Labor and Delivery Flashcards
five Ps
passenger, passage, powers, placenta, and psychology
Passenger (fetus)
Presentation of the fetus
Cephalic: head alone is presenting part
vertex brow military face
Breech: head alone is not the presenting part
frank: buttocks present, fetal hips are flexed and knees are extended
complete: buttocks and feet present, fetal hips and knees are flexed, lower legs crossed
kneeling: knees present
footling: foot or feet present
shoulder: shoulder presents, transverse lie
compound: two presenting parts such as head and hand
Position of the fetus designated by these factors (see table below for examples) Presenting part
O = occiput
M = mentum
S = sacrum
A = acromion process D = dorsal

Right or left
How the presenting part faces the pelvis
front (A = anterior) back (P = posterior) side (T = transverse)
Size of the fetus
Passage (birth canal)
Parity of the woman
Resistance of the soft tissues as the fetus passes through the birth canal Fetopelvic diameter
Powers (contractions)
Force of uterine contractions Frequency of uterine contractions
Placenta
Site of implantation
Whether it covers part of the cervical os
Psychology (psychological state of the woman)
Anxiety levels
Emotional factors
Amount of sedation required
four stages of the labor process
First stage of labor
Dilating stage
Begins with the first true labor contractions to complete dilatation of the cervix (10 cm)
Three phases

Latent (early) or prodromal
contractions last from 30 to 45 seconds with the intensity gradually increasing; frequency of contractions is from 5 to 20 minutes
dilation is from 0 to 3 centimeters bloody show is usually present
the mother is usually able to walk and talk during this phase; diversion is usually welcomed
Active or accelerated
contractions become stronger and last longer, usually 45 to 60 seconds; frequency is from 3 to 5 minutes
cervix dilates from 4 to 7 centimeters
the mother is not able to walk, tends to withdraw from the surrounding environment but desires companionship and encouragement
Transient or transitional
contractions are sharp, more intensified, lasting 60 to 90 seconds; frequency of contractions is from 2 to 3 minutes
cervix dilates from 8 to 10 centimeters
increase in the bloody show
mother feels an urge to push or to have a bowel movement
Second stage of labor

Delivery or expulsive stage: complete dilatation of the cervix to birth of the baby
Crowning
Delivery of the head
Delivery of the anterior shoulder and the posterior shoulder Delivery of the trunk and lower body
Clamping and cutting of the umbilical cord
Imminent signs
Increased bloody show Desire to bear down
Bulging of the perineum Dilatation of the anal orifice
Impending signs
Nausea
Irritability and uncooperative Complaints of severe discomfort Pleas for relief
Third stage of labor
Placental stage: The period from birth of the baby until delivery of the placenta Signs of placental separation
Uterus becomes globular in shape and firmer
Uterus rises in the abdomen
Umbilical cord descends three inches or more further out of the vagina Sudden gush of blood
Fourth stage of labor
Recovery or stabilization stage
Begins with delivery of the placenta and ends when the uterus no longer tends to relax
The primary goal is to prevent hemorrhage from the uterine atony and the cervical or vaginal lacerations
Mechanisms of Labor (Cardinal Movements)
Engagement, descent, flexion: the widest part of the head passes the ischial spines as the head is flexed onto the chest
Internal rotation: the anteroposterior diameter of the head lines up with the anteroposterior diameter of the pelvis
Extension: the head passes the symphysis pubis and extends from the perineum
External rotation: the baby rotates back to its position during engagement and then an additional 45 degrees to align the shoulders with the anteroposterior diameter of the pelvis. The anterior shoulder passes under the symphysis pubis followed by the posterior shoulder

Expulsion: the rest of the body passes under the symphysis pubis and is expelled
Position of Fetus
LOA
Left Occiput Anterior
Fetal occiput is on the left side of the maternal pelvis toward the front
The fetus’s face is toward the rear of the pelvis
ROA
Right Occiput Anterior
Fetal occiput is on the right side of the maternal pelvis toward the front
The fetus’s face is toward the rear of the pelvis
LOP
Left Occiput Posterior
Fetal occiput is on the left side of the maternal pelvis toward the rear
The fetus’s face is toward the front of the pelvis
ROP
Right Occiput Posterior
Fetal occiput is on the right side of the maternal pelvis toward the rear
The fetus’s face is toward the front of the pelvis
Newborn Reflexes
Reflexes are involuntary movements or actions.
They help transition newborns to life and to learn what they need to survive.
As a general rule, reflexes will stop or disappear cephalocaudally (from head-to-toe).
Action
Gag
Stimulation of posterior pharynx causes individual to gag
Persists through out life.
Blink
Eyes blink when strong light or object nears baby.
Persists throughout life
Nose
Glabellar
Tapping briskly on bridge of nose causes eyes to close tightly
Disappears around the fourth month
Sneeze Stimulated nasal passages result in sneezing Persists throughout life  Mouth Gag Persists throughout life
Rooting
Touching or stroking cheek beside mouth causes baby to turn head to the side of the stimulus and begin to suck
Usually stops at 3 to 4 months
Extrusion
Touch or depress the tongue, and it is forced outward
Usually stops by 4 months of age

Sucking
This occurs when something is placed in the baby’s mouth
Slowly replaced by voluntary sucking around 2 months of age
Hand Grasp
Stroking palm of hand causes flexion of digits
Lessens by about 3 months of age when it is replaced by voluntary grasp

Babinski or plantar grasp
Stroking outer sole of foot upward from heel across ball of foot causes toes to fan and hyperextend with the big toe in dorsiflexion
Usually disappears at 12 to 18 months of age

Moro or startle reflex
Sudden jarring (as when someone fails to support or hold the neck and head) causes extension and abduction of extremities and fanning of fingers, followed by flexion and adduction of extremities; it is a bilateral process
Usually disappears atabout 2 months of age
Dance or stepping reflex
Holding newborn so feet touch hard surface causes flexion and extension of legs, simulating walking.
Usually disappears at about 3 to 4 weeks of age

Crawl
Placing baby on abdomen causes crawling-like movements of arms and legs
Usually disappears at about 6 weeks of age

Parachute
When an infant is suspended in a horizontal prone position and suddenly thrust forward, the hands and fingers extend forward. This reflex is protective; as the child learns to walk, the reflex helps protect him/her from falls.
Found initially between 7 to 9 months and persists indefinitely

Tonic neck or fencing
When the infant is supine and his/her head is turned to one side, the arm and leg extend on the side the head is turned and the arm and leg flex on the opposite side. The reflex protects the infant from rolling over before he or she is neuromuscularly mature enough to do so.
Usually disappears by 4 to 9 months of age

Physiological Changes and Related Normal Discomforts of Pregnancy FIRST TRIMESTER
Menses cease
Nausea and vomiting, referred to as “morning sickness”, but may occur at any time of the day (due to increased hCG, fetal demand for glucose)
Breast tissue enlarges (due to hypertrophy of glandular tissue, increased blood flow to area, hormonal effects)
Areola and nipples darken
Mood swings
Urinary frequency and nocturia (due to pressure on bladder from expanding uterus)
Yawning, fatigue
Chadwick’s sign: discoloration or bluish purple hue that appears on the cervix, vagina, and vulva
Goodell sign: cervical softening caused by stimulation from estrogen and progesterone
Physiological Changes and Related Normal Discomforts of Pregnancy SECOND TRIMESTER
Enlargement of the abdomen
Vascular spiders, leg varicosities
Groin pain (from round ligament stretching)
Constipation (due to hormonal/progestin effects; slowing down of peristaltic movement and compression of colon by uterus and baby)
Heartburn or gastric reflux (due to progestin hormone effect; enlarged uterus displaces stomach upward; relaxation of the stomach, esophagus, and gastroesophageal sphincters)
Leg cramps (due to calcium-phosphorus imbalance)

Colostrum is produced
Linea nigra: darkened vertical line on mid-abdomen (due to melanin and progestin effects)
Melasma gravidarum or “mask of pregnancy”: dark, blotchy brownish pigmentation change occurs around the hairline, brow, nose and cheeks; fades after pregnancy, may recur after exposure to sun
Supine hypotensive syndrome
Bleeding gums (due to increased vascularity of oral cavity)
Hemodilution (Hgb peaks at 10.5; Hct peaks at 32)
Physiological Changes and Related Normal Discomforts of Pregnancy THIRD TRIMESTER
Dyspnea
Braxton-Hicks contractions (as opposed to true labor)
Urinary frequency
Flatulence
Constipation (partly due to iron supplements)
Hemorrhoids (caused by pressure from fetal presenting part and increased vascular activity)
Leg and feet cramps
Lumbar lordosis, low back pain (due to increased pressure, fatigue, poor weight distribution)
Gait changes (“pregnancy waddle”)
Pedal edema
Supine hypotensive syndrome
Urinary incontinence (pressure on bladder due to dropping of fetus or “lightening” into pelvic cavity)
Insomnia (due to increased fetal movements, muscular cramping, frequency, dyspnea)
Varicosities in the leg, vulva (due to pelvic vasocongestion, pull of gravity, pressure of uterus, forcing stool in constipation; also a hereditary link)
