L&D I Flashcards
Exam 2
What are the components of the birthing process?
Powers, Passage, Passenger, Psyche
What do the powers refer to in the birthing process?
Forces responsible for moving the fetus through the birth canal
What does the passage refer to in the birthing process?
The mother’s pelvis and its role in facilitating the passage of the fetus
What does the passenger refer to in the birthing process?
The fetus and its position and presentation in relation to the maternal pelvis
What does the psyche refer to in the birthing process?
The emotional and psychological well-being of the mother during labor
Why are contractions intermittent?
Gives baby time to rest
Why is it best to take a clients vital signs during the interval between contractions?
BP increases when blood shunts away from the uterus during contractions
How can supine hypotension be managed?
Tilt hips with pillows to a lateral positions to promote blood return
What can cause hyperventilation during labor?
Pain, anxiety
How can hyperventilation be managed?
Help them breathe
What effect does the birth process have on gastric motility?
Reduced gastric motility
What dietary recommendation is given for reduced gastric motility during labor?
Clear liquids
How often should a woman void her bladder during labor?
Void every two hours
What can happen if the bladder is full during labor?
Decreased fetal descent
How much blood loss is expected during labor?
500 to 1000 mL
How much does blood volume increase during pregnancy?
40 to 45%
What are the hemoglobin and hematocrit levels during labor that do not require nursing interventions ?
Hemoglobin of at least 11, hematocrit of 30
Why do mom only get clear liquids?
Aspiration
How often should the mother be encouraged to void?
Every two hours
What should be monitored for during labor?
Blood clots
What is the normal heart rate range in utero?
110 to 160
What are the physiologic effects of the birth process on the fetus?
Placenta circulation, cardiovascular system, and pulmonary system
Can diabetes and hypertension impair placental circulation?
Yes
What is a potential effect of fetal anemia during labor?
Difficulty during labor for the fetus
What is the significance of labor in terms of the fetal pulmonary system?
Helps move fluids out of the lungs
Are c-section babies at higher risk for respiratory distress and crackles in their lungs?
Yes
What is the primary force moving the fetus through the maternal pelvis during the first phase of labor?
Uterine contractions
What can happen if uterine contractions are not strong enough?
Labor will not progress
What does the woman use to add power to the contraction and push the fetus through the pelvis during the second stage of labor?
Her voluntary pushing efforts
What can happen to pushing efforts if the epidural is not working properly?
They will be decreased
What can help make contractions stronger?
Oxytocin IV
How may pain tolerance affect pushing?
May not be able to push well
What is cervical dilation and effacement?
The process of opening and thinning of the cervix during labor.
Who does effacement typically take longer for?
First-time mothers (primigravida) and does not take a s long for multigravida mothers
What does nulliparous mean?
A female who has never carried a pregnancy beyond 20 weeks.
What is the most important factor for the outcome of childbirth?
Maternal pelvis
What can cause a c section during childbirth?
Maternal pelvis shape
What hormone causes the cartilage linking the pelvic bones to soften near term?
Relaxin
What is the best pelvis shape for delivery?
Gynecoid
Which pelvis shape can deliver vaginally but may result in the fetus being in the opposite posterior position?
Anthropoid
Which pelvis shapes are harder to deliver vaginally?
Android and platypelloid
Can you determine the pelvic shape prior to birth?
No
What allows the head to move through the cervix?
suture lines are not fused so the bones can overlap event and allows the head to move through.
What is shoulder dystocia?
Difficulty delivering the shoulders
Why is it easier to deliver the shoulders if the head is already out?
Typically if head is out, shoulders can also be delivered
What are the two types of lie?
Longitudinal or transverse
Which type of lie do we want?
Longitudinal
What is the likely outcome if the baby is in a transverse lie?
C-section
What is an external version?
Attempting to move the baby into the right position
What is a major risk with external version?
Placental abruption
What is the most common preparation for a transverse lie?
C-section
What is the preferred position during childbirth?
Flexion
What position should be avoided during childbirth?
Extension
What cephalic presentation would you ideally want?
vertex with complete flexion because it does not cause as much pressure on the cervix
What is the ideal position for a baby during birth?
Complete flexion with cephalic presentation
Why is complete flexion with cephalic presentation ideal?
The head is harder and larger in diameter, putting more pressure on the cervix
What is the term for the ideal position of the baby’s head during birth?
Vertex position
Why won’t a vaginal birth be done if the baby is in the frank position?
Baby cannot breath if cord is in frank
What are some risk factors for a breech presentation?
Multiple gestation, placenta previa, hydrocephaly
What are the possible positions for a baby during childbirth?
First letter Right (R) or Left (L)
Occiput (O), Mentum (M), or Sacrum (S)
and Anterior (A), Posterior (P), or Transverse (T)
What does LOA stand for?
Left Occiput Anterior
What does ROA stand for?
Right Occiput Anterior
What does OP stand for?
Occiput Posterior
What does OA stand for?
Occiput Anterior
Why is it preferable for a baby to be in the OA position?
Baby will be looking down when it first comes out
What is the OP position?
Baby’s face is looking up at the ceiling
What can be done to help a baby get into the OA position?
Different position changes/movement of the mother
What is the occipital?
The back of the head
What is an important aspect of childbirth?
Mother’s psyche
How can anxiety affect labor?
Affect coping and progression
What can culture and expectations influence during childbirth?
Experience of birth
What can help decrease anxiety and fear during childbirth?
Prenatal classes, hospital tour, education
How can culture and expectations affect childbirth?
Men in the room, epidural, hospital preference
What is the goal when providing care during labor?
Safe delivery while honoring their desired experience
What are some premonitory signs of labor?
Braxton Hicks contractions, lightening, increase in vaginal secretions, bloody show, energy spurt, small weight loss
What are Braxton Hicks contractions?
False contractions
What can cause Braxton Hicks contractions?
Dehydration and being hot
What can make Braxton Hicks contractions go away?
Resting after being active
When should you seek medical attention regarding Braxton Hicks contractions?
If they do not go away after rest
What should you do if you’re leaking fluid and your baby is not good?
Seek medical attention
What is lightening?
When the baby drops lower and allows mom to breath
What is the possible significance of a bloody show?
Could indicate the mucus plug being expelled, but not necessarily true labor
Is small weight loss at the end of pregnancy normal?
Yes, 1-3 pounds can be normal
What are the signs of true labor?
Increased contractions, increased discomfort, cervical change
What are the signs of false labor?
Inconsistent contractions, discomfort is more annoying than painful
What is the most important sign of true labor?
Progressive effacement and dilation of the cervix
When should a patient enter the birth center for evaluation?
If she is uncertain or has concerns
What does false labor contractions feel like?
Inconsistent in frequency, duration, and intensity.
A change in activity, such as walking, does not alter contractions, or activity may decrease them.
What does cervical change look like in true labor?
Effacement and/or dilation of cervix occurs. Progressive effacement and dilation of cervix are most important characteristics.
What does true labor contractions feel like?
A consistent pattern of increasing frequency, duration, and intensity usually develops.
Walking tends to increase frequency and strength of contractions.
What does discomfort feel like in true labor?
Begins in lower back and gradually sweeps around to the lower abdomen like a girdle.
Back pain may persist in some women. Early labor often feels like menstrual cramps.
Where is false labor discomfort feel like?
abdomen and groin
may feel more annoying than truly painful
What are the mechanisms of labor?
Descent, Engagement, Flexion, Internal rotation, Extension, External rotation, Expulsion
What is engagement of the presenting part?
Positioning of the baby’s head in the pelvis
What is flexion of the fetal head?
Bending of the baby’s head towards the chest
What is internal rotation?
Rotation of the baby’s head to align with the mother’s pelvis
What is extension of the fetal head?
Baby’s head moving out of the birth canal with the neck extended
What is external rotation?
Rotation of the baby’s shoulders to facilitate delivery
What is expulsion of the fetal shoulders and body?
Delivery of the rest of the baby’s body after the head
What are the stages of labor?
First, second, third, and fourth stage
What happens during the latent (0-5) phase of the first stage?
Mom is socially engaged and excited
This is a good time to educate
What happens during the active phase (6-9) of the first stage?
Contractions get stronger and closer together
How long is the second stage of labor for multiparas?
1 to 3 hours
What happens during the third stage of labor?
Birth to delivery of placenta, expect a gush of blood
How long is the fourth stage of labor?
4 hours
What is the first stage of labor?
Latent phase
What is the cervix dilation range during the latent phase?
0-5 cm
What is characteristic of moms during the latent phase?
Engaged, excited, social
What is the best time for education during labor?
Latent phase
What is the second stage of labor?
Active phase
What is the cervix dilation range during the active phase?
6-9 cm
What happens to contractions during the active phase?
They become stronger and closer together
What symptom may occur during the active phase?
Nausea and vomiting
What primary characteristic might the mom exhibit during active phase if experiencing natural childbirth?
Less social
What happens during the second stage of labor?
Cervix dilation from 10 cm to birth
How long does it typically take for multiparas to deliver during the second stage?
1 to 3 hours
How long does it typically take for primiparas to deliver during the second stage?
2 to 4 hours
What is normal during the delivery of placenta?
A gush of blood
How long does it take for the placenta to be delivered?
Approximately 6 minutes
What may be felt during the delivery of placenta?
A little pain
What should be checked in the fourth stage of birth?
Fundus and bleeding
How long does the recovery stage last?
4 hours
What is the main concern during the fourth stage?
Hemorrhaging
