Labour + Delivery + postpartum + newborn Flashcards
what are the 5 P’s of labour
1) Passenger
2) passageway
3) powers
4) position of mother
5) psychological response
What are the external forces effecting labour?
- place of birth
- type of provider
- availability of labour support
- procedures
what are the internal forces effecting labour?
-physiology / sensations
does the placenta usually cause birthing complications?
NO it rarely impedes the labour process
What are the factors that effect the passenger
- size of fetal health
- Fetal presentation
- fetal lie
- fetal altitude
- fetal position
what are the 3 parts of fetal position
- fetal lie
- fetal attitude
- fetal position
what are sutures
the cranial joints
what are fontanelles
where the sutures intersect
the soft spots on babies head
what shape is the front fontanelle
diamond (large)
what shape is the back fontanelle
triangle (small)
during labour… the sutures & fontanelles are:
flexible to accommodate brain growth
can slide over each other (mould) to fit maternal pelvis
when will the brain assume its normal shape after birth?
It’ll take shape 3 days after
do the babies shoulders usually cause an issue at birth?
No they can be moved so they usually aren’t problems
what is the fetal “presentation”
The part the enters the pelvic inlet first
What are the 3 main presentations
- Cephalic
- Breech (butt or feet)
- shoulder presentation
what percentage of births are cephalic
96%
what percentage of births are breech
3%
what percentage of births are shoulder
<1%
what would be the region presented for cephalic
the occiput (vertex)
what would be the region presented for breech
the sacrum
what would be the region presented for shoulder
the scalpula
What is the fetal lie
The relation of long axis (spine) of fetus to long axis (spine) of mother
What are the types of fetal lies
- Longitudinal/vertical
- transverse / horizontal
- oblique
what is a longitudinal lie
paralel axis’s with mom
what is a transverse lie
long axis @ right angle with mom
what is a oblique lie
long axis at an angle (will usually correct itself)
what is fetal attitude
the relation of fetal body parts to each other
what is the normal fetal attitude
- General flexion
- rounded back, chin flex, thighs flexed, sarcasm crossed over chest, cord between arms & legs
what are the consequence of an abnormal attitude
- prolonged labour
- forceps/ vacuum
- cesarean
what is the largest transverse diameter
the biparietal diameter
9.25 cm
what is the fetal position
the relationship of a reference pt on the presenting point to the 4 quadrants of the moms pelvis
What does the first letter mean in fetal position
Left or Right side of mom
What does the second letter mean in fetal position
The part that is presenting
what does the 3rd letter mean in fetal position
if it’s posterior, anterior or transverse
what is the “station”
Relationship of fetal part to an imaginary line drawn down the maternal ischial spines
***the measure of degree of descent of preceding part through the birth canal
What does it mean if the station is a negative number
it is above the ischial spine
what does it mean if the station is a positive number
it is below the ischial spine
at what station does birth take place
usually +4 or +5
what is engagement
the largest transverse diameter of the presenting part has passed through maternal pelvic brim or inlet into the true pelvis
when does engagement occur
usually +2 station
- can often occur weeks before labour in nulliparas
- in muiltiparas it happens during labour
how can engagement be determined
can be determined by abdominal or vag expansion
describe the passageway
rigid bony pelvis, soft cervix, pelvis floor, vag & introits
what part plays the biggest role in birth
the pelvis size & shape
What is the false pelvis
part above the brim, no role in child bearing
what is the true pelvis
part involved in birth (brim, mid-pelvis, cavity, outlet)
what is the pelvic inlet/ brim
upper boarder of true pelvis
What is the pelvic cavity
curved passage w/ short anterior wall
what is the pelvic outlet
lower boarder of pelvis (ovoid/ diamond shape)
what are the factors that are important to determine if natural birth is possible
- subpubic angle / pubic arch
- length of pubic rami
- subpubic arch
what are the 4 types of pelvis’s
1) gynecoid
2) Android
3) Anthropoid
4) Platypelloid
% & shape? (Gynecoid)
circle - 50%
% & shape? (android)
Resembles a male pelvis (23%) heart
% & shape? (anthropoid)
24% and it’s an oval
% & shape? (platypelloid)
3% flat pelvis
is the pelvis size tested?
no it’s approximate b/c radiographic exam is bad for baby
What are the soft tissues
lower uterine segment, cervix, pelvic floor muscles, vagina & introitus
the uterus becomes… ( once birth begins)
very muscular so that it can push against the cervix
To allow the first fetal position to descend into vagina….
the cervix (effaces) thins & dilates opens)
what is efface
thin (happens first)
what is dilate
opens (happens after)
what is the pelvic floor
muscular layer that separates pelvic cavity from perineal space below & helps rotate fetus
the soft tissues …
develope throughout pregnancy until the vagina can dilate to accommodate fetus
what are the 2 types of powers
involuntary & voluntary
What are the primary powers?
involuntary contractions that originate from certain pace maker points in upper uterine muscles
they move downward in waves, separated by short rests
How are primary powers described?
1) Freq. (from beginning of one to the beginning of next one)
2) Duration ( length of contraction
3) Intensity (strength of contraction @ peak)
What are the primary powers responsible for?
Effacement- shortening/ thinning of cervix
this usually happens before dilation
facts about dilation
- goes from <1 cm to 10cm.
- can’t be palpated when fully dilated
- marks end of 1st labour stage
- due to pressure AND hormones
Are uterine contractions independent or dependent of external forces
uterine contractions are independent of external forces
-may reduce if given narcotics which can cause prolonged labour
When do the secondary powers begin
As soon as the presenting part reaches the pelvic floor
What are the secondary powers contractions like?
explosive- involuntary urge to push
-bearing down efforts: contracts diaphragm & abs
What is the result of secondary powers?
intra-abdominal pressure
do secondary powers have an effect on dilation?
No
Are frequent positions changes good or bad
good
what are the benefits of position change
reduce fatigue
increase comfort
increase circulation
What are the benefits of upright birth
- gravity promotes descent
- contractions are stronger & more effective in dilating cervix
- labour is shorter
- improves blood flow
- pressure on vena cava reduce
If the woman wants to lie down…
lateral ( on side) is best
benefits of all 4’s birth
- relieve back ache
- decreases length
- decreases need for assistance
how is a birthing position determined
- woman preference
- condition
- environment
- HC provider confidence
What is lightening
dropping of the baby into the pelvis
- happens 2-4w before term in first time pregnancy
- in multipara’s lightening won’t happen till the uterus contracts
signs of labour coming
- lightening
- strong frequent irregular contraction
- low back pain
- bloody show: mucus
- cervix soften
- membranes rupture
signs of days proceeding labour
1) loss of 0.5-1.5kg (water weights)
2) surge of energy (nesting)
or diarrhea, nausea, vomit & indigestion
3) return of frequent urination
is there a single cause of labour?
no there is no single cause
- hormones
- distention of uterus & pressure
- result in strong, regular rhythmic contractions
What are the stages of labour
1) regular progression of uterine contractions
2) Effacement & progressive dilation of cervix
3) progress in descent of presenting part
Describe stage one of labour
- last onset of regular uterine contractions to full dilation of the cervix
- longest stage
- can take 1-18hr
- 2 phases: -latent (early)
- active labour - quicker dilation & descent
Describe stage two of labour
- fully dilated to brith
- latent (passive)
- active (urge to push stretch receptors)
describe stage three of labour
birth of fetus - birth of placenta
3-5 mins or an hour
Describe stage four of labour
2hr after placenta
recovery, bonding & breastfeed
What are the mechanisms of labour
- engagement
- descent
- flexion
- internal rotation
- extensions
- restitution & external rotation
- expulsion
What is meant by engagement
- when the biparietal diameter of head passes pelvic inlet
- in nulliparas - this occurs b4 active labour
what is asyclitsm
- head is deflected in pelvis
- head is positioned so that it cannot descend
- this is an error in engagement
what is meant by the descent
- progression through the pelvis by 4 forces
- slow & steady in first baby
- Rapid in second baby
What are the 4 forces that determines descent
1) pressure via amniotic fluid
2) direct pressure exerted by contracting fundus on fetus
3) force of contraction of diaphragm & abs
4) extension & straighten fetal body
why does the head flex into the chest
to produce a smaller diameter
what is internal rotation
head must rotate in order to exit
what is extension
the head emerges vis extension
the occiput, then face, then chin
what is restitution & external rotation
after the head is born , baby rotates to position it was in, in inlet (restitution)
the anterior shoulder will descend first
what is expulsion
trunk is born by flexing laterally
fetal heart rate?
110-160bmp
fetal circulation is affected by…
- Maternal position
- uterine contractions (contractions decrease circulation)
- bp
- umbilical cord flow
fetal respiration
decreases during labour
maternal cardiac changes during labour
- increase cardiac output will return to baseline after both
- increased bp during contractions
- increased HR
- increased WBC
- flushed or hot or cold cheeks & hemmorhoids
maternal respiratory changes during labour
- increased respiratory rate
- o2 consumption doubles
maternal renal changes during labour
spontaneous voiding becomes hard
proteinuria is common
integumentary system changes during labour
skin will stretch and tear
increased temperature
musculoskeletal maternal changes during labour
- diaphoresis, fatigue
- joint pain
neurological changes maternal during labour
euphoric, serious, elated or fatigued
-decreased perception of pain
GI tract maternal changes during labour
- motility & ability to absorb food decrease
- nausea & vomiting is common
endocrine maternal changes during labour
decreased progesterone, increased estrogen. Increased metabolism
moms with a history of sexual abuse may be triggered by
- memories during invasive procedures
- loss of control or feeling of being restrained
- being watched by students or intense sensations
women with a history of sexual abuse may…
fight labour process
be controlling
be submissive or dependent
mentally retreat or dissociation
the nurse can help women in labour with history of sexual abuse by
- help associate feelings with present
- maintain sense of control by informing her
- validate needs
- fulfil requests
- permission before touch
- be conscious about words
- limit invasive procedures
- help her come an advocate
- *** care for all women like this you don’t know who is a victim
What is assessed during a psychosocial assessment of labouring woman
- verbal interaction
- body language
- perceptual ability
- discomfort level
women reactions to labour reflect their life experiences with:
childbirth, physical, social, cultural & religion aspects
some society expectations of birthing women:
- pain is inevitable and must be endured by birthing moms
- pain can be avoided in childbirth
- pain in childbirth indicates sin
- pain can be managed by a women
muiltiparas base their expectations on…
their last birth & may only voice their concerns when asked
how will stress effect labour
it will cause a slower labour
how can the nurse help with stress during labour
- provide trust & support
- explain things in detail
- let woman know that there aren’t any expectations
- explain the role of the nurse
- encourage the woman to trust her ability to give birth
- acknowledge that the support person may also feel stressed
- be sensitive to needs
how to better accommodate LGBTQ+ labour
- transmen can give birth (biologically female)
- ask how they describe their gender identity
- document their gender identity & pronoun
- best if met before birth to plan
- ask permission to touch
indigenous birth is a….
family event & community - the hospital vistitor limit may effect this
what questions should you ask to provide culturally safe care during labour
- value/ meaning of childbirth
- view of wellness or sickness of childbirth
- private vs social
- diet, med, activity, emotional & physical support
- appropriate maternal/ paternal behaviour
- birth companions
- views of immediate newborn care
a birth companion is a source of…
- support
- encouragement
- comfort
- *not always the partner!!!
- *some woman prefer another women
- *woman will determine their role
- *some women modesty is very important
how a non-english speaking women in labour feels:
- increased anxiety
- loss of control
- panic
- withdrawn
- agression
- *some only want a female interpreter
- *over the phone is better than nothing
- *speak slow w/ no jargon
How long is postpartum / puerperium / 4th trimester
6 weeks
what is the postpartum involution process of the uterus
it means to return to non-pregnant state
when does involution begin
immediately after explosion of placenta with contraction of uterus
where is the uterus at the end of the 3rd stage of labour
- uterus midline
- 2cm above from umbilicus
- fundus rest on sacral promontory
- weights about 1000g
within 12hr uterus is
1cm below umbilicus
within 24hr the uterus is
the same size as @ 20 w
the fundus descends…. (rate)
1-2cm /24hr
by day 6 the uterus is
half way between symphysis pubis & umbilicus
when should the uterus no longer be palpable
by 2 weeks