Labour & Delivery

Question 1

What defines true labour?

Answer 1

increase in frequency, duration and strength of contractions

Question 2

How many phases of labour are there in the 1st stage of labour? and what are they called?

Answer 2

1. latent
2. active
3. transition

Question 3

In the latent stage of labour how many cm’s does the cervix stretch to?

Answer 3

1-3cm

Question 4

In the active stage of labour how many cm’s does the cervix stretch to?

Answer 4

4-8cm

Question 5

In the transition stage of labour how many cm’s does the cervix stretch to?

Answer 5

8–10cm

Question 6

What happens during the 2nd stage of labour?

Answer 6

pushing and birth of baby

Question 7

How long can pushing last for primips vs multips?

Answer 7

primip - 2 hours

multips - 15min - 1 hour

Question 8

What happens during the 3rd phase of labour?

Answer 8

between birth of baby and the delivery of the placenta

Question 9

When does the 4th stage of labour happen?

Answer 9

1-4 hours after the delivery of the placenta

watching for hemorrhaging

Question 10

How long does the latent phase typically last for in a primip vs a multip?

Answer 10

primip: 8.6 hours
multip: 5.3 hours

Question 11

How many cms/hour does the cervix dilate in a primip vs a multip?

Answer 11

primip: 1.2 cm/hour
multips: 1.5 cm/hour

Question 12

How long does the active phase typically last for in a primip vs a multip?

Answer 12

primip: 4.6 hours
multip: 2.4 hours

Question 13

How long does the transition usually last for in a primip vs. a multip?

Answer 13

primip: 3 hours
multip: less then 1 hour

Question 14

When can you tell if someone is in false labour? what is the name for these contractions?

Answer 14

when there is no increase to strength, length and duration. Random contractions and tightening of uterus.

Braxton-hicks contractions

Question 15

What are a few benefits of “passive decent” (natural birth)?

Answer 15

• decreased FHR decels, better fetal O2 levels
• cost effective
• decreased length of pushing time
• decreased maternal fatigue

Question 16

What are signs a woman in labour should be going to the hospital?

Answer 16

regular contractions - 5 mins apart
bleeding
water broken (breaks)
painful contractions
lightening - baby drops lower

Question 17

What theory describes the onset of labour as being the uterus can only stretch so big and then PE2 (prostaglandins) are released and start labour?

Answer 17

Mechanical theory

Question 18

What theory suggests that the pressure on the cervix releases oxytocin and then contractions begin?

Answer 18

Neurological theory

Question 19

What theory suggests that the increase in estrogen then stimulates contractions and more irritability on the uterus?

Answer 19

Progesterone Withdrawal Hypothesis

Question 20

Which theory focuses on the amnion and decidua?

Answer 20

prostaglandin hypothesis

Question 21

What is the theory that has an increased CRH hormone throughout prenancy with a sharp increase at term? CRH is also known to stimulate what?

Answer 21

corticotrophin releasing hormone (CRH) hypothesis

known to stimulate synthesis of prostaglandin

Question 22

Was is the length of time a contraction can last from?

Answer 22

30 - 90 secs

Question 23

The intensity can be measured as mmHg.  For example at rest the measurement is 10-12mmHg. Describe the measurements at the following stages and describe their intensity:
early labor
active labor
transition
pushing

Answer 23

early labor: 25-40 mmHg - mild
active labor: 50-70 mmHg - moderate
transition: 70-90 mmHg - strong
pushing: 70-100 mmHg - strong

Question 24

What are the critical factors during labor known as the 5 P’s?

Answer 24

1. passage - pelvis & soft tissue, joints, inlet, outlet, perineum, vagina, pelvic floor
2. passenger - baby longitudinal, lie, presentation, presenting part , position
3. relationship of passage & passenger
4. physiological forces (contraction and pushing)
5. psychosocial

Question 25

What are 6 psychosocial considerations? and give examples

Answer 25

1. mental preparedness - readings and prenatal class 2. physical preparedness - prenatal fitness 3. socio-cultural values & beliefs - do their beliefs assist or impede? 4. previous reproductive experience - horrific experience may afftect 2nd birth (positive or negative) 5. support from signifciant others - positive influences? 6. emotional status - reactions, responses towards labor - what are they bringing with them emotionally?

Question 26

What are the 7 cardinal movements (mechanism of labour) a fetus takes through the birthing canal?

Answer 26

1. decent 2. flexion 3. internal rotation 4. extension 5. restitution 6. external rotation 7. expulsion

Question 27

What is happening in the 1st stage of labour in terms of mechanism of labour?

Answer 27

decent and flexion

Question 28

What is happening in the 2nd stage of labour in terms of mechanism of labour?

Answer 28

``` decent & flexion internal rotation extension restitution external rotation expulsion ```

Question 29

What happens during the 3rd stage of labor?

Answer 29

placenta separation and expulsion

Question 30

What are the signs of placental separation?

Answer 30

1. globular shaped uterus 2. rise of the fundus in the abdomen 3. sudden gush or trickle of blood 4. further protrusion of umbilical cord out of the vagina

Question 31

What is the placenta known as when it delivers with the fetal (shiny) side presenting?

Answer 31

shiny schultz

Question 32

What is the placenta known as when it delivers sideways with maternal surface delivering first?

Answer 32

dirty duncan

Question 33

Which area of the uterus controls the bleading after the placenta is delivered?

Answer 33

the middle layer of the myometrium

Question 34

How often is the mother monitored in the 4th stage of labour?

Answer 34

every 5 mins for 1-4 hours

Question 35

What is the first thing to check in the initial care of the newborn?

Answer 35

check neck for umbilical cord

Question 36

While the cord is being clamped and cut where is the baby?

Answer 36

being kept at level of vagina with head down

Question 37

Once baby dried off where is he/she placed?

Answer 37

under radiant heat or directly on mom

Question 38

What is the apgar system evaluating?

Answer 38

the physical condition of the newborn at birth

Question 39

When is the newborn rated with the apgar system?

Answer 39

1 minute and at 5 minutes after birth

Question 40

If the apgar score is less than 7 at 5 minutes what should happen?

Answer 40

the test should be repeated every 5 minutes up to 20 minutes

Question 41

What 5 things are being assessed in the apgar test?

Answer 41

``` heart rate respiratory effort muscle tone reflex irritability skin color ```

Question 42

If a baby shows a heart rate of less than 100 bpms what needs to happen?

Answer 42

immediate resuscitation

Question 43

The blood from the cord is obtained for what purpose?

Answer 43

to test the blood gases, group, type and possible stem cells

Question 44

If a newborn scores anywhere between 7-10 what does this indicate?

Answer 44

newborn is in good condition

Question 45

What does an apgar score of 4-7 indicate?

Answer 45

indicates need for stimulation

Question 46

If score is less than 4 what may this indicate?

Answer 46

possible resuscitation

Question 47

If score is less than 3 at 5 minutes what may this indicate?

Answer 47

neonatal mortality