Chapter 16 Flashcards
What are the 5 factors that affect process of labor and birth?
Passesnever
Passageway
Powers
Position
Psychologic response
What are the two examples of passenger?
Fetus and placenta
What is the Example of passageway?
Brith canal
What is the example of powers?(2)
Primary?
Secondary?
Contractions
Pushing
What does position mean?
How the mother is positioned
She is in a position to deliver a baby? Standing?
What are the 4 pelvis ?
- Gynecoid
- Anthropoid
- Andriod
- Platypelloid
What is the most favorable pelvis?
Gynecoid
( pumpkin shape )!! ( round shape )
What’s the second most best pelvis?
Anthropoid( oval shape )
( human face shape )
What is the worst type of pelvis we don’t want mothers to have?
And can lead mothers to getting a what?
Andriod type
( alien shape pelvis )
( heart shape )
( poor prognosis & c section )
What is the flat pelvis called?
Platypelloid
( flat !! )
( poor prognosis & possible c section )
When looking at the passenger ( the fetus and placenta ), we like to look at 5 things, what are they?
Presentation
lie
Attitude
Position
Station
What is the definition of presentation and lie when regarding the care of the passenger ( fetus and placenta )?
- Presentation is part of fetus entering the pelvic inlet first
- Relationship of maternal long axis ( spine ) to fetal long axis ( spine )
This can be transferred or longitudinal ( parallel )
^ pretty much how the baby is facing with the lie, is it ready for birth? Head down? Or is it on its side, back/butt first
What is the definition of attitude when regarding parts of the passenger ( fetus and placenta )?
Relationship of body parts to another
Flexion or extension
( mad, fist! ). (Relax, spread out )
What does position mean when regarding the passenger ( fetus and placenta )
Literally how the baby is position,
Head down and chin down
Head down and chin up?
Feet down ?
Etc
What does station mean when regarding the parts of the passenger ( fetus and child )
Fetal presentation part in relation to the maternal ischial spines
How far fetus progressed down birth canal
( so measuring how far the baby has moved down to prepare for birth from the ischial spine, to coming head out )
So we know that powers equals to uterine contractions and pushing, but what does uterine contractions mean or do?
Used to think and dilate the cervix while pushing the fetus to be expelled
What are 3 key terms to know when regarding uterine contractions ?
Duration : how long a contraction last
Frequency : how often contractions occur
Intensity : how strong the contractions are
Why does psyche mean when regarding the 5 Ps?
The maternal stress
Anxiety
Etc
So calm the patient!
When regarding the passanger, the fetus in this case, we know that the biggest thing to get through the pelvis, is the fetal head, how does the fetus get through?
The bones in the fetal skull, the fontanels in particular, can change shape, or MOLD!! To fit through the mothers pelvis
The reason why the fetus is able to have fontanels molding is because it needs to get through.this is why we babies have those ??
Really long cone shape heads
How long does it take so the baby cone head goes back to normal?
Couple of days
The reason why most patients who have really bad pelvis shapes or simple the baby doesn’t mold, is the reason why we ?
Have a lot of c sections because the head won’t get through
What does fetal presentation mean, professor definition?
When you do a vaginal exam and you find the cervix and you touch the first part of the baby , and what you’re feeling is the baby presentation
What are the 3 presentations we can feel during fetal presentation?
Cephalic
Breech
Shoulder
What is cephalic presentation?
Presenting part is the occiput( vertex )
( the head )
What is the breech for fetal presentation ?
Presenting part is the sacrum
( butt or feet )
What is shoulder presentation ?
Presenting part of the scapula
( shoulders )
There are two types of breech presentation, what are the names and definition of each?
Foot lane breech ( where the feet are down )
Frank breach ( butt down )
Most of the time, some people have difficulty telling the difference between a frank breech ( butt ) and a cephalic ( head down ) when feeling for a baby presentation. How can you tell?
Butt is always softer!!!
Head will be hard
Why do we not deliver foot lane breechs as often or usually?
Because the head applies a lot of pressure on the cervix to dilate
However when the feet are down, they aren’t really applying pressure to dilate
Meaning it’s not gonna be big enough or stretched out enough to fit the whole baby
So big pain for mom!
Can cause severe neurologic damage
Why don’t we give frank ( butt ) breech births as often?
Because the butt is soft. The uterine contractions try its best to push and allow the cervix to thin and dilate. However when there isn’t pressure cause the butt is soft
No pressure is gonna be applied to dilate
Making labor longer and more painful
Overall the biggest problem with any type of breech is that the ?
Head is gonna get stuck or body get stuck
There is another thing called a brow cephalic, which is?
Why is this also bad?
Where the forehead is coming out , like instead of the top of the head, it’s like your forehead
The fontanlles can’t mold, so it gets stuck
When you’re doing a vaginal exam, what are the two boney process you want to feel for?
Ischial spine
What does position of the baby mean, professor definition?
Where the body of the baby is in to relationship to where the ischial spine is
When the baby isnt passed the ishcial spine, what do we rate it?
Negative 1-5 whatever
What the baby is passed the ischial spine, what do we rate it?
+1-5 then delivered
THE SUPER IMPORTANT THING TO NOTE IS THAT WHEN THE BABY IS TRYING TO GO DOWN, IT CAN TRICK US TO BELIEVE ITS FURTHER DOWN THAT IT IS BECSUSE OF THE FONATANLLES MOLDING ( THAT CONE SHAPE ) SO ITS IMPIRTSNT TO?
Walk your fingers back to the suture lines to use to measure the position of the baby to the ischial spine
What is the anterior fontanel?
What’s the shape
It’s a obstetrical landmark because of its distinctive diamond shape
So when you’re putting your fingers in to feel for the baby, the vaginal exam, you feel the baby head and the diamond shape, what does that mean or like what would you write?
Baby is vertex ( cephalic ) OA
What’s the most ideal position for a baby to be born?
OA
What does LOA and ROA mean?
So OA means it’s coming down head first in its optimal position however
The diamond shape is leaning towards the mothers left leg
Or the mother right leg
( just a little bit slanted )
What does OP feel like and mean?
Y shape!!
Where the baby is coming down chip up! But still the head
So what does LOP and ROP mean?
the baby is coming head doen, but instead it’s chin is facing up because you can feel a Y shape
So LOP
Is that the chin/ Y shape is slanted to the left side of mother leg
Or the baby chin/ y shape is panted to the right side of mother right leg
What does the fetal lie mean? The most basic definition of?
How the baby is lying down
Side to side
Up to down
Down to up
Since passenger is also fetus and placenta, what does it mean for placenta, how does it matter for labor?
Where is the placenta?
Like low line?
Going to come out before the baby?
What are the primary powers?
What do we want to know about this?(6)
Contractions
Frequency, duration, intensity
Effacement
Dilation
Ferguson reflex
How does contractions play a role with dilation?
The body contractions in order to put pressure on the baby to put pressure onto the cervix in order to dilate
How does the contractions and dilations play a role with primates? A female first time giving birth?
It takes time to dilate it, so you go through stages 1-10 stages of dilation
What does effacement mean?
How thick the cervix is, long
We don’t really care as much of the centimeters, but more so care for?
If you’re making progress of growth
What is the secondary power?
How does this happen?
Pushing
So once the cervix is completed dilated 10CM
It’s time to push
If mother is in so much pain, she can inhibit labor, so it’s best we tell mom to what?
Try to change position, find a comfortable way
What does labor mean?
Process of moving fetus, placenta and membranes out of the uterus and through the birth canal
What are the 2 big signs of preceding labor?
What normally is primate?
Lightening/dropping
Bloody show
Primary
- everything, lightening
When do we know true labor starts, like what are the two big signs during the third trimester before labor?
This then allows us to know that true labor contractions have started
If this doesn’t happen, we know the contractions are just Braxton hicks
Plug of mucous and blood
Amniotic sac ruptures
( water breaking )
The the contractions pull on the thick tissues of the cervix causing it to thin, this is also called?
Effacement
What is the first stage of labor ?
What are 2 phases?
How does the contractions start off as then go into ?
When the body is starting to dilate
Latent and active
In latent they start off as irregular
Then into active they get more controlled or regular enough that she’s continuing to change her cervix
Normally for a primate, mother who’s never had a baby, what happens in the first stage of labor, or when does she go through active labor?
And a multip
Usually a little bit later, around 4-6cm
Usually zooms through these phases by fast!
If the amniotic sacs hasn’t ruptured before, during active labor it will?
Yes it will
How do we know when wr go into the second stage of labor?
When the cervix is fully dilated
During the second stage of labor, mainly know as the pushing stage, it’s now the babies turn to be able go through the pelvis, what’s the the 3 ps that help the baby?
Power ( pushing from the uterine contractions )
Passenger ( fetus go )
Passage ( birth canal )
Notes
Things she’s saying in the video
She’s mentions how it’s super important that the we know how the baby is position and how it’s going to fit through. Like the best attitude for the baby to be in is being flexed
So the chin is down at the chest and the head can mold
But if it’s extended it won’t mold properly
So that’s why most babies need c section to be removed
What is the best fetal lie ?
Longitudinsl ( ideal ) down top
Spine is with mom spine
What does transverse fetal lie mean?
What does oblique mean?
Side to side
Kinda at an angel
During the second stage of labor, we have cardinal movements , or simply put it as, the baby moving down for birth.
What does descent mean?
How does this play with fetal station?
Downward movement of the grid to pelvic inlet
How down the baby is moving to be delivered into the world
Or think of how we said before, feeling those suture lines to see how close it is to the pelvic ischial spines
When does the third stage of labor begin?
When the baby is fully delivered
And the placenta is going down to be removed
What is the 4th stage of labor?
Adaptation to blood loss
Start of the uterine involution ( going back to how it was before )
First starts : dilation is starting
Second ends : dilation is full
Second starts : dilation fully /push
Second ends : baby is delivered
Third starts : baby is delivered
Third ends : placenta is delivered
Fourth start : recovery period
How do we know we are in the first stage of labor?
True labor contractions
How do we know they are true labor contractions?
When we dilate the cervix!!!
When we see the progression of getting bigger cervix!!
Stages of labor
First stage is ?
Onset of regular uterine contractions to full dilation of the cervix
Second stage of labor ?
From the time the cervix is fully dilated to the birth of the infant
Third stage of labor?
From the birth of the infant until the placenta is delivered
What’s the fourth stage of labor?
Begins with the delivery of the placenta and lasts until the woman’s condition is considered stable in the immediate postpartum period, usually within 1 hours after giving birth
What does mechanism of labor mean?
The turns and adjustments necessary in human birth process
What are the 7 cardinal movements of mechanism of labor?
- Engagement
- Descent
- Flexion
- Internal rotation ( head moving for fontanells to mold )
- Extension
- External rotation ( restitution )
- Expulsion
What is normal fetal heart rate?
110-160
Why does fetal respirations matter during labor or more so change?
No longer mom doing it
They gotta do it!
