Labour & Birth Flashcards
Process of Labour ?
Moving the fetus, placenta, and membranes out of the uterus and through the birth canal.
Various changes take place in a woman’s reproductive system in the days and weeks before labour begins.
Signs of labour include? And what are they?
Lightening- “dropping” , presenting part of fetus (usually head) drops downward into the true pelvis; usually occurs 2-4 weeks before term in first time pregnancies & during labour in multiparous
Braxton Hicks- strong, frequent; and irregular contractions
Onset of labour
Distinction of the uterine muscles causing > prostaglandin. Connective tissue loosens to permit softening thinning and opening of cervix
Change in biochemistry of fetal membrane leads : progesterone; prostaglandins, estrogen stimulating contractile response of fetus , resulting in strong, regular, rhythmic uterine contractions
Muscles of upper uterine segment shorten and exert an upward pull on cervix
Signs of impending labour besides lightening and Braxton Hicks
Possible rupture of membrane Increase vaginal discharge ; bloody show Weight loss GI upset sudden burst of energy Low backache
False labour
Irregular contractions
Walking relieves contractions
Bloody show not present
No cervical change in effacement and dilation
True labour
Contractions regular and increase in frequency duration and intensity
Contractions are stimulated with walking
Discomfort in lower back / abdomen
Bloody show
Progressive effacement and dilation I’d cervix
Factors affecting labour (5 Ps)
Passenger, passageway, powers, position, psychological
Assess the passenger, you use:
Leopoldo maneuver - determine the position of the fetus:
1) determine fetal lie (longitudinal)and presentation
Identify part occupying the Fundus
2) palmar- feel for fetal back and irregularities (bumps/ lumps) identifies fetal presentation in breetch presentation FHR is above umbilicus
3) feeling uterus with fingers and thumb- slightly pressed
If head is presenting (not engaged) determine the attitude (flexed or not)
4) turn to face woman’s feet use both hands to outline the fetal head, cephalic prominence are with the irregularities
If the cephalic prominence with back= presenting face first
Fetal lie
Position of the baby in relation to the woman’s pelvis /spine
Longitudinal (vertical)
Cephalic (97) breetch is 3 and transverse oblique is 0.5
Presentation
Part of the fetus that enters the pelvic inlet
Cephalic- head first
Vertex presentation
Back part of the head. Flexed
Siniput
Military style presentation
Brow presentation
Brows presenting
Face presentation
Literally what it means
Frank presentation
Breetch presentation - everything is flexed except knees and legs
Complete position
Flexion I’d hope and knees - legs crossed
Footling
Extended hips and knees
Attitude
Relation of the fetal body parts to one another
Flexion
Stationary
Level of the head of fetus in relation to ischial spine
Relationship if the presenting part of the fetus to an imaginary line drawn between the ischial spine and is the measure of the degree of decent of the presenting part through the birth Canal
Fetal position
Reference point in the presenting part to the four quadrants of the mother’s pelvis
LOA LOP ROA ROP
Factors affecting passenger
Size of the fetal head Fetal presentation (lie and attitude) Fetal position Engagement Cardinal movements Placenta
Fetal head
Palpating reveals presentation position and attitude
Mcranium vault - 2 frontal 2 parietal 2 temporal and occipital
United by membranous/ suture lines (sagittal, coronal, frontal, lamboid
Where the sutures intersect = frontanelles
Anterior fonteanelle closes at …
18 months
Posterior fontenelle closes at
6-8 weeks
Shape of the fetal head adapts in labour called
Moulding
Engagement
Largest part of presenting part reaches of passes through pelvic inlet
Primigravida
Multigracida
Pregnant for the first time (2 weeks before term)
Pregnant multiple times - several weeks to labour
Electronic fetal monitoring
Monitor continuously
Used when assessing to see fetal oxygenation
Intermittent auscultation
Listening every —- interval
Cardinal movements
Descent- process of the fetus through pelvis
Flexion- fetal chin in contact with chest
Internal rotation - occipitalanterior position come out straight
Extension- fetal head reaches perineum
Restitution- after head is born
External rotation- shoulders rotate to midline
Expulsions- birth!
passageway composed of
Bony pelvis- inlet; brim, mid pelvis; cavity, outlet
Soft tissue- lower uterine segment , cervix, pelvic floor muscles, vagina opening
Bony pelvis
True pelvis -“bony canal” : inlet, pelvic cavity and outlet
Pelvis widens and stretches
Progesterone and relaxin facilitate softening and increase elasticity of muscles ligament and pelvic joints
Whether or not the birth canal can accommodate presenting part of fetus determines whether vagina birth is possible
4 pelvis shape
1) gynecoid - classic female shape
2) Android - resembles male pelvis
Anthropoid- ape
-platypellod1 flat pelvis
Factors affecting birth- powers
Primary forces
Uterine muscular contractions cause effacement and dilation of cervix ; signal beginning of labour
Involuntary rhythmic intermittent to allow rest and restore iteriolacental circulation
Secondary power
Use of abdominal muscles to push 2nd stage of labour - adds to primary force after full dilation of cervix
-bearing down efforts (trigger by endogenous oxytocin release)intraabdomjnal pressure compresses uterus leading to expulsion
Effacement
Drawing up of internal is and cervixal ealls into side walls of uterus
Position of women during labour
Affects woman’s anatomical and physiological adaptions to labour
Frequent changes in position
Relieve fatigue
Increase comfort
Improve circulation
Labouring women find position comfortable for her
Impact of stress
Adrenaline
Causes : lack of control and feeling judged
Muscles tighten energy sent to limp increased sensitivity to pain,
Signs, tension, high pitched voice
Impact of stress
Oxytocin and endorphins
Muscles relax
Energy sent to uterus
Decreased sensitive to awareness of pain
Feels loved, safe and supported
1 stage or labour: latent
Mild regular contractions with increasing in frequency duration and intensity defined as 0-3 dilated
- Active stage of birth: active phase
Anxiety increases intensity, nulliparous- 4 cm
Multiparous- 4-5 cm
Primary goals of 1st stage labour
Safety of mother and infant
Interventions based in the needs of the mother/ partner
Assessment;
FHR and contractions at least every hour
Assess maternal status
Assess status of fetal membrane
Assess psychosocial state and ability to cope
Provide physical and psychological care
Communicating labour progress to family and team
Maternal adaption
Estrogen prostaglandins oxytocin increases
Increases in endorphins- sedating and raises pain threshold
Increase CO
Heart rate WBC BP systolic, systolic and diastolic
Elevated temp. And oxygen consumption doubles
Higher metabolism
Fetal adaptions to labour
Fetal health surveillance- oxygen; FHR to uterine activity
Fetal circulation: maternal position, uterine contractions, BP and umbilical coed flow
Fetal respiration- changes prepare fetus for initiating respirations immediately after birth
Emotional support
Less fearful and anxious
- interferes with progress of labour; reduce blood flow, increase pain
Assessing progress of labour
Bishops score
To see if induction of labour is required
Dilation Effacement Position of cervix Consistency Station
2nd stage of labour
Completed cervical dilation and ends with birth of fetus
- descent of fetal presenting part
- bulging of perineum, uncontrollable urge to bear down, intraabdominal pressure increase bloody show
Discomfort; contracting uterine muscle cells, distension of vagina and perineum and pressure of fetus
Crowning
Fetal head is encircled by external opening on the vagina
Nursing interventions for stage 2 labour
Emotional support Take vitals q15 Fetal heart test Q 15 if healthy ( mother no risk of birth complications) Access ability to buss Prepare of dil erg Change position of breathing
3rd stage of labour
Births of placenta
After infant born, uterus contracts firmly and placenta start to separate from wall
Signs of separation of labour
Globular shapes uterus
Rise in fundus
Sudden trickle of blood
Exclusion <30
Cord protrusion
4th stage of labour
1-2 hours after birth
Physiologic readjustment if mother body - homestasis
Mother may feel energize
Optimal time for infant bonding- a
Nursing role for 4th stage of labourers
Infant assessment
First period is reactivity - skin to skin contact
Provide comfort measures
Okay anaesthesia q15
Promote family relationships
Post partum assessment
BUBBLLEE
Breast Uterine fundus Bladder Bowel Lochia Legs (peripheral edema) Episiotomy Emotional support
