Labour and delivery Flashcards
What are the 4 stages of labor?
1st: onset of reg contractions to full dilation
2nd: full dilation until birth of baby
3rd: birth of baby until delivery of baby
4th: first 1-4 hours after birth
What is the average length of time for a primigrivada (primip) for each
1st: latent 8.6 hrs
active 4.6 hrs
transition 3 hrs
2nd: 2hrs
3rd: 5 minsWhat is the average length of time for a multigrivada (multip) for each phase?
1st: latent 5.3 hrs
active 2.4 hrs
transition <1 hrf
2nd: 1 hr
3rd: 5 minsDescribe what happens in each stage of labour.
1st: decent, flexion
2nd: decent and flexion, internal rotation, extension, restitution, external rotation and expulsion
3rd: expulsion of the placenta.
4th: close monitoring and time to start breast feeding
What are the two sides of the placenta called?
gray side : dirty or Duncan
codyledon side : shiny or schultz
What does nursing care just after admission for labor look like?
assessing status of mother: contractions (length, strength, frequency)
history
change and get comfortable
physiological assessment
vag exam (dilation, effacement, presentation, station), urine test and swabs
What does nursing care in the first stage of labor look like?
regular assessments (15-30 mins) assess contractions (str, length, freq) offer fluids and ice chips mobilize/change positions frequently comfort measures/distraction assess BP and temp
What does nursing care in the second stage of labor look like?
contact MD
provide comfort measures (ice chips, assist breathing, relaxation, focal point)
encourage not to push until the active part of this stage.
assess contraction and fetal heartrate every 5 mins
instruct how to push
note time of birth
What does nursing care in the third stage of labour look like?
administration of synthetic oxytocin assist in immediate care of the newborn assess blood flow and contraction of uterus obtain fetal blood from cord assist with delivery of placenta Perform apgar on baby
what does nursing care look like in the 4th stage of labour?
assess general state of mother assess BP, pulse, flow, fundus every 15 mins assess temp APGAR performed on the baby assist breast feeding clean up allow family time
what are the three ways a baby can present?
cephalic - head
breech - feet
shoulder
What does fetal lie refer to?
the position of the baby’s spine in relation to it’s mothers
Longitudinal - parallel to mom
transverse - perpendicular to mom
What is the fetal attitude?
The relation of the fetal parts to one another
ideal is head slightly down thighs on abdomen and calves on thighs with arms tucked between legs
What does station mean?
the relationship of the presenting part to the ischial spines
What is engagement?
when the presenting part reaches or passes the pelvic inlet
what are the two forces during labor?
primary force: uterine muscle contractions
secondary force: abdominal muscles which are used in the second stage of labour.
these forces work together to deliver the baby and placenta
What are the three common theories that address the onset of labour?
Progesterone withdrawal hypothesis
Prostaglandin hypothesis
corticotropin-releasing hormone hypothesis
Explain the progesterone withdrawal hypothesis
Progesterone relaxes the smooth muscle of the myometrium by interfering with the conduction of cell-to-cell impulses.
this theory suggests that biological changes at the end of labour decrease the availability of progesterone and this withdrawal starts labor
Explain the prograstaglandin hypothesis
believes that prostaglandin is produced to induce labor.
were able to induce labor by introducing it and able to stop labor by introducing a prostaglandin inhibitor.
Explain corticotropin-releasing hormone hypothesis
suggests that the level of CRH is the inducer. levels increase throughout pregnancy and before labor. it is known to stimulate the synthesis of other hormones.
What is lightening?
the decent of the fetus to the pelvic inlet
may be able to breath better
What is the difference between false and true labour.
False: the woman is experiencing irregular contractions with significant pain that makes her think she is experiencing labor.
True: the contractions produce progressive dilation and effacement. Occur regularly and inc in freq, duration and intensity
What physiological changes signify approaching labor?
lightening
Braxton hicks contractions (false labor)
cervical changes
bloody show (expulsion of the mucous plug 24-48hrs)
rupture of membranes (amniotic membranes. occurs in 12% of ppl and labor starts within 24 hrs)
Sudden burst of energy 24-48 hrs before
What is decent?
Baby moving down because of uterine pressure
What is flexion?
the flexion of the chin to the chest as a result of coming into contact with resistance in the pelvic floor and cervix
what is internal rotation?
rotation of the fetal head to fit the diameter of the pelvic cavity
what is extension?
as the fetal head passes under the symphysis pubis the head extends to cause the occiput to come out first
What is restitution?
shoulders go through the pelvic girdle obliquely twisting the neck. restitution refers to the shoulders realigning with the head after they have passed
What is external rotation?
rotation of the shoulders and head to the anteroposterior position in the pelvis
what is expulsion?
body follows quickly after the anterior shoulder
What are the 5 P’s for successful labor?
Passage (pelvis and soft tissue)
Passenger (lie, attitude, presentation, position)
Physiological forces (contractions/pushing)
Psychosocial
Explain what factors are important in the psychosocial aspect.
mental preparedness physical preparedness socio-cultural values/beliefs previous birthing experiences support system (husband, parents, siblings) emotional status
What are the three parts of the first stage of labor and what indicates each one?
Latent: cx to 3cm, effacement, contractions 5-20
Active: cx to 7cm, contractions 3-4 mins lasting 40-60 secs
Transition: cx to full (10cm), contractions every 2-3 mins lasting 60-90 secs
