Labour & Birth Flashcards
Factors affecting labour: The 5 p’s
- Passenger (fetus and placenta)
- Passageway (birth canal)
- Powers (contractions)
- Position of mother
- Psychological response
What are the characteristics of PASSENGER?
Size of fetal head Fetal presentation Fetal lie Fetal attitude Fetal position
PASSAGEWAY, or birth canal, is composed of the following:
Bony pelvis Soft tissues of the cervix Pelvic floor Vagina Introitus (external opening to the vagina
Primary POWERS include:
-Strength, frequency, and duration of contractions -Effacement (0-100%) -Dilation (0-10cm) -Ferguson reflex -Secondary powers -Urge to push -Bearing-down efforts
What might interfere with the ability to push?
POSITION of labouring woman includes:
Position affects woman's anatomical and physiological adaptations to labour -Freq changes position *Relieve fatigue *Increase comfort *Improve circulation -Labouring woman should be encouraged to find positions most comfortable to her
PSYCHOLOGICAL response of mother includes:
-Excited, crying, groaning, vocal, non-vocal. -Prepared, breathing appropriately. -Not prepared, scared/frightened, out of control, tense. -Level of motivation.
Desrcibe the process of labour
Labour is the process of moving the fetus, placenta, and membranes out of the uterus and through the birth canal.
Various changes take place in the woman’s reproductive system in the days and weeks before labour begins.
Labour can be discussed in terms of mechanisms involved in the process and stages the woman moves through.
Signs preceding labour include?
- Lightening or dropping
- Bloody show
Onset of Labour include:
Onset of true labour cannot be ascribed to a single cause. Many factors are involved, including changes in the maternal uterus, cervix, and pituitary gland.
Stages of labour?
First stage
Second stage
Third stage
Fourth stage
Stages of Labour: 1st Stage - Latent stage (0-3cm)
Latent stage: (0-3cm) -Contractions -Strength: Mild/Moderate -Rhythm: irregular -Frequency: 5-30minutes -Duration: 30-45seconds -Decent: nullparous: 0 station, multiparous: -2 to 0 station -Show: Brownish; mucous plug, pale pink mucous; scant amount -Behaviour: excited, may be talkative or silent; calm or tense, alert, follows directions openly
Stages of Labour: 1st Stage - Active Stage (4-10cm)
Contractions Strength: Moderate to very strong Rhythm: Regular Frequency: 2-5 minutes apart Duration: 40-90seconds Decent: nullparous: varies: +1 to +3 station, multiparous: +1 to +3 station Show: pink to bloody show Behaviour: becomes more serious, difficulty following directions; express doubt about being able to continue, shaking tremors of thighs, pressure in anus
2nd Stage
Pushing and Birth-begins with full dilation and ends with the birth of the baby
30 mins-2hours
3rd Stage
Placenta Delivery
3 - 60 minutes
4th Stage
2 hours after birth
Pain theory
Tension, Fear, Pain
Non-Pharmacological Comfort Measures
Relaxation Imagery and visualization Music Touch and massage Breathing techniques Water (hydrotherapy) Jacuzzi tub TENS Acupressure/acupuncture Application of heat and cold Biofeedback Aromatherapy Maternal position and movement Condition response to pain; needs to practice prenatally Music Imagery Hypnosis Therapeutic touch Counter-pressure (esp. back pain) Birthing ball
Pharmacological Managementof Discomfort
-Analgesics -Narcotic
-Nubain drug of choice
-Often combined with
anti-emetics (gravol),
have systemic effects;
cross the placental
barrier
-Effects of sedation can
be seen in the baby
(sleepiness, respiratory
distress)
-Nitrous Oxide- “laughing
gas” -Self-administered
inhalation
-Nerve Block: Pudendal Block
Pharmacological Managementof Discomfort
-Analgesics -Narcotic
-Nubain drug of choice
-Often combined with
anti-emetics (gravol),
have systemic effects;
cross the placental
barrier
-Effects of sedation can
be seen in the baby
(sleepiness, respiratory
distress)
-Nitrous Oxide- “laughing
gas” -Self-administered
inhalation
-Nerve Block: Pudendal Block
Anaesthetics: Epidural/Spinal- Labour and C/S
Does not cross placenta to fetus
For most women provides full pain relief from contractions
Can cause maternal hypotension (which can cause decrease in uteroplacental perfusion)
General Anaesthetic
Reserved for emergencies where time or circumstance does not permit spinal anaesthetic
crosses placental barrier
Basis for Fetal Monitoring
Fetal response
Labour is a period of physiological stress for the fetus.
Frequent monitoring of fetal status is part of nursing care during labour.
Fetal oxygen supply must be maintained during labour to prevent fetal compromise.
Fetal well-being during labour is measured by response of fetal heart rate (FHR) to uterine activity (UA)
Normal FHR patterns are: -Baseline FHR in a normal range of 110 to 160 beats/min, with no periodic changes and a moderate baseline variability
Accelerations of FHR with fetal movement
The nurse’s role is to assess that the FHR pattern reflects adequate fetal oxygenation.
Types on Monitoring
Intermittent auscultation
Electronic fetal monitoring
What is involved in Nursing Care Management
Patient and family teaching:
-Maternal positioning
-Discourage Valsalva
manoeuvre
Electronic Fetal Monitoring pattern documentation: -Must evaluate essential components of an FHR tracing -Baseline rate, variability, accelerations,decelerations, changes/trends in pattern, and uterine contraction pattern -Determine whether intervention is needed -Avoid terms asphyxia, hypoxia, and fetal distress
Medical interventions for labour and birth
Caesarian Section (C/S) Forceps – Assisted Birth Vacuum – Assisted Birth External/Internal Version Induction
