Labor & Birth Processes

Question 1

Powers
Passenger
Passageway
Position of the mother
Psyche - psychologic response
People - support sys equally imp
Factors that affect labor - at least 5 affect labor and birth - not people

Answer 1

The Six P’s

Question 2

There are involuntary and voluntary powers that combine to expel the fetus and the placenta from the uterus
Primary
Secondary

Answer 2

Powers

Question 3

Involuntary
include frequency duration and intensity: how we measure uterine contractions
responsible for efacement and dilation of the cervix and Descent of the fetus
efacement of the cervix means the shortening and thinning of a cervix during the first stage of Labor the degree of efacement is expressed in percentages from 0 to 100% keeping in mind that effacement is purely subjective - it is just a feel and experience as to how a face to cervix is
dilation of the cervix is the enlargement or widening of the cervical opening and the cervical Canal that occurs once labor has begun the diameter of the cervix increases from less than a centimeter to full dilation or 10 cm to allow birth of a term fetus when the cervix is fully dilated it can no longer be palpated so when we do a vaginal exam
at eight or nine centimeters we can actually feel the outside Rim all around the baby’s head
when we are fully dilated or at a 10 and when you go to do a vaginal exam you can no longer feel cervix at any part
all the way around the fetal head dilation of the cervix occurs by the drawing upward of the musculofibrous components of a cervix caused by strong uterine contractions pressure exerted by the amniotic fluid while the membranes are attacked or by the force applied by the presenting part can promote cervical dilation in the first and second stages of labor increased intrauterine pressure caused by contractions exerts pressure on the descending fetus and the cervix when the presenting part of the fetus reaches the perineal floor mechanical stretching of the cervix occurs
Stretch receptors in the posterior vagina vagina cause release of endogenous oxytocin that triggers the maternal urge to Bear Down of that Ferguson’s reflex we also refer to that as the point of no return
Forces generated by uterine musculature (fundus)
Frequency, amplitude and duration of contractions
Assessment:

Answer 3

Primary

Question 4

Observation,
Manual palpation,
Tocodynamometry,
Intrauterine pressure catheter (IUPC)

Answer 4

Assessment:

Question 5

the signal at the beginning of labor once the cervix is dilated voluntary bearing down efforts by the mother called the secondary Powers augment the force of the involuntary contractions so they work together
as soon as the presenting part reaches the pelvic floor the contractions change in character and become quite explosive
the laboring woman experiences an involuntary urge to push
the bearing down efforts result in increased interabdominal pressure that compresses the uterus on all sides and as the power of these explosive forces
secondary Powers have no effect on cervical dilation when and how a woman pushes in the second stage of Labor are much debated topics
Bearing down efforts to actively aid in the expulsion of the fetus

Answer 5

Secondary

Question 6

The first P’s
Movement passagener/fetus through the birth canal is determined by sev interacting factors - size fetal head, fetal presentation, fetal lie, fetal attitude, fetal position; also placenta - rarely prob
Fetal head
Fetal size
Fetal Position
Fetal lie
Fetal attitude
Fetal presentation

Answer 6

Passenger:

Question 7

Major effect on birth process
Areas where more than 2 bones meet: fontanels
During labor after rupture - palpation of fontanels and suture lines (bones skull join together) during vaginal exam can tell fetal presentation, fetal direction, fetal attitude
Sutures and fontanels make skull flexible to accommodate infant brain - cont grow for some time after birth
Slight overlapping/molding conts occur during labor to allow for accommodation of fetal head through pelvis

Answer 7

Fetal head

Question 8

Abdominal palpation or Ultrasound
Macrosomia (>4500g) associated with failure to progress

Answer 8

Fetal size

Question 9

Relationship of a nominated site of presenting part to denominating location on internal pelvis and pelvic inlet and to 4 quads of pelvis
Changes with mechanism of labor - with external and internal rotation; noted in delivery summary
Station

Answer 9

Fetal Position

Question 10

Relation to fetal position to imaginary line drawn between maternal ischial spines to degree of descent of presenting part of fetus thru birth canal
Lowermost portion of presenting part 1 cm above spine - being -1; level of spine - 0 station; cm below spine - +1; further + get - further baby is through vagina - birth immenent when +4-+5 - could easily visualize fetal head; -1 to -3 - opp want do - birth is + experience; floating fetus is a negative experience

Answer 10

Station - Fetal Position

Question 11

Longitudinal axis of fetus relative to longitudinal axis of uterus
Relation of long axis/spine of fetus to long axis/spine of mother
Longitudinal (vertical - preferable, head down), transverse or oblique (horzintal - long axis fetus at exact rt angle of mother’s)
cephalic/breech
Vaginal birth cannot occur with transverse lie - shoulder - modification of this - cannot deliver shoulder before deliver shoulder

Answer 11

Fetal lie

Question 12

Relation of the body parts to each other - norm back of fetus is rounded so chin flexed on chest - thighs flexed on abdomen and legs flexed on knees; arms crossed over thorax and umbilical cord lies between arms and legs - gen flexion - most babies in this position - fetal position

Answer 12

Fetal attitude

Question 13

Part fetus that enters pelvic inlet first and leads through birth canal during labor at term
Flexion - chin to chest, thighs curled; everything curled in classic fetal position
Extension - chin extended away from chest - face presentation; can be born this way vaginally - typ not tolerate labor as well - occiput/back baby’s head smaller in diameter - molding at forehead instead back head; lot facial bruising; often C-section
Fetal part that directly overlies pelvic inlet
3 major presentations: Cephalic (preferable), breech (buttox, feet, or both), or shoulder (very rare)
Presenting part is the part fetus that lies close to internal os of cervix - part fetal body first felt by examining fingers during vaginal exam
Factors that influence presenting part: fletal lie, attitude, extension or flexion of head
Compound – presence of >1 fetal part over the pelvic inlet
Attitude – position of head with regard to fetal spine

Answer 13

Fetal presentation

Question 14

Degree of flexion or extension
Flexion allows smallest diameter of fetal head to present at pelvic inlet

Answer 14

Attitude – position of head with regard to fetal spine - Fetal presentation

Question 15

Aka birth canal: composed of pelvis and soft tissue of cervix, pelvic floor, vagina, introdus - external opening to vagina
Pelvis
Soft tissues

Answer 15

Passageway

Question 16

Gynecoid - typical shape of female pelvis
Android - typ shape of male pelvis
Suprapubic angle - look down on pelvis - imp because big hold up - narrow angle - challenging underneath it; rounded, wider arch far more accommodating for fetus to pass through
Pelvic exam - rough estimate of size and shape pelvis at first prenatal visit; during labor - pelvis flexes to accommodate the fetus; does not predict ability to give birth vaginally because many ways a fetus can negotiate pelvis

Answer 16

Pelvis

Question 17

Soft Tissues
Vagina - rugae
Cervix- dilation
Pelvic floor – stretches, what exercise promotes support and healthy tissues?
Disensible lower uterine segment
Cervix
Pelvic floor muscles
Vagina
Antrodutus
After Labor has begun uterine contractions cause a uterine body to have a thick and muscular upper segment and a thin walled passive muscular lower segment the contractions of this uterine body exert downward pressure on the fetus pushing it against the cervix the cervix then e-faces or thins out and dilates sufficiently to allow the first people portion to descend into the vagina as the fetus descends the cervix is actually drawn upward and over first portion
The pelvic floor aids in helping to rotate the fetus anteriorly as it passes through that birth canal

Answer 17

Soft tissues

Question 18

Maternal positions can promote comfort and enhance labor progress
Position affects the woman’s anatomic and physiologic adaptations to labor frequent changes in position relieve fatigue increase comfort and improve circulation
Lots diff ways can labor - best thing to do in labor when not on an epidural pump - is continued movement while in labor - movement during labor helps opitmize the best birth position for the fetus

Answer 18

Position (Maternal)

Question 19

Support
Education
fifth and 6th
labor affects women very differently - a lot of it has to do with how they’re prepared
psyche has to do has has more to do with home and copes how she perceives her pregnancy how she perceives her labor and the other component of that being the people around her supporting her
it’s very important that a woman builds her support system when it comes to this often very scary time and a woman’s life the other part of the education so the more that’s why we really do our best in the preconception counseling and during prenatal care to advocate for breastfeeding classes and baby Basics classes and childbirth classes and really encourage women to do some reading and some research just to familiarize themselves with the entire process

Answer 19

Psyche and people

Question 20

The term labor refers to the process of moving the fetus placenta and membranes other than the uterus through the birth canal and first time pregnancies the uterus sinks downward and forward about 2 weeks before term
Signs Preceding Labor
Stages of Labor

Answer 20

Process of labor

Question 21

Lightening
Increased lower back pain
Cervix ripens
Nesting behaviors
Slight weight loss
Increased vaginal discharge

Answer 21

Signs Preceding Labor

Question 22

when the presenting part of the fetus (hopefully the fetal head) descends into the true pelvis this settling is called lightning or dropping after this event women feel less pressure below the rib cage and breathe more easily but usually more bladder pressure until after uterine contractions or established and true labor is in progress so that happens a little differently for everybody

Answer 22

Lightening

Question 23

the woman May complain a persistent low backache and sacroiliate distress as a result of relaxing at the pelvic joints she may identify strong frequent but irregular uterine contractions the vaginal mucus becomes more profuse and response to the extreme congestion of the vaginal mucous membranes brownish or blood tend to cervical mucus may be passed your often refer to this as bloody show the cervix becomes soft and partially a face May begin to dilate the membranes May rupture spontaneously other phenomena are common in the days preceding labor as in a weight loss of five to 1.5 kilos caused by that water loss resulting from the electrolyte shift said in Turner produced by changes in estrogen and progesterone levels and a surge of energy women speak of having this person energy or this nesting where they are constantly moving around and cleaning and organizing and getting ready for this baby to come last commonly some of them will actually have a little bit of diarrhea and nausea and vomiting and some indigestion

Answer 23

Increased lower back pain

Question 24

Bloody show

Answer 24

Increased vaginal discharge

Question 25

First stage
Second stage
Third stage
Fourth stage

Answer 25

Stages of Labor

Question 26

so the first stage of Labor is considered to last from the efacement to full dilation or 10 cm of the cervix of Labor is difficult to establish because women may be admitted to the labor unit just before birth and the beginning of labor may only be an estimate most women who come in and act of Labor and during your admission questions and you’re asking them you know when did your labor starts it’s kind of fuzzy - they don’t know when they’re cervix started changing so if you look back here at the definition of the actual onset of Labor it’s regular uterine contractions and Progressive dilation of the presenting part
they can probably give you an idea of when they started contractions but efacement and Progressive dilation they have no idea when that started and the progress in The Descent of the presenting part so 0.2 and 3 and that first paragraph is stages of labor they can tell you in the regular progression of the uterine contractions perhaps started and that’s usually the time that we will put down as a start of Labor because anybody’s guess before they come in and get checked where at
the first stage is much longer than the second and third combined
this first stage of Labor with epidural anesthesia separate transition phase May not always be identified because that separate transition phase more often is identified through maternal behaviors the grunting the nausea physical Sensations like extreme pressure so in the events that a woman has an epidural for anesthesia
first stage is actually condensed to two phases which would be the early and the active but for the sake of learning about these stages
Early
Active
Transition

Answer 26

First stage

Question 27

during that latent phase there is more progress in efacement of the cervix but little increase in The Descent the cervix has got to get thin in order for it to stretch or dilate
from the time the cervix is fully dilated to the birth of the fetus it is composed of two phases the latent and the active
latent part
active pushing phase

Answer 27

Second stage

Question 28

is where the fetus is going passively through the birth canal the contractions are going to be what helps Force the baby further down into the birth canal

Answer 28

latent part

Question 29

is when the woman all of a sudden feels this urge to push she has to push and bear down and that’s where she is going to data voluntary power if she’s going to start to Bear Down

Answer 29

active pushing phase

Question 30

the third stage of Labor last from the birth of the fetus until the placenta is delivered this usually takes minutes we’re talking five to 10 minutes it can take upward you know to 20 minutes but typically this is just several contractions in the placentas delivered that is your third stage so from the time of the placenta is delivered until about 2 hours after birth

Answer 30

Third stage

Question 31

fourth stage of Labor granted she’s not pregnant but it’s a very critical time assessment for the nurse and perhaps even intervention depending on the the mother’s response to this fourth stage so it’s important time to observe for complications as in abnormal bleeding

Answer 31

Fourth stage

Question 32

Engagement (A)
Descent (A)
Flexion (B)
Internal Rotation (C)
Extension (D)
Restitution/External Rotation (E)
Expulsion (F)
Professional birth to occur the fetus must adapt the birth canal during The Descent the turns and other adjustments necessary in the human birth process are termed the mechanism of Labor
the seven Cardinal movements occur

Answer 32

Mechanism of labor

Question 33

engagement when the biparietal diameter of the head passes the pelvic andlet the head is said to be engaged in the pelvic Inlet

Answer 33

Engagement (A)

Question 34

descent refers to the progress of the presenting part through the pelvis and it depends on at least four forces number one the pressure exerted by the amniotic fluid number two the direct pressure exerted by the Contracting fundus on the fetus number 3 force of the contraction of the maternal diaphragm and abdominal muscles in the second stage this would be like your active phase of the second stage and number four extension and straightening of a fetal body the effects of these forces are modified by the size and shape of the maternal pelvic planes and the size of the fetal head and it’s capacity to mold the degree of descent is measured by the station
Little descent occurs during this latent phase this first stage of Labor descent accelerates in the active phase of first stage labor it is especially apparent when the membranes have ruptured during first time labor and birth decent is usually slow but steady progress is assessed by vaginal exam

Answer 34

Descent (A)

Question 35

as soon as the descending head meets resistance and that flexion permits the smaller diameter to present to the outlet internal rotation the maternal pelvic Inlet is widest in the transverse diameter therefore the fetal head passes the inlet into the true pelvis in the occiput transverse position for the fetus to exit though the head must rotate

Answer 35

Flexion (B)

Question 36

it’s going to rotate internal rotation begins at the level of the issue spine so this is like a zero station but it’s not completed until the presenting part reaches the lower pelvis = +1 or +2

Answer 36

Internal Rotation (C)

Question 37

With each contraction the fetal head is Guided by the Bony pelvis in the muscles of the pelvic floor and then we get into the extension when the fetal head reaches the perineum for birth it is deflected anterior by the perineum

Answer 37

Extension (D)

Question 38

When under the lower border of the synthesis pubis first and the head emerges by extension first the occiput then the face and finally that chin after the head is born then we get into the restitution and external rotation it rotates briefly to the position of occupied when it was engaged in the inlets this is the restitution the 45° turn realize the infant’s head with her or his back and shoulders this external rotation so the head is out the head is out you can see the entire head and you’re not the provider is not the one doing the rotation the baby does this rotation

Answer 38

Restitution/External Rotation (E)

Question 39

then expulsion after birth of the shoulders a head and shoulders are lifted up toward the mother’s pubic bone in the trunk of the baby is born by flexing it laterally in the direction of the synthesis pubis so

Answer 39

Expulsion (F)

Question 40

In addition to the maternal and Fetal anatomic adaptations that occur during birth physiologic adaptations must also occur accurate assessment of the laboring woman and fetus
Fetal HR
Fetal circ
Fetal respiration

Answer 40

Physiological adaptation: fetal

Question 41

normal range is 110 to 160 however temporary accelerations and slight early deceleration to the fetal heart rate can be expected in response to several things fetal movement vaginal exams fundal pressure you during contractions abdominal palpation and Fetal head compression stresses to this utero-fetal placental unit result in characteristic fetal heart rate patterns
Fluctuates in response to fetal movement, vaginal examination, fundal pressure, uterine contractions, and fetal head compression

Answer 41

Fetal HR

Question 42

circulation can be affected by many factors including maternal position uterine contractions blood pressure and umbilical cord blood flow uterine contractions during during labor intent to decrease circulation through the spiral arterioles and subsequent perfusion through the intervalist space most healthy fetuses are well able to compensate for the stress and exposure to increase pressure while moving passively through the birth canal during labor
Affected by maternal position, uterine contractions, blood pressure, and the umbilical cord blood flow
Most healthy fetuses can compensate for these changes

Answer 42

Fetal circ

Question 43

certain changes stimulate chemoreceptors in aorta and carotid bodies to prepare for initiating respirations immediately after birth - changes: fetal lung fluid cleared from air passages as passes through birth canal, fetal oxygen pressure decreases, arterial PCO2 increases, arterial pH decreases, bicarb decreases, fetal respiratory movements decrease during labor
Prepare for extrauterine respiration
Fetal lung is cleared from air passages during descent into canal
PO2: decreases
PCO2: increases
arterial pH: decreases
Bicarb: decreases
Respiratory “practice” movements

Answer 43

Fetal respiration

Question 44

As the woman progresses through systems of labor various sys adaptations cause experience obj and subjective symptoms
Cardiovascular Changes
Respiratory Changes
Renal Changes
Integumentary Changes
Musculoskeletal Changes
Neurologic Changes
Gastrointestinal Changes
Endocrine Changes

Answer 44

Physiological adaptation: maternal

Question 45

Cardiac output during contractions increased by 51% above baseline
CO peaks 10-30 minutes after birth and returns to prelabor baseline in the first hour postpartum!!
Blood pressure increases during contractions and returns to baseline between contractions
WBC increase
Peripheral vascular changes as well

Answer 45

Cardiovascular Changes

Question 46

during each contraction an average of 300 to 500 mL of blood is shunted from the uterus into the maternal vascular system by the end of the first stage of Labor cardiac output during contractions is increased by 51% above Baseline pregnancy values

Answer 46

Cardiac output during contractions increased by 51% above baseline

Question 47

peeks about 10 to 30 minutes after both of vaginal and cesarean birth and return to its pre-labor Baseline the first postpartum hour changes in blood pressure also occur in general both systolic and diastolic pressures increased during contractions and return to Baseline levels between contractions supine hypotension occurs when the ascending vena cava and descending aorta are compressed in addition some medications can cause hypotension

Answer 47

CO peaks 10-30 minutes after birth and returns to prelabor baseline in the first hour postpartum!!

Question 48

The white blood cell count increases this is probably secondary to the stress of Labor

Answer 48

WBC increase

Question 49

in response to the cervical dilation and compression of maternal vessels by the fetus passing through the birth canal flushed cheeks hot or cold feet and aversion of hemorrhoids may also result

Answer 49

Peripheral vascular changes as well

Question 50

Respiratory changes increased physical activity with greater oxygen consumption is reflected in an increase in the respiratory rate she’s working hard
Increased oxygen consumption
Hyperventilation -> respiratory alkalosis, hypoxia, hypocapnia

Answer 50

Respiratory Changes

Question 51

Difficulty voiding
during labor spontaneous voiding may be difficult for various reasons such as tissue edema caused by pressure from the presenting part discomfort analgesia and embarrassment nobody wants to pee on the doctor and memory changes

Answer 51

Renal Changes

Question 52

Vagina introitus stretching/distention
changes are evident especially in the great disability in the area of the vaginal and troitus makes sense and the reason that the reason that all of these changes that occurred if you look back into the adaptations of pregnancy when it comes to the distensibility the vagina and the perineum are getting more blood supply there they’re actually getting a little larger is to accommodate for these exact changes that happen in labor

Answer 52

Integumentary Changes

Question 53

Increase stress
Backache, joint aches, leg cramps

Answer 53

Musculoskeletal Changes

Question 54

stress during labor diaphoresis fatigue proteinuria and possibly an increased temperature a company that marked increase in muscle activity backache and Joint ache unrelated to the fetal position occur as a result of increased joint laxity at term and remember what two hormones are responsible for that joint laxity relaxin and progesterone

Answer 54

Increase stress

Question 55

Sensorial changes (i.e. euphoria)
Endorphins
Physiologic anesthesia of perineum

Answer 55

Neurologic Changes

Question 56

occur as a woman moves to the phases of the first stage of Labor and from one stage to the next initially she may be euphoric
Euphoria gives way to increase seriousness then to Amnesia between contractions during the second stage and finally to Elation or fatigue or a mixture of both after giving birth

Answer 56

Sensorial changes (i.e. euphoria)

Question 57

endogenous endorphins raise the pain threshold and produce sedation in addition physiologic anesthesia of perineal tissues caused by pressure the presenting part decreases perception of pain

Answer 57

Endorphins

Question 58

Decreased absorption and motility of the gutàN/V, diarrhea/constipation
gastrointestinal motility and absorption of solid foods are decreased the body is working so digesting food is not an important function so stomach emptying is slow they’ll be some nausea and vomiting of undigested food
In active: May state that diarrhea accompanied the onset of Labor that’s just the body’s way of it’s not the priority - the body’s going to get rid of what’s not important and feces not important

Answer 58

Gastrointestinal Changes

Question 59

Onset of labor triggered by decreasing progesterone, increasing levels of estrogen and prostaglandins, and oxytocin
Glucose levels decrease with the work of labor
metabolism increases and blood glucose levels May decrease with the work of Labor

Answer 59

Endocrine Changes