Labor and Delivery Flashcards
What are the 5 P’s of delivery ?
- Passenger (baby)
- Passageway (birth canal)
- Powers (contractions)
- Position (of mother)
- Psychological (response)
What does Passenger mean ?
baby and their positioning
What does passageway mean ?
mom’s pelvis and how cervix is opening
What is the Leopold Maneuver ?
used to determine fetal position, presentation, and placement of EFM
What are the different external fetal monitoring types ?
TOCO and EFM
What does the TOCO (tocodynamometer) do ?
measures the pressure of mom’s contractions
- low-tech device
What does the EFM (external fetal monitor) do ?
feels for baby’s position and how much baby is tolerating labor
- mom being able to get up and move around is more ideal
What does Powers mean ?
the strength that gets the cervix to dilate
- responsible for dilation and effacement
What does psychosocial mean ?
behavior affecting woman
- if they come in alone or not
- cultural differences & language barrier
- history of sexual abuse
- birth plan
- support system
What does position mean ?
the position mom is in during birth
What causes back labor pain in mom ?
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)
What is dilation ?
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
What is effacement ?
the gradual thinning, shortening, and drawing up of the cervix measured in percentages
- from 0 to 100%
What is station ?
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
What do you chart in a sterile vaginal exam ?
- station
- effacement
- dilation
- time & person who performed exam
What are some physical signs of labor ?
- regular contractions
- bloody show or loss of mucous plug
- pain in lower back and front abdomen
- surge or energy “nesting”
What happens during the 1st stage of labor ?
- 3 stages (early/latent, active, transition)
- 0-10 cm
- longest stage (can last for days)
What happens during the 2nd stage of labor ?
- 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
What happens during the 3rd stage of labor ?
- delivery of placenta
- do any repairs or tears if necessary
- make sure no pieces of placenta are missing
What happens during the 4th stage of labor ?
- 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
What happens during the Early/Latent phase ?
- 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
What happens during the Midphase/Active phase ?
- 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
What happens during the transition phase ?
- 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
What is the purpose of the mucous plug ?
keep the environment inside
Why might the belly get hard during labor ?
- the uterus will harden during contractions (palpable)
How do you know if the mom is in true labor ?
when cervix starts to thin out and dilate
What are Braxton Hicks contractions ?
intermittent, painless contractions that do not cause cervix dilation
What are some intrinsic factors that can start labor ?
- placental aging
- uterine distention
- progesterone deprivation
Why does labor begin ?
signaled by start of contractions causing cervical dilation or spontaneous rupture of membranes
What should you document/assess right after AROM occurs ?
first thing you will want to assess is the fetal heart rate
- want to see if baby is tolerating well
How does skin-to-skin contact help ?
helps baby and mom regulate vital signs and go back to homeostasis
- helps stimulate breastfeeding
What happens if there is still some retained placenta inside the mother ?
the uterus won’t clamp down completely
What needs to be documented about the rupture of membranes ?
- time
- color (clear, bloody, meconium)
- amount (scant, small, moderate, large)
- odor (foul-smelling could mean infection or fever)
What is the longest stage of labor ?
the first stage
- varies the most in length
- affected by parity (previous # of pregnancies and deliveries)
What is nuchal cord ?
umbilical cord encircles neck and may cause hypoxia
What do we document about contractions ?
- frequency (how often)
- duration (how long)
- intensity (how strong)
How do we know if our patient’s amniotic membranes have ruptured ?
- nitrozine paper test (pH test)
- amniotic fluid is more basic and neutral and urine is more acidic
What do we use to artificially rupture the membranes ?
an amniohook by the provider
What is crowning ?
when widest part of head distends the vulva just before birth
- perineal massage by provider to reduce chance of laceration
What are the different degrees of episiotomy/lacerations ?
1st: extends through skin
2nd: extends thru muscles of perineal body
3rd: extends through anal sphincter
4th: extends anterior rectal wall
What is nuchal cord ?
umbilical cord encircles neck and may cause hypoxia
What is the function of the Leopold maneuver ?
helps determine fetal position
