Labor and Delivery(HD) Flashcards
Labor
- process by which the baby is expelled
- 4 stage process or sequence of events that begin with progressive consistent uterine contractions and ends 1hr after delivery of baby
Stage 1 of Labor
rhythmic contractions to 10cm cervix dilation
1-latent phase-slow/mild
2-active phase-alot of activity
3-transition phase-from baby being inside to out
Stage 2 of Labor
-dilated cervix to birth of baby
Stage 3 of Labor
-birth of baby to delivery of placenta
Stage 4 of Labor
-1-4 hrs after delivery of placenta
how long stage of labor 1-4
-16-36hrs
Factors Effecting Labor(Passageway)
- the structure the fetus passes through(size) of pelvis
- size of pelvis, cervix, vagina, baby
Factors Effecting Labor(Passenger)
-size and position of fetus
Factors Effecting Labor(Power)
-intensity of contractions
Factors Effecting Labor(placenta)
-can separate to early where placenta is attached
Factors Effecting Labor(Psyche)
-moms emotional status
Factors Effecting Labor(Position)
-maternal position and gravity
Passageway
- True vs False pelvis- linea terminals
- True pelvis: pelvic inlet, cavity, outlet
- size and shape of pelvis has effect on delivery of baby
Soft tissue(passageway)
-vagina cervix
Effacement(passageway)
- dilation of internal os
- shorteining/flattening
- measured in percentage
Dilation(Passageway)
- cervix thins out
- 0-10cm
- how open it is
vagina(passageway)
-rugae is going to stretch as baby is coming through
Fetal Skull(passenger)
- molding
- cephalo pelvic relationship(CPD)
- size of head/size of pelvis is disproportion
Fetal lie(passenger)
- how baby is lieing in mother uterus
- position of fetus long axis in relation to moms long axis
- longitudinal transverse,oblique
- how do the vertebrae line up
- if the baby vertebrae lines up with mothers=longitudinal lie
- tranverse= ——-
- oblique= baby at an angle
Fetal Presentation(passenger)
- what part of the fetus is coming into the pelvis first
- ideally we want head first
- cephalic
- vertex=ideal presentation=tip of head
- military=top head
- brow=forhead coming first= chance for neck injury
- face=face first=least preferable
- breech=any other part of the body=feet,buttock,shoulder
Fetal Attitude
- relationship of fetal parts to its self/ one another
- flexion-head down, arms and legs up, smallest part of head entering first
Fetal Position
- relationship of the presenting parts to moms pelvic 4 quadrants
- 3 letters used
- side of moms pelvis (L or R)
- reference point of presenting part
- O=ossiput(head first)
- M=mentum(face first)
- S Sacrum(back first)
- anterior or posterior quadrant(A or P)
Fetal station/engagement
- relationship of presenting part to ischial spine
- measured in cm
- represents descent
- negative to positive
- engaged at zero station
- how up high the fetus is
- -5-+5
- +5 you get to see fetus
Powers(contractions)
-involuntary contractions of the uterus
Phases of contractions(Increment)
-build up of contractions
Phases of contractions(Acme/Peak)
-peak of contractions
Phases of contractions(Decrement)
-letting up phase of contractions
Frequency
- how often from beginning of one to start of the next
- period of relaxation
- o2 goes down during contraction
Duration
- how long from beginning to end of one contraction
- how long each contraction last
- beginning very short
- ready for delivery if a min or more
- lasting 90secs is too long fetus is without oxygen
Intensity
- how strong contractions are
- subjective
- relying on what mom tells us
- document by feeling the uterus
- stiff/hardening during contraction
- increase as birth becomes iniment
- fhr decrease 110, fetal distress during a contraction
Placenta
- upper portion of uterus
- detaches from wall with contractions
Position(Maternal)
- prior to delivery standing/walking
- traditional lithatomy position
- using gravity to assist with descent
- left side lying(fetal distress)-off of blood vessels
- knee chest(prolapse cord)
- birthing beds
- water delivery
Psyche
- can lengthen /shorten behavior
- mothers emotional state
- support system
- previous history
- can interfere with progression
- keep mom calmn and focus and trust
Pain control(natural alternative)
- postitioning
- relaxation techniques
- control breathing w/ effleurage(massaging circular motion in abdomen
- positive imagery
- distractions
- accupressure
- massage
- individual comfort measures
- cultrual implications
Pain control(Analgesics)
- provides emotional and physiological benefits but can interfer with resp. system of newborn. not given if birth is anticipated within one hour
- opiates=decrease perception of pain
- sedatives-used in latent phase(allows mom to rest)
- tranquillizer-relaxes mom
- narcotics-given during active phase
- cultural implications-some culures view medication as sign of maternal weakness
Anesthesia(general)
-mom is completely asleep
Anesthesia(pudenal block)
- local in the perinieum
- good for episiotomy
Anesthesia(Epidural)
- blocks pain sensation
- catheter in epidural space(med dripping in)
- must have i/v
- potentential for hypotension(monitor bp)
Anesthesia(spinal)
- injection in the 3,4,5 space
- must lie flat
- potential for headache
Continuous Fetal Monitoring
- FHR decreases during contraction
- temporary lack of oxygen
- HR should return to 120 btw contractions
- monitoring gives ongoing fetal status
External Assessment of fetus
- fetal heart rate(120-160)
- intensity of contractions
- permanent record
- frequent adjustments needed
Internal assessment of fetus
- ruptured membrances
- accurate assessment
- monitor FHR
- intensity of contractions
- risk of infection
- permanent record
Variable FHR deceleration
- deceleration begins and ends abruptly
- not consistent
- umbilical cord compression
Late FHR deceleration
- delay in decrease
- does not go back to baseline
- uteroplacental insufficiency=not enough oxygen to placenta
Maternal Response to Labor
Cardiovascular
- BP and HR increase during first and second stage
- Return to pre-labor levels during the 3rd and 4th stage
- increase in HR during secong stage
Maternal Response to Labor
Respiratory
-increase in respiration rate prine to blood gas disturbances
Maternal Response to Labor
Renal
- trace of protein as a result of muscle breakdown during labor
- potential for derease urinary flow due to postition
Maternal Response to Labor
GI
- peristalsis and absorption decreases
- NPO: except ice chips
Maternal Response to Labor
Fluid balance
- muscle activity increase body temp
- increase sweating and fluid evaporation
- increase rate can alter balance
Signs and Symptoms of Impending Labor
- lightening=baby drops into pelvic cavity
- Braxton Hicks contractions
- cervical changes=effacement and dilation
- increased energy(nesting)
- weight loss(fluid shift)
- rupture of amniotic membranes
- 1000ml of fluid
- nitrazine to determine ph of
- amniotic=alkaline
- urine is acidic
Characterisitcs of True Labor
- regular intervals
- located in the back
- increase frequency,duration,intensity
- walking intensifies
- cervica; changes
- sedation doesnt decrease number
Characteristics of False Labor
- irregular intervals
- located in abdomen
- NO increase of frequency,duration,intensity
- walking eases
- no cervical changes
- sedation decreases number
Mechanism of Labor(cardinal movements)
pg. 128
1-Engagement 2-Descent 3-Flexion 4-Internal Rotation 5-Extension 6-External Rotation 7-Expulsion
First stage of Labor
- Starts with onset of contractions and ends at 10cm dilation
- longest stage of labor(10-16hrs)
- higher the parity(number of births) shorter the labor
- has 3 stages: Latent,Active,Transition
Latent Stage:
- sedative may be given
- 0-3cm
- longest stage
- effacement starts
- contractions q20-q5
- 15-40secs/mild
Active Stage:
- 4-7cm
- amniotic rupture
- contractions 2-5mins
- 40-60secs/mild-moderate
- pain med can slow down contraction
- pain medication given end of the latent phase
- once get to 7cm no more pain medication
Transition Stage:
- 8-10cm; fully effaced and completly dilated
- difficult for mom
- moody,argumentive,combative
- contractions q2mins
- 60-90secs/firm
- shortest phase of first stage but most difficult for mom
Nursing care for First stage of Labor
- Monitor FHR
- Time and assess contractions; beginning of one end to next, feeling uterus tightening
- Monitor mothers vs/ i&o; for increased vital signs
- NPO-ice chips(limited), peristalsis has slowed down
- IV fluids(change frequently)
- vaginal exams by MD and RN
- encourage breathing techniques
- pain management
- monitor mothers response
- change postition(what ever makes more comfortable and non-compromising)
- positive encouragement
Second Stage of Labor
- Mechanisms of Labor
- Begins with 10cm dilation and ends with birth of baby
- Bulging perineum
- Elevated Bp during contractions
- Episiotomy may be done
- Bladder distention(impedes descent)
- unable to dollow directions
- uncontrollable urge to push
- for head of baby to come out(multipara=30mins)(primi=3hrs)
- check perineum when mom feels pressure in area and she wants to go to the bathroom
Nursing Care-Second stage of Labor
- continued monitoring of mothers Vs and FHR
- Vs between contractions
- mother is pushing
- episotomy done if needed
- support back or assume appropriate positions
- check for bladder distention
- assist with breathing and pushing
- prepare resuscitation equipment for baby
- cord is clamped and cut when pulsating stops
- baby is shown to mom and support person
Third Stage of Labor
-Begins with birth of baby ends with placental expulsion
-5-60min after baby is born
-signs and symptoms of placenta detachment
-cord stops pulsating
-lengthening of cord
-gush of blood
Mechanisms
-Schultz-fetal side=shiny
-Duncan-maternal side=raw/lumpy
Nursing Care-Third stage of Labor
Mom
- assess placenta
- monitor mothers VS
- potential for hemorrhage(Diaphoresis,decreae Bp, increase HR/Pulse
- massage uterus
- obtain cord blood if needed for stem cells
Baby
- dry off and assess infant
- apgar score
- apply id bands to infant and parents
- assess and allow for parent/infant bonding
Apgar Score
- 8-10 acceptable
- 1min and 5min of life
- 4-7=ok
- below 3 baby is in trouble
Fourth Stage of Labor
- recovery stage
- begins with delivery of placenta
- involution takes place-takes about 6weeks for everything to go back into place
- lasts 1- hrs
- frequent assessment of mother
- potential for hemorrhage
Nursing care-4th stage of Labor
monitor moms VS -q15min then q30mins then q1hour asses fundus -firm-ripe plum -if boggy-massage -if ridged-cal MD -just below umbilicus -midline -if to one side have mom empty bladder I&O -assess bladder Monitor Lochia color and amount -lochia is post partum bleeding -pain in urination is normal -lochia no oder, should progress forward -300cc-500cc=normal blood loss during birth -Lochia Rubra=red,small clots=should not bleed through pad less than 2hrs-2-3days -Lochia Serosa=pinkish 4-7days -Lochia Alba=whitish color-up to couple weeks Pain Management -after pain -ice to peri area Allow mom to rest -allow for parent/infant bonding
Nursing care of neonate
immediate care -suction -clean secretions -vernix=cheesy substance -instillation of neomycin drops for opthalmia neonatorum Provide warmth -warm blanket -heated bassinet -radiant heat -hat General Observation -body structures intact -skin-milia(white spot)(clogged pores) -acrocyanosis-blueish color of hands and feet -fontanels-triangular -caput succedaneum: pointed shape of head due to edema -cephalo hematoma: accumulation of blood btw skull and periosteum
Labor
process of that begins with uterine contractions and ends one hour after delivery of the baby
Effacement
thinning and shortening of the cervix
Dilation
opening of the cervix
Cephalo-pelvic relationship
size of fetal head in relation to mom pelvis
Lie
relation of fetus long axis to moms long axis
Attitude
degree of flexion of fetus; relationship of fetal body parts to each other
Presentation
the part of the fetus that enters the pelvis first
Position
relationship of the fetus presenting part to the mothers 4 quadrants of the pelvis
Station
relationship of the presenting part to moms ischial spine
contraction
uterine activity that is part of the labor process
increment
beginning of contraction
acme
height of contraction
decrement
contraction starts to subside
intensity
mild moderate firm, strength of contraction
frequency
how often contraction occur, measured from the beginning of one to the beginning of the other
duration
how long a contraction lasts measured for increment to decrement
lightening
descent of fetus into the pelvis
Braxton hicks contraction
random mild abdominal contractions-false labor
mechanism of labor
rotation the fetus goes through while descending out of the body
apgar score
assessment tool of the neonate
done 1min and 5min after birth
crowning
appearance of fetal head in the vagina during contraction
loccia
bleeding that occurs after delivery
loccia rubra
bright red with small clots
loccia serosa
thin pinkinsh, brown discharge
Loccia Alba
white creamy discharge
after pain
contractions of the uterus after delivery may last 48-72hrs
involution
returning of the reproductive organs to the pre pregnant state
