Exam 2 - Labor & Birth Flashcards
Exam 2
An approach that recognizes the impact of trauma on individuals and creates a safe, supportive environment for healing
trauma-informed care
what are the 3 common settings for childbirth?
(1) traditional hospital rooms
(2) free-standing birth centers
(3) home births
regular uterine contractions with cervical change; process when fetus, amniotic fluid, placenta, and membranes are separated and expelled from the uterus to the outside world
labor
onset of labor in gravid person with gestational age prior to 37 weeks
preterm labor
abnormally slow or protracted labor
distocia
never given birth to a child
nulliparous / “nullip”
has given birth before
multiparous “multip”
labor at 37-42 weeks, low-risk throughout, and spontaneous birth of infant in vertex presentation describes what?
normal components of labor
Lightening occurs ____ weeks before term
2-3
subjective feeling by pregnant person as baby settles in lower uterine segment
Lightening
Engagement occurs ___ weeks before term in first time parents
2-3
Widest part of the baby’s head passes through the pelvic inlet and into the pelvis
Engagement
pushing phase is ___ stage of labor
second
first / latent stage of labor is ____
cervical dilation
third stage of labor is ____
delivery of the placenta
fourth stage of labor is ____
maternal stabilization
first and second stages of labor go faster for ___ than ____
multip, nullip
if the placenta has not been delivered in ___ minutes, it can be concerning
30
if the placenta has not been delivered in 30 minutes this is called ___
retained placenta
the first stage has 3 main parts:
latent, active, transition
name 4 things about the latent stage
(1) steady but spaced contractions
(2) slow dilation (0-5cm)
(3) lasts 12-24 hours
(4) not as strenuous on birthing person
during the normal active phase, dilation progresses to _____
~5-8 cm
the fetal head engages during the ___ stage
normal active (first)
effacement becomes complete in which stage of labor?
normal active (first)
Name at least 4 components of the normal transition stage (first)
(1) contraction frequency is 2-3m
(2) dilation goes from 8 to 10cm
(3) contractions are intense
(4) emesis
(5) sweating
(6) shaking
the process of thinning and softening in prep for childbirth
cervical effacement
when does coping and discomfort start with labor (typically)?
normal active phase
cervical effacement goes from 0 to __ and dilation goes from 0 to ___
100%; 10 cm
how do we assess cervical effacement and dilation?
vaginal exam
swelling that appears as a cone-shaped head
caput
what happens during the second stage of labor?
(1) spontaneous urge to push
(2) contractions increase & intense
(3) fetal head may caput, mold, rotate
(4) completion of labor mechanics
the second stage of labor takes longer for ___ than ____
nullips; multips
Name at least 4 physiologic changes during labor
(1) CO increases
(2) HR increases
(3) BP increases during contractions
(4) RR increases
(5) WBC increases
(6) Temp can be slightly elevated
(7) GI motility and absorption decrease
(8) Blood glucose levels decrease
nurses should take vitals during what phase of contractions?
resting phase
name the 5 Ps of labor
(1) Passengers (fetus and placenta)
(2) Passageway (birth canal)
(3) Powers (contractions)
(4) Position (of the birthing person and fetus)
(5) Psychological response
part of the fetus entering into the pelvic inlet first
presentation
____ is shoulder/scapula first presentation
transverse
we want ____ presentation for the fetus
cephalic / head down
which presentation can you not delivery vaginally with?
transverse lie
relationship of the maternal longitudinal axis (spine) to fetal spine
lie
2 types of lie are
longitudinal and transverse
relationship of fetal body parts to one another
attitude
2 types of attitude are
flexion and extension
chin flexed to chest and extremities to torso
flexion
chin & extremities extended away
extension
relationship of presenting part of fetus in relation to its directional position of one of the 4 maternal pelvic quadrant
position
____ is the optimal position for vaginal delivery
Left Occiput Anterior (LOA)
passageway refers to
the pelvis and its shape
___ is the most common pelvic shape
gynecoid
____ is the most optimal pelvic shape for vaginal delivery
gynecoid
____ is the least common pelvic shape and is not conducive for vaginal birth
platypelloid
birth can occur but may not progress with ____ pelvic shape
android
anthropoid pelvic shape often results in ____ positioning / birth
occiput posterior birth (OP)
the 3 major parts of the fetal head are
face, base of skull, and vault of the cranium
which part of the fetal head is not well-fused?
vault of the cranium
relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis
fetal station
station 0 means what?
fetal head is engaged
+3/+4 station means what?
almost crowning
we typically want baby’s head to be at station 0 before ____
starting to push
when the largest diameter of the presenting part reaches or passes through the pelvic inlet
engagement
power refers to ___
contractions
time b/w the beginning of one contraction and the beginning of the next contraction
frequency of contractions
how do you measure contraction intensity?
palpation
mild contractions feel like
tip of the nose (soft)
moderate contractions feel like
chin (medium hard)
strong contractions feel like
forehead (hard)
Frequent position changes for birthing person to increase comfort, relieve fatigue, promote circulation
position - birthing person
moving during labor helps to promote ____
optimal fetal position
____ is unpleasant sensations in the body we may want to avoid
pain
____ is distressing state that feels helpless
suffering
what are the 3 ways to provide physical comfort during labor?
(1) promote self-comforting behaviors
(2) give partner suggestions
(3) encourage use of birth place areas
what is the important nursing intervention of the 3rd stage of labor?
once placenta is delivered, assess if it is intact
placenta should be delivered within ___ or it is a _____
30 minutes; retained placenta
why do we inspect the placenta for intactness?
we don’t want to leave anything in the uterus b/c it can lead to infection and bleeding
during labor, name the 5 nursing assessments that should be completed
(1) maternal health history
(2) physical assessment
(3) fetal assessment
(4) lab studies
(5) psychological assessment
Feel and palpate fetus externally to get a sense where the back is / general positioning
Leopold’s Maneuvers
during labor, name at least 3 things that nurses should do for assessment
(1) VS
(2) Leopold’s Maneuvers
(3) heart
(4) lungs
(5) headache, dizziness, vision changes
(6) pulses (LE, UE)
(7) cervical dilation / effacement
(8) membrane status
(9) contractions
(10) pain
during the 1st stage of labor and we assess membranes, fluid should be ____
clear
during the active phase assessment, what should you always assess?
fetal surveillance - contractions and FHR
during the second / pushing stage, what nursing prep should occur?
(1) support position changes
(2) have delivery meds ready
(3) continue monitoring status
(4) be prepared for the unknown
during the third stage, the fundus maintains ____ to ____
tone; deliver the placenta
during stage 4 of labor, continue to check ____
fundus
