[Exam 2] Chapter 13 - Labor and Birthing Process Flashcards
It is widely believed that what cascade of events causes labor?
Uterine stretch from the fetus and amniotic fluid volume , progesterone withdrawal to estrogen dominance, increased oxytocin sensitivity, and increased release of prostaglandins
What is the estrogen-to-progesterone ratio theory?
During last trimester of pregnancy, estrogen levels increase and progesterone levels decrease. LEads to increase of myometrium gap junctions (Are proteins that connect cell membranes and facilitate coordination of uterine contractions)
What happens since Oxytocin is increasing?
This paired with increasing cortisol levels syntheize prostaglin, which lead to additional contractions, cervical softening, gap junction induction leading to dilation (enlargement of the exernal cervical os)
Uterine contractions have what two functions
To dilate the cervix and to push the fetus through the birth canal
Premonitory Signs of Labor and Cervical Changes: What occurs to the cervix?
Cervical softening and possible cervical dilation with descent of the presenting part of the pelvis occur. Can occur 1 month to 1 hour before
Premonitory Signs of Labor and Cervical Changes: Cervix length changes?
From elongated structure to a shortened, thinned segment
Premonitory Signs of Labor and Cervical Changes: Cervical collagen fiber changes?
Enzymatic rearrangement into smaller, more flexible fibers that facilitate water absorption, leading to a softer, more stretchable cervix.
Premonitory Signs of Labor and Cervical Changes: Ripening and softening of cervix essential for effacement and dilatement, which reflect what
the enhanced collagen breakdown that was previously inhibited by progesterone
Premonitory Signs of Labor and Lightening: When does this occur?
When fetal presenting part begins to descent into the true pelvis. Uterus lowers and moves into more anterior position.
Premonitory Signs of Labor and Lightening: With descent, woman usually notes what improvements?
Breathing much easier and decreas ein gastric reflux
Premonitory Signs of Labor and Lightening: Will complain of what because of this?
Complains of increased pelvic pressure, leg cramping, dependent edema in lower legs and low back discomfort
Increase in vaginal discharge and more frequent urination
Premonitory Signs of Labor and Lightening: When will this occur in primiparas?
Lightening can occur 2 or more weeks before labors. Multiparas may not occur until labor starts
Premonitory Signs of Labor and Increased Energy: What is this referred to as and where do they put this energy toward?
Nesting. Put it toward cleaning, cooking, preparing the nursery, and spending extra time with other children.
Premonitory Signs of Labor and Increased Energy: When does this occur?
24-48 hours before onset of labor. Thought to be because of increase in epinephrine bc of decrease in progesterone
Premonitory Signs of Labor and Bloody Show: Why does this happen?
Mucous plug that fills cervical canal is expelled as a result of cervical softening and increased pressure of the presenting part.
Premonitory Signs of Labor and Bloody Show: What does this appear as?
Ruptured cervical capillaries release small amount of blood that mixes with mucus, resulting in pink-tinged secretions known as bloody show
Premonitory Signs of Labor and Braxton Hicks Contractions: How does this usually feel?
Felt as a tightening or pulling sensation of the top of the uterus. Occurs in abdomen and groin and spread down before relaxing.
Lasts about 30 seconds but can persist as long as 2 minutes.
Premonitory Signs of Labor and Braxton Hicks Contractions: Where are true contractions felt?
In the lower back.
Premonitory Signs of Labor and Braxton Hicks Contractions: This aids in helping with what?
Aid in moving the cervix from a posterior to anterior position. Also soften and ripen the cervix.
Premonitory Signs of Labor and Braxton Hicks Contractions: How can these be decreased?
Walking, voiding, eating, increasing fluid intake, or changing position
Premonitory Signs of Labor and Braxton Hicks Contractions: What happens as birth draws near to uterus?
Uterus becomes more sensistive to oxytocin, and frequency and intensity of these contractions increase.
Premonitory Signs of Labor and Braxton Hicks Contractions: When should woman contact provider?
If contractions last longer than 30 seconds and occur more often than 3-6x an hour. May be preterm labor.
Premonitory Signs of Labor and Braxton Hicks Contractions: What is the late preterm range?
34 0/7 weeks to 36 6/7 weeks.
Premonitory Signs of Labor and Spontaneous Rupture of Membranes: What is PROM?
Rupture of membranes with loss of amniotic fluid prior to the onset of labor . Ococurs in 8-10% of women.
Premonitory Signs of Labor and Spontaneous Rupture of Membranes: What can this appear as?
Sudden gash or a steady leakage of amniotic fluid. Although fluid lost, new fluid is made to protect baby.
Premonitory Signs of Labor and Spontaneous Rupture of Membranes: Danger with this?
Barrier for infection is gone. Danger of cord prolapse too if engagement has not occured with the sudden release of fluid and pressure with rupture.
True Versus False Labor: What is False Labor?
Irregular uterine contractions felt, but the cervix is not affected.
True Versus False Labor: True labor characterized by?
Those that occur at regular intervals that increase in frequency, duration, and intensity
True Versus False Labor: True Labor Contraction Timing?
Regular, becoming closer together, usually 4-6 min apart lasting 30-60 seconds
True Versus False Labor: False Labor contraction timing?
Irregular, not occuring close together
True Versus False Labor: True labor contraction strength?
Become stronger with time, vaginal pressure is usually felt
True Versus False Labor: False labor contraction strength
Frequently weak, not getting stronger with time or alternating (strong and then weak)
True Versus False Labor: True labor contraction discomfort
Starts in the back and radiates around toward front of abdomen
True Versus False Labor: False labor contraction discomfort
Usually felt in froont of the abdomen
True Versus False Labor: True labor change in activity?
Contractions continue no matter what positional change made
True Versus False Labor: false labor change in activity?
Contractions may stop or slow down with walking or making a position change
True Versus False Labor: True labor stay or go?
Stay home until contractions 5 mins apart, last 45-60 seconds, and strong enough that conversation cannot happen
True Versus False Labor: False labor stay or go?
Drink fluids and walk around to see if theres any change in intensity of the contractions.
True Versus False Labor: With first pregnancy, how long can cervix take to dilate?
Up to 20 hours
Factors Affecting Labor Process: What Five P’s affect the process of labor and birth?
Passageway (birth canal) Passenger (Fetus and placenta) Powers (Contractions) Position (Maternal) Psychological Response
Factors Affecting Labor Process: What five additional P’s affect labor process?
Philosophy (low tech, high touch) Partners (support caregivers) Patience (natural timing) Patient (client) preparation (childbirth knowledge base) Pain management (comfort measures)
Factors Affecting Labor Process - Passageway: As the pregnancy progresses, the hormones relaxin and estrogen cause what to happen to connective tissue?
Become more relaxed and elastic and cause the joints to become more flexible to prepare the mother’s pelvis for birth
Factors Affecting Labor Process - Passageway and Bony Pelvis: False portion composed of what?
Upper flared parts of two iliac bones with their concavities andw ings of the base of the sacrum.
Factors Affecting Labor Process - Passageway and Bony Pelvis: What is the linea terminalis?
The line dividng the false pelvis from the true pelvis. False lies above it, true lies below it.
Factors Affecting Labor Process - Passageway and Bony Pelvis: What is the true pelvis?
The bony passageway through which the fetus must travel. Made of inlet, mid-pelvis, and outlet
Factors Affecting Labor Process - Passageway and Bony Pelvis - Pelvic Inlet: Allows entrace to what?
To the tue pelvis. Wider in trh sidways aspect than from front-to-back
Factors Affecting Labor Process - Passageway and Bony Pelvis - Mid-Pelvis: What is this?
Fetus must travel through this to reach outside. Chest compressed, causing lung fluid and mucus to be expelled.
Factors Affecting Labor Process - Passageway and Bony Pelvis - Pelvic Outlet: What is this?
Wider from front to back. Consists of three measurements that determine whether fetus will pass thourhg or not?
Factors Affecting Labor Process - Passageway and Bony Pelvis - Pelvic Outlet: What is the diagonal conjugate?
Distance between anterior surface of sacral prominence and the anterior surface of symphysis pubis
Factors Affecting Labor Process - Passageway and Bony Pelvis - Pelvic Outlet: What is the transverse or ischial tuberosity diameter?
Distance at medial and lowest aspect of ischial tuberosities, at the level of anus
Factors Affecting Labor Process - Passageway and Bony Pelvis - Pelvic Outlet: What is the true or obstetric conjugate?
Distance estimated from measurement of the diagonal conjugate , 1.5 cm substracted from diagonal conjugate
Factors Affecting Labor Process - Passageway and Bony Pelvis - Pelvic Outlet: What size is recommended for diagonal conjugate and true/obstetric conjugate?
11.5 cm at least, and then 10 cm or more. Pelvis then large enough for vaginal birth
Factors Affecting Labor Process - Passageway and Pelvis Shape - Gynecoid Pelvis: What is this?
Considered to be true female pelvis, occurs in 40% of women. Vaginal birth most favorable here.
Factors Affecting Labor Process - Passageway and Pelvis Shape - Anthropoid Pelvis: What is this?
Commen in men and non-white women. Occurs in 25% of women. Pelvic inlet oval and sacum long.
Factors Affecting Labor Process - Passageway and Pelvis Shape - Android Pelvis: What is this?
Considered the male-shaped. 20% of women. Pelvic inlet heart-shaped. Descent of fetal head slow, and failure of fetus to rotate is common. Generally leads to C-Section.
Factors Affecting Labor Process - Passageway and Pelvis Shape - Platypelloid (Flat) Pelvis:
3% occurence. Shallow, widens at pelvic outlet. Difficult to descent mid pelvis. Usually C-Section.
Factors Affecting Labor Process - Passageway and Soft Tissues: Soft tissues here include what
cervix, pelvic floor muscle, and vagina.
Factors Affecting Labor Process - Passenger: What portiosn of the fetal have an important impact on birthing process?
Fetal Head Fetal Attitude (degree of body flexion) Fetal Lie (relationship of body parts) FEtal presentation (first body part) Fetal position (relationship to maternal pelvis) Fetal Station Fetal Engagement
Factors Affecting Labor Process - Passenger and Fetal Head: Capat Succedaneum occurs, which is what?
Edema of the scalp at the presenting part. Swelling crosses suture lines and disappears within 3-4 days.
Factors Affecting Labor Process - Passenger and Fetal Head: What is Dephalohematoma?
Colelction of blood between the periosteum and the bone tht occurs several hours after birth. Reasborbed over next 6-8 weeks
Factors Affecting Labor Process - Passenger and Fetal Head: What is the anterior fontanelle important?
Soft spot of newborns head. Remains open for 12-18 months after birtht o allow for growth of brain.
Factors Affecting Labor Process - Passenger and Fetal Head: What are the two most important diametes that affect the birth process?
Suboccipitobregmatic (9.5 cm at term)
Biparietal (9.25 cm )
Factors Affecting Labor Process - Passenger and Fetal Attitude: What does this refer to?
Posturing (flexion or extension) of the joints and the relationship of fetal parts to one another
Factors Affecting Labor Process - Passenger and Fetal Attitude: Most comon fetal attitude?
When labor begins with all joints flexed, fetal back rounded, and chin is on the test, thighs flexed on abdomen, and legs flexed at knees.
Factors Affecting Labor Process - Passenger and Fetal Attitude: What happens when fetus presents with abnormal attitudes (no flexion or extension)
Their nonflexed position can increase the diameter of presenting part, as it passes through the pelvis and increases difficulty of birth
Factors Affecting Labor Process - Passenger and Fetal Lie: What is this?
The relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother.
Factors Affecting Labor Process - Passenger and Fetal Lie: Three possible lies?
Longitudinal (most common) , transverse, and oblique
Factors Affecting Labor Process - Passenger and Fetal Lie: What is a longitudinal lie?
When the long axis of the fetus is parallel to that of the mother (fetal spine to maternal spine side-by-side)
Factors Affecting Labor Process - Passenger and Fetal Lie: When does a transverse lie occur?
When the long axis of the fetus is perpendicular to the long axis of the mother (Fetal spine lies across the maternal abdomen and crosses her spine)
Factors Affecting Labor Process - Passenger and Fetal Lie: When does a oblique lie occur?
The fetal long axis is at an angle to the bone inlet, and no palpable fetal part is presenting.
Factors Affecting Labor Process - Passenger and Fetal Lie: What lies cannot be delievered vaginally?
Transverse and oblique lie
Factors Affecting Labor Process - Passenger and Fetal Presentation: What does this refer to?
The body part of the fetus that enters the pelvic inlet first (presenting part). This lies over the inlet of the pelvis or the cervical os.
Factors Affecting Labor Process - Passenger and Fetal Presentation: What are the three main fetal presentations?
Cephalic (head first) , breech )pelvis firsT) and shoulder (scapula first)
Factors Affecting Labor Process - Passenger and Fetal Presentation: What are teh variations of the vertix position (cephalic)
Military, brow, and facial presentation
Factors Affecting Labor Process - Passenger and Breech Presentation: When does this occur?
When fetal buttocks or feet enter the maternal pelvis first and fetal skull enters last . Skull may become stuck on pelvis. Umbilical cord may also become compressed.
Factors Affecting Labor Process - Passenger and Breech Presentation: What happens in frank breech?
Buttock presents first with both legs extended up toward the face
Factors Affecting Labor Process - Passenger and Breech Presentation: What happens in a full or complete breech?
Fetus sits crossed-legged above the cervix
Factors Affecting Labor Process - Passenger and Breech Presentation: What happens in footling or incomplete breech?
One or both legs are presenting.
Factors Affecting Labor Process - Passenger and Breech Presentation: What are breech presentations associated with?
Prematurity, placenta previa, multiparity, uterine abnormalities
Factors Affecting Labor Process - Passenger and Breech Presentation: Which breech presentations require C-Section?
Complete, footling, and incomplete
Factors Affecting Labor Process - Passenger and Shoulder Presentation: When does this occur?
When fetal shoulders present first, with the head tucked inside.