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NU314 OB > Labor and Birth Process > Flashcards

Labor and Birth Process Flashcards

1
Q

What are the premonitory signs of labor?

A
  • cervical changes
  • lightening
  • increased energy (nesting)
  • bloody show
  • Braxton hicks contractions
  • spontaneous rupture of membranes
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2
Q

As labor approaches how does the cervix change shape?

A

Changes from an elongated structure to a shortened thinned segment

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3
Q

Cervical Changes for Labor

A

Cervical softening and possible dilation with descent of presenting part into the pelvis
-can occur 1 month to 1 hour before birth

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4
Q

When does lightening begin?

A

when the fetal presenting part begins to enter the true pelvis

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5
Q

Lightening

A

Baby moves into true pelvis
Abdominal changes occur
Mom can breathe easier and decrease in gastric reflux

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6
Q

When can lightening occur for a primiparas mother?

A

2 weeks or more before labor begins

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7
Q

When can lightening occur for a multiparas mother?

A

May not occur until labor starts

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8
Q

What will be some discomforts of lightening?

A 
increased pelvic pressure
leg cramping 
dependent edema in lower legs 
low back pain 
increased vaginal discharge 
more frequent urination
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9
Q

Increased Energy Levels (Nesting)

A

Many women focus energy of childbirth preparation towards cleaning, cooking, preparing the nursery, and spending extra time with other children in the house

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10
Q

When do women typically experience this increase in energy?

A

24-48 hours before the onset of labor

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11
Q

What is thought to be the cause of the increase in energy?

A

An increase in epinephrine release caused by a decrease in progesterone

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12
Q

Bloody Show

A

at the onset of labor or before the mucus plug is expelled and the ruptured cervical capillaries release a small amount of blood tinging it pink

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13
Q

What causes the body to expel the mucus plug?

A

Cervical softening and increased pressure of the presenting part

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14
Q

What do Braxton Hicks contractions typically feel like?

A

a tightening or pulling sensation at the top of the uterus

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15
Q

Where are Braxton Hicks contractions felt?

A

Abdomen, groin and gradually spread downward before relaxing

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16
Q

Where are normal contractions felt?

A

lower back

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17
Q

Braxton Hicks Contractions

A

Aid in moving the cervix from a posterior position to an anterior position
Help to ripen and soften the cervix

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18
Q

Are Braxton Hicks Contractions regular or irregular and how can they be helped?

A

Irregular and can be helped by walking, voiding, eating, increasing fluids, or changing position

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19
Q

How long do Braxton Hicks contractions last?

A

Usually last for 30 seconds, but can persist for 2 minutes

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20
Q

When should a women contact her physician for Braxton Hicks Contractions?

A

If the contractions last longer than 30 seconds and occur more often than 4-6 times an hour so she can be evaluated for preterm labor
-Especially if less than 38 weeks

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21
Q

The rupture of membranes can result in what 2 ways?

A

A sudden gush or a steady leakage of amniotic fluid

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22
Q

What are the dangers of the ruptured membranes?

A

cord prolapse and infection

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23
Q

True Labor

A

Characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity

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24
Q

True Labor contractions will cause what to happen?

A

Progressive cervical dilation and effacement

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25
Q

What are the traditional 5 P’s of critical factors that affect the process of labor and birth?

A 
Passageway
Passenger
Powers
Position
Psychological Response
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26
Q

What are the 5 additional P’s that can affect the labor and birth process?

A 
Philosophy 
Partners
Patience
Patient preparation 
Pain management
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27
Q

Passageway

A

the route in which the fetus must travel to be born vaginally

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28
Q

What does the passageway consist of?

A

the maternal pelvis and soft tissues

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29
Q

What is the division of the true and false pelvis known as?

A

Linea terminalis

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30
Q

False Pelvis

A

above the linear terminalis
-composed of the upper flared parts of the two iliac bones with their concavities and the wings of the base of the sacrum

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31
Q

True Pelvis

A

below the linear terminalis

  • the boney passageway the fetus must travel through
  • made up of three planes
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32
Q

What are the 3 planes of the True pelvis?

A

Inlet
Mid-pelvis
Outlet

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33
Q

Pelvic Inlet

A

Allows entrance to the true pelvis

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34
Q

Mid-Pelvis

A

Snug and curved space the baby must travel through

-Baby’s chest is compressed causing lung fluid and mucus to be expelled so air can enter the lungs

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35
Q

Pelvic Outlet

A

Determines is mom will be able to have vaginal birth

-pelvic measurements

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36
Q

What are the four main shapes of the pelvis?

A

Gynecoid
Anthropoid
Android
Platypelloid

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37
Q

Gynecoid Pelvis

A
  • true female pelvis

- vaginal birth is most favorable because the inlet is round and the outlet is roomy

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38
Q

Anthropoid Pelvis

A

Common in men and non-white women

  • Pelvic inlet is oval and the sacrum is long, producing a deep pelvis
  • Vaginal birth is usually adequate
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39
Q

Android Pelvis

A
  • MALE shaped pelvis
  • characterized by a funnel shape
  • pelvic inlet is heart shaped and posterior segments are reduced
  • poor prognosis for vaginal birth; normally transitions to c/s
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40
Q

Platypelloid Pelvis

A

“Flat pelvis”

  • least common among men and women
  • pelvic cavity is shallow, but widens at the outlet making the mid-pelvis difficult to get through
  • not favorable for vaginal delivery; will usually be c/s
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41
Q

Regardless of the shape of the pelvis a newborn can still be born vaginally if what?

A

If the size and positioning remain compatible

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42
Q

The soft tissues of the passage way consist of what?

A

Cervix
Pelvic Floor Muscles
Vagina

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43
Q

Cervix

A

thins through effacement to allow presenting part to descend into vagina

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44
Q

Pelvic Floor Muscles

A

help the fetus to rotate anteriorly as it passes through the birth canal

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45
Q

Vagina

A

soft tissues will expand to accommodate the baby being born

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46
Q

What are the important factors for the passenger?

A

Fetal skull, attitude, lie, presentation, position, station, and engagement

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47
Q

Fetal Skull

A

Largest and least compressible structure

-made up of sutures, fontanels, and diameters

48
Q

Skull Sutures

A
  • allows for overlapping and changes in the shape

- helps identify position of fetal head

49
Q

Fontanels

A

“Soft spots”
Intersections of sutures
Helps identify position of fetal head and molding

50
Q

Anterior Fontanelle

A
  • famous “soft spot”
  • diamond shaped space
  • remains open 12-18 months after birth to allow for growth of the brain
51
Q

Posterior Fontanelle

A
  • triangular shaped

- closes 8-12 weeks after birth

52
Q

Diameters of Skull

A

Measurements of skull

  • occipitofrontal
  • occipitomental
  • suboccipitobregmatic
  • biparietal
53
Q

Caput Succedaneum

A

swelling of fluid collected under the scalp at whatever part comes out first

  • crosses suture lines
  • goes away in 3-4 days
54
Q

Cephalohematoma

A

Collection of blood beneath the scalp

  • will NOT cross suture lines
  • takes 6-8 weeks to go away
55
Q

Fetal Attitude

A

the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another

56
Q

What is the most common fetal attitude when labor begins?

A

All joints flexed, fetal back is rounded, the chin is on the chest, thighs are flexed on the abdomen, and the legs are flexed at the knees
-Most favorable position for vaginal births

57
Q

Fetal Lie

A

refers to the long axis (spine) of the fetus to the long axis (spine) of the mother

58
Q

What are the 3 possible fetal lies?

A

longitudinal
transverse
oblique

59
Q

Longitudinal Lie

A

Most common

-occurs when the long axis of the fetus is parallel to that of the mother

60
Q

Transverse Lie

A

Occurs when the fetus is perpendicular to the long axis of the mother
-can NOT be delivered vaginally

61
Q

Oblique Lie

A

the fetal long axis is at an angle to the bony inlet, and no palpable fetal part is presenting

  • transitionary and occurs between other lies
  • can NOT be delivered vaginally
62
Q

Fetal Presentation

A

refers to the body part of the fetus that enters the pelvic inlet first

63
Q

What are the 3 main fetal presentations?

A

Cephalic
Breech
Shoulder

64
Q

Cephalic Presentation

A

Head First

  • usually the occipital part of the head
  • also referred to as the vertex presentation
65
Q

What are some variations of cephalic/vertex presentation?

A

military
brow
facial

66
Q

Breech Presentation

A

Occurs when the fetal buttocks or feet enter the maternal pelvis first and the skull enters last

67
Q

What are some complications of breech delivery?

A
  • Fetal skull can become “hung up”/stuck
  • Umbilical cord can become compressed between skull and the maternal pelvis
  • trauma to head from lack of molding
68
Q

What are the three types of breech positions?

A

Frank
Complete
Single footling
Double footling

69
Q

How are the types of breech presentations determined?

A

By the positioning of the fetal legs

70
Q

Frank Breech

A

Buttocks present first with both legs extended up towards the face

71
Q

Full/Complete Breech

A

Fetus sits cross-legged above the cervix

72
Q

Footling/Incomplete Breech

A

One or both legs are presenting

73
Q

Shoulder Presentation

A

“Shoulder Dystocia”

occurs when the fetal shoulders present first with the head tucked inside

74
Q

The landmark fetal presenting parts include what?

A

Occipital bone (O)
Chin (Mentum; M)
Buttocks (Sacrum; S)
Scapula (Acromion Process; A)

75
Q

Occipital Bone

A

O

vertex presentation

76
Q

Chin

A

Mentum (M)

Face presentation

77
Q

Buttocks

A

Sacrum (S)

Breech Presentation

78
Q

Scapula

A 
Acromion Process (A)
Shoulder presentation
79
Q

How is the position indicated by a three-letter abbreviation system?

A
  • First letter defines if presenting to the left (L) or right (R)
  • Second letter represents the particular presenting part (Occipital = O)
  • Third letter defines the location of part: anterior, posterior, transverse
80
Q

What is the most common and most favorable fetal position?

A

LOA

81
Q

Fetal Station

A

the relationship of the presenting part to the level of the maternal pelvic ischial spines

82
Q

How is Fetal Station measured and referred to?

A

Measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines

83
Q

When is the fetus said to be engaged in the pelvis?

A

When the presenting part reaches 0 station

84
Q

Fetal Engagement

A

signifies the entrance of the largest diameter of the fetal presenting part into the smallest diameter of the maternal pelvis

85
Q

What is the primary stimulus powering labor?

A

Contractions

86
Q

What do contractions cause?

A

Complete dilation and effacement of the cervix during the first stage of labor

87
Q

What are secondary powers in labor?

A

the use of intrabdominal pressure exerted by the woman as she pushes and bears down during the second stage of labor

88
Q

Uterine Contractions

A

Involuntary

Rhythmic and intermittent with a period of relaxation

89
Q

Why is there a pause in between uterine contractions?

A

Allows the women and the uterine muscles to rest

Restores blood flow to the uterus and placenta

90
Q

What are the 3 parameters for assessing contractions?

A

Frequency
Duration
Intensity

91
Q

What would be a fully dilated cervix?

A

10 cm

92
Q

Frequency

A

how often contractions occur and is measured from the beginning of one contraction to the beginning of the next

93
Q

Duration

A

how long a contraction lasts and is measured from the beginning of one contraction to the end of the same contraction

94
Q

Intensity

A

the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter

95
Q

What are the factors that promote a positive birth experience?

A 
Clear info about procedure
Support; not being alone 
Self-confidence 
Trust in staff
Positive reaction to pregnancy
Personal control over breathing
Preparation for childbirth
96
Q

What are the physiological responses to labor we will see in MOM?

A
  • increased HR, cardiac out put, BP, WBC’s, RR, oxygen consumption, BMR
  • decrease in gastric motility, food absorption, gastric emptying, gastric PH, blood glucose levels
  • Muscle aches and cramps
  • Slight temperature elevation
97
Q

What are some physiological responses you will see in BABY?

A
  • Periodic FHR accelerations and slight decelerations
  • Decrease in circulation and perfusion
  • Increase in arterial carbon dioxide pressure
  • Decrease in fetal breathing movements
  • Decrease in fetal oxygen pressure
98
Q

What are the four stages of labor?

A

Dilation
Expulsive
Placental
Restorative

99
Q

First Stage of Labor

A

Begins w/ first true contraction and ends with full dilation of the cervix

  • longest stage
  • divided into 3 phases
100
Q

What are the 3 phases of the First Stage of labor?

A

Latent phase
Active phase
Transition phase

101
Q

Second Stage

A

Expulsive Stage

begins when the cervix is completely dilated and ends with the birth of the newborn

102
Q

How long can the second stage last?

A

Minutes to hours

103
Q

What are contractions like in the second stage?

A

Occur every 2-3 minutes, lasting 60 to 90 seconds and are strong by palpation

104
Q

Third Stage

A

Placental Expulsion
starts after the newborn is born and ends with the separation and birth of the placenta
-bonding begins

105
Q

Fourth Stage

A

Restorative Stage-Post Partum
lasts from 1-4 hours after birth
Mom is awake and excited

106
Q

Latent Phase

A

Begins with the start of regular contractions and end when rapid cervical dilation begins

  • Cervix dilates from 0-3 cm
  • Moms are apprehensive but excited
107
Q

How long can the Latent phase last for a nulliparas women vs a multiparas women?

A

Nulliparas can last about 9 hours while multiparas can last about 6

108
Q

Active Phase

A

Time from increase in cervical dilation to complete dilation
-Dilates from 4-7 cm

109
Q

What is the typical dilation rate for a multiparas woman and a nulliparas woman?

A

Multi- 1.5 cm/hour

Nulli- 1.2 cm/hr

110
Q

Transition Phase

A

Dilation slows, progressing from 8 to 10 cm
Most difficult, but shortest phase
Lasts from 15 minutes to 1 hour

111
Q

What are contractions like in the Transition phase?

A

Stronger, more painful, and more frequent and they last longer
- every 1-2 minutes for 60-90 seconds

112
Q

Maternal Symptoms during Transition phase

A 
Strong rectal pressure
Strong desire to contract abdominal muscles and push
Nausea/vomiting 
Trembling extremities
Backache 
Increased apprehension, irritability, and restlessness
Increased bloody show 
Diaphoresis
Loss of control and overwhelmed
113
Q

What is the focus during the fourth stage?

A

Monitor mom closely to prevent hemorrhage, bladder distention, and venous thrombosis

114
Q

What are the signs for placental separation?

A

Uterus rises upward
Umbilical cord lengthens
Sudden trickle of blood from vaginal opening
Uterus changes its shape to globular

115
Q

What factors can influence pain during birth?

A 
Physiologic
Spiritual
Psychosocial
Cultural 
Environmental

NU314 OB (21 decks)

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