Labor and Birth

Question 1

Premonitory signs of labor?

Answer 1

Cervical changes, lightening, increased energy level, “bloody show,” Braxton hicks contractions, spontaneous rupture of membranes. Full term labor is 38-42 weeks

Question 2

Overview of true labor?

Answer 2

Contraction timing is regular, becoming closer to together. 4-6 min apart, lasting 30-60 seconds. Contractions become stronger over time, vaginal pressure is usually felt. Discomfort starts in the back and radiates to the front. They continue no matter what positional change is made. Stay home until they’re 5 min apart and 45-60 sec or cannot talk through them

Question 3

What is the definition of labor?

Answer 3

Uterine contractions resulting in cervical change, which consists of dilation or effacement

Question 4

Overview of false labor?

Answer 4

Contractions are irregular and do not become closer together. They are weak, not getting stronger. usually felt in the front of the abdomen. Stop or slow with walking or positional change. Drink fluid and walk. If contractions diminish, then stay home.

Question 5

Factors affecting the labor process?

Answer 5

Passageway, passenger, powers, position, psychological response or psyche

Question 6

What are the four pelvic shapes?

Answer 6

Gynecoid, anthropoid, android (male), platypelloid (usually needs C?S)

Question 7

Explain the stages of dilation?

Answer 7

Before labor the cervix is not effaced or dilated. Early effacement, early dilation to 1cm. Complete effacement, mid-dilation to 5cm. Full dilation to 10cm.

Question 8

What things need to be assessed about the passenger?

Answer 8

Head, attitude, lie, presentation, position, station, engagement.

Question 9

Vertex (cephalic) presentation?

Answer 9

Most often. Molding

Question 10

Breech presentation?

Answer 10

Frank, full or complete, footling

Question 11

Letters of the fetal presentation?

Answer 11

First letter is Left or Right side of the woman’s pelvis.
Second letter is the presenting part. Occiput, Mentum (chin), Sacrum
Third letter is front or back of the woman’s pelvis. Anterior, posterior, transverse

Question 12

Cardinal movements of labor?

Answer 12

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

Question 13

Powers; uterine contractions?

Answer 13

Frequency, duration, intensity, interval, maternal pushing

Question 14

Position; maternal?

Answer 14

Encourage movement. Squatting enlarges the pelvis. Kneeling helps rotate the fetus. Any position other than supine or upright may give the mother control, reduce the length of labor and the incidence of assisted deliveries, reduce tears and the use of episiotomies, assist gravity for fetal descent.

Question 15

Psychological response?

Answer 15

Preparation for childbirth. Trust in the staff and partner to help and support. Clear information of the process and procedures. Control over decisions being made. Control over breathing.

Question 16

First stage of labor? Three parts?

Answer 16

Onset of labor until completely dilated.
Latent: cervical change 1-3 cm, effacement 0-40%, mild contractions q 5-10 min for 30-45 sec
Active: cervical change 4-7 cm, effacement 40-80%, moderate contractions q 2-5 min for 45-60 sec
Transition: cervical change 8-10 cm, effacement 80-100%, strong contractions q 1-2 min for 60-90 sec

Question 17

How are cervical dilation, effacement, and station documented?

Answer 17

Always cervical dilation first, cervical effacement second, fetal station third.

Question 18

What’s involved in the second stage of labor? What two kinds?

Answer 18

Expulsion of the fetus: pushing. 30 minutes to 3 hours. Directed pushing. Spontaneous pushing (laboring down)

Question 19

Explain directed pushing in the second stage of labor?

Answer 19

Directed by the caregiver, valsalva maneuver to 10 seconds, breathe, 10 seconds again. Decreases oxygen to fetus and increases risk to the perineum.

Question 20

Explain spontaneous pushing (laboring down) in the second stage of labor?

Answer 20

Patient centered. Doesn’t push until she feels a strong urge to do so. Better outcomes for the mother and the baby.

Question 21

What occurs during the third stage of labor?

Answer 21

Placental stage (2-30 minutes). Birth of infant to the delivery of the placenta. Placenta detaches from the uterus and is expelled. Blood loss about 500mL vaginal, 1000mL C/S

Question 22

What occurs during the fourth stage of labor?

Answer 22

Restoration stage (right after delivery for 1-4 hours). Initial attachment to the newborn. Excited and awake. Critical to watch for postpartum hemorrhage and bladder distention.

Question 23

What’s involved in an initial maternal assessment?

Answer 23

Review of pre-natal records. Current labor and amniotic status. Personal medical/surgical and social history. Plans and desires for labor and birth, for care of the newborn. Cultural preferences.

Question 24

What’s involved in an assessment of the current labor status?

Answer 24

Vaginal exam, fetal descent, uterine contraction pattern, leopold’s maneuvers, analysis of amniotic fluid status, analysis of fetal heart rate (FHR or FHT)

Question 25

How are uterine contractions assessed?

Answer 25

By palpation or electronic devices. Intermittent or continuous. External (toco-transducer) or internal (IUPC- intrauterine pressure catheter)

Question 26

Beginning of one contraction to the beginning of the next contraction.
Beginning to end of contraction

Answer 26

Frequency

Duration

Question 27

Used to determine the position of the fetus in utero and the expected presentation for labor and delivery.

Answer 27

Leopold’s manuvers. Should be done on every laboring patient when they come in.

Question 28

Intermittent fetal monitoring

Answer 28

Allows freedom of movement for the woman. May miss concerning fetal heart rate.

Question 29

Continuous fetal monitoring

Answer 29

Restricts movement. Identifies concerning changes in the fetal heart rate.

Question 30

Eternal or internal fetal monitoring

Answer 30

Fetal scalp electrode used in high risk situations

Question 31

Assessing the fetal HR. Baseline?

Answer 31

Baseline is measured in a 10 minute period. Both brady and tachy can be very serious if FHR variability (beat to beat changes in FHR) and late FHR decelerations are present.

Question 32

Different kinds of FHR?

Answer 32

Normal is 110-160 bpm. Brady <110 for 10min or more. Tachy is >160 for 10min or more.
Accelerations are an increase in FHR by 15bpm or more lasting 15secs. It denotes a healthy fetus.

Question 33

Explain decelerations?

Answer 33

Early decelerations occur with the start of contraction. Late occurs after the start of contraction. Early and late are shaped like a “U” on the chart. Variables are shaped like a “V”. They have a variable onset which means they occur at any point before, during, or after a contraction.

Question 34

Nursing care during the first stage of labor?

Answer 34

Close attention to the FHR and contrction patterns. Rupture of membranes. Somewhat independent role: knowledge and performance of interventions. Documentation of all communication in a timely manner.

Question 35

What documentation is done during the first stage of labor, the rest of the stages?

Answer 35

Before and after calls to the provider. Before and after interventions. Detailed documentation of progress and changes.

Question 36

What lab studies are done if not available in prenatal screening?

Answer 36

H/h and blood trying. Hep B surface antigen (HbsAg). VDRL (syphilis). GBS (group B strep). HIV (with consent). Drug screening if history supports use of them.

Question 37

Non-pharmacologic pain management during the first stage of labor?

Answer 37

Walking and position changes. Hydrotherapy. Therapeutic touch. Imagery. Acupuncture. Breathing techniques.

Question 38

Systemic analgesia for labor?

Answer 38

Synthetic opioids: butorphanol, meperidine
Antiemetics: promethazine, hydroxyzine
Tranquilizers: diazepine

Question 39

Regional analgesia for labor?

Answer 39

Local anesthetic and opioid into lumbar epidural space. Catheter remains inserted for continuing analgesia. Prolongs second stage of labor, assisted deliveries. 60-90 % of women have them, PCA pump. Left lateral position after placement. Local anesthetic, then injection of epidural anesthetic

Question 40

Complications of an epidural?

Answer 40

Hypotension that can lead to fetal distress for the baby. Respiratory depression. Allergic reaction. Intravascular injection. Fever/infection.

Question 41

Contraindications of an epidural?

Answer 41

Previous spinal injury. Spinal abnormalities. Coagulation defects. Anticoagulation therapy. Infection. Obesity.

Question 42

Nursing care during the second stage of labor?

Answer 42

Allow rest prior to the onset of pushing. Allow woman to push as needed and not “directed”. Encouragement, watch the baby descend. Push 6-7 times with each contraction, not once, long. Alert for complications. Get the provider there in time! Preparing the bed and set up instruments. Immediate care of the newborn

Question 43

Second stage lacerations?

Answer 43

Lacerations to the perineum are described by depth.
1st degree is through the skin
2nd is through the muscle
3rd is through the anal sphincter muscle
4th is through the anterior rectal wall

Question 44

Nursing care during the third stage of labor?

Answer 44

Unhurried, uninterrupted bonding of the mother and the baby. Assessments during and after delivery of the placenta: firm funds, umbilical cord lengthening, gush of dark red blood, examination of the placenta and membranes a 2nd time

Question 45

Firm funds vs boggy fundus?

Answer 45

Whether the fundus is firm or boggy. With both firm and boggy, bright red trickling blood is not normal. Dark red blood and too many clots are not normal ever.