Chapter 12 & 15 Flashcards
Exam 1
How far apart should contractions be before you decide to go to the hospital/ birth center?
regular, 5 minutes apart, lasting 1 minute, for 1 hour
A gush or trickle of fluid from the vagina, with or without contractions is what?
a ruptured membrane
When your membrane ruptured should you go to the hospital/ birth center?
yes
If you are bleeding- bright red blood
go to the hospital/ birth center
if you have concerns or feelings that something might be wrong..
go to the hospital/ birth center
Ways to establish a therapeutic relationship with your laboring mother:
*convey confidence
*assign a primary nurse
*use touch for comfort
*respect cultural values
*determine family expectations
Characteristics of contractions
*Coordinated
-Frequency (beginning of one uterine contraction to the beginning of the next)
-Durations (beginning of a uterine contraction to the end of the same contraction)
-Intensity (strength of a contraction)
-Involuntary
-Intermittent
Beginning of one uterine contraction to the beginning of the next
Frequency
Beginning of a uterine contraction to the end of the same contraction
Duration
strength of a contraction
intensity
Contraction Cycle
1.)Increment
2.)Peak or acme
3.)Decrement
period of increasing strength
increment
period during which the contraction is most intense
peak or acme
period of decreasing intensity
decrement
Which part of the uterus contracts actively to push the fetus down during a contraction?
the upper two thirds
Which part of the uterus remains less active during a contraction?
the lower third
During a contraction what is the cervix?
passive
thinning and shortening of the cervix
effacement
opening of the cervix during labor
dilation
What occur concurrently during labor but at different rates?
effacement and dilation
a client who has not completed a pregnancy of at least 20 weeks gestation and will complete most cervical effacement early in the process of cervical dilation
nullipara
a client who has given birth after a pregnancy of a at least 20 weeks of gestation; it also designates the number of pregnancies that end after at least 20 weeks gestation; the cervix is usually much thicker than that of a nullipara at any point during labor
parous
Why does blood flow to the placenta decreases during a contraction?
*the muscle fibers of the uterus constrict around the maternal spiral arteries, which supply the placenta
*there is a relative increase in the woman’s blood volume
*this temporary change increases her blood pressure slightly an slower her pulse rate
When should vitals be assessed during labor?
during the interval between contractions
What may occur if the laboring woman lies on her back during labor?
supine hypotension
Why is the laboring woman encouraged to rest in positions other than supine during labor?
it promotes blood return to her heart and decreases the risk for supine hypotension
What may occur during rapid, deep breathing of labor?
hyperventilation
What may occur as the laboring mother exhales too much carbon dioxide (hyperventilation)?
respiratory alkalosis
What may the laboring mother feel if she is hyperventilating (in resp. alkalosis)?
tingling of her hands & feet; numbness and dizziness
What should the nurse do if the laboring mother is hyperventilating?
help her slow her breathing; breath into a paper bag or cupped hands to restore normal blood levels of carbon dioxide and relieve symptoms
A reduction in gastric motility can affect a laboring client resulting in what?
n/v
What is commonly provided to laboring mothers experiencing n/v during labor?
ice chips; small amounts of other clear liquids may be allowed; solid foods are usually withheld to prevent vomiting and aspiration if general anesthesia is required.
A full bladder can inhibit what in a laboring client?
fetal descent
Why can a full bladder inhibit fetal descent?
occupies space in the pelvis ; increases risk of bladder hypotonia and infection
Most research suggests that there is how much normal blood loss for a vaginal delivery?
500 to 1000mL
Elevated levels of several clotting factors (esp. fibrinogen) during pregnancy and continue to be higher during labor and after delivery increase what for the client?
can provide protection from hemorrhage yet it increases the mother’s risk for a venous thrombosis during pregnancy and after birth
The exchange of oxygen, nutrients, and waste products through what system?
placental circulation
When does most placental exchange occur?
during the interval between contractions
Fetal intolerance to the stress of labor causes their HR to be what?
110- 160 bpm
In the fetal pulmonary system, the lungs produce what to allow normal development of the airways?
fluid
Four major factors interact during normal childbirth (4Ps)
Power
Passage
Passenger
Psyche
Primary force that moves the fetus through the maternal pelvis
uterine contractions
Woman feels an urge to push and bear down as the fetus distends her vagina and puts pressure on her rectum
maternal pushing efforts
During the 1st stage of labor
uterine contractions- onset to full cervical dilation
During the 2nd stage of labor
pushing efforts- full cervical dilation to birth of the baby
usually more important to the outcome of labor than the soft tissue
the bony pelvis
What do not readily yield to the forces of labor?
bones and joints
pelvic brim
the linea terminalis
what divides the bony pelvis
the linea terminalis
Where is the false pelvis located?
(top) above linea terminalis
Where is the true pelvis located?
(bottom) below linea terminalis
The 3 subdivisions of the true pelvis
*Inlet
*midpelvis
*outlet
Who is the passenger?
fetus, membranes, and placenta
Several fetal anatomic and positional variables influence what?
the course of labor
Components of the birth fetal head
*Bones
*Sutures
*Fontanels
Bones of the fetus head
-2 frontal bones on the forehead
-2 parietal bones at the crown of the head
-1 occipital bone at the back of the head
Sutures of the fetal head
Narrow areas of flexible tissue that connect fetal skull bones
Fontanels of the fetal head
-Wider spaces at the intersections of the sutures connecting the skull hones
-Anterior fontanel diamond shape
-Posterior fontanel triangular shape
The fetus enters the birth canal in what presentation?
cephalic
At what percentage does the fetus enter the birth canal in the cephalic presentation?
96- 97% of the time
What serves as key landmarks for assessing fetal position and head flexion during vaginal exams?
the sutures and fontanels
What enables the fetal head to mold and adjust to the pelvis’s shape?
sutures and fontanels
the orientation of the long axis (spine) of the fetus to the long axis (spine) of the woman client
fetal lie
In more than 99% of pregnancies, the lie is longitudinal and parallel to the what of the woman?
long axis (spine)
relationship of fetal body parts to one another
attitude
normal attitude
flexion
Presentation examples
*Cephalic
vertex, military, brow, face
*Breech
frank, full, footling
*Shoulder
the fetal part that first enters the pelvis and termed the presenting part
presentation
The most common presentation?
the cephalic presentation with the fetal head flexed
Other presentations besides the cephalic are associated with what?
associated with prolonged labor and are more likely to require caesarean birth
location of fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis
location
Position references
*Right or Left
*Occiput (O)
Mentum (M)
Sacrum (S)
*Anterior (A)
Posterior (P)
*Transverse (T)
The 4 Ps are an interrelated what?
whole
Factors that appear to have a role in starting labor
1.) progesterone levels fall
2.) increase release of prostaglandins
3.) Increased secretion of natural oxytocin
4.) Increased oxytocin receptors in the uterus
5.) Fetal membrane release prostaglandins
6.) Cortisol secreted by fetal adrenal glands
7.) Increased stretching and pressure of the uterus and cervix
When does labor normally start?
when the fetus is mature enough to adjust easily to extrauterine life but after it grows so large that vaginal birth is impossible
Normal Labor: Premonitory Signs
*Braxton Hicks contractions
*Lightening
*Increased vaginal mucus secretion
*cervical changes (softening, possible dilation, bloody show)
*energy spurt and weight loss
true labor
*increased contractions; tend to increase with walking
*increased discomfort; lower back; resembles menstrual cramps
*cervical change; progressive effacement and dilation most important
false labor
*contractions inconsistent; decrease with activity (walking)
*discomfort is felt in the abdomen and groin an can be annoying
*cervix does not change
movement of fetus through the birth canal
descent
fetal presenting part reaches 0 station
engagement
Normal Labor: Labor Mechanisms
1.) Descent
2.) Engagement
3.) Flexion
4.) Internal rotation
5.) Extension
6.) External rotation
7.) Expulsion
the mechanism of labor that accompanies all the others; without it none of the mechanisms will occur
descent
occurs when the largest diameter of the fetal presenting part (normally cephalic) has passed the pelvic inlet and entered the pelvic cavity
engagement
the fetal head is flexed farther as it meets resistance from the soft tissues of the pelvis; presents the smallest anteroposterior diameter to the pelvis
flexion
allows the largest fetal head diameter to align with the largest pelvic diameter
internal rotation
of the fetal head as the neck pivots on the inner margin of the symphysis pubis, allowing the head to align with the curves of the pelvis outlet
extension
of the fetal head, aligning the head with the shoulders during expulsion
external rotation
the fetal shoulders and fetal body exit the pelvis- birth canal
expulsion
1st stage of labor
-latent phase
-active phase
How many phases of labor is there?
4
labor duration varies significantly between first time mothers and whom?
experienced mothers
first time mothers & experienced mothers may have…
fast labor
1st stage of labor this position is ideal for pushing because it enlarges the pelvic outlet slightly and adds the force of gravity to the client’s efforts
squatting
positions of labor
-standing
-lunge
-abdominal left and tuck
-counter-pressure
-sitting/ squatting
-side lying with peanut ball
allowing uterine contractions to cause most of the fetal internal rotation and descent after full dilation
laboring down
lower extremity nerve injury
LENI
What is the goal of maternity care?
To protect the health of the mother, fetus, and newborn while enhancing the birth experience.
What does technology do in the birth experience?
aids in identifying and addressing issues quickly but can make care feel impersonal
