Labor And Delivery Flashcards
Factors Affecting Labor Progress “The 5 P’s”
- Passageway (birth canal)
- Passenger (fetus)
- Powers (maternal)
- Position (maternal)
- Psyche (maternal)
Passageway
4 types
And cervical changes
• True pelvis (space enclosed by the pelvic girdle and below the pelvic brim: between the pelvic inlet and the pelvic floor)
– Inlet, midpelvis, outlet
• Four types – Gynecoid= wide – Android= narrower shape can make labor difficult – Anthropoid= elongated – Platypelloid= wide but shallow
• Cervical changes
– Dilation= Widening of cervix during first stage; 0-10 centimeters
– Effacement= Stretching and thinning of the cervix; 0-100%
Fetal head
– Fontanelles
• Intersections of the cranial sutures
• Anterior: diamond shape
• Posterior: triangle shape
– Molding
• Bones of fetal skull overlap to allow passage through birth canal
– Landmarks—mentum (chin), sinciput (brow), bregma (anterior fontanelle), occiput (back of head)
Fetal Attitude
– The relation of the fetal body parts to one another
– Normal attitude is flexion
Fetal Lie
– The relationship of spinal column of the fetus to that of the mother
– Longitudinal or transverse
Fetal Presentation
What you see first ?
What is engagement?
What is station?
Presenting part enters pelvic passage 1st
• Cephalic, Breech, Shoulder
- Cephalic broken down to vertex, sinciput, brow, face
– Engagement
• Largest diameter of presenting part reaches level of ischial spines
• Determined by vaginal exam
– Station
• Relationship of the presenting part to the ischial spines
• Ischial spines are zero station
• If presenting part above the ischial spine—negative number
• If presenting part below the ischial spine—positive number
Fetal Position
How do you get the 3 letters
– Relationship of presenting part to maternal pelvis
1) (R) or (L) side of the maternal pelvis
2) Landmark: occiput (O), mentum (M), sacrum (S), or acromion (scapula[Sc]) process (A)
3) Anterior (A), posterior (P), or transverse (T)
– Determine by inspection/palpation of maternal abdomen or vaginal exam
Powers
How is baby pushed out? Two ways?
• Primary forces—uterine muscular contractions. (Involuntary)
– Contraction phases
– Described with frequency, duration, and intensity
– Braxton-Hicks: irregular and intermittent contractions; false labor
• Secondary forces—abdominal muscles used in pushing
Position
- Whatever is comfortable
- Allow mom to listen to her body
- NEVER supine!
Psyche
- Fears
- Anxieties
- Excitement level
- Feelings of joy and anticipation
- Level of social support
Pre- Labor Signs
- Lightening
- Braxton Hicks contractions
- Cervical changes (effacement, dilation, ripening)
- Bloody show
- Mucous plug released
- Rupture of membranes (ROM)
- Sudden burst of energy
- Weight loss
- Backache
- Nausea and vomiting
- Diarrhea
True Labor
- Progressive dilation and effacement
- Regular contractions increasing in frequency, duration, and intensity
- Pain usually starts in the back and radiates to the abdomen
- Pain is not relieved by ambulation or by resting
False Labor
- Irregular contractions do not increase in frequency, duration, and intensity
- Contractions occur mainly in the lower abdomen and groin
- Pain may be relieved by ambulation, changes of position, resting, or a hot bath or shower
FIRST STAGE of labor
What are the 3 sub-stages?
from beginning of labor to complete dilation and effacement of cervix
1) Latent phase (0-3cm)
• Contractions every 10-30 min, lasting 30-40 seconds, mild
2) Active phase (4-7cm)
• Contractions every 2-3 min, lasting 40-60 seconds, moderate to strong
3) Transition phase (8-10cm)
• Contractions every 1 ½ - 2 min, lasting 60-90 seconds, strong
Interventions for 1st stage labor
- Complete Admission Assessment and Review History
- Assessment: Maternal VS, Response to Labor and Pain, Cervical Changes, Membrane Status, Fetal Position and Descent
- Diet and Hydration: Clear Liquids
- Activity and Rest: Frequent Position Changes/Ambulation/Pad Pressure Points
- Elimination: Frequent Emptying, Perineal Care
- Comfort: Meds and Non-Pharmacologic Strategies, Warm or Cool Cloths, Oral Care, Fresh Bed Linen
- Support: Keep Family Involved; Decrease Anxiety
- Education: About Labor, Procedures,
- Safety: Safe and Friendly Environment
SECOND STAGE of labor
Signs?
What may they need to help push?
begins with complete dilation of cervix and ends with birth of baby “PUSHING”
SIGNS= sudden increase in bloody show, uncontrolled bearing down efforts, bulging of the perineum, Crowning
• Episiotomy
– Midline
– Mediolateral
Interventions for 2nd stage labor
- Support and Encourage Spontaneous Pushing Efforts
- Monitor for Fetal Response to Pushing
- Provide Comfort Measures (Cool, warm cloths, sips of fluids or ice chips, change linens)
- Position Changes as needed
- Perineal Hygiene as needed
- Give Praise and Encouragement
- Encourage Rest between Contractions
- Teach Breathing Technique
- Teach Pushing Technique
- Meds as ordered
- Assist the Support Person
- Advocate on Woman’s Behalf
THIRD STAGE of labor
How long should this take ?
begins with birth of the baby and ends with delivery of placenta
• Should deliver within 30 minutes
• Considered a “retained placenta” if greater than 30 mins.
• May need to remove manually
Interventions for 3rd Stage
- Maternal VS per protocol
- Encourage Breathing
- Encourage Rest
- Palpate Uterus
- Initial Newborn Care
- Encourage Bonding with Neonate
- Meds as ordered
FOURTH STAGE of labor
What should uterus be doing ?
What are priority risk ?
initial recovery time
• First 1-4 hours after delivery of placenta
• Essential for uterus to remain contracted
• Uterus should remain midline
• Uterus typically b/n symphysis pubis and umbilicus
• Priority problems during this stage
- Risk for hemorrhage
- Risk for urinary retention
Interventions for 4th stage
• Maternal VS
• Assess Uterus Frequently: Position, Tone, Location
-Uterine Massage if needed
• Assess Lochia: Color, Amount, Clots
• Monitor Perineum for Swelling or Hematomas
• Meds as ordered
• Assist with Laceration/Episiotomy Repair
• Apply Ice to Perineum
• Monitor for Bladder Distention
- Promote Urinary Elimination
• Assess for motor-sensory function return if spinal or epidural used
• Encourage Bonding with Neonate
• May Eat and Drink Immediately if Vaginal Delivery
Discharge to Postpartum Care
• Discharge criteria
– Stable vital signs – Stable bleeding – Undistended bladder – Firm fundus – Sensations fully recovered from any anesthetic agent received during birth
Maternal Physical Responses during Labor
- ⬆️ cardiac output
- ⬆️ blood pressure, pulse
- Diaphoresis
- Hyperventilation
- Changes in acid-base balance
- Impaired blood and lymph drainage from base of bladder
- Reduced gastric motility and food absorption, and prolonged emptying time
- ⬆️ WBCs
- 🔽 maternal blood glucose
- Pain
Fetal Responses to Labor
- Head compression
- Decreased pH, anoxic periods
- Aware of sensations such as light, sound, touch, pressure
Cesarean Section Indications
• Most common indications for cesarean birth
– Fetal distress – Active genital herpes – Multiple gestation (three or more fetuses) – Umbilical cord prolapse – Lack of labor progression (“failure to progress”) – Pelvic size disproportion – Placenta previa – Placental abruption – Previous cesarean section
Preparation for cesarean birth requires
– Establishing IV lines – Placing indwelling catheter – Performing abdominal/perineal prep – NPO except antacids 30 min prior – Maternal VS – EFM
Incisions for c-section
- Skin – Vertical (b/n navel and symphysis pubis); Transverse (below pubic hairline)
- Uterus – Transverse (upper or lower uterine segment); Classical (vertical in upper uterine segment)
Nursing Care after c section
1) Vital Signs
– Every 5 min til stable
– Every 15 min for 2 hours
– Every 4 hours until transferred to postpartum
2) Check dressing and perineal pads every 15 min for 1 hour
3) Numbness/sensation checked every 15 min until full feeling returns
4) Intake and output
5) Monitor IV Pitocin if given
6) Assess fundus
Vaginal Birth After Cesarean (VBAC) OR Trial of Labor After Cesarean (TOLAC)
What are common risk?
• Can occur after trial of labor in cases of nonrecurring indications for cesarean birth
• Most common risks are: – Uterine rupture – Hemorrhage – Surgical injuries – Infant death or neurological complications
Nursing Care for VBAC
What to monitor and give?
What to avoid ?
What’s contraindicated ?
• Continuous EFM
- Internal Monitoring
• IV fluids
• Avoid Pitocin if at all possible
- Classic or “T” uterine incision is contraindication to VBAC
- Important for nurse to support couple, explore their feelings, and provide information throughout labor
