Labor and Birth Flashcards
def labor
progressive cervical changes, in the presence of regular, frequent, painful uterine cxns
factors that contribute to the birth passage
- size of pelvis
- type of pelvis
- ability of cervix to dilate
- ability of vaginal canal to distend
birth of fetus
- head
- attitude
- lie
- presentation
def fetal attitude
- relation of the fetal body parts to one another
- “characteristic posture”
- usually a position of general flexion
def fetal lie
-relation of the spine of the fetus in relation to spine of the mom
what position do you want the fetal lie to be?
parrallel, vertical
def fetal presentation
the part of the fetus that enters the pelvis first
what fetal presentation do you want and is most common
cephalic
what factors contribute to passage
engagementstationfetal position
def engagement
the largest diameter of the presenting part that has passed into the true pelvis
true pelvis is considered what station
“0” station
when does engagement typically happen
- weeks before labor
- “baby has dropped”
what might mom experience with engagement
- urinary freq
- back ache
- easier breathing
- less heart burn and reflux
def station
relation of the presenting part of the fetus to the ischeal spine
- determining the rate of descent
what station does real labor start
“0” station
def fetal position
position of the baby in utero
what are the physiologic forces of labor?
- freq of cxns
- effectiveness of pushing
def interval of cxns
the period from the end of one cxn to the beginning of the next
def acme of cxn
the peak of a cxn
do we want the cxns to be regular or irregular?
regular
flow of cxns
increment
peak
decrement
ROM puts mom at risk for what?
infec
if mom is tired of pushing after a few hours, what should we do?
section mom
psychosocial considerations r/t labor and birth
- mental and phys preparation
- sociocultural values
- previous experience
- support
- emotional status
stages of labor
stage 1-4
stage 1 of labor
-from onset to full dilation
what happens during stage 1 labor?
- thinning and dilation of the cervix
stage 2 of labor
full dilation to delivery of baby
stage 3 labor
delivery of the placenta
stage 4 labor
recovery from delivery
how long does stage 4 labor last
approximately 2 hours
what are the 3 phases of labor
latency
active
transition
latency phase of labor
- (0-3 cm) dilation
- 4-24 hrs
active phase of labor
(4-7 cm) dilation
3-5 hrs
transition phase of labor
(8-10 cm) dilation
1/2- 2 hrs
when can mom not be given an epidural
during the transition phase
why might mom be given an epidural during the latency phase of labor
- to relax mom enough for labor to progress and allow descent of the baby
what is done upon admission of mom to the labor suite?
hx cxns when they last ate VS US vaginal exam
what might we ask mom upon admission to the suite pertaining to the cxns
- when did they start
- what were you doing when they started
- how often are they
- pain scale
what in the hx should we ask mom upon admission to the labor suite?
- how was the preg
- GTPAL
- previous births
why do we ask mom about when they last ate when they get admitted to the labor suite?
in case they need to be sectioned
for the anesthesia
when the mom is admitted to the labor suite, what do we determine with the US
station
gest age
placement
what is determined when a vaginal examination is done upon admitting mom to the labor suite
effacement
dilation
what do we measure with cxns?
freq
duration
strength
how much fluid is expelled when ROM occurs
600-800 cc
how do we determine of it is a true membrane rupture
- speculum exam
- pH 7.0-7.5
- (+) ferning
what color should the amniotic fluid be?
clear straw color
if the amniotic fluid is greenish/black, what could this indicate?
infecmeconium
does amniotic fluid normally have an odor?
no
what should we suspect if the amniotic fluid has an odor
infec
what is used to determine if there is a true ROM
nitrazine paper
describe the device used for external fetal monitoring
2 belts
what do the 2 belts on the external fetal monitoring do?
- measure cxns
- FHR
benefits of external fetal monitoring
see if baby is having decelsmonitor contractions
not invasive
drawbacks to external fetal monitoring
- mom cant get up an walk around
- not as accurate as internal
what comprises the internal fetal monitoring system?
- fetal scalp electrode
- intrauterine pressure cath
what does the fetal scalp electrode do?
-internal FHR monitor
what is the avg pressure of the internal fetal monitor
50-80
what does the intrauterine pressure cath do?
measures and monitors cxns
how does an intrauterine pressure cath work
coil needle is placed on the babys head
what is the benefit of using internal fetal monitoring
more accurate than external
what is the drawback of the internal fetal monitoring system
invasive
what is the normal FHR range in utero?
110-160
variability in FHR is ______
good
def minimal variability
< 5 bpms
def moderate variability
6-25 bpms
def marked variability
> 25 bpms
def accelerations
a 15 bpm incr for greater than 15 secs with return to baseline in less than 2 mins
if an accel or decel occurs for longer than 2 mins, it is considered
a change in baseline
accelerations are signs of
- fetal awakeness
- well being
when do early decels occur
when the cxn starts, the babys HR decr
what causes early decels
head compression
vaginal exam
when do late decels occur
they begin after the peak of the cxn
what do late decels indicate
- fetal hypoxemia
are late decels cause for concern?
yes- take action immediately!!!
def variable decels
- a visually abrupt decel in FHR below the baseline
what characterizes variable decels
- a 15 bpm or more for at least 15 secs
when do variable decels occur
can happen at any time
what do variable decels indicate?
cord compression
placental delivery sequence
cxn
globular uterus
cord lenthens
rush of vaginal blood
def globular uterus
uterus becomes very soft
what do we do when the cord lengthens?
gently guide it out
if the placenta is expelled in fragments, mom is at a very high risk for what?
hemorrhage
common analgesics used during labor
stadol
nubain
what adverse rxn do analgesics cause and what should we monitor for?
resp depression
regional anesthesia techniques
epidural
spinal
pudendal
epidural anesthesia
- cath inserted into epidural space
- indwelling
- hooked up to a pump
-delivers continuous meds
spinal anesthesia
-needle is injected, admin med, and removed
what is a pudendal used for?
- episiotomy or tear
- pain relief if mom needs stitches
what is given before a pudendal
lidocaine
what position should mom be in for the admin of regional anesthesia
sitting position nurse bear hugs mom
what should we do with mom immediately after the admin of regional analgesics
have mom lie down immediatelyput feet up
major side effects of regional anestesia
- hypotension
- bladder distention
natural pain mgmt methods
lamaze dick read bradley hypnobirthing hydrotherapy
what is a doula
- a natural birth coach
- not a nurse
