Module 5: birth Flashcards by Jenny Lew

What is prodromal labor?

False labor

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What are the characteristics of false labor?

Contractions do not increase in frequency, duration, or intensity/strength

Cervix does not dilate or efface

Contraction pattern decreases with change of position

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What are the characteristics of true labor?

Contractions become rhythmic and regular (Q4-10 min)

Increase in frequency, duration and intensity/strength

Contraction pattern does not change with activity or position change

Associated with increase in vaginal discharge or show

Cervix begins to dilate and/or efface

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What is the nurses role in labor and delivery?

Assess onset and pattern of contraction
Assess contraction frequency, duration, strength/intensity
Provide information related to maternal self-care (nutrition and fluid intake)
Provide reassurance

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What are you determining during palpation of the abdomen

Lie

Position

Level of engagement

Presenting part

Presence of contractions (frequency, strength/intensity, duration)

Foetal well-being- heart rate, movement

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What are the 3 levels described in “station” of birth?

Floating: -5
Engaged: 0
Crowning: +5

Fetal head becomes engaged deep into the boney pelvis and the height of the fundus decreases

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True or False: There are known mechanism/triggers of why labor begins

False

Exact mechanism/trigger unknown- but there are many theories..

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What are the hormonal theories regarding labor onset?

Oestrogen theory

Progesterone withdrawal

Prostaglandin theory

Oxytocin theory

Foetal cortisol theory

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What are the mechanical theories regarding labor onset?

Uterine distension theory

Stretch of lower uterine segment by presenting part

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What are the 4 P’s of the components of labor?

The Passage
The Passenger
The Power
The Psyche

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What are the components of “The Passage” in labor?

DIMENSIONS:

Pelvis

Resistance provided by soft tissue

Cervix

Perineum

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What are the components of “The Passenger” in labor?

POSITIONS, SIZE, & LIE:

Foetal head is largest diameter of the foetus

Head can pass through the pelvic ring

Foetal head molds, changes shape, and adapts as moves through maternal pelvis because of fontanelles

Molds in response to pelvic floor muscles and boney pelvis

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What is “LIE” referring to?

Relationship of fetal spine to spine of mother

Longitudinal, transverse, or oblique

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What is “presentation” referring to?

Part of passenger’s body presenting at the cervix

Usually….
Longitudinal lie
Occiput (bone)
Posterior fontanel

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What are the components of “The Power” in labor?

STRENGTH, DURATION & FREQUENCY

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What are the primary “powers” of labor?

Contractions begin in myometrium of uterus

Contractions move from the fundus downward in waves, separated by short periods of muscle relaxation

Contractions become progressively stronger, regular, and intense

Pressure of fetal head against cervix, causes thinning (effacement) and dilation of cervix

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What are the primary “secondary” of labor?

As presenting part reaches pelvic floor, contractions change in character – become more expulsive

Woman may experience involuntary pushing urge

Begin bearing down to aid the work of the uterus to expel the baby

Bearing down- increases intra-abdominal pressure, compresses uterus on all sides, adds to expulsive power

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What are the components of “The Psyche” in labor?

The psyche and the goal of health care providers:

Psychological outlook is preserved

Knowledge

Fear

Support

Trust
Self
Care provider
Support persons

Beliefs, values, culture

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What are some of the psychosocial factors of labor and delivery?

Transgender FTM

Gender non-conforming

LBGTQ2+

Cultural factors

What are the 3 stages of the first stage of labor?

Latent or early – 0-3 (4) cm
Active – 3-7 (4-6) cm
Transition- 7- 10 (6-10) cm

What are the characteristics of 2nd stage of labor?

Cervix fully dilated (10 cm)

Crowning– head delivers by extension

External Rotation

Restitution

Shoulders rotate internally

Shoulders deliver

What are the characteristics of 3rd stage of labor?

Birth to delivery of placenta

Placenta separates from uterine wall with contraction

Gush of blood and lengthening of cord at entroitus

Woman pushes and placenta appears at vaginal opening

Uterine contraction to firm uterus

What are the characteristics of 4th stage of labor?

1-4 hrs post partum

Mom and babe stabilizing

Maternal V/S

Check uterus

Newborn temp, resp, HR

Vaginal blood loss monitored

Breastfeeding

What are the maternal cardiovascular responses to labor?

Cardio output increases→ shift of maternal bloodflow from uterus and placenta to maternal vascular system w/ contractions

↑ WBC – may be due to stress of labour

Peripheral vascular changes → cold hands and feet

Compression of vena cava may cause nausea, dizziness, and anxiety → wedge to left hip or left side

What are the maternal respiratory responses to labor?

Increase in O2 consumption due to uterine activity Increase in respiratory rate

What are the maternal gastrointestinal responses to labor?

Gastric motility ↓; emptying time of stomach ↑ Clear fluids and light diet recommended**

What are the maternal Genitourinary & Renal: | responses to labor?

Glomerular filtration rate ↑ → polyuria

What is the nurses role after delivery of the fetus?

Continued assessment of woman and foetus Assessment and anticipation of possible interventions which may be needed Communication with healthcare team and family Support and direction to partner and woman’s support Encourage strategies for comfort and techniques for promoting progress Provide encouragement and positive reinforcement of work she is doing Documentation

What are the physiological changes to the uterus after birth?

Process involves contraction of the uterus immediately following delivery of the placenta (living ligature) Placental site thromboses to prevent bleeding Lochia is produced Separation of the uterine decidua into 2 layers New endometrium forms from the inner layer on the wall of the uterus Outer layer (adjacent to placenta and membranes) necrotic, sloughs off and is discarded

What are the 3 different kinds of lochia. Describe color and long each lasts?

Lochia Rubra (red) - 3-4 days Serosa (brownish-red) - 4-10days Alba (yellowish)- 10-28days

Approximately how many days does it take for the uterus to return to size?

9 (according to the slides)

What is included in the postpartum maternal assessment? (BUBBLEE)

``` B-reasts - Colostrum present. Milk in day 3-4 U-terus- - Fundus B-ladder B- owels L-ochia L-egs E-pisiotomy/perineum/incision E-motional status ```

What are the 3 phases of transition into parenthood

Phase 1: Taking in Phase 2: Taking hold Phase 3: Letting go

What is included during " Phase 1: Taking in" phase?

Time of reflection (day 1-2/3) May be less autonomous and relies on nurse more Tired and uncertain about how caring for her newborn Wants to talk about her pregnancy and birth wants to rest and recover Getting to know new baby

What is included during " Phase 2: Taking hold" phase?

Begins to be more assertive in care of herself and her infant Interested in learning about her newborn’s needs Seeks assistance and support while learning new skills associated with infant care and parenting Information seeking Looks for guidance and feedback from nurse Working with partner to share care and prepare for transition to community

What is included during " Phase 3: Letting go" phase?

Begins to define her new role as parent and mother Shifts from vision or fantasy image of infant carried throughout pregnancy to reality of current newborn Lets go of previous role of childless woman and family Adjusts to new role throughout the coming years Begins to make adjustments in relationships as assumes new role and responsibilities

How does the father transition into parenthood with "expectation and intention"?

Seeking deep and emotional connection with newborn

How does the father transition into parenthood with "Confronting Reality"?

Adjusting expectations

How does the father transition into parenthood with "Creating role of father"?

Redefine role Assume care of infant Negotiate role and tasks with partner

How does the father transition into parenthood with "Reaping Rewards"?

Infant smile | meaning

How can bonding between parent and newborn be fostered?

Development of a mutual psychological and emotional connection or closeness between parents and newborn infant. Parent responds to newborns cries and needs Generally involves direct eye-contact between parent and child “en face position” and intense exploration of infant “engrossment” Commonly assumed behaviours associated with attachment have a cultural dimension

How might the mother feel when attention moves away from woman to her newborn?

abandonment

How might the mother feel if the baby may not be the parents envisioned or hoped for throughout pregnancy?

Disappointment

What are postpartum blue?

Occur between days 3-5 Cry for no apparent reason Mood swings Anxiety

What are the behavioural characteristics influencing parental behaviours:

Modulation of rhythm Modification of behavioural repertoire Mutual Responsivity