Giving Birth: Sherpath

Question 1

Coordinated Contractions?

Answer 1

The uterus contracts in a coordinated way. Labor contractions gradually assume a regular pattern of increasing frequency, duration, and intensity. Coordinated labor contractions begin in the uterine fundus and spread downward toward the cervix to propel the fetus through the pelvis.

Question 2

Involuntary Contractions

Answer 2

Uterine contractions are not under conscious control. The mother cannot cause labor to start or stop by conscious effort. Walking or other activity may stimulate existing labor contractions. Anxiety and excessive stress can diminish them.

Question 3

Intermittent Contractions

Answer 3

Labor contractions are intermittent rather than sustained, allowing relaxation of the uterine muscle and resumption of blood flow to and from the placenta.

Question 4

Increment, Peak, Decrement of contractios

Answer 4

• Occurs as the uterine contraction begins in the fundus and spreads throughout the uterus
• The uterine contraction is the most intense
• The period of decreasing intensity as the uterus relaxes

Question 5

Frequency of contractions

Answer 5

• The period from the beginning of one uterine contraction to the beginning of the next
• Usually expressed in minutes and fractions of minutes

Question 6

Duration of contractions

Answer 6

• The length of each uterine contraction from beginning to end
• Usually expressed in seconds

Question 7

Intensity of contractions

Answer 7

The strength of the uterine contractions:

• Mild uterine contractions often described as feeling like the tip of the nose
• Moderate uterine contractions often described as feeling like the chin
• Firm uterine contractions often described as feeling like the forehead

Question 8

Primigravida

Answer 8

A woman pregnant for the first time

Question 9

Nullipara

Answer 9

A woman who has not given birth to a viable infant. The designation “para 0” indicates nulliparity.

Question 10

Multipara

Answer 10

A woman who has been pregnant more than once.

Question 11

Effacement

Answer 11

Thinning of the cervix

Question 12

Dilation

Answer 12

Opening of the cervix

Question 13

Which is a characteristic of typical labor contractions?

Answer 13

Coordinated

Question 14

Which phase of the contraction cycle likely would be the most painful for the laboring woman?

Answer 14

Peak

Question 15

Which part of the labor contraction cycle is the nurse describing when stating, “Contractions are 2.5 to 3 minutes apart”?

Answer 15

Frequency

Question 16

Which part of the labor contraction cycle is the nurse describing when stating, “Contractions are lasting 40 to 50 seconds?”

Answer 16

Duration

Question 17

Which are progressive changes that occur to the cervix during labor?

Answer 17

Dilation, Effacement

Question 18

The 4 “P’s” of the birthing process

Answer 18

Powers
Passage
Passenger
Psyche

Question 19

What are the 2 powers of birth?

Answer 19

The two powers of labor are uterine contractions and maternal pushing efforts.

Question 20

What are the passages of birth?

Answer 20

The maternal pelvis and its soft tissues.

Question 21

What are the passengers of birth?

Answer 21

The fetus plus the membranes and placenta.

Question 22

What is the psyche of birthing process?

Answer 22

Maladaptive stress responses decrease a woman’s ability to cope during labor. Adaptive responses to stress augment the natural birth process.

Question 23

What are the components of the passage?

Answer 23

Inlet
Midpelvis
Outlet

Question 24

What is the inlet

Answer 24

If the inlet is small, the fetal head may not be able to enter it. Because it is almost entirely surrounded by bone, except for cartilage at the sacroiliac joint and symphysis pubis, the inlet cannot enlarge much to accommodate the fetus. The bony measurements are essentially fixed.

Question 25

What is the Midpelvis

Answer 25

The narrowest part of the pelvis through which the fetus must pass during birth.

Question 26

What is the outlet

Answer 26

The angle of the pubic arch also is an important pelvic outlet measure. The angle of the pubic arch should be at least 90 degrees. A narrow pubic arch displaces the fetus posteriorly toward the coccyx as it tries to pass under the arch.

Question 27

Components of the Birth Process: Passenger

Answer 27

Variations of lie
Variations of Attitude 
Variations of Presentation 
Cephalic presentation 
Variations of presentation: Breech

Question 28

Variations of lie

Answer 28

The orientation of the long axis of the fetus to the long axis of the woman is the fetal lie. In more than 99% of pregnancies, the lie is longitudinal, or parallel to the long axis of the woman. In the longitudinal lie, either the head or buttocks of the fetus enter the pelvis first. A transverse lie exists when the long axis of the fetus is at right angles to the woman’s long axis; it occurs in less than 1% of pregnancies. An oblique lie is one at some angle between the longitudinal lie and the transverse lie.

Question 29

Variations of Attitude

Answer 29

The attitude of the fetus is the relation of fetal body parts to each other. As seen below in image ‘A’, the normal fetal attitude is one of flexion, with the head flexed toward the chest and the arms and legs flexed over the thorax. As seen in image ‘B’, the fetal back is curved in a convex C shape in the abnormal attitude of extension.

Question 30

Variations of Presentation

Answer 30

The fetal part that enters the pelvis first is the presenting part. Presentation falls into three categories: (1) cephalic, (2) breech, and (3) shoulder. The cephalic presentation with the fetal head flexed is the most common. The breech and shoulder presentations are associated with prolonged labor or other problems and are more likely to require cesarean birth.

Question 31

Cephalic Presentation

Answer 31

The cephalic presentation is more favorable than others, for several reasons: The fetal head is the largest single fetal part. After the head is born, the smaller parts follow easily as the extremities unfold. During labor the fetal head can gradually change shape to adapt to the size and shape of the maternal pelvis. The fetal head is smooth, round, and hard, making it an effective part to dilate the cervix, which is also round. The vertex presentation is the most common cephalic presentation and is seen below. The fetal head is fully flexed. This presentation is the most favorable for normal progress of labor because the smallest diameter of the fetal head is presenting first.

Question 32

Variations in presentation: Breech

Answer 32

The breech presentation has three variations that are identified depending on the relationship of the legs to the body (Figure 16-9). A breech presentation occurs when the fetal buttocks or feet enter the pelvis first and are associated with several disadvantages: The buttocks are not smooth and firm like the head and are less effective at dilating the cervix. By the time the fetal head is deep in the pelvis, the umbilical cord is subject to compression between the baby’s head and the maternal pelvis.
Because the umbilical cord can be compressed after the fetal chest is born, the head must be delivered quickly to allow the infant to breathe. In frank breech presentation the fetal legs are extended across the abdomen toward the shoulders. The complete breech is a reversal of the usual cephalic presentation. The head is flexed, and the knees and hips are also flexed, but the buttocks are presenting. The footling breech occurs when one or both feet are presenting. Most fetuses that present as breech are delivered by cesarean section.

Question 33

Components of the Birth Process: Psyche

Answer 33

Marked anxiety, fear, or fatigue decreases a woman’s ability to cope with pain in labor. Maternal catecholamines secreted in response to anxiety or fear can inhibit uterine contractility and placental blood flow. Relaxation, however, augments the natural process of labor. Many expectant mothers will have relaxation techniques included in their birthing plan that may be guided by their birthing partner or others in their support system. The nurse’s interactions with the expectant mother will be crucial in creating an environment in which the expectant mother can feel as safe and relaxed as possible. Interventions the nurse can implement to assist with relaxation include visualization, slow breathing patterns, massage, aromatherapy, music, hydrotherapy, and hot and cold therapies.

Question 34

How might a pubic arch of 85 degrees affect labor?

Answer 34

A pubic arch with an angle less than 90 degrees may impede the fetus from passing under it.

Question 35

How does cephalic presentation of the fetus facilitate labor?

Answer 35

Allows the fetal head to adapt to the maternal pelvis

Facilitates dilation

Question 36

Which roles does the maternal psyche play in facilitating childbirth?

Answer 36

• Calmness increases a woman’s ability to cope with pain during labor.
• Relaxation supports the natural process of labor.

Question 37

Match the laboring woman’s description of her contraction pattern with the most likely phase.

Answer 37

“They don’t bother me that much, but my belly tightens a little each time I have a contraction.”
**Mild, every 5 min, lasting 30-40 sec
“They are getting more intense. I have to breath with them and concentrate.”
**Moderate, every 2-3 min, lasting 40-60 sec
“They are so close together and they really hurt, I can’t do this anymore.”
**Strong, every 1½-2 min lasting 60-90 sec

Question 38

Which characteristics of effacement and dilatation describe the laboring woman who is closest to delivery?

Answer 38

9cm dilatation, 100% effaced
Transition may be used to describe the intense contractions of fetal descent and final cervical dilatation, about 7 or 8 cm to complete.

Question 39

Which fetal presentation is ideal for labor?

Answer 39

Cephalic
The fetal head is the largest single fetal part. After the head is born, the smaller parts follow easily as the extremities unfold.

Question 40

Which type of fetal presentation results most often in caesarean section?

Answer 40

Shoulder
The shoulder presentation is a transverse lie and accounts for less than 1% of births, usually premature. A cesarean birth is necessary.

Question 41

Which cardinal movement of labor is crucial to the success of labor and must occur before all others?

Answer 41

Descent
Descent of the fetus is a mechanism of labor that accompanies all the others. Without descent, none of the mechanisms will occur.