Factors Affecting Labour and Delivery Flashcards
What are the 5 Ps of labour?
Passageway, passenger, powers, position, and psyche
What is passageway?
Ability of the pelvis/cervix to accommodate passage of the fetus. It includes passenger (ability of fetus to complete the birth process, along with amniotic membranes/placenta)
4 types of pelvis and best one for birth?
- Gynecoid- best for birth, 50% of people
- Android- 2nd best
- Anthropoid
- Platypelloid
What is molding?
Cranial bones overlap under pressure of powers of labour/demands of the unyielding pelvis. Fontanels arent fused together yet so sutures overlap to allow head to push through pelvis
Smallest and optimal diameter of the head to pass through the birht canal?
Suboccipitobregmatic diameter
5 parts of passenger for the fetus?
Attitude, lie, presentation, position, and station
What is fetal attitude?
Relationship of fetal parts to one another. Fetal head can be extended, flexed (what we want), or brow
What is fetal lie?
Refers to relationship of the fetal spine to maternal spine. Different lies- longitudinal (optimal for delivery), transverse (makes a T), and oblique (diagonal). This has no say whether head is up or down
Fetal presentation?
Determined by fetal lie/by body parts of fetus that enters the pelvic passage first (presenting part). Can be cephalic (head- vertex, brow, face, chin), or breech (buttocks), shoulder, or compound (baby is vertex but there’s a hand on the head)
Best fetal presentation?
Vertex flexed
3 different kinds of breech?
Complete- legs crossed sitting cross legged on the pelvis
Incomplete- legs not fully crossed
Frank- legs right up by the ears
Fetal position?
Describes position of fetus in relations to the pelvis. Ideal positions are ROA and LOA for delivery. R- right, L- left, O- occiput (flexed), S- sacral, M- mentum (chin)
Passenger station?
Relationship of presenting part (head or butt) to imaginary line drawn between ischial spine of maternal pelvis. Negative numbers are higher up and positive numbers are down further. Head at 0 station is engaged
What does engagement mean?
Presenting part at 0 is engaged or largest diameter of presenting part reaches/passes through pelvic inlet
What is powers? 2 parts
Powers work together to achieve birth of fetus, fetal membranes, and placenta.
1. Primary power- uterine muscle contractions
2. Secondary power- use of abdomen muscles to push during second stage of labour
What are contractions caused by?
Pressure of fetal head increased cervical dilation/effacement. There is a range of physical sensations felt- very mild to severe
Why do we assess contractions?
Help us understand where they’re at in labour and helps us make decisions about care.
3 different parts to assess about contractions?
- Frequency- start one contraction to start of the next, or # of contractions/10 minutes
- Duration- from start to end (how long the contraction is)
- Intensity- strength of the contractions (weak, moderate, strong- assess by put hand on fundus when they’re having a contractions)
What else is importnat to assess about contractions?
After the contraction the uterus return to being soft (resting tone)
Position (maternal)?
Certain position can help promote comfort/enhance labour progress. Repeated position change in helpful. Ideal positions is upright (gravity helps)
Psyche considerations?
Present emotional status, understanding/prep for childbirth, hx/previous experiences, beliefs/values, age/general wellness, support from support persons, and support from HCP
Premonitory signs of labour? 7 of them
- Lightening- feel the baby drop into pelvic inlet/become engaged
- Braxton hicks contractions- irregular/intermittent practice contractions that occur throughout pregnancy (painless/cause no cervical change)
- Vaginal mucous increase
- Cervical change- cervix softens/weakens (ripening)
- Bloody show- loss of cervical mucous plug that seals of the cervix, causes bloody tinged discharge, can release slowly
- Rupture of membranes- aka water breaking, can be sing labour is coming
- Sudden burst of energy- aka nesting, occurs 24-48 hrs before start of labour
- Loss of 0.5-1 kg, diarrhea, indigestion, N/V
True labour vs prodomal labour (false labour)?
TL- contractions happen regularly, 4-6 minutes apart, last a minute, start in back and radiates to front of abdomen, getting more intense, vaginal pressure felt
PL- irregular contractions that are weak frequently/don’t get stronger, felt in front of abdomen, contractions may stop/slow down with position changes
1st stage of labour with 3 phases?
FS- cervical dilation from 0-10 cm
- Early/latent phase- cx dilates 0-3 cm
- Active phase- dilates 4-7 cm
- Transition phase- dilates 8-10 cm
Latent/early phase physiologic and psychological signs?
- Regular/mild contractions begin, increase in intensity/freuency (q5-10), cervical effacement/dilation begins, 0-3 cm
- Relief labour has begin, high excitement with some anxiety
Active phase physiologic and psychological signs?
- Contraction increase in intensity/frequency/duration (q2-5), 4-7 cm dilated, fetus begins to descend into pelvis
- Fear of loss of control, anxiety increases
Transition phase physiologic and psychological signs?
- Contractions increase in intensity/duration/frequency, cervix thin/stretch to 8-10 cm, fetus descends rapidly into passage way, N/V, diaphoresis, increase bloody show
- May experience trembling, restless, anxious, irritable, feel overwhelmed/loss of control
Physiological changes that happen with labour?
CVS- BP increases with each contraction/may increase with pushing
Resp- increase in O2 demand, mild respiratory acidosis can occur at time of birth
GI/GU- edema in bladder d/t pressure from fetus head, delayed gastric motility/emptying
Haematological/immune- WBC increase, blood glucose decreases
Second stage of labour?
Cx fully dilated to delivery of the infant. This is the pushing stage. Can take up to 3 hrs.
Physiologic changes- pushing with abdominal muscles d/t pressure of fetal head, per item bulge/flatten/moves anteriorly as fetus descends, crowning (head visible and doesn’t retract between contractions)
Psychological changes- feel sense of purpose, pushing can feel better than pressure, tired, may feel out of control/frightened
Does someone have to push when fully dilated and have an epidural?
No they can wait a bit to push b/c they can’t feel the pressure most times. If you don’t have a epidural and feel like you need to push, then you can’t stop that
Cardinal movements of the fetus?
Engagement/descent/flexion- head flexed, head is engaged at station 0 or beyond
Internal rotation- they get further down in pelvis and they rotate to find the largest diameter of pelvis
Extension- as the get under symphis they extend the head
External rotation (shoulders)- shoulders rotate and head lines back up with the shoulders
Expulsion- head is delivery outside the canal and rest of the body comes out
What is oxytocin (syntocinon) and when is it given to the pregnant mother?
This medication given to enhance placental separation/uterine contractions. Given after delivery of anterior shoulder or after the baby is out. Usually give 3 units IV is the most common.
Third stage of labour?
Delivery stage. Birth of the infant to delivery of placenta and can take 5-30 minutes.
Physiologic changes- uterine contractions, slight blood loss, lengthening of cord, uterus shrinks smaller/rounder/more firm, fundus rises in abdomen, parturient may feel pressure to bear down, delivery of placenta
Psychological changes- relief, focused on welfare of baby, may not recognize that placental expulsion is happening, bonding, family time
4th stage of labour?
Recovery and stabilization. Lasts 1-4 hrs (until pt is stable).
Physiologic changes- increased pulse/decreased BP d/t redistribution of blood from uterus/blood loss, uterus contracted between belly button and symphysis pubis, can experience shaking chills, urinary retention r/t decreased bladder tone/possible bladder trauma
Psychological- euphoric/energized at birth of child but then tired, hungry, breastfeeding, bonding
