Labor and Delivery

Question 1

What are the 5 P’s of delivery ?

Answer 1

• Passenger (baby)
• Passageway (birth canal)
• Powers (contractions)
• Position (of mother)
• Psychological (response)

Question 2

What does Passenger mean ?

Answer 2

baby and their positioning

Question 3

What does passageway mean ?

Answer 3

mom’s pelvis and how cervix is opening

Question 4

What is the Leopold Maneuver ?

Answer 4

used to determine fetal position, presentation, and placement of EFM

Question 5

What are the different external fetal monitoring types ?

Answer 5

TOCO and EFM

Question 6

What does the TOCO (tocodynamometer) do ?

Answer 6

measures the pressure of mom’s contractions
- low-tech device

Question 7

What does the EFM (external fetal monitor) do ?

Answer 7

feels for baby’s position and how much baby is tolerating labor
- mom being able to get up and move around is more ideal

Question 8

What does Powers mean ?

Answer 8

the strength that gets the cervix to dilate
- responsible for dilation and effacement

Question 9

What does psychosocial mean ?

Answer 9

behavior affecting woman
- if they come in alone or not
- cultural differences & language barrier
- history of sexual abuse
- birth plan
- support system

Question 10

What does position mean ?

Answer 10

the position mom is in during birth

Question 11

What causes back labor pain in mom ?

Answer 11

baby’s occiputs (back of head) is rubbing against mom’s tailbone
- you can have mom change positions so that gravity repositions baby into a more ideal position
- when baby is in left occiput posterior “LOP or OP” (presenting part is head)

Question 12

What is dilation ?

Answer 12

the gradual opening of the cervix measured in cm
- goal is to be at about 10 cm
- when palpating for dilations this is subjective data

Question 13

What is effacement ?

Answer 13

the gradual thinning, shortening, and drawing up of the cervix measured in percentages
- from 0 to 100%

Question 14

What is station ?

Answer 14

position of fetal head in relationship to ischial spine (-3 to +3)
- 0: baby head is aligned with ischial spine
- (-): head is above spines
- (+): below spines
- the higher the number and positive then the closer the baby is to being out

Question 15

What do you chart in a sterile vaginal exam ?

Answer 15

• station
• effacement
• dilation
• time & person who performed exam

Question 16

What are some physical signs of labor ?

Answer 16

• regular contractions
• bloody show or loss of mucous plug
• pain in lower back and front abdomen
• surge or energy “nesting”

Question 17

What happens during the 1st stage of labor ?

Answer 17

• 3 stages (early/latent, active, transition)
• 0-10 cm
• longest stage (can last for days)

Question 18

What happens during the 2nd stage of labor ?

Answer 18

• 10 cm to birth of baby
• all about pushing
• epideral can prolong this stage
• in a new mom it can take longer
• monitor baby & mom HR, and babies toleration to pushing

Question 19

What happens during the 3rd stage of labor ?

Answer 19

• delivery of placenta
• do any repairs or tears if necessary
• make sure no pieces of placenta are missing

Question 20

What happens during the 4th stage of labor ?

Answer 20

• immediate postpartum recovery period (up to 4 hrs)
• physiological readjustment of mother (back to homeostasis)
• palpate uterus to see if its contracting back down
• monitor mom’s vitals

Question 21

What happens during the Early/Latent phase ?

Answer 21

• loss of mucus plug
• 0 to 3 cm dilated
• 0 to -3 station
• about 8 hours
• can talk about what to expect, open to instructions
• mild-moderate contractions
• irregular contractions 5-30 mins and last 30-45 sec
• excited, talk about birth plan

Question 22

What happens during the Midphase/Active phase ?

Answer 22

• about 6 hours
• 4-7 cm dilated
• +1 to +2 station
• mod-strong contractions
• more reg contraction 3-5 mins and 40-70 sec long
• doubt control, fatigue, more difficult to follow directions
• Nurses provide: pain relief options, rest, comfort, reassurance

Question 23

What happens during the transition phase ?

Answer 23

• 20-40 min
• 8-10 cm dilated
• +2 to +3 station
• strong-very strong contractions
• reg contractions 2-3 mins and 45-90 secs
• CANT PUSH YET
• frustrated with pain, irritable, loss of control, may not want to talk
• help them relax, keep upright if possible, cool cloth, ice chips

Question 24

What is the purpose of the mucous plug ?

Answer 24

keep the environment inside

Question 25

Why might the belly get hard during labor ?

Answer 25

• the uterus will harden during contractions (palpable)

Question 26

How do you know if the mom is in true labor ?

Answer 26

when cervix starts to thin out and dilate

Question 27

What are Braxton Hicks contractions ?

Answer 27

intermittent, painless contractions that do not cause cervix dilation

Question 28

What are some intrinsic factors that can start labor ?

Answer 28

• placental aging
• uterine distention
• progesterone deprivation

Question 29

Why does labor begin ?

Answer 29

signaled by start of contractions causing cervical dilation or spontaneous rupture of membranes

Question 30

What should you document/assess right after AROM occurs ?

Answer 30

first thing you will want to assess is the fetal heart rate
- want to see if baby is tolerating well

Question 31

How does skin-to-skin contact help ?

Answer 31

helps baby and mom regulate vital signs and go back to homeostasis
- helps stimulate breastfeeding

Question 32

What happens if there is still some retained placenta inside the mother ?

Answer 32

the uterus won’t clamp down completely

Question 33

What needs to be documented about the rupture of membranes ?

Answer 33

• time
• color (clear, bloody, meconium)
• amount (scant, small, moderate, large)
• odor (foul-smelling could mean infection or fever)

Question 34

What is the longest stage of labor ?

Answer 34

the first stage
- varies the most in length
- affected by parity (previous # of pregnancies and deliveries)

Question 35

What is nuchal cord ?

Answer 35

umbilical cord encircles neck and may cause hypoxia

Question 36

What do we document about contractions ?

Answer 36

• frequency (how often)
• duration (how long)
• intensity (how strong)

Question 37

How do we know if our patient’s amniotic membranes have ruptured ?

Answer 37

• nitrozine paper test (pH test)
• amniotic fluid is more basic and neutral and urine is more acidic

Question 38

What do we use to artificially rupture the membranes ?

Answer 38

an amniohook by the provider

Question 39

What is crowning ?

Answer 39

when widest part of head distends the vulva just before birth
- perineal massage by provider to reduce chance of laceration

Question 40

What are the different degrees of episiotomy/lacerations ?

Answer 40

1st: extends through skin
2nd: extends thru muscles of perineal body
3rd: extends through anal sphincter
4th: extends anterior rectal wall

Question 41

What is nuchal cord ?

Answer 41

umbilical cord encircles neck and may cause hypoxia

Question 42

What is the function of the Leopold maneuver ?

Answer 42

helps determine fetal position