Labor and Birth Process Flashcards
What are the premonitory signs of labor?
- cervical changes
- lightening
- increased energy (nesting)
- bloody show
- Braxton hicks contractions
- spontaneous rupture of membranes
As labor approaches how does the cervix change shape?
Changes from an elongated structure to a shortened thinned segment
Cervical Changes for Labor
Cervical softening and possible dilation with descent of presenting part into the pelvis
-can occur 1 month to 1 hour before birth
When does lightening begin?
when the fetal presenting part begins to enter the true pelvis
Lightening
Baby moves into true pelvis
Abdominal changes occur
Mom can breathe easier and decrease in gastric reflux
When can lightening occur for a primiparas mother?
2 weeks or more before labor begins
When can lightening occur for a multiparas mother?
May not occur until labor starts
What will be some discomforts of lightening?
increased pelvic pressure leg cramping dependent edema in lower legs low back pain increased vaginal discharge more frequent urination
Increased Energy Levels (Nesting)
Many women focus energy of childbirth preparation towards cleaning, cooking, preparing the nursery, and spending extra time with other children in the house
When do women typically experience this increase in energy?
24-48 hours before the onset of labor
What is thought to be the cause of the increase in energy?
An increase in epinephrine release caused by a decrease in progesterone
Bloody Show
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
What causes the body to expel the mucus plug?
Cervical softening and increased pressure of the presenting part
What do Braxton Hicks contractions typically feel like?
a tightening or pulling sensation at the top of the uterus
Where are Braxton Hicks contractions felt?
Abdomen, groin and gradually spread downward before relaxing
Where are normal contractions felt?
lower back
Braxton Hicks Contractions
Aid in moving the cervix from a posterior position to an anterior position
Help to ripen and soften the cervix
Are Braxton Hicks Contractions regular or irregular and how can they be helped?
Irregular and can be helped by walking, voiding, eating, increasing fluids, or changing position
How long do Braxton Hicks contractions last?
Usually last for 30 seconds, but can persist for 2 minutes
When should a women contact her physician for Braxton Hicks Contractions?
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
The rupture of membranes can result in what 2 ways?
A sudden gush or a steady leakage of amniotic fluid
What are the dangers of the ruptured membranes?
cord prolapse and infection
True Labor
Characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity
True Labor contractions will cause what to happen?
Progressive cervical dilation and effacement
What are the traditional 5 P’s of critical factors that affect the process of labor and birth?
Passageway Passenger Powers Position Psychological Response
What are the 5 additional P’s that can affect the labor and birth process?
Philosophy Partners Patience Patient preparation Pain management
Passageway
the route in which the fetus must travel to be born vaginally
What does the passageway consist of?
the maternal pelvis and soft tissues
What is the division of the true and false pelvis known as?
Linea terminalis
False Pelvis
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
True Pelvis
below the linear terminalis
- the boney passageway the fetus must travel through
- made up of three planes
What are the 3 planes of the True pelvis?
Inlet
Mid-pelvis
Outlet
Pelvic Inlet
Allows entrance to the true pelvis
Mid-Pelvis
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
Pelvic Outlet
Determines is mom will be able to have vaginal birth
-pelvic measurements
What are the four main shapes of the pelvis?
Gynecoid
Anthropoid
Android
Platypelloid
Gynecoid Pelvis
- true female pelvis
- vaginal birth is most favorable because the inlet is round and the outlet is roomy
Anthropoid Pelvis
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
Android Pelvis
- 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
Platypelloid Pelvis
“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
Regardless of the shape of the pelvis a newborn can still be born vaginally if what?
If the size and positioning remain compatible
The soft tissues of the passage way consist of what?
Cervix
Pelvic Floor Muscles
Vagina
Cervix
thins through effacement to allow presenting part to descend into vagina
Pelvic Floor Muscles
help the fetus to rotate anteriorly as it passes through the birth canal
Vagina
soft tissues will expand to accommodate the baby being born
What are the important factors for the passenger?
Fetal skull, attitude, lie, presentation, position, station, and engagement
Fetal Skull
Largest and least compressible structure
-made up of sutures, fontanels, and diameters
Skull Sutures
- allows for overlapping and changes in the shape
- helps identify position of fetal head
Fontanels
“Soft spots”
Intersections of sutures
Helps identify position of fetal head and molding
Anterior Fontanelle
- famous “soft spot”
- diamond shaped space
- remains open 12-18 months after birth to allow for growth of the brain
Posterior Fontanelle
- triangular shaped
- closes 8-12 weeks after birth
Diameters of Skull
Measurements of skull
- occipitofrontal
- occipitomental
- suboccipitobregmatic
- biparietal
Caput Succedaneum
swelling of fluid collected under the scalp at whatever part comes out first
- crosses suture lines
- goes away in 3-4 days
Cephalohematoma
Collection of blood beneath the scalp
- will NOT cross suture lines
- takes 6-8 weeks to go away
Fetal Attitude
the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another
What is the most common fetal attitude when labor begins?
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
Fetal Lie
refers to the long axis (spine) of the fetus to the long axis (spine) of the mother
What are the 3 possible fetal lies?
longitudinal
transverse
oblique
Longitudinal Lie
Most common
-occurs when the long axis of the fetus is parallel to that of the mother
Transverse Lie
Occurs when the fetus is perpendicular to the long axis of the mother
-can NOT be delivered vaginally
Oblique Lie
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
Fetal Presentation
refers to the body part of the fetus that enters the pelvic inlet first
What are the 3 main fetal presentations?
Cephalic
Breech
Shoulder
Cephalic Presentation
Head First
- usually the occipital part of the head
- also referred to as the vertex presentation
What are some variations of cephalic/vertex presentation?
military
brow
facial
Breech Presentation
Occurs when the fetal buttocks or feet enter the maternal pelvis first and the skull enters last
What are some complications of breech delivery?
- 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
What are the three types of breech positions?
Frank
Complete
Single footling
Double footling
How are the types of breech presentations determined?
By the positioning of the fetal legs
Frank Breech
Buttocks present first with both legs extended up towards the face
Full/Complete Breech
Fetus sits cross-legged above the cervix
Footling/Incomplete Breech
One or both legs are presenting
Shoulder Presentation
“Shoulder Dystocia”
occurs when the fetal shoulders present first with the head tucked inside
The landmark fetal presenting parts include what?
Occipital bone (O)
Chin (Mentum; M)
Buttocks (Sacrum; S)
Scapula (Acromion Process; A)
Occipital Bone
O
vertex presentation
Chin
Mentum (M)
Face presentation
Buttocks
Sacrum (S)
Breech Presentation
Scapula
Acromion Process (A) Shoulder presentation
How is the position indicated by a three-letter abbreviation system?
- 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
What is the most common and most favorable fetal position?
LOA
Fetal Station
the relationship of the presenting part to the level of the maternal pelvic ischial spines
How is Fetal Station measured and referred to?
Measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines
When is the fetus said to be engaged in the pelvis?
When the presenting part reaches 0 station
Fetal Engagement
signifies the entrance of the largest diameter of the fetal presenting part into the smallest diameter of the maternal pelvis
What is the primary stimulus powering labor?
Contractions
What do contractions cause?
Complete dilation and effacement of the cervix during the first stage of labor
What are secondary powers in labor?
the use of intrabdominal pressure exerted by the woman as she pushes and bears down during the second stage of labor
Uterine Contractions
Involuntary
Rhythmic and intermittent with a period of relaxation
Why is there a pause in between uterine contractions?
Allows the women and the uterine muscles to rest
Restores blood flow to the uterus and placenta
What are the 3 parameters for assessing contractions?
Frequency
Duration
Intensity
What would be a fully dilated cervix?
10 cm
Frequency
how often contractions occur and is measured from the beginning of one contraction to the beginning of the next
Duration
how long a contraction lasts and is measured from the beginning of one contraction to the end of the same contraction
Intensity
the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter
What are the factors that promote a positive birth experience?
Clear info about procedure Support; not being alone Self-confidence Trust in staff Positive reaction to pregnancy Personal control over breathing Preparation for childbirth
What are the physiological responses to labor we will see in MOM?
- 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
What are some physiological responses you will see in BABY?
- 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
What are the four stages of labor?
Dilation
Expulsive
Placental
Restorative
First Stage of Labor
Begins w/ first true contraction and ends with full dilation of the cervix
- longest stage
- divided into 3 phases
What are the 3 phases of the First Stage of labor?
Latent phase
Active phase
Transition phase
Second Stage
Expulsive Stage
begins when the cervix is completely dilated and ends with the birth of the newborn
How long can the second stage last?
Minutes to hours
What are contractions like in the second stage?
Occur every 2-3 minutes, lasting 60 to 90 seconds and are strong by palpation
Third Stage
Placental Expulsion
starts after the newborn is born and ends with the separation and birth of the placenta
-bonding begins
Fourth Stage
Restorative Stage-Post Partum
lasts from 1-4 hours after birth
Mom is awake and excited
Latent Phase
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
How long can the Latent phase last for a nulliparas women vs a multiparas women?
Nulliparas can last about 9 hours while multiparas can last about 6
Active Phase
Time from increase in cervical dilation to complete dilation
-Dilates from 4-7 cm
What is the typical dilation rate for a multiparas woman and a nulliparas woman?
Multi- 1.5 cm/hour
Nulli- 1.2 cm/hr
Transition Phase
Dilation slows, progressing from 8 to 10 cm
Most difficult, but shortest phase
Lasts from 15 minutes to 1 hour
What are contractions like in the Transition phase?
Stronger, more painful, and more frequent and they last longer
- every 1-2 minutes for 60-90 seconds
Maternal Symptoms during Transition phase
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
What is the focus during the fourth stage?
Monitor mom closely to prevent hemorrhage, bladder distention, and venous thrombosis
What are the signs for placental separation?
Uterus rises upward
Umbilical cord lengthens
Sudden trickle of blood from vaginal opening
Uterus changes its shape to globular
What factors can influence pain during birth?
Physiologic Spiritual Psychosocial Cultural Environmental
