LABOR AND BIRTH STAGES CHAPTER 16 PART 2 Flashcards
What does the first stage of Labor consist of
Begins with regular uterine contractions that change the cervix.
* Ends at full cervical effacement & dilation
* Two phases
* Latent Early phase: up to 5 cm of dilation
* Active phase: 6 to 10 cm of dilation (can transition at end of active phase) -
-CONTRACTIONS ARE MORE FREQUESNT
-CONTRACTIONS ARE REGULAR
-CONTRACTIONS ARE LONGER
-CONTRACTION INTENSITY IS HIGHER
Assessment of patient
Birthing parent is talkative and eager in latent phase, becoming tired, restless, and anxious as labor intensifies and contractions become stronger
Which one of these women who are pregnant process quickly during labor?
A. Nulliparous
B.Multiparious
B.Multiparious
During the early phase of first-stage labor, nulliparous and multiparous women progress at similar rates. After reaching a cervical dilation of 6 cm, however, multiparous women progress more rapidly in labor
Which one of these women are likely to come in prematurely to the hospital to give birth?
A. Nulliparous
B.Multiparious
A. Nulliparous
Most nulliparous women planning to give birth in a hospital or birth center seek admission in the latent (early) phase because they have not experienced labor before and are unsure of the “right” time to come in. Multiparous women may not present to the birth center or hospital until they are in the active phase of the first stage of labor. Even though no two labors are identical, women who have given birth before often are less anxious about the process unless their previous experience was negative.
Nulliparous women admission during latent phase, mild-moderate
irregular contractions 30sec-2 min. apart, 30-40 seconds duration
- Multiparous women often admitted in active phase;
- moderate-strong contractions
- every 5-1.5 min. 40-90 seconds
- duration
What does True Labor consist of ?
- Occur regularly, becoming stronger, lasting longer, and occurring closer together
- Become more intense with walking
- Are usually felt in the lower back, radiating to the lower portion of the abdomen
- Continue despite use of comfort measures
- cervical dilation
What does False labor consist of ?
Occur irregularly or become regular only temporarily
* Often stop with walking or position change
* Can be felt in the back or the abdomen above the umbilicus
* Can often be stopped through the use of comfort measures
Is Electric fetal monitoring important during Labor
A. Yes
B. no
yes
Physical examination
* General systems assessment
* Vital signs
- Leopold maneuvers-Leopold maneuvers are performed using abdominal palpation (Box 16.5). These maneuvers help to answer three important questions: (1) Which fetal part is in the uterine fundus? (2) Where is the fetal back located? (3) What is the presenting fetal part? Leopold maneuvers can also be used to estimate fetal size.
- Assessment of fetal heart rate
- (FHR) and pattern
- Assessment of uterine contractions
- Frequency, Duration
- Intensity, Resting tone
What are the two instruments used during electric fetal monitoring?
Toco - mothers contractions
Ultrasound- fetal heart rate
Toco-measures pressure
changes with uterine
contractions
* Ultrasound- records fetal
heart tones
Second stage of Labor
Infant is born
* Begins with full cervical dilation (10 cm),
effacement (100%)
* Ends with baby’s birth
* Two phases
* Latent: passive descent baby through
birth canal
* Active: active pushing and urges to bear
down
- Signs and symptoms of impending birth
-Increase in frequency and intensity of uterine contractions - Urge to push or feeling need to have a bowel movement
- An episode of vomiting
- Increased bloody show
- Uncontrolled shivering
- Verbalizations of feeling out of control or unableto cope
- Involuntary bearing-down efforts
Assessment of patient
Birthing parent has intense con- centration on pushing with con- tractions; may fall asleep between contractions
Preparing for Labor
Maternal position; bearing-down efforts; FHR
and pattern; support of father or partner
Crowning-bulging fetal head on perineum with
contractions
Supplies, instruments & equipment
Birth in delivery or birthing room
Lacerations and Episiotomy
Perineal lacerations may occur as the fetal head is being born. The extent of the laceration is defined in terms of its depth (Kilpatrick et al., 2021):
* First degree: Laceration that is confined to the skin
* Second degree: Laceration that extends into the perineal body
* Third degree: Laceration that involves injury to the external anal
sphincter muscle
* Fourth degree: Laceration that extends completely through the anal
sphincter and the rectal mucosa
Episiotomy
An episiotomy is an incision made in the perineum to enlarge the vaginal outlet (Fig. 16.24)
Third stage of Labor
Placental separation & expulsion
* Fundus contracting
* Change uterus shape
* Sudden gush of dark blood and fluid from
introitus
* Apparent lengthening of umbilical cord
* Vaginal fullness
When passive management is prac- ticed, the placenta is usually expelled within 15 minutes after the birth of the baby. As soon as the placenta is expelled, the uterine fundus is massaged, and medication to contract the uterus (usually oxytocin [Pitocin]) is administered (Box 16.14)
Assist mother to bear down to facilitate expulsion of the separated placenta. * Administer an oxytocic medication as ordered to ensure adequate contraction
of the uterus, thereby preventing hemorrhage.
* Provide nonpharmacologic and pharmacologic comfort and pain relief measures. * Perform hygienic cleansing measures.
* Keep mother/partner informed of progress of placental separation and expulsion
and perineal repair if appropriate.
* Explain purpose of medications administered.
* If mother’s and baby’s conditions permit, encourage immediate skin-to-skin
contact and delayed cord clamping.
* Introduce parents to their baby and facilitate the attachment process by
delaying eye prophylaxis.
* Provide private time for parents to bond with new baby; help them create
memories.
* Encourage breastfeeding if desired and assist with positioning and latch as
needed.
MAKE SURE PLACENTA IS INTACT
AFTER DELIVERY OF PLACENTA MASSAGE THE UTERUS TO MAKE SURE IT IS FIRM AND HARD
Assessment of patient
Birthing parent is relieved after birth of newborn; Birthing parent is usually very tired
4th stage of Labor
Assessment
Post-anesthesia recovery
Care new mother, infant, family
Signs of potential problems
* Excessive blood loss - MONITORING
* ASSESSING LOCHIA
* MASSAGING FUNDUS EVERY 15 MINUTES
* Alteration in vital signs & consciousness
* Care of placenta after delivery
* Cultural traditions
BONDING IMPORTANT PARTNER AND FAMILY WITH BABY
2-4 HOURS OF BIRTH
assessment of patient
Birthing parent is tired but is eager to become acquainted with the newborn
EMTALA
The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal regulation enacted to protect pregnant women during an emergency regard- less of their insurance status or ability to pay for care.
Measuring contractions on external monitor
use tochometer- over fundus of uterus extrnal does not give intensity
frequency- start of one contraction to the start of the second contraction
duration- start of one contraction to the end of the same contraction
Intensity- use of internal intrauterine catheter -membranes must be ruptured ACCURATELY
MEASURES REST BETWEEN EACH CONTRACTION(THIS IS CRUCIAL TO SEE IF FETUS IS GETTING ADEQUATE PERFUSION, during contractions flood flow to the uterus decreases* late deceleration’’’’
Can you measure the intensity of contractions externally
Yes by palpating the fundus during a contraction
MILD- low intensity
MODERATE- medium intensity
FIRM- highest intensity
NOT ACCURATE NO NUMBER
