day 3 Flashcards
5 ps of labour
passanger
passegways
powers
position
psychological response
passenger
fetal presentation, lie, attitude,
1.2 Fetal presentation
- Refers to the part of the fetus that enters the pelvic inlet first
- Cephalic 96% (head)
- Breech 3-4% (buttocks or feet)
- Shoulder < 1%
1.3 Fetal lie
- Relationship of the long axis (spine) of the fetus to the long axis of the mother
1.4 Fetal attitude
- The relation of the fetal parts to each other
- Chin rests on sternum
- Arms onto chest
- Legs onto abdomen
- Deviations may cause difficulties in labour
Passenger CTD
engagement, fetal position and station
engagment
- Presenting part is ‘engaged’
- Corresponds with station of ‘0’
fetal positoin
- direction
- presenting part
- where is presenting part related to the maternal pelvis (ant or posterior transverse)
station
- A measure of the degree of descent of presenting part
Passegways
what is the passageway and soft tissues
Passageway = Maternal bony pelvis & soft tissue structures.
soft tissues
- Cervix, vagina & perineum
must stretch (Progesterone & relaxin)
powers
primary vs secondary
Primary powers
- Involuntary uterine contractions
- Rhythmic tightening & shortening of uterinemuscles (build – peak – let up - rest)
Contractions cause:
- Effacement: thinning & shortening of cervix. Range is from 0 - 100% effacement
- Dilation: expansion of the external os of the cervix from an opening of a few mm in size (closed) to 10cm (fully dilated).
Secondary powers
- Bearing down efforts
- Does not dilate cervix
- Reserved’ for 2nd stage (after complete effacement & dilation).
psychologial response
Psychological response
Helping Labour Progress - Physiology First
Environment
Gravity
Movement and Positioning
Labour Support
stage 2 of labour
second stage recap and nursing care
phases and nursing care
Begins
- when cervix fully dilated and completely effaced to birth of infant
- Mean duration is 60-70 min (nulliparous) 20-30 min (multiparous)
- 4-5 contractions every 10 minutes / duration ~ 90 seconds
2 phases:
- Passive phase – period of calm (fetus descends & rotates anteriorly)
- Active pushing phase – strong urges to bear down
nursing care for active phase
- Comfort & pain relief measures
- Monitor FHR after contractions/pushing (Approx q5 min)
- Monitor maternal /physiological responses (including VS) to pushing & pain levels.
- support
open glottis pushing
what and benefits
what
- With sensation of pressure, person takes deep cleansing breaths & then exhales slightly while pushing.
- Should not hold their breath > 5-7 seconds
Benefits of this technique
- Facilitates maternal-fetal circulation
- Less maternal fatigue
- Protects pelvic organs from undue pressure and “descent”
- Decreased incidence of perineal tears due to gradual fetal descent
consequences of lithotomy, semi foulers and closed glottis pushing
- Decreased blood flow due to pressure on vena cava
- supine hypotension
- Slowed fetal descent
- Restricted movement of the lower sacrum
- Stirrups exerting pressure on the lower extremities
- Increased incidence of episiotomy and severe perineal tearing.
- Increased incidence of instrumental delivery
- Decreased blood flow to the uterus and fetus
interventions affecting 2nd stage
EFM, epidural increases what? lacerations?
Electronic Fetal Monitoring
- May limit ambulation
- Increased rates of caesarean & instrumental vaginal births (Alfirevic et al., 2017)
Epidural Anaesthesia Increases
- Oxytocin administration for labour augmentation
- Length of 2nd stage (d/t decreased urge to bear down & ability to be upright)
- Assisted vaginal births (forceps / vacuum)
Dictated birthing position
2nd Stage: Perineal trauma
Perineal lacerations
- 1st to 4th degree
- Episiotomy
- Vaginal lacerations
- cervical injuries
positional changes of the newborn:
engagement, descent flexion, internal/ external rotation, extentsion, restitution, birth
Engagement:
- biparietal diameter passes pelvic inlet
Descent:
- progress of bb through the pelvis
Flexion:
- resistance from soft tissues & musculature of the pelvis causes the fetal head to flex
Internal rotation:
- Fetal head rotates to fit the widest diameter of the pelvic cavity
Extension:
- as the fetal head passes under symphysis pubis & extends to emerge.
- Occiput, then brow & face emerge from the vagina.
Restitution and external rotation:
- once head emerges it turns to one side to realign with infant’s back & shoulders – then head turns farther to the side.
- Anterior shoulder extends under symphysis pubis, then posterior shoulder.
Birth:
- Head and shoulders are lifted toward the mother’s pubic bone, and trunk of baby is born.
stage 3 recap and nursing care
risk? give anything?
Stage 3
- Begins with birth of baby and ends with delivery of placenta
- Usually 5-30 minutes
- risk of hemorrhage
Nursing care
- VS
- Assess for signs of placental separation
- Assist birthing person to bear down to facilitate delivery of placenta
- Prophylactic oxytocin administration as ordered
- Keep parents informed
- Facilitate skin-to-skin and breastfeeding
stage 4
stage 4 recap and nursing care
Stage 4
- From delivery of the placenta until about 2 hours after birth:
Nursing care
- Promote distraction, comfort measures and relaxation during laceration repair
- Cleanse vulvar area, apply a perineal pad and ice pack
- Show/explain placenta and cord to birthing person, if desired
- Promote uninterrupted skin-to-skin with newborn
assesment
- Mom : VS: q 15 min. x 1 hour then once during 2nd hour;
- baby: Vitamin K, weight, ID bands
labour pain 1st stage pathway
abdo/spinal, visceral caused by? and reffered pain
Abdomen and lower back.
- During contractions, unless OP
- Transmitted by T10 to T12 and L1 spinal nerves, and accessory lower thoracic and upper lumbar sympathetic nerves.
Visceral pain:
- Caused by uterine contraction and stretching of the cervical tissues
- Pressure and traction on adjacent structures, such as fallopian tubes, ovaries, and ligaments.
Referred pain
- Pain radiates from uterus to abdominal wall, lumbrosacral area, iliac crests, gluteal area, thighs, and lower back.
benefits of uninterupted skin to skin
Higher blood oxygen saturation
More stable regular breathing
Less tachycardia
Better blood glucose stability
Lower risk of cold stress
Promotes bonding and breastfeeding
Lower risk of jaundice.
Helps uterus to contract after birth of placenta.
