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Maternity - 431 > Exam 1 - Labor and Birth Processes > Flashcards

Exam 1 - Labor and Birth Processes Flashcards

1
Q

Components of the Birth Process:

The 5 P’s

A
  1. Passenger
  2. Passageway
  3. Powers
  4. Position
  5. Psych
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2
Q
  1. Passenger
A
  • Fetus
  • Membranes
  • Placenta
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3
Q

Variations in the Passenger:

the 4F’s

A

a. Fetal Lie
b. Fetal Attitude
c. Fetal Presentation
d. Fetal Station

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4
Q

a. FETAL LIE

A
    • The orientation of the long axis of the fetus to the long axis of the woman:
      - - Longitudinal lie
      - - Transverse lie
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5
Q

b. FETAL ATTITUDE

A

– The relation of the fetal body parts to one another. The normal fetal attitude is one of flexion.
– Flexion
– Extension (chin extended)

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6
Q

c. FETAL PRESENTATION

A
  • The fetal part that first enters the pelvis is the presenting part.
  • Presentation falls into three categories: cephalic, breech, and shoulder.
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7
Q

c. FETAL PRESENTATION (con’t)

–position:

1 – L or R
2 – O or M or S
3 – A or P or T

– by 35 or 36 weeks, we want the baby to be head down

A 
Position:
–	1st letter – either L or R – where occipital, chin, or Sacrum is facing
–	2nd – what you feel when u touch:
•	O = occipital
•	M = Chin
•	S = Sacral
–	3rd – 
•	A = Anterior, 
•	P = Posterior 
•	T = Transverse
–	Where the heartbeat – to know the position of the baby – then via examination to know the presentation
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8
Q

d. FETAL STATION

– Negative is higher
– Positive means – baby is engaged and low

A

• Station describes the descent of the fetal presenting part in relation to the level of the ischial spines.

• Note:
– Ischial spine – how much diameter – if the baby is engage, means they are in the ischial spine and will not go back up !!
– Negative is higher
– Positive means – baby is engaged and low

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9
Q
  1. Passageway
A
  • Maternal Bony Pelvis– the size determines if the mom can deliver vaginally
  • Maternal Soft Tissues
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10
Q
  1. Powers
A 
Kinds of POWERS:
1.	PRIMARY (what the body is doing)
           –	Contractions
           –	Dilation
           –	Effacement
  1. SECONDARY (Mom pushing)
    – Maternal Pushing
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11
Q

Primary Power: UTERINE CONTRACTION

A

DURATION – starts at 30 sec and makes longer and longer

FREQUENCY – from the start of a contraction to the start of the next contraction

INTENSITY –

RESTING INTERVAL – relaxing to get oxygen – resting in between the contractions

RESTING TONE – how tense the uterus in between contraction – should be completely relaxed

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12
Q

Primary Power: DILATION and EFFACEMENT

A
  • 10 cm – for complete dilation

- - Don’t push when cervix is not completely dilated – to prevent complications

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13
Q

Secondary Power: MATERNAL PUSHING

A

– Techniques vary
– Prolonged pushing can lead to perennial trauma
– Breath holding can lead to fetal hypoxia
– Delayed pushing results in less fetal desaturation (waiting until woman feels the urge to push)
– Push while breathing out

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14
Q
  1. Position
A

– The actual position the mother assumes for labor and birth

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15
Q
  1. Psyche
A
  • The most crucial part of childbirth
  • Maternal catecholamines released in response to fear and anxiety can inhibit uterine contractility and placental blood flow.

• How do we help the psyche?
– If mom is convinced that she can do it, she can do it.
– how they look at thing can make a different
– Decrease the mom’s anxiety

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16
Q

Theories of onset of NORMAL Labor

A

– Decrease in progesterone with an increase in estrogen
– Increase in prostaglandins
– Increase in oxytocin
– Increase in oxytocin receptors
– Fetal Role
– Mechanical – what we do to manipulate the situation

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17
Q

Premonitory Signs of Labor

A
  • Braxton Hicks Contractions
  • Contractions – getting more intense
  • Lightening –
  • Increased vaginal mucous secretions – sign – mucous plug
  • Cervical ripening and bloody show
  • Energy spurt – mom becomes energetic
  • Weight loss –
  • Ruptured Membranes –
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18
Q

FOUR Stages of Labor

A

1st stage – CERVICAL EFFACEMENT and DILATION
• Latent: 0-3 cm
• Active: 3-8 cm
• Transition: 8-10 cm

2nd stage – stage of FETAL EXPULSION – the pushing

3rd stage – PLACENTAL EXPULSION – until placenta is delivered ( can last to an hour)

4th stage – RECOVERY → the most risky for hemorrhage for mom; contraction feeling means good bec that stops the bleeding

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19
Q

1st Stage –

LATENT

A

Signs:

  • bloody
  • cramping
  • pressure/tightening
  • loose bowels
  • backache
  • flu
  • nesting
  • contractions
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20
Q

Duration of Labor –

1st stage – CERVICAL EFFACEMENT and DILATION

A

• First Stage
– Latent: 8.6hr nullipara, 5.3hr multipara
– Active: 4.6hr nullipara, 2.4hr multipara
– Trans: 3.6hr nullipara, variable multipara

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21
Q

Duration of Labor –

2nd stage – stage of FETAL EXPULSION – the pushing

A

30min-2hr nullipara,

5-20min in multipara

22
Q

Duration of Labor –

3rd stage – PLACENTAL EXPULSION – until placenta is delivered

A

3-60 minutes

23
Q

Duration of Labor –

4th stage – RECOVERY

A

4 hrs (text states 2 hours) ??

24
Q

Mechanisms of Labor: AKA Cardinal Movements of Labor

A
  1. Descent of Presenting Part
  2. Engagement of fetal presenting part
  3. Flexion of the fetal head
  4. Internal Rotation
  5. Extension of fetal head
  6. Restitution and external rotation
  7. Expulsion of head, shoulders, and body
25
Q

Physiologic Adaptation to Labor: FETAL ADAPTATION

A

• Placental Circulation
– Fetal HGB
– High H/H
– Higher CO
• Cardiovascular
– Fetal heart Rate
• 110-160 bpm (average 140)
• Higher when preterm (average 160 bpm)
– Fetal Circulation
• Affected by maternal position, uterine cx, blood pressure, and umbilical cord blood flow
• during contractions, child BP should go up
• Pulmonary
– Fetal Respirations
• Fetal lung fluid is cleared from air passages during labor and vaginal birth
• Fetal O2 pressure (pO2) decreases
• Fetal CO2 pressure (pCO2) increases
• Fetal arterial pH decreases
• Fetal bicarbonate level decreases
• Fetal respiratory movements decrease during labor

26
Q

Physiologic Adaptation to Labor:

Maternal Adaptation: REPRODUCTIVE System

A

Reproductive:
– Contraction
– Uterine
– Cervical

27
Q

Physiologic Adaptation to Labor:

Maternal Adaptation: CARDIOVASCULAR System

A

Cardiovascular:
– Temporary increase in blood volume
– Supine hypotension

28
Q

Physiologic Adaptation to Labor:

Maternal Adaptation: RESPIRATORY

A

Respiratory:
– Increased RR
– at Risk of Hyperventilation
• for light headed, tingling/numbness on face, need to rebreathe the CO2

29
Q

Physiologic Adaptation to Labor:

Maternal Adaptation: GI & GU

A

Gastrointestinal:
– N/V

Urinary:
– Decreased Sensation of Bladder Fullness
– Need bladder to be emptied bec they can not control or feel if the bladder is full

Hematopoietic:
–	Blood loss during L&D
•	800 cc or less blood loss for CS
•	500 cc or less for vaginal blood loss
–	Increased levels of clotting factors
30
Q

Physiologic Adaptation to Labor:

Maternal Adaptation: INTEGUMENTARY

                                NEUROLOGIC

                                ENDOCRINE
A

Integumentary:
– Distensibility in the area of the vaginal intraoitis

Neurologic
– Sensorial changes

Endocrine
– Labor is triggered by decreased progesterone and increase estrogen, and increased prostaglandins, and oxytocin

31
Q

Natural delivery

A

means NO epidural but can get pain meds through IV

32
Q

Expression of Pain

A

• Respirations increase (hyperventilation common)
• Gastric acidity increases (N/V)
• Emotional: tiring, exhausting, annoying, sickening, nauseating, anxiety, writhing, crying, groaning
• Sympathetic nervous system stimulated and results in catecholamine release
– Increased heart rate
– Increased blood pressure
• BP shld NOT be over 140/90

33
Q

Factors Influencing Pain Response

A
  • Physiologic
  • Culture
  • Previous Experience
  • Comfort
  • Support
  • Environment
34
Q

Factors that Influence Perception or Toleration of Pain

A
  • Intensity of Labor
  • Cervical Readiness
  • Fetal Position
  • Characteristics of the Pelvis
  • Fatigue and Hunger
  • Intervention of Caregivers
35
Q

Nonpharmacologic Pain Management

A
  • Advantages: Do NOT slow labor and have no side effects

* Disadvantages: Some not able to achieve desired level of pain relief

36
Q

Nonpharmacologic Techniques OF PAIN Management

A

– Focusing and Relaxing
• Reduces tension and stress
• Attention-focusing and distraction techniques (focusing on an object)

--	Cutaneous Stimulation
        •	Effleurage and counterpressure
        •	Water Therapy 
        •	Application of Heat and Cold
        •	Touch and Massage 
--	Breathing techniques
--	Meditation
--	Environmental Changes
37
Q

BREATHING TECHNIQUES

A

• First Stage Breathing
– Always start and end a contraction with a Deep Cleansing Breath
– Slow paced (latent)
– Modified paced (active)
– Patterned paced (transition)
– Breathing to prevent pushing (pursed lip)

• Second Stage Breathing
– Limit breath holding
• Do not hold breath while pushing bec baby will become hypoxic
• Encourage the patient to breath during pushing

38
Q

Pharmacologic Pain Management

A

Pharmacologic Pain Management:
• Any drug taken by the woman is likely to affect the fetus
• Drugs can affect the course and length of labor
• Pregnancy complications may limit the choice of pharmacologic pain management

39
Q

Systemic PAIN Drugs for Labor

A

Systemic Drugs for Labor:
• Have effects on multiple systems because distributed throughout the body
• Parenteral Analgesia
– Opioid/Sedatives
– Opioid Antagonist
• When resp is low, DON’T give sedatives/opioids
• Opioid Antagonist – not given to addicts – bec they will have an INSTANT WITHDRAW – !!!!
Ex. Nubain, Stadal —NO! NO! NO!

40
Q

PAIN MANAGEMENT Procedure

A

Procedure:
• Assess pain level
• Estimate time of delivery
• Educate patient
• Check for order/call care provider if order needed–SBAR
• Evaluate if medication appropriate for patient
• Evaluate Fetal Heart Rate (don’t give if FHR is low)
• Administer med according to the 7 rights
– When do you give the med?
– IV Push—slow
• Assess maternal and fetal response
– What is expected, what is an adverse effect?
– Timing
• Baby has to look good before I give pain med.
• Administer the pain meds while in contraction

41
Q

Vaginal Birth Anesthesia (kinds)

A
  • Local Infiltration Anesthesia

* Pudendal Block

42
Q

Local Infiltration Anesthesia

A

Local Infiltration Anesthesia:
• Infiltration of the Perineum with a local anesthetic → Just numbing the perineum – lidocaine
• Can be performed by physician or CNM
• Does not alter pain from contractions or distension of the vagina
• Used for episiotomy or laceration repair
• Rarely has adverse effects for mother or fetus

43
Q

Pudendal Block Anesthesia

A

Pudendal Block
• Anesthetizes the lower vagina and part of the perineum
• Provides pain relief for episiotomy and vaginal birth
• Does not block contraction pain
• Highly localized
• Complications: Reaction to anesthetic, rectal puncture, hematoma, sciatic nerve block.
• Fetus usually not affected

44
Q

Regional Pain Management (kinds)

A

Regional Pain Management
• Epidural block
• Intrathecal opioid analgesics
• Subarachnoid (SPINAL) block

45
Q

Lumbar Epidural Block

A

Lumbar Epidural
• Used for both vaginal and Cesarean births
• Injection of local anesthesia through a catheter into tiny epidural space at about L-3, L-4

• S/E: maternal hypotension, Bladder distention, Prolonged second stage, catheter migration, c-section, maternal fever, N/V, pruritis, delayed respiratory depression
– maternal hypotension – need a liter of fluid bec epidural can lower their BP; also need platelet count à contraindicated to pt w/ risk of bleeding,

46
Q

EPIDURAL : Nursing Considerations

A

Epidural: Nursing Considerations
• Before epidural
– Fluids
– Platelets
– assess Fetal Heart Rate
• During epidural
– Positioning
– Support
– Fetal Heart Rate
• After epidural
– Assess BP for hypotension and Fetal Heart Rate for tolerance
– Left Side-Lying Position
– If hypotension occurs, initiate intrauterine resuscitation !!!!!
– Manage other side-effects as necessary
– Assess for return of sensation/assist with ambulation

47
Q

Intrathecal Opioid Analgesics

A

Intrathecal Opioid Analgesics:
• The drug is injected into the subarachnoid space, where it binds directly to opioid receptors allowing much smaller doses of the medication
• Limited duration of action
• N/V, pruitis
• Advantageous b/c does not cause hypotension
– Assess for return of sensation/assist with ambulation

48
Q

Subarachnoid (SPINAL) Block

A

Subarachnoid (Spinal) Block
• Simpler than epidural
• Performed when a quick C-Section is necessary, performed just before birth
• Local anesthetic injected into subarachnoid space
• Adverse Effects: maternal hypotension, bladder distension, and postdural puncture headache
– Do this just before they take the baby out !!
– Quick acting and short acting !!
– Risk S/E – HA

49
Q

SPINAL BLOCK: Nursing Considerations

A

Spinal Block: Nursing Considerations
• Hypotension a concern (see epidural considerations)
• After Spinal
– Foley Catheter Necessary
– Post Anesthesia Recovery and Assessment for return of sensation/assist with ambulation when permitted
– Patient at risk for CNS depressant symptoms for 24 hours after medication insertion into spinal and special precautions in effect for 24 hours
• Frequent respiratory and vital sign assessment
• Decreased doses of pain medications related to compounding effects of CNS depression
• Antidote
• Always assess the respiration !!
• Antidote is narcan

50
Q

Postdural Puncture Headache

A

Postdural Puncture Headache
• Occurs because of CSF leakage
• Worse when woman is upright and disappear when lying flat
• Tx: bedrest with oral hydration, caffeine, blood patch

51
Q

General Anesthesia

A

General Anesthesia:

  • For Emergency C-Sections
  • Planned C-Sections when woman not a candidate for epidural or spinal

Special Considerations:

    • General Anesthesia can affect the fetus; therefore, once anesthesia is administered the baby must be delivered quickly !!!
    • Post Anesthesia Recovery

Maternity - 431 (4 decks)

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