Conference One - Module 5 (Exam 2) 1 Flashcards
The 5 “Ps”
- Powers
- Passage/Passageway
- Passenger
- Psyche
- Position/Partnership
Powers
- Primary Power
- Secondary Power
- Tertiary Power
Primary Power
Regular, Effective, Uterine Contractions
Secondary Power
Maternal Pushing Effots
“Bearing down”
Tertiary Power
Forceps (FAVD) or vacuum assisted delivery/birth (VAVD)
Coordinated Uterine Contractions
Begin in the uterine fundus and spread downward toward the cervix to proper the fetus through the pelvis.
*Upper 2/3 of the uterus contract, muscle thickens and shortens*
Involuntary Uterine Contractions
Uterine contractions are involuntary and not under conscious control. The mother cannot cause labor to start or stop by conscious effort. Walking and other activities stimulate labor contractions and anxiety and excessive stress can diminish contractions, relaxation can facilitate the natural processes
*Lower 1/3 of the uterus relaxes and the muscle thins*
Intermittent Uterine Contractions
“Off and on” instead of sustainedd, allowing relaxation of the uterine muscle and resumption of blood flow to and from the placenta
What does the uterus and cervix do during contractions?
- Upper two thirds of the uterus contracts, muscle thickens
- Lower one third of the uterus relaxes, muscle thins
- Uterus elongates and narrows - straightens and directs the fetus downward
- Cervix relaxes and contractions pull the cervix up and over the presenting part
Bearing down: Pushing with/through contractions to birth the baby
- Physiological pushing
- Open glottis (airway) that provides better oxygenation to fetus
- Directed Pushing
- Closed glottis
- Active “pushing” with effort
Bearing Down: Passive Descent/Laboring Down
Delayed addition of secondary power until maternal urge to push presents itself
*usually happens with an epidural*
Pelvis
- Gynecoid and thropoid pelves are most favorable for vaginal birth
Cervix
- Effacement (thinning) that is measured in percentage (0-100%)
- Dilation (opening) that is measured in centimeters (1-10)
Weight of Fetus
- 2500-4000 grams
Fetal Lie
Orientation of the fetal long axis to maternal long axis
“L for Lie, L for Long”
can be vertical, horizontal
Fetal Attitude
Attitude is the relationship of body parts to one another. Normal attitude is flexion.
Fetal Presentation
The fetal part entering the pelvis first
Cephalic Presentation
- Vertex
- Military
- Brow or Face
Vertex Presentation
Complete flexion of baby. Most common type of cephalic presentation in which the fetal head is fully flexed. It is the most favorable for normal progress of labor because the smallest suboccipitobrematic diameter is presenting.
Military Presentation
- The head is in a neutral position, neither flexed nor extended . The longer occipitofrontal diameter is presenting
Brow Presentation
The fetal head is partly extended. The brow presentation is unstable, usually converting to a vertex presentation if the baby flexes or toa face presentation if it extends. The longest supraoccipitomental diameter is presenting
Face Presentation
The head is extended, and the fetal occiput is near the fetal spine, The submentobregmatic diameter is presenting
Fetal Position
Location of the fetal occiput R/T pelvic quadrant
Can be:
- Left occiput anterior (LOA)
- Right occiput anterior (ROA)
- Left occiput posterior (LOP)
- Right occiput posterior (ROP)
Psyche
Depends on:
- Experience
- Preparation
- Cultural Norms
- Inherent Coping Skills
- Partner/Family Support
- Chronologic/Developmental Age
- Progression of Labor/Birthing Process
- Nursing Care
Partnership Interaction
Passenger and Passageway progress in labor
Station
Presenting part R/T ischial spines
Negative Five Station
Floating. Negative means above the ischial spines.
Zero Station
At ischial spines
Plus Five
Head on perineum. Plus means below the ischial spines.
Cardinal Movements
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- Restitution
- External Rotation
- Expulsion
Every Darn Fool In Rochester Eats Rotten Egg Rolls Every (Day)
Engagement
Presenting part settles into true pelvis
Descent
Downward Movement
Flexion
Chin flexes on chest with resistance met at zero station. Presents smallest portionof fetal head (vertex) to smallest diameter of pelvis (ischial spines). Allows head to serve as dilating wedge after rupture of membranes (ROM).
Internal Rotation
Fetal occiput rotates anteriorly. Aligns widest diameter of the head with widest diameter of the headwith widest diameter of the pelvis at zero station.
Extension
Fetal head swings under the pubic arch. Caput = visulization of fetal vertex. Crowning = fetal head encircled by baginal introitus (Station plus 5, Rim(ring) of fire)
Restitution
Head realigns with shoulders and body and pressure from the birth canal is relived.
External Rotation
Shoulders rotate to align with anterior-posterior diameter of pelvis
Expulsion
Anterior shoulder slips under pubic arch, followed by posterior shoulder
Stage One of Labor
Cervical Effacement and Dilation
Stage Two
Pushing and Birth
Stage Three
Placental Delivery
Stage Four of Labor
Recovery/Early postpartum
Stage One Phases
- Phase One: Latent
- Cervical dilation 0-3cm
- Cervical effacement variable
- Nullipara: significant effacement prior to dilation
- Multipara: Simultaneous effacement and dilation
Breech Presentations
- Complete
- Frank
- Footling
Complete Breech
- Flexed, “sitting” on cervix
Frank Breech
Legs folded on to chest
Footling Breech
One or both feet are presenting. Requires c-section
Most favorable fetal positions
LOA, ROA
