraction?
Yes
59
What does a contraction signal?
Beginning of labor
60
Is a contraction responsible for dilation, effacement, and descent?
Yes
61
When 10cm voluntary what occurs?
Secondary powers
62
Is dilation 0 to 10cm?
Yes
63
Is effacement thick to thin or 0 to 100%?
Yes
64
Is descent measured by station?
Yes
65
What does a 0 for station mean?
Middle rate meaning engaged
66
Can a baby be delivered without the amniotic sac being ruptured?
Yes
67
What are secondary powers?
Abdominal muscles during second stage of labor (bearing down)
68
Are secondary powers important in the expulsion of the fetus?
yes
69
During secondary powers the presenting part hits what?
The pelvis floor
70
Do secondary powers cause the urge to push?
Yes
71
Does the urge to push depend on pain relief?
Yes
72
What do primary powers include?
- Effacement
- Dilation
- Ferguson reflex (when mom needs to start pushing)
73
What do secondary powers include?
- Bearing down efforts
| - Valsalva maneuver (holding and breathing while pushing)
74
When secondary powers begin can the contraction power subside and the need for piton to help occur?
Yes
75
Does labor begin irregular and become regular?
Yes
76
Can labor be felt in the back and radiate to the front?
Yes
77
Does walking during labor increase intensity?
Yes
78
Does labor cause cervical changes?
Yes
79
Is labor a bloody show?
Yes
80
Does the fetus engage during labor?
Yes
81
Does labor become stronger, last longer, and become more frequent?
Yes
82
Does the position of a laboring women affect labor?
Yes
83
What do frequent changes in position do during labor?
- Relieve fatigue
- Increase comfort
- Improve circulation
84
Does position affect the woman's anatomic and physiologic adaptations to labor?
Yes
85
Should a laboring women be encouraged to find positions most comfortable for her?
Yes
86
What is the process of moving fetus, placenta, and membranes out of uterus and through the birth canal called?
Labor
87
Do various changes take place in woman's reproductive system in days and weeks before labor begins?
Yes
88
What signs are seen preceding labor?
- Lightening or dropping
- Mucous plug
- Bloody show
89
Can the onset of labor be ascribed to a single cause?
No
90
What is include in the mechanism of labor?
The seven cardinal movements
91
What are the seven cardinal movements of labor?
- Engagement (synclitic vs. asynclitic)
- Descent
- Flexion
- Internal rotation
- Extension
- Restitution and external rotation
- Expulsion (birth)
92
What is it called when the fetal head moves into pelvis?
Descent
93
What is it called when the head passes into pelvic inlet?
Engagement
94
What is it called when the head meets resistance of cervix?
Flexion
95
What is it called when the head rotates to fit pelvis?
Internal rotation
96
What is it called when the head is under the symphysis pubis?
Extension
97
What is it called when the head twists and turns to one side?
Restitution
98
What is it called when the shoulders rotate and the head turns?
External rotation
99
What is it called when the shoulders and then body is born?
Expulsion
100
What is the fetal heart rate range and average?
Range =110-160
| Avg=140bpm
101
Why may the baseline fetal heart rate in early gestation be higher?
sometimes higher due to imbalance in neurological system
102
Can most healthy fetuses are well able to withstand the normal stresses of labor and birth and exposure to increased pressure during labor and birth?
Yes
103
1st stage: difficult to determine onset, longest stage,pariety has effect on length of 1st stage, can take >20 hours and includes what three phases?
latent, active and transition
104
Can many factors can affect first stage of labor ( maternal weight, medications, risk status, age, clinical management of labor)?
Yes
105
During the latent phase cervix effaces and woman are often doing what?
breathing, walking, sitting, rocking
106
During the active phase and transition phase are woman more uncomfortable, contractions stronger, asking for pain medicine-cervix dilates, fetus descends?
Yes
107
In what stage of labor is there 10 cm to birth of fetus, 30 minutes to 2 hours(primigravida) 5min-30 min for (multigravida), variable?
2nd stage
108
During what stage of labor is there an increased bloody show. ,client often states I cannot continue, I want a c section, most difficult part of labor?
2nd stage
109
studies have shown that ethnicity may play a role in length of 2nd stage, true or false?
true
110
What stage of labor is birth to delivery of placenta 5-30 min.
Placenta separates and expels
Risk of PP hemm. Increases as stage lengthens
3rd stage
111
What stage of labor is 2 hours after delivery of placenta, observe for complications and pp bleeding
4th stage
112
Does blood pressure increases slightly during labor and are woman already at risk for hypertension due to stress of labor?
Yes
113
Is there and increase in CO for women during labor?
| 400cc blood emptied from uterus into maternal vascular blood stream
Yes
114
Is the mom's heart rate elevated slightly and blood pressure increases slightly during labor?
Yes
115
May there be maternal hypotension in labor which can lead to fetal hypoxia?
Yes (Due to compression of vena cava)
116
Is there an increase WBC’s etiology unknown?
Yes (? Stress, tissue trauma, exercise)
117
-Increased physical activity results in greater 02 consumption
-Anxiety results in increased 02 consumption
-May have hyperventiliation due to rapid breathing
... are what types of changes seen during labor?
Respiratory
118
- Difficulty voiding
- Proteinuria
-GI changes
(Decreased motility-N and V)
... are what types of changes seen during labor?
GI/Renal
119
-System stressed in labor
-Increase muscle use of muscles never used before
-Backache
-Joint pain
-Leg cramps
... are what types of changes seen during labor ?
Musculoskeletal
120
-Life change for both parents
-May worry about unknown and competency
-Fear of loss of control
-Coping skills
-Knowledge helps decrease stress
... are what types of changes seen during labor?
Psychosocial
