Chapter 16: Labor & Delivery Flashcards
Power
5 P’s of labor
secondary and primary
- primary: involuntary uterine contractions and Ferguson reflex –> cervical dilation
- secondary: voluntary action of pushing –> increase intraabdominal pressure
passageway
5 p’s of labor
anatomy of bony pelvis and soft tissue of pelvic floor muscles, introitus (opening to vagina), and vaginal canal
passenger
5 p’s of labor
fetus
- fetal head (fontanels, sutures)
- fetal presentation (breech, cephalic, shoulder)
- fetal attitude (position of body parts in relation to each other)
- fetal lie (longitudinal or transverse)
- fetal position (presenting part relation to maternal pelvis)
psyche
5 p’s of labor
- maternal affect
- feelings abt herself, pregnancy, surroundings
- psychological health
- ex) anxiety, stress, fear
position
5 p’s of labor
- gravity assists in labor and delivery
- upright and ambulating –> better contractions
- sharply flexed angle of pelvis –> easier fetal passage
- lithotomy position –> better perfusion
- engourage positions where mom is comfy like upright or lateral
fetal head
moulding = infant head molds (sutures and fontanels move) to fit birth canal easier
fetal presentation
part of fetus that enters pelvis first, or the presenting part
cephalic presentation
enter pelvis head first
vertex presentation
- most common and ideal
- chin is on chest
- head down, facing spine
- occiput enters first
breech presentation
butt or feet descending first into pelvis
shoulder presentation
- shoulder entering true pelvis first
- needs correction if vaginal delivery
sinciput presentation
- fetal chin off chest
- neck straight
- aka military attitude
- face and forehead present first
fetal attitude
- position of fetal body parts in relationship to each other
- ex) chin on chest, arms flexed against chest, legs flexed at knees, neck rounded
- if neck is straight, fetus may not be able to pass through true pelvis
fetal lie
- longitudinal (vertical)
- transverse (horizontal)
fetal position
- relationship of presenting part to maternal pelvis
- best = vertex, OA (occiput, anterior)
- bad = sacrum (breech), mentum (face/brow), Sc (transverse lie)
fetal position 1st letter
direction
- L/R
- left or right
fetal position 2nd letter
presenting part
- O: occiput (back of head) GOOD
- M: mentum (brow or face) NOT GOOD
- Sc: scapula (transverse lie)
- S: sacrum (breech)
fetal position 3rd letter
position relative to maternal pubic symphysis
- P: posterior
- A: anterior
- T: transverse
ROA, LOA, ROP, LOP
- right occiput anterior
- left occiput anterior
- right occiput posterior
- left occiput posterior
signs of impending labor (8)
- bloody show
- contractions more frequent, consistent
- 4-1-1 rule: new contraction every 4 min, lasts 1 min for 1 hr
- lightening: descent of fetal head to pelvis
- nesting
- cervical changes
- GI symptoms
- weight loss
amniotic fluid norm and abnormal findings
- normal: clear, meconium in late babies but check FHR to make sure not fetal hypoxia
- abnormal: cloudy, foul odor = infection
how to describe and chart contractions?
- intensity: mild, moderate, strong
- duration: seconds, beginning to end
- frequency: seconds, beginning to beginning
- uterine tone at rest b/t contractions: hard or soft?
cervical dilation
- gradual opening of cervix
- happens during 1st stage of labor
cervical effacement
- gradual thinning of cervix
- happens during labor and late in preg
fetal station
- how far fetal presenting part descends into the uterine canal
- 0 station = presenting part at lvl of ischial spines aka fetus engaged
- goes from +1 to +5 station
- +5 station = crowning
- negative numbers = presenting part still above station 0
first stage of labor
- cervical dilation and effacement
- menstrual cramp-like contractions
- low backache
- has 3 phases
stage 1 phase 1 of labor
- latent
- cervix dilates 0-3 cm
stage 1 phase 2 of labor
- active phase
- cervix dilates 3-7 cm
stage 1 phase 3 of labor
- transition phase
- cervix dilates 8-9.9 cm
- many women irritable and don’t want to be touched
stage 2 of labor
- cervix fully dilates to 10 cm
- ferguson reflex
- birth of baby
stage 3 of labor
- birth of baby
- birth of placenta
stage 4 of labor
- birth of placenta
- recovery
- 4 hrs postop or when mom is stable
nursing assessments for 1st stage of labor (8)
- interview
- vitals, FHR, contractions
- duration, frequency, intensity, onset of contractions
- any pain or other discomfort?
- last food or drink
- sterile speculum exam for membrane rupture or bleeding
- sterile vaginal exam for dilation, effacement, fetal station/presentation/position
- leopold maneuver
nursing interventions for 1st stage of labor (5)
- IV and labs
- encourage voiding
- encourage participation in activities + ambulation
- educate to not lie flat on back
- soothing voice, offer affirmations
nursing interventions and assessments for 2nd stage of labor (4)
- check FHR every 15 min
- vitals hourly
- comfort measures (ice chips, positioning, etc.)
- support, encouragement for open glottis pushing (pushing without holding breath), coaching to push
nursing assessments and interventions for 3rd stage of labor (5)
- initiate skin-skin contact and breastfeeding
- put baby under warmer
- vitals every 15 minutes
- coach mother to breathe with contractions
- encourage father bonding with baby
nursing assessments and interventions for 4th stage of labor (7)
- examine maternal portion of placenta, look for retained
- administer uterotonics and analgesics
- assess fundal tone, position, location (norm = lvl of umbilicus right after birth)
- rubia lochia = norm, 500 mL blood loss
- ice packs
- perineum
- bladder function
external fetal monitoring
- want to put on fetus’ back
- placed outside of belly
internal fetal monitoring
- IUPC
- invasive, so only done if membranes ruptured or cervix is dilated (acute situations bc more accurate)
- want to put on fetus’ head
intermittent fetal monitoring
- only used if low risk pt
continuous fetal monitoring
- usually the norm now
- higher risk pts or pts further along in contractions
pain in 1st stage of labor
- like wrapping lower torso with belt
- more acute in lower-mid abd + lower back
- referred pain that radiates
- pain subsides b/t contractions
- like running up and down mountain
pain in 2nd, 3rd, 4th stage of labor
- perineum
- feeling of stretching, pulling, tearing
- visceral (in organs) similar to 1st stage but not as acute
- bearing down may decr intensity
pharm pain mgmt
6
- opioids: meperidine (demerol), sublimaze (fentanyl)
- mixed opioid agonists/antagonists: nalbuphine (Nubain), butorphanol (Stadol)
- antiemetics: promethazine (phenergan), hydroxyzine (vistaril)
- epidurals, spinals, combined spinal-epidural
- nitrous oxide (laughing gas)
- pudenal block
careful with use because can cause neonate resp depression and maternal somnolence + hypotension
nonpharm pain mgmt
6
- breathing techniques
- hypnosis
- biofeedback
- aromatherapy
- music therapy
- cutaneous stim (effleurage, counter pressure, intradermal water block, acupuncture, massage, hydrotherapy)
