labor

Question 1

What are the 5 critical factors in labor

Answer 1

1) Birth passage, 2) fetus, 3) the relationship between the passage and the fetus, 4) physiologic forces of labor, 5) psychosocial considerations.

Question 2

How are the critical factors in labor related

Answer 2

All variables have to work together in order for a successful vaginal birth to occur. The woman’s pelvis has to accommodate the fetus size, the fetus has to be in the right position and be engaged, there has to be contractions in order for the cervix to dilate and to move the fetus down and out, the woman’s psychosocial state will affect her labor on many different levels.

Question 3

fetal attitude

Answer 3

the relation of the fetal parts to one another –normal is moderate flexion

Question 4

Fetal lie

Answer 4

the infant’s spine and the mother’s spine in relation to each other

Question 5

Fetal presentation

Answer 5

the presenting part of the fetus being born first

• cephalic, breech, or shoulder.
• Head down (cephalic presentation) in a OA (occiput anterior) position is ideal for successful vaginal birth.

Question 6

What is meant by the term engagement

Answer 6

the infant and his/her location into the maternal pelvis which is zero station.
-When the infant is engaged the infant’s head does not float away/move out of the pelvis (ballotable)

Question 7

What is meant by the term station

Answer 7

the (subjective) assessment for the exact location of the infant’s presenting part into the maternal pelvis.

• Ischial spines is a zero station,
• the closer to the outlet/delivery the station is a positive # (+1, +2, +3, etc.) and the higher up (further away from the outlet/delivery or deeper into the pelvis) the station is a negative # (-1, -2, -3, etc.).

Question 8

If the fetus is in a negative station, (-3,-2. or -1) what is the significance of this?

Answer 8

early labor or is not progressing normal.

-Rupturing membranes (amniotomy) when the infant is in a negative station, increases the risk for cord prolapse

Question 9

If the fetus is in a positive station (+1, +2 0r +3) what is the significance of this?

Answer 9

Labor is progressing because the fetus is closer to the outlet/delivering

Question 10

What is meant by fetal position

Answer 10

the presenting part’s landmark

• vertex-occiput, face-mentum (chin), breech-sacrum
• and its relation to the maternal pelvis
• -anterior-front, left/right-side, or posterior-back

Question 11

ROA

Answer 11

Right Occiput Anterior, which means the infant’s occiput is facing the front right side of the pelvis.

Question 12

LOA

Answer 12

Left Occiput Anterior, which means the infant’s occiput is facing the left front side of the pelvis

Question 13

ROP

Answer 13

Right Occiput Posterior, which means the infant’s occiput is facing the right posterior side of the pelvis

Question 14

LOP

Answer 14

Left Occiput Posterior, which means the infant’s occiput is facing the left posterior side of the pelvis.

Question 15

How do you assess contractions

Answer 15

Frequency, duration, and intensity

Question 16

Frequency

Answer 16

the time between the beginning of one contraction and the beginning of the next contraction

Question 17

Duration

Answer 17

is the time measured from the beginning of one contraction and the end of that same contraction

Question 18

Intensity

Answer 18

the strength of the contraction during acme

-mild, moderate, strong which can be assess by palpitation when external monitoring is being used

Question 19

lightening

s/s-5

Answer 19

the (maternal) effects that occur when the fetus begins to settle into the pelvic inlet (engaged).
-leg cramps, increased pelvic pressure, increased urinary frequency, increased venous stasis (edema in the lower extremities), and increased vaginal secretions.

Question 20

Cervical effacement

Answer 20

the thinning of the cervix, which occurs when the internal os and the cervical canal draws up into the uterine side walls

Question 21

Dilation

Answer 21

the opening of the cervix from 0 cm (closed) to 10 cm (complete).

Question 22

bloody show

Answer 22

pink-tinged vaginal secretion that may be a sign that labor will start within 24-48 hrs.
-caused by the ripening and effacement of the cervix, which leads to the mucus plug being expelled which then leaves the highly vascular cervix open

Question 23

What is the clinical significance when the membranes rupture-3

Answer 23

the beginning of the labor journey;

• labor will statistically start on its own within 24-28 hrs.
• creates a portal of entry for infection,
• Prolapsed cord=> depending on the situation (engaged or not, negative stations, preterm, polyhydramnios, etc.)

Question 24

membranes rupture relationship to infection-4

Answer 24

Portal of entry is now created, limit vaginal exams, monitor maternal temp(Q2 hrs. per AWHONN), and monitor FHR baseline

• increasing baseline is a sign of maternal temperature increase (fever–>infection)
• if the patient is a GBS + or unknown, antibiotics need to be initiated immediately to prevent infection of the infant (which can be fatal).

Question 25

membranes rupture relationship to a fetus in a high fetal station

Answer 25

When the infant is not engaged and the membranes rupture, there is an increased risk that the umbilical cord will follow the initial amniotic fluid gush out and then the fetus will come down into the pelvis and compress the umbilical cord which is an immediate emergency (baby is no longer receiving blood flow).
-never be ruptured on purpose unless the infant is engaged.

Question 26

What are the nursing responsibilities in relationship to when the membranes rupture? (i.e. fetal heart tones, monitoring maternal temperature, assessments regarding amount, color and odor?-5

Answer 26

-remain at the bedside after and continue to monitor and assess fetal heart tones (for signs of infection, prolapsed umbilical cord, and how well fetus is tolerating labor ),
-contractions (increased frequency, duration, and intensity),
-patient’s coping skills,
-maternal temperature (infection),
-assessment of amniotic fluid for color (green/brown – meconium, environment increases the risk for infant resuscitation at delivery (respiratory aspiration)), odor (infection?), and the amount (oligohydramnios or polyhydramnios).
=>Polyhydramnios increases the risk for a prolapsed umbilical cord

Question 27

premonitory signs of labor-11

Answer 27

Lightening, braxton hicks contractions, cervical change, bloody show, rupture of membranes, sudden burst of energy, weight loss (1-3 lbs.), diarrhea, indigestion, nausea, and vomiting

Question 28

nurse’s responsibility regarding premonitory signs of labor

Answer 28

Educate patient about signs and symptoms of labor and when to contact OB/PCP and when to come in for assessment to rule our labor. Ensure that the patient knows where to go (triage, labor floor, ER, etc.)