Labor and Birth

Question 1

Premonitory Signs of Labor

Answer 1

Braxton Hicks contraction
Lightening
Increase in clear and non-irritating
Vaginal secretions
“Bloody Show” -> cervical mucos w/ pink tinge ( 2 wks b/4 plugs pop out)
Energy spurt/ nesting (2 wks)
Small Weight loss (1 -3.5 lbs) d/t water loss

Question 2

True Labor

Answer 2

Pain in lower back radiates to abdomen
Pain accompanied by reg rhythmic contractions
Contractions that intensify w/ ambulation
Progessive cerivcal dilation and effacement

Question 3

False Labor

Answer 3

Discomfort localized in abdomen
NO lower back pain
Contractions decrease in intensity or frequency w/ ambulation
Cerivx doesn’t change

you would hemorrahge if you aren’t fully dilated

Question 4

Components of the birthing process (5 Ps)

Power

Contractions

Answer 4

Uterine contractions (myometrium layer) and maternal pushing effort
* strength/intensity (lay hands on abd, feel if its hard as forehead)
* Duration → how long the contractions last (45
* Frequency → beginning of one contraction/beginning of the next

Question 5

Passage

Answer 5

True pelvis → position through which the baby must travel
3 planes:
* Pelvic inlet
* Mid pelvis → ischial spines ( 0 -> engaged)
* Pelvic outlet

gonocid is the right shape

Question 6

Passenger

Fetus

Answer 6

Molding ( makes baby head smaller to fit)
Attitude → flexion of the baby’s neck
Presentation → what’s presenting to the outlet first
Position → ROA/LOA/ROP/LOP for cephalic presentation
Fetal lie → baby’s spine r/t mother’s spine
* Longitudinal is most common
* Transverse
Situation
**Engagement **→ 0 station
**Station **→ relationship of the presenting part to the ischial spines
-4: the baby’s head hasn’t entered the pelvis (ballotable)
+4: the baby is crowning (HOP)
Engagement → largest part of the baby has “engaged” or passed through the most narrow part of the mom’s pelvis
* 0 station
* Typically primigravida (first pregnancies) engage around 38 weeks

LOA is most common followed by ROA

Question 7

Psyche

Maternal responses

Answer 7

Birth affects the whole way a woman thinks of herself
Lasting effects
Postivie birth experience (role of the RN)
* Clear information
* Positive support
* Breathing exercising and other aspects of the birth that she can controls

Question 8

Position of Mom

Answer 8

Standind, squatting, lithotomy
Upright position
lithotomy

Question 9

Stages of Labor

Stage 1

Answer 9

begins w/ regular contractions, ends in complete cervical dilation

Question 10

Latent Phase

Answer 10

beginning of true of labor until 3-4 cm
Mild contractions
Able to speak, smile, talk with family/caregiver
Hard to predict how long it will last
Assess uterine contractions every hour
Assess maternal vital signs every hour
Temp is taken every 2 hours once ROM
Assess FHR every hour

6-9 hours for nulliparous, less for multipar

Question 11

Active Phase

Answer 11

4-7 cm
Strong active contraction
“Serious” about labor vs. earlier joking around
Maternal VS, FHT and uterine contractions assessed every 30 minutes
N/V is common in this stage
Hyperventilation d/t discomfort can lead to respiratory alkalosis → help the patient calm down/slow breathing
Can use brown paper bag for this

Question 12

Transition Phase

Answer 12

8-10 cm
Maternal VS every 15 minutes
Assess FHR and uterine contractions every 15 minutes
Shortest but very intense ( 10 min -1hr)
May feel “pushy” /usually very IRRITABLE
Urge to push → Ferguson reflex
* Don’t allow patient to push unless FULLY dilated
* Full bladder can impede labor, contractions are then ineffective and labor can be longer b/c of this

Question 13

Leopold’s Maneuvers

Answer 13

used to determine fetal position
Preference for baby in a flexed position
Landmark on the baby’s body
Occiput (back of head) sacrum (buttocks) most common
Assessment of FHR and pattern
* Check FHR tones if pt thinks membranes have ruptured
Assessment of ROM → nitrazine test/tfern test
* Assess amniotic fluid under microscope → assess if fern-like pattern is present
* Check color → should be clear or brown (w/ meconium)
Blood is ABNORM
There should be NO odor (this would mean infection)

Question 14

Pitocin

Answer 14

Meds that can be used to induce contractions/labor

Question 15

Stage 2

Answer 15

10 cm to delivery
Involuntary urge to push
Gravity is best for fetal descent (squatting)
1 hour for nulliparous, 15 minutes for multipara
Usually will not allow the mother to push more than 2-3 hours
Assess FHR and uterine contractions every 15 minutes
Assess maternal VS every 5-15 minutes

Question 16

Stage 3

Answer 16

Delivery of Placenta
d/c oxytocin if in use until after placenta is delivered
* Admin after delivery
* Perform fundal massage after placenta

Pushing and birth

Question 17

Stage 4

Answer 17

**First 1-4 hours following delivery **
Recovery phase
Gentle cleanse perineal area
place crushed ice or cold peri-pack on perineum
Breastfeeding for the first 30 mins of life
Uterine stimulants → common drugs used to promote uterine contraction and control postpartum bleeding
* Oxytocin (pitocin) → 10-20 units IV or IM
* Methylergonovine maleate (methergine) 0.2 mg IM or PO
DO NOT give to patients w/ hypertension d/t its vasoconstrictive action
* Carboprost (Hemabate) 0.25 mg q 15-90 minutes (up to 8 doses)
DO NOT give to patients w/ asthma

Never give uterine stimulants before delivery of the placenta
Assess for bladder distention → full bladder is one of the most common reasons for uterine atony or hemorrhage in the first 24 houes after delivery
Maintain bed rest for 1 -2 hours to prevent orthostatic Hypotension if epiduralized
Immediate PP assessments → include maternal VS, fundal assessment, lochia assessment

Question 18

Vaginal exams

Answer 18

Performed throughout labor
Baseline vaginal exam upon admission
Client in modified lithotomy position
Sterile gloves are worn
Restricted once ROM has occurred
* Once membranes are ruptures, limit vaginal exams