Chapter 13 Labor And Birth Process Flashcards
Four things for labor to start
Uterine stretch, progesterone withdrawal, increased oxytocin sensitivity, and increased release of prostaglandins
Cervical changes
Softening, possible dilation with descent.
Lightening
Fetal presenting part begins to descend into the pelvis. The women usually has easier breathing but may also have increased pelvic pressure, cramping, low back pain, increased vaginal discharge and more frequent urination.
Braxton Hicks contractions
Contractions that are felt as a tightening or pulling on top of the uterus. They occur in the abdomen and growing and gradually spread downward. They are irregular, can be decreased by Walking, voiding, eating, increased fluid intake, or changing position.
Late preterm
Born between 34 and 36 completed weeks of gestation.
Spontaneous rupture of membranes
Barrier to infection is gone, ascending infection is possible, danger of cord prolapse if engagement has not occurred, sudden release of fluid and pressure with rupture.
False labor
Irregular, far apart contractions. Weak contractions that do not get stronger. Felt in front of the abdomen. They may stop or slowdown with walking or position change. Should drink fluids and walk around. If the contractions diminish in intensity they can stay home.
True labor
Contractions become closer together, usually 4 to 6 minutes apart and lasting 30 to 60 seconds. It becomes stronger with time. Start in the back and radiate towards the front of the abdomen. They continues no matter what position change is made. Stay home until contractions are five minutes apart, last 45 to 60 seconds, and are strong enough so that you cannot have a conversation.
Five P’s of the labor process
Passageway/birth canal Passenger/fetus and placenta Powers/contraction Position/maternal Psychological response
Five additional P’s of the labor Process
Philosophy/low-tech, high touch Partners/support caregivers Patience/natural timing Patient preparation/childbirth knowledge base Pain management/comfort measures
False pelvis or greater pelvis
Upper flared parts of the two iliac bones and the wings at the base of the sacrum. It is divided from the true pelvis by an imaginary line drawn from the sacral prominence at the back to the superior aspect of the symphysis pubis at the front of the pelvis. The line is called Linnaea terminalis
True pelvis
Lies below the Linea terminalis. Bony passageway through which the fetus must travel. Inlet, cavity, and outlet
Gynecoid pelvis
Vaginal birth is most favorable with this pelvis because the inlet is round and the outlet is roomy. This type of pelvis allows early and complete fetal internal rotation during labor
Anthropoid pelvis
Occurs in 25% of women. Inlet is oval and the sacrum is long, producing a deep pelvis. Second most favorable pelvis.
Android pelvis
Male shaped pelvis that occurs in 20% of women. Inlet is heart-shaped the posterior segments are reduced. Descent of the fetal head into the pelvis is slow and failure of the fetus to rotate is common. Prognosis for labor is poor leading to C-section
Platypelloid or flat pelvis
Least common and occurs 5%. Pelvic cavity is shallow but widens at the pelvic outlet, making it difficult for the fetus to descend through mid pelvis. Labor prognosis is poor. Not favorable for a vaginal birth unless the fetal head can pass through the inlet. They usually require a C-section.
Effacement
The cervix thins and allows the presenting fetal part to descend into the vagina. Similar to that of pulling a turtleneck sweater over your head
Fetal head
The largest and least compressible fetal structure. Sutures allow the cranial bones to overlap in order for the head to adjust in shape, this is known as molding. Palpation of the sutures help identify the position of the fetal head. The anterior and posterior fontanelles also help identify position and allow for molding. The anterior is diamond shape, the posterior is triangular. The anterior remains open for 12 to 18 months. The posterior closes within 8 to 12 weeks.
Fetal attitude
The flexion or extension of the joints and the relationship of fetal parts to one another. Most common begins with all joints flexed. Back is rounded, chin on chest, size legs are are flexed. Most favorable for vaginal birth.
Fetal lie
Long axis spine of the fetus to the long axis spine of the mother. Longitudinal most common and transverse. Longitudinal occurs when the fetus is parallel to that of the mother. Transverse is perpendicular and cannot be delivered vaginally
Fetal presentation
The part of the body that enters the pelvic inlet inlet first. Three main fetal presentations are cephalic headfirst, breach pelvis first, and shoulder scapula first.
Cephalic presentation
Occiput portion of the fetal head is first.
Breech presentation
Frank breech is 50 to 70%, the butt presents first with both legs towards the face.
Full or complete breach is 5 to 10%, fetus is crosslegged above the cervix.
Footling or incomplete breach occurs 10 to 30%, one or both legs are presenting
Frank breech can deliver vaginally but complete, footling, and incomplete need a C-section
Shoulder presentation
One in 300 births. Must assess for fetal anomalies. Associated with placenta previa, prematurity, high parity, premature rupture of membranes, multiple gestation, or fetal anomalies. A C-section is usually necessary before labor begins
