[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.
Factors Affecting Labor Process - Passenger and Shoulder Presentation: How does this look in person?
Appear when woman is pushing as the head slowly extends and emerges over perineum, but then retracts back into vagina (turtle sign).
Factors Affecting Labor Process - Passenger and Shoulder Presentation: Conditions associated with this?
Placenta previa, prematurity, high parity, premature rupture of membranes
Factors Affecting Labor Process - Passenger and Shoulder Presentation: How is the baby deleivered?
Via C-Section
Factors Affecting Labor Process - Passenger and Fetal Position: What is this?
Relationship of a given point on the presenting part of the fetus to a designated point of the maternal pelvis
Factors Affecting Labor Process - Passenger and Fetal Position: Landmark fetal presenting parts include what?
Occipital Bone (O) which shows vertex position)
Chin (Mentum, MI) which shows fetal presentation)
Buttocks (Sacrum (S)) which designates a breech position
Scapula (Acromion Process (A)), which shows shoulder presentation
Factors Affecting Labor Process - Passenger and Fetal Position: Maternal pelvis divided into what quadrants? and show what?
Right Anterior/Left Anterior
Right/Left Posteiror .
They designate whetehr the presenting part is directed toward the front, back, left, or right side of pelvis
Factors Affecting Labor Process - Passenger and Fetal Position: What does the first letter indicate?
Whether presenting part is tiled toward the (L) or the right (R) side of the maternal pelvis
Factors Affecting Labor Process - Passenger and Fetal Position: What does the second letter indicate?
Particular presenting part of fetus. (O) for occiput, (S) for sacrum), M for chin, A for Acromion process and D for dorsal (fetal back)
Factors Affecting Labor Process - Passenger and Fetal Position: What does third letter indicate?
Location of presention part in relation to anterior (A) portion of maternal pelvis or posterior (P). If to the side of the maternal pelvis (desgianted as transverse (T).
Factors Affecting Labor Process - Passenger and Fetal Position: Example of occiput is facing the left anterior quadrant of the pelvis?
LOA (most commona nd most favorable fetal positioning for birth)
Factors Affecting Labor Process - Passenger and Fetal Station: What does this refer to?
The relationship of the presenting part to the level of the maternal pelvic ischial spines.
Factors Affecting Labor Process - Passenger and Fetal Station: How is this measured?
In centimeters and is referred to as a minus or plus, depending if its above or below the ischial spines. These are the narrowest part of the pelvis
If below ischial spines, recorded as plus.
If above bby 1 cm, documented as -1 station.
Factors Affecting Labor Process - Passenger and Fetal Station: When is zero (0) station designated?
When the presenting part is at the level of the maternal ischial spines.
Factors Affecting Labor Process - Passenger and Fetal Station: How should we view fetal station as?
Meeting a goal. If fetus descending downward past ischial spines toward goal of birth, station is positive and cm numbers grow bigger from +1 to +4.
Factors Affecting Labor Process - Passenger and Fetal Engagement: What is this?
Signifies the entrance of the largest diameter of the fetal presenting part (usually fetal head) into the smallest diameter of maternal pelvis.
Said to be engaged in pelvis when presenting part reaches 0 station
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor: What is this?
The many positional changes that the fetus goes through as it travels through the passageway
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Engagement: What is this?
Occurs when the greates ttransverse diameter of the head in vertex (biparietal diameter) passes through the pelvic inlet (usualy 0 station).
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Descent: What is this?
Downward movmeent of fetal head until it is within pelvic inlet. Occurs intermittenly with contraction is broughy by oen or more forces
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Descent: What are the forces that affect this?
Pressure of amniotic fluid
Direct pressure of fundus on fetus buttocks or hed
Contractions of abdominal muscles
Extension and straightening of fetal body
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Flexion: When does this occur?
As vertex meets resistance from cervix, walls of pelvis or pelvic floor. Chin brought into contact with fetal throax and presenting diameterI is changed from occipitofrontal tosuboccipitobregmatic which achieves smallest fetal skull diameter
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Internal Rotation : What is this?
After engagement. Head descends and lower porition of head meets resistance from one side of pelvic floor. Head then rotates 45 degrees.
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Internal Rotation : What does this align?
The long axis of the fetal head with the long axis of the maternal pelvis.
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Extension: What is this?
Occurs after internal rotiation is complete. Head emerges through extension under the symphysis pubis along with the shoulders.
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Extension: What occurs as a result of this?
Anterior fontaneal, brow, nos,e mouth, and chin born successfully
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and External Rotation: What happens here?
After head born and free of resistance, it untwists, causing the occiput to move about 45 degrees back to its original left or right position. Allows shoulders to rotate internally to fit the maternal pelvis
Factors Affecting Labor Process - Passenger and Cardinal Movement of Labor and Expulsion: What is this?
Expulsion of rest of body occurs more smoothly after birth of the head and posterior shoulders.
Factors Affecting Labor Process - Powers: What is the primary stimulus powering labor?
Uterine contractions. Cause complete dilation and effacement of cervix during first stage of labor.
Factors Affecting Labor Process - Powers: Secondary powers in labor involve what?
The use of intra-abdominal pressure (voluntary muscle contracctions) exerted by the woman as she pushes and bears down
Factors Affecting Labor Process - Powers - Uterine Contractions: Why is there a pause in uterine contractions?
Allows woman and uterine muscles to rest. In addition, pause restores blood flow to the uterus and placenta, which is temporalily reduced during each uterine contraction
Factors Affecting Labor Process - Powers - Uterine Contractions: What are these responsible for?
Thinning and dilating the cervix, then thrusting the presenting part toward the uterine lower segment.
Factors Affecting Labor Process - Powers - Uterine Contractions: What happens in effacement in primigravidas?
Typically starts before the onset of labor and usually begins before dilation
Factors Affecting Labor Process - Powers - Uterine Contractions: Cervical canal of 2 cm, 1 cm, and 0cm would be described as what percent effaced?
0% effacted
50% effaced
100% effaced
Factors Affecting Labor Process - Powers - Uterine Contractions: External cervical os distance when closed, half open, and fully open?
0 cm dilated
5 cm dilated
10 cm dilated
Factors Affecting Labor Process - Powers - Uterine Contractions: Contractions during early labor?
Mild, last about 30 seconds and occur about every 5-7 minutes.
Factors Affecting Labor Process - Powers - Uterine Contractions: Contractiosn that are moderate to high intensity?
Last longer (60 seonds) occur more frequently (2–3 mins apart)
Factors Affecting Labor Process - Powers - Uterine Contractions: Each contraction has what three phases ?
Increment (buildup of the contraction)
Acme (peak or highest intensity
Decrement (descent or relaxation of the uterine muscle fibers)
Factors Affecting Labor Process - Powers - Uterine Contractions: Uterine contractiosn are monitored and assessed according to what three parameters?
Frequency, duration, and intensity
Factors Affecting Labor Process - Powers - Uterine Contractions: What is frequency?
How often contractions occur and measured from beginning of one contraction to beginning of next contraction
Factors Affecting Labor Process - Powers - Uterine Contractions: What is duration?
How long a contraction lasts and measured from beginning to endd
Factors Affecting Labor Process - Powers - Uterine Contractions: what is Intensity?
Strength of contraction. Can be used by internal intruterine pressure catheter
Factors Affecting Labor Process - Powers - Uterine Contractions: How is the catheter positioned?
In uterine cavity through cervix after membranes . Measures intensity by measuign pressure of amniotic fluid inside uterus in millimeters of mercury.
Factors Affecting Labor Process - Powers - Intra-abdominal pressure: What does an increased intra-abdominal pressure do?
Compresses the uterus and adds to the power of expulsion forces of the uterine contractions. Promotes birth of fetus and expulsion of the fetal membranes.
Factors Affecting Labor Process - Positions (Maternal): What does quatting and kneeling do to the body?
Squatting: Enlarges the pelvic inlet and outlet diameters
Kneeling: Removes pressure on the maternal vena cava and helps to rotate the fetus from a posterior position to an anterior one
Factors Affecting Labor Process - Positions (Maternal): Advantages of an upright or lateral position
Reduced length of the first stage of labor
Reduced number of assited deliveries
Contribute to fewer abnormal fetal heart rate patterns
enhance sense of control by mother
Factors Affecting Labor Process - Psychological Response: Factors promoting a positive birth experience include what?
Clear information about procedure
Support, not being alone
Trust in staff caring for her
Personal control over breathing
Factors Affecting Labor Process - Philosophy: Examples of philosophies?
One assuming women cannot manage birth experience adequately and need cosntant monitoring
Other says women are capable, reasoning individuals who can actively participate in their birth experience
Factors Affecting Labor Process - Philosophy: what is family-centered birthing?
Is more approprite today to denote the low-tech, high-touch approach requested by many childbearing women, who view childbirth as normal process
Factors Affecting Labor Process - Partners: What can a caring partner use?
Massage, light touch, acupressure, hand-holding, stroking, and relaxation
Factors Affecting Labor Process - Partners: What is a Doula?
A women who offers emotional and practial support to a mother or couple before, during, and after childbirth
Factors Affecting Labor Process - Patience: Healthy People 2020 has what two goals for C-Sections?
Reduced rate of cesarean birth among low-risk women
Reduce the rate of c-section births among women who had previous cesarean birth
Factors Affecting Labor Process - Patience and Induction of Labor: There is a trend to attempt to manipulate process of labor thorugh medical means such as
artifical rupture of membranes (amniotomy) and augmentation of labor with oxytocin
Factors Affecting Labor Process - Patience and Induction of Labor: Why would an amniotomy be performed?
To augment or induce labor when the membranes have not ruptured spontaneously. Allows fetal heat to have more contact with cervix to dilate it. Performed when at -2 station with cervix dilated
Factors Affecting Labor Process - Patience and Induction of Labor: What does Synthetic Oxytoicn (Pitocin) do?
Used to induce or augment labor by stimulating uterine contractions. Administered piggybacked into primary IV line with an infusion pump titrated
Factors Affecting Labor Process - Patience and Induction of Labor: Elective induction has a cascade of related interventions suhc as what?
IV Line, continuous electronic fetal monitoring, confinement to bed, amniotomy, pharmacoloic labor-stimulating agents
Factors Affecting Labor Process - Patience and Induction of Labor: Elective induction of labor in nulliparas is associated with what?
Increased rates of cesarean, postpartum hemorrhage, neonatal resucitation and longer hospitalizations without improvement in neonatal outcomes
Factors Affecting Labor Process - Patience and Induction of Labor: Current medical indicates for inducing labor include
Spontaneous rupture of membranes
Large-size fetus not expected to nagigate maternal pelvis
FGR where external intervention needed
Pregnancy more than 42 weeks
Factors Affecting Labor Process - Patient (Client) Preparation: Prenatal Education: Increasing body of evidence also indicates that a well-prepared woman with good labor support is less likely to need
analgesia or anesthesia and is unlikely to require cesarean birth
Factors Affecting Labor Process - Patient (Client) Preparation: Prenatal Education: A few herbs used include what?
Caulophyllum , made from herb blue, Blue and black cohost, rasberry leaves, castor oils, and evening primose used for cervical ripening
Physiologic Responses to Labor: What does Progesterone do here?
From placenta, and suppresses the spontaneous contractions of a typical uterus, keeping the fetus within the uterus
Physiologic Responses to Labor: What do the contractions end up causing to the body?
Shortening that causes effacement and dilation of the cervix and busting of fetal membranes
Physiologic Responses to Labor: Uterine contractions that are how strong promote cervical dilation?
30 mmHg or stronger
Physiologic Responses to Labor and Maternal Responses: Heart rate increases by how much ?
10-20 bpm
Physiologic Responses to Labor and Maternal Responses: Cardiac increases by how much during first and second stage of labor?
12-31 first stage
50% second stage
Physiologic Responses to Labor and Maternal Responses: WBC count increases by how much
25000-3000
Physiologic Responses to Labor and Maternal Responses: Factors that determine how a woman responds to labor are what?
Previous birth experience.
Current pregnancy experience.
Cultural considerations and support system
Exercise during pregnancy
Physiologic Responses to Labor and Fetal Responses What may occur here?
Increase in arterial CO2 pressure
Decrease in fetal breathing movement
Decrease in fetal oxygen pressure
Stages of Labor: Divided into what four stages?
Dilation, expulsive, placental, and restorative.
Stages of Labor: What does the first stage begin and end with?
Begins with the first true contraction and ends with full dilation of cervix
Stages of Labor: What occurs during stage two, the expulsive stage?
Cervix is completely dilated and ends with the birth of the newborn. Can last mins to hours. Contractions occur every 2-3 mins, lasting 60-90 seconds.
Stages of Labor: What occurs during third stage, or placental expulsion?
Starts after newborn is born and ends with separation and birth of the placenta. Cause placenta to be expelled within 5-30 mins
Stages of Labor: What occurs during the fourth stage, or the restoratitve stage?
Lasts from 1 hour to 4 hours after birth. Body begins to stabilize after hard labor.
Stages of Labor and First Stage: Most fundamental change in here?
The process is progressive dilation of the cervix. Gauged by vaginal exam.
Stages of Labor and First Stage: First stage ends when?
Ceervix is dilated to 10 cm in diameter and is large enough to permit the passage of a fetal head of average size
Stages of Labor and First Stage: How long does this last for primigravida?
Lasts about 12 hours.
Stages of Labor and First Stage: Pain here is primarily a result of what?
Dilation of the cervix and lower uterine segment and the distention (stretching) of these structures during contractions.
Stages of Labor and First Stage: Divided into what three phases?
Latent/Early, Active Phase, and Transition Phase
Stages of Labor and First Stage - Latent/Early PhasE: Begins when?
With the start of regular contractiosn adn ends with rapid cervical dilation begins . Cervical effacement occurs during this stage and dilates from 0-3 cm
Stages of Labor and First Stage - Latent/Early PhasE: Contractions occur how often?
Every 5-10 mins, last 30-45 seconds, and are described by palpation by the nurse
Stages of Labor and First Stage - Latent/Early PhasE: How is intensity assessed?
By pressing down on the fundus during a contnraction to see if it can be dented with nurses fingers. Indenting indicates a mild contraction
Stages of Labor and First Stage - Latent/Early PhasE: Effacement of cervix here?
0-40%
Stages of Labor and First Stage - Latent/Early PhasE: How long does this last for nulliparous woman and multiparous woman?
Nulliparous - 9 hours
Multiparous - 6 hours
Stages of Labor and First Stage - Active Phase: When does this last?
Time from an increase in the rate of cervical dilation (end of latent phase of labor) until coompletion of cervical dilation .
Stages of Labor and First Stage - Active Phase: Cervix dilation here? and effacement?
4-7 cm, with effacement being 40-80%.
Stages of Labor and First Stage - Active Phase: How long does this last for nulliparous womana nd multiparous woman?
Nulliparous - 6 hours
Multiparous 4.5 hours
Stages of Labor and First Stage - Active Phase: Contractions here?
More frequent (every 2-5 mins) and increase in duration (45-60 seconds)
Stages of Labor and First Stage - Active Phase: How does she act toward others?
Focuses on herself. Begins to use what she learned in her birthing classes to prepare for this.
Stages of Labor and First Stage - Transition Phase: What occurs there?
Dilation slows, progressing from 8-10 cm. Effacement from 80% to 100%.
Stages of Labor and First Stage - Transition Phase: How long does this last?
1 hour in first birth. Most difficult and shortest phase for the woman.
Stages of Labor and First Stage - Transition Phase: Contractions here?
Stronger (hard by palpation), more painful , more frequent (every 1-2 mins) and last longer (60-90 seconds).
Stages of Labor and First Stage - Transition Phase: Maternal symptoms seen here during this stage include what
N/V, trembling extremities, backache, increased apprehension, restless movement and increased bloody show from vagina
Stages of Labor and Second Stage: When does this begin?
With complete cervical dilation (10 cm) and effacement and ends with the birth of the newborn. This involves moving the fetus through the birth canal and out of the body
Stages of Labor and Second Stage: Contractions here?
Occur every 2-3 mins, last 60-90 seconds, and are described as strong by palpatation
Stages of Labor and Second Stage: Average length of second stage of labor?
1 hour or less. Mother feels more in control and less irritable and agitated. Focusd on work of pushing
Stages of Labor and Second Stage - Pushing: Second stage of labor has what two phases?
Pelvic and perineal related to the existence and quality of the maternal urge to push and to obstetric conditions related to fetal descent
Stages of Labor and Second Stage - Pushing: The early phase of the second stage is called what
the pelvic phase, because it is during this phase that the fetal head negotiates the pelvis, rotating, and advancing in descent
Stages of Labor and Second Stage - Pushing: What is the later phase called?
Perineal phase, because the fetal ehad is lower in the pelvis and is distending the perineum
Stages of Labor and Second Stage - Pushing: When the top of head no longer regresses bewen contractions, it is said to have
crowned
Stages of Labor and Second Stage - Pushing: How long does this stage last?
Up to 3 hours in the first labor
Stages of Labor and Second Stage - Pushing with Spontaneous Pushing versus Directed Pushing: What is spontaneous pushing?
Represents a natrual way of managing the second stage of labor.
Stages of Labor and Second Stage - Pushing with Spontaneous Pushing versus Directed Pushing: What is directed pushing?
Pushing directed by the caregiver.
Stages of Labor and Second Stage - Pushing with Spontaneous Pushing versus Directed Pushing: Why is valsalva beairng down and supine maternal positions a problem?
Is linked to hemodynamic changes in the mother and interferes with oxygen exchange between the motehr and the fetus
Stages of Labor and Second Stage - Pushing with Spontaneous Pushing versus Directed Pushing: Research shows that delaying pushing for up to 90 m inutes after complete cervical dilation resulted in what?
Significant decrease in the time mothers spend pushing without a significant increase in total time in second stage of labor
Stages of Labor and Third Stage: What happens here?
Begins with birth of the newborn and ends with teh separation and birth of the placenta.
Stages of Labor and Third Stage: COnsists of what two phases?
Placental separation and placental expulsion.
Stages of Labor and Third Stage - Placental Separation: What happens after infant born?
Uterus continues to contract strongly and can now retract, decreasing markedly in size. Cause placenta to pull away from uterine wall
Stages of Labor and Third Stage - Placental Separation: Signs of separation that indicate that placenta is ready to deliver?
Uterus rises upward
Umbilical cord lengthens
Sudden trickle of blood is released from vaginal opening
Uterus changes its shape
Stages of Labor and Third Stage - Placental Separation: Spontaneous birht of placenta occurs in what two ways?
Fetal side (shiny gray side) presenting first (called Schultz method or shiny Shultz)
Maternal Side (red raw side) presenting first
Stages of Labor and Third Stage - Placental Expulsion: What happens after separation ofp lacenta from the uterine wall?
Continued uterine contractions cause the placenta to be expelled within 2-30 mins unless there is gentle external traction to assis
Stages of Labor and Third Stage - Placental Expulsion: What to do after placenta expelled?
Uterus is massaged briefly by the attending physican, NP, or midwife, until it is firm so that uterine blood vessels constrict minimizing rf hemorrhage
Stages of Labor and Third Stage - Placental Expulsion: Blood l oss here?
500 mL for normal
1000 for C-Section
Blood loss over 1000 mL is severe
Stages of Labor and Fourth Stage: What happens here?
Begins with completion of the expulsion of placenta and membranes and ends with the initial physiologic adjustmeent and stabilization of the mother (1-4 hours after birth). Initiates postpartum period
Stages of Labor and Fourth Stage: How should fundus feel?
Should be firm and well contracted. Located at midline between umbilicus and symphysis but slowly rises to level of the umbilicus during first hour after birth
Stages of Labor and Fourth Stage: How is the lochia (vaginal discharge)?
Red, mixed with small clots, and of moderate flow
When determining the frequency of contractions, the nurse would measure which of the following?
Start of one contraction to the start of the next contraction Beginning of one contraction to the end of the same contraction Peak of one contraction to the peak of the next contraction End of one contraction to the beginning of the next contraction
Start of one contraction to the start of the next contraction
Which fetal lie is most conducive to a spontaneous vaginal birth?
Transverse Longitudinal Perpendicular Oblique
Longitudinal
Which of the following observations would suggest that placental separation is occurring?
Uterus stops contracting altogether. Umbilical cord pulsations stop. Uterine shape changes to globular. Maternal blood pressure drops.
Uterine shape changes to globular
As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is:
Discomfort level is greater with false labor. Progressive cervical changes occur in true labor. There is a feeling of nausea with false labor. There is more fetal movement with true labor.
Progressive cervical changes occur in true labor.
The shortest but most intense phase of labor is the:
Latent phase Active phase Transition phase Placental expulsion phase
Transition Phase
A laboring woman is admitted to the labor and birth suite at 6 cm dilation. She would be in which phase of the first stage of labor?
Latent Active Transition Early
Active
Which assessment would indicate that a woman is in true labor?
Membranes are ruptured and fluid is clear. Presenting part is engaged and not floating. Cervix is 4 cm dilated, 90% effaced. Contractions last 30 seconds, every 5 to 10 minutes.
Cervix is 4 cm dilated, 90% effaced.
Interventions that are underutilized in promoting a normal birth. Select all that apply.
Oral nutrition and fluids in labor Open glottis pushing in the second stage of labor Skin-to-skin contact after birth for infant bonding Routine artificial rupture of membranes (amniotomy) Labor induction with Pitocin given intravenously Routine episiotomy to shorten labor length
Oral nutrition and fluids in labor
Open glottis pushing in the second stage of labor
Skin-to-skin contact after birth for infant bonding
Physiologic preparation for labor would be demonstrated by:
Decrease in Braxton Hicks contractions felt by mother Weight gain and increase in appetite by mother Lightening, whereby the fetus drops into true pelvis Fetal heart rate accelerations and increased movement
Lightening, whereby the fetus drops into true pelvis
