Labor and Delivery Flashcards
Exam 1
Delivery Location Options
- Hospitals
- Home births
- Birthing centers
Where do most women choose to deliver?
Hospitals
Why do many women choose home births?
Many choose home births because of negative hospital experiences; Women may feel more comfortable, empowered, and in control at home.
Labor consists of five components, referred to as the five Ps: What are they?
Power
Passageway
Passenger
Psyche
Position
Five P’s of labor: Power
Refers to uterine contractions and pushing efforts
Five P’s of labor: Passageway
Refers to the anatomy of the patient’s bony pelvis and soft tissues
Five P’s of labor: Passenger
Refers to the fetus
Five P’s of labor: Psyche
Refers to the patient’s state of mind
Five P’s of labor: Position
Refers to patient position
Five Ps of Labor: POWER- what are the primary powers of labor
1 _ Primary powers of labor are the involuntary uterine contractions.
Five Ps of Labor: POWER- where do the primary powers of labor occur?
Primary powers occur in the upper two-thirds of the uterus and apply pressure to the fetus.
Primary powers occur in the upper two-thirds of the uterus and apply pressure to the fetus. What occurs as a response to the pressure?
In response to the pressure, the cervix dilates and effaces, allowing for passage of the fetus.
What effects power?
Contraction frequency, duration, and intensity affect power.
What can be administered to augment contraction power?
Oxytocin can be administered to augment contraction power.
Five Ps of Labor: POWER- what are the secondary powers of labor
2 _ Secondary powers are the voluntary action of pushing.
Secondary powers are the voluntary action of pushing- what does this mean?
Secondary powers are the maternal pushing efforts after the cervix is completely dilated.
What should occur with contractions?
Effective pushing should occur with the contractions and may require coaching from the nurse.
Which pelvis shape provides the most ideal passageway
Gynecoid pelvis shape provides the most ideal passageway.
What does passageway depend on?
The passageway also depends on the ability of soft tissue to stretch.
When would soft tissue be an issue for fetal passage?
Soft tissue is rarely an impediment to fetal passage but may be a problem if a woman has scar tissue from gynecologic surgery.
What helps to turn and orient the fetus through the cardinal movements of delivery?
The muscles of the pelvic floor help turn and orient the fetus through the cardinal movements of delivery.
Fetal station
The relationship between the fetal presenting part and the pelvis is assessed by fetal station.
A Zero Station
A zero station means the presenting part is at the level of the ischial spines.
Important factors related to the fetus and labor are:
Fetal head size, fetal presentation, fetal attitude, fetal lie, and fetal position.
Five Ps: Passenger: What is the largest part of the fetus?
The fetal head is the largest part of the fetus.
Five Ps: Passenger: What qualities of the fetal skull allow it to pass through the birth canal?
The fetal skull bones are not fused and allow for the head to adjust to the birth canal.
Fetal presentation
Fetal presentation - refers to the part of the fetus entering the pelvis first.
Fetal presentation: The majority of babies are in what position?
The majority of babies are in a headfirst or cephalic(vertex) presentation.
What is breech position?
A breech presentation means the baby is in a buttocks or feet first presentation.
Fetal attitude
Fetal attitude- refers to the position of the fetal parts in relationship to itself
( chin to chest best)
Fetal lie –
fetal position in relation to mother’s spine
Three main Fetal Presentation groups
- Cephalic
- Breech
- Shoulder
Cephalic (vertex) types:
Flexed
Military
Brow
Face
Breech Fetal presentation includes:
Frank
Full or complete
Footling or double footling
Fetal position landmarks:
- occipital bone [O]. vertical presentation
- chin (mentum [M]) face presentation
- buttocks (sacrum [S]) breech presentation
Examples of Psyche that can influence labor?
Anxiety
Stress
Fear
Pain tolerance
What (part of psyche) can augment labor?
Relaxation can augment labor.
Five Ps of Labor: Position
When are contractions more effective?
Contractions are generally more effective when a patient is in an upright position.
Five Ps of Labor: Position
What can assist a successful labor and delivery?
Gravity
What angle of the pelvis is most conducive to birth?
The angle of the pelvis most conducive to birth is when the patient’s hips are sharply flexed, like when squatting
What is associated with improved outcomes of birth?
Encouraging movement into positions of comfort is associated with improved outcomes.
How did the lithotomy position of birth come to be?
Lithotomy position for birth may have evolved for the ease of the provider.
Signs of impending labor
Contractions become regular
Presence of bloody show
Descent of the fetus into the birth canal (lightening), may occur about two weeks before labor for a primigravida
Nesting impulse
GI distress (heartburn, nausea, diarrhea)
Weight loss of 1 to 3 lb just before onset of labor
What is labor confirmed by?
Labor is confirmed by cervical change - dilation (0-10) and effacement (0-100%).
How many stages of labor are there?
4 stages
First stage of labor
First stage: dilation and effacement of the cervix.
What are the three substages of the first phase?
Latent phase: 0 to 6 cm dilation
Active phase: 6 to 10 cm dilation
Transition phase: 8 to 10 cm dilation
Second stage:
pushing started with the cervix completely dilated and ends with the birth of the baby.
Third stage
begins with the birth of the baby and ends with delivery of the placenta
Fourth stage
Fourth stage: begins with the delivery of the placenta and ends after 4 hours or when the patient becomes clinically stable.
True labor- Where are contractions felt
Contractions are felt in the lower back and abdomen, pressure is felt in the pelvis.
True labor- How long are contractions
Contractions at least 60 seconds long approximately every 4 minutes may indicate labor.
True labor- What happens to contractions over time?
Contractions become stronger and closer together over time.
Rest or hydration do not resolve contractions.
False labor- where are contractions felt
Contractions are felt in the abdomen.
False labor- how are contractions felt
Contractions may become regular for short periods of time, but mostly they are irregular.
Contractions often stop.
False labor- what would resolve the contractions
Rest or hydration often resolve contractions.
Stages and Phases of Labor: First Stage #1
Latent phase characteristics (contractions etc)
Longest lasting phase of labor
Period of excitement
Contractions feel like menstrual cramps and are mild to palpation
Stages and Phases of Labor: First Stage #1. Active phase characteristics:
Patient may become more focused, anxious, or restless.
Contractions become more regular and painful.
Contractions are moderately strong to palpation.
Stages and Phases of Labor: First Stage #1.
Transition phase characteristics:
Contractions strong and close together
Patient may feel out of control, irritable, or dependent.
Shortest lasting phase of labor
Stages and Phases of Labor: Second Stage
Why may pushing be delayed
How long does this stage last
Pushing may be delayed until the patient feels the urge to push.
Second stage may last 20 minutes to 2 hours.
Stages and Phases of Labor: Second Stage
As fetus descends, what happens
As the fetus descends through the birth canal, the fetal head rotates for optimal delivery. These movements are called cardinal movements.
Cardinal movements of second stage
Engagement: Fetal head reaches level of the ischial spines.
Descent: Fetus moves past the ischial spines.
Flexion: Fetal chin touches chest in
response to pressure from maternal tissue.
Internal rotation: Fetal head rotates
Extension: Fetal chin comes off the chest and the neck arches as the head is born.
External rotation (restitution): Fetal head is born and rotates again as the shoulders move into position for birth.
Expulsion: Body of the fetus is born.
Stages and Phases of Labor: Third Stage
How long does this stage take?
The third stage is complete within approximately 5 to 30 minutes.
Stages and Phases of Labor: Third Stage
What occurs?
The uterus contracts to deliver the placenta.
Stages and Phases of Labor: Third Stage
What occurs after the placenta is delivered?
After delivery, of the placenta, the uterus continues to contract to “pinch” or close the open blood vessels in the decidua to prevent maternal hemorrhage
Stages and Phases of Labor: Third Stage
Failure to contract is called what? What is it a primary cause for?
Failure to contract is called uterine atony and is a primary cause of postpartum hemorrhage.
During the Fourth Stage of Labor, what should the nurse do?
- Assess uterine position, vaginal bleeding (lochia), and vital signs
- administer pain meds as needed
- assist the pt with skin to skin contact and initiating breastfeeding
Fetal monitoring
- assessment of the fetal heart rate (FHR) for patterns that indicate fetal compromise.
Fetal monitoring- what is associated with positive outcomes?
A normal (or reassuring) pattern is associated with positive outcomes for the neonate.
Fetal monitoring- abnormal (nonreassuring) patterns are associated with what?
Abnormal (or nonreassuring) patterns are associated with hypoxemia and may lead to hypoxia.
Fetal Monitoring: Intermittent monitoring
Intermittent monitoring generally includes auscultation of the FHR every 15 to 30 minutes during the active phase of labor and every 5 to 15 minutes in the second stage of labor.
Fetal Monitoring: How often are low risk woman monitored?
How about high risk women?
Low risk woman monitoring, every 30 minutes during first stage and every 15 during the second stage.
High-risk woman, the fetal monitor strips are reviewed more frequently.
Fetal monitoring: Baseline HR
Baseline HR: assessed over a 10-minute period between 110 and 160 bpm.
Fetal monitoring: Variability
Variability: irregular fluctuations in the baseline FHR.
Fetal monitoring: Moderate Variability
Moderate variability has an amplitude of 6 to 25 minutes and is assessed over a 10-minute period.
Fetal monitoring: Accelerations
Accelerations are an increase in baseline of at least 15 beats and lasting at least 15 seconds in a term fetus.
Fetal monitoring: decelerations
Decelerations are decreases in the fetal heart rate from baseline.
