Chapter 7 Flashcards
When does onset of labor begin
38-42 weeks
What factors initiate labor
maternal and fetal factors
what have to happen to the moms body for labor
cervical softening, uterine excitability (contractions), and cervical dilation
what are some maternal factors that initiate labor
: Uterine muscle stretching (causes release of prostaglandins), pressure on the cervix (stimulates release of oxytocin which gradually increases during labor), rising estrogen levels the uterus becomes more excitable and contractions begin
what fetal factors happen to initiate labor
placental aging/deterioration trigger the initiation of contractions, fetal cortisol increases which increases the release of prostaglandins, fetal membranes also release prostaglandins which aide in stimulation of uterine contraction
what are the 4 Ps of labor
Powers, passegeway, passenger, and psychosocial influences
what are the 2 components of power
primary force of labor (uterine contractions), and secondary force of labor (maternal pushing)
what are the 3 phases of uterine contraction
increment, acme, and decrement
what is the increment phase of uterine contraction
the building up of the contraction, the longest phase where contractions build strength
what is the acme phase of uterine contraction
where contractions peak to the strongest points
what is the decrement phase of uterine contraction
the relaxation of the contractions when the uterus contractions go back to the resting baseline
what happens to the fundus when contractions start
Fundus then spread throughout the uterus pushing fetus downward which in turn puts pressure on the cervix to thin and open
why do we need rest periods during contractions
need it because mom needs it and very vital to fetal oxygenation (oxygen is cut off during contractions)
what happens to the uterus during contractions
) With each contraction the uterus longates
what are the 3 descriptions used for uterine contractions
beginning of one contraction to the next), Duration (beginning of one contraction to the end of the same contraction), and Intensity (mild/moderate/severe for eternal or by mmof mecury for internal
why does the cervix have to be 10cm dilated before pushinf
because were worried about cervical damage, edema (they wont be able to push through that and if they can the rip can cause a hemmorrhage
when do women normally feel the urge to push
women are usually fully dialated when they feel the urge to push
for the 4 Ps of labor what is included in the passage way
maternal pelvis and soft tissue (the cervix and vaginal cannal are also part of passageway made up of soft tissue)
what are the 3 segments of the pelvis
Inlet, Midpelvis, and outlet
what determines if a mom can have a vaginal birth
The shape and dimension of moms pelvis
in order for the birth to occur what movements must occur
cardinal movements
what is engagement and descent for cardinal movements
: initial movement of the babies head into uterine inlet
what are the 4 forces that facilitate decent
pressure of amniotic fluid. Direct pressure of uterine fundus/contraction of maternal abdominal muscles/ extension and straigtening of fetal body
what is flexion of cardinal movements
resistant that’s encountered from the fetal head, meaning the cervix and the pelvic floor- allows the smallest part of the fetal head to pass through the pelvis first
what is internal rotation and how does it happen
fetal head rotates from tansverse position to anterioir position
Early in labor the transverse position because the pelvis is widest from side to side, During active labor it rotates to anterior position
what is the most favorable position for labor
anterior
if there is no rotation during internal rotation of cardinal movments what does that do
labor is prolonged, because the widest part of the head is presenting
if posterior position instead of anterior position happens during internal rotation of cardinal movements what does that do
labor is prolonged because the infant has to rotate to get into the anterior prior to birth which is more painful
what is extension of cardinal movements
when fetus reaches the pubis arch, it must extend the head to pass under the pubic arch and symphysis pubis – the face is facing down towards the rectum
what is external rotation of cardinal movements
birth of head, shoulders must line up with head, anterior shoulder delivers first
what is explosion of cardinal movements
- lateral flexion of shoulder and head occurs and posterior shoulder delivered – rest of body quickly follows
what does passenger include in the 4Ps of labor
Refers to fetus: skull, attitude, presentation, position, and station (all affects labor process)
what occurs for fetal skull that help labor
cartilage between bones of fetal skull allow for overlapping during labor, molding (the actual over lapping of the cranial bones) or elongating of fetal head also allows for accommodation through the birth canal
what is the anterior fontanelles - soft spots and when does it close
diamond shape top of the head, position where sagittal, frontal, coronal sutures – closes around 18 months
what is the posterior fontanelles - soft spots and when does it close
triangular shape in the back of the head, positioned where lambdoidal and sagittal sutures meet – closes around 6-8 weeks of age
what is fetal attitude
: the relationship of fetus body parts to one another
what is the most common and favorable for vaginal birth position
flexion - presents the smallest diameter of fetal skull to the bony pelvis (approx. 9.5cm which is why 10cm for dilation is needed)
what is fetal presentation
the fetal part that enters the pelvic inlet first
what is cephalic fetal presentation and what are the different types
when the fetal head presents first (largest part of the infant by 96%), Vertex (head is flexed), Military (head is neither flexed nor extended), Brow (partial extension), Face (head full extended)
what is a breech fetal position and what can happen because of it
feet or buttocks come. First happens in about 4.6% of delievers it cause a much higher risk of baby having cord prolapse, less effecgive cervical dilation, delivery is difficult because the head mold and the butt doesn’t
who is more at risk for a transverse or shoulder fetal presentation
happens in less then 1% usually preterm high parity, PROM, polyhidrangeous, previa, this breech almost always calls for a c section
what does osopite mean
back of fetal head
where is the narrowest diameter of the pelvis
ischial spine
what is a position above the ischial spine called
minus station
what is a position below the ischial spine called
a positive station
what is a 4+-5+ station mean
crowning and delivering
what roles play a factor in the moms emotional readiness for labor
previous experiences, cultural oriented views of childbirth shape expectations and ongoing perceptions of birth
what is a labor process enhanced
women feels confident in her ability to cope with the process of labor and when she finds a way to work though the pain of contraction
what is a labor process delayed
mom is fearful and tense, or she fights the pain and contractions
what is the nesting phase
energy spurt where mom gets the house ready for baby
what is lightening
beginning of engagement the head isn’t fully engaged
what is a bloody show
cervical stretching/softening cause mucous plug to expel blood tinged mucus
what should you teach a patient before ROM
TACO
Time your water broke, Amount of fluid, Color of fluid, and Odor of fluid
how does a AROM (artificial rupture of membrane) happen with a HCP
amniotomy
how do you know if ROM or just pee
only way to tell is if they come in and get it tested via an nitrogene or aminosure kit
what is a doula
professionally trained person that is experienced in child birth – no clinical role just there to support mom
what info should be taken when a mom gets to a birthing center
describe contractions, ROM?, any vaginal bleeding, decrease in movement of baby, any changes to your health
what is the first thing you need to do when getting a new patient
Need to establish a positive relationship, patient centered atmosphere, support of birthing plan if they have one
what is included for collection data
expectations for birthing, subjective expirence of labor, psychosocial/cultural factors, VS, weight gain, fundal height, FHR
what is included in the initial admission assessment
if its true labor, is birth imminenet, any factors that increase mom or fetal risk, name of support person, any prenatal care, EDB, ROM, complications, allergies, medications, contractions, smoke/drug use, birth plan
what labs should be ran when a mom gets to a birthing center
blood type, Rh factor, CBC, Hgb, Hct, blood glucose, urine sample
what shoudl be documented when a patient gets to a birthing center
patient name and age, FHR, contraction pattern
when does the first stage of labor start and end and how long does it last
begins with true regular contractions and ends with full dialation of cervix at 10cm- generally lasts 8-20 hours for primips and approx. 5-14 hours for multis
what are some factors lengthen labor
analgesia, maternal position, moms body size, moms level of fitness
what is included in the latent period (early labor)
not active begins with the establish of regular contractions, Dilation is 0-3cm, frequency of contractions is about 5 minutes apart, duration of contractions is about 30-45 seconds, contraction intensity is mild, and time is 10-14 hours- it is recommended to be at home during this time and do frequent position changes to facilitate labor changes
what is included in the active phase
Dilation is 4-7 cm, Contractions: frequency is 3-5 mins, duration is 60+ seconds and intensity is moderate to strong, increasing discomfort primips dilate about 1cm per hour, and multips dilate about 1.5cm/hr
what is included in the transition phase
Dilation 8-10cm, frequency is every 2-3min, duration of contraction is 60-90 seconds, intensity of contraction is strong
what labor phase is decribed as as the most difficult part of labor and often the quickest phase of labor
Transition phase
what is second stage of labor and when does it start and end
characterized by maternal pushing
Starts at 10cm dilation, Ends with birth of infant
If a women feels like she needs to poop what should you do
don’t let her and check her dilation because shes probably close to ready to push
what is the urge to push stimulated by
ferguson reflex (as presenting part stretches pelvic floor muscles)
what are the two types of pushing
closed glottis (involuntary pushing), and open glottis (directive pushing, pushing when you reach full cervical dilation)
is burning sensation normal during labor
is normal because of the perineal stretching
how long does birth take during the second stage of labor for primips and mulipts
Primpis take about 1-2 hours, and multips approx. a few pushed to an hour
what should you never do during the second stage of labor
leave the patient alone during 2nd stage of labor you do want to encourage rest periods between contractions and pushing
what is a laceration
a tear that happens naturally more common in first time labor moms, can happen on cervix, vagina, and perineal Described by degree
what is a first degree laceration
perineal skin and vaginal mucous membranes
what is a second degree laceration
skin, mucous membrane, fascia or perineal body
what is a third degree laceration
skin, mucous membrane, muscles or the perineum and extended to rectum
what is a fourth degree laceration
extended to rectal mucous and expose lumen of the rectum
what is a episiotomy
surgical incision made by HCP
what are the complications of an episiotomy
cystocele (buldge of the bladder into the vagina), rectocele (tissue wall between the vagina and rectum weaken), dyspareunia (painful intercourse),
what is a midline episiotomy purpose
2nd degree easily repaired heals quickly but does have a higher risk of 3rd and 4th degree tear
what is a mediolateral episiotomys purpose
less likely for 4th degree tear but greater blood loss, more difficult surgical repaur and increase perineal pain
how can you decrease perineal trauma
perineal massage, warm compress, lubricating oil, and manual support
can you delay cord clamping
– you can delay cord clamping by 30-120 seconds so fetus can get increase blood supply, increased Hct, increased ferritin its controversial
what are the risks for delayed cord clamping
hyperbillrubin and polycythemia
what is the third stage of labor
begins at birth of baby and ends with delivery of placenta
o Length is 5-10 minutes up to 30 minutes if longer then it could be a retained placenta
what happens to the uterus during third stage of labor
Uterus becomes sqherical in shape, uterus rises up as placenta descend into vagina (immediately after birth between umbilical and symphois pubis then itll lower to be at the umbilicus when the placenta is birthed)
what happens after the umbilical lengthens
– a gush of blood occurs when the placenta detached from uterus
what are the two different presentations of the placenta
shiny Schulze (placenta separated from fetal size) or a dirty Duncan (placetna seperates from maternal side first)
what medications can be given for uterine bleeding
oxytocin IV or IM
what meds can be given for increased blood loss
hemabate, and methergine
what is the fourth stage of labor
begins immediately after birth of placenta and ends 1-2 hours postpartum
what do you want to assess in the fourth stage of labor
Want to assess firm uterus, lochia rubra with occasional small clots which is normal , o Watch of excessive amounts of bleeding,
if there is an excessive amount of bleeding in the fourth stage of labor what should you do
is massage the fundus, ensure oxytocin has been given, and you can put ice on the perineum
