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Labor and Birth > Presentation and Position > Flashcards

Presentation and Position Flashcards

1
Q

Presentation

A

Describes the part of the baby that is lying over the cervix and the part that will be delivered first

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2
Q

Vertex presentation

A

crown of baby’s head is presenting (95% of births)

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3
Q

Brow presentation

A

Not completely the face

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4
Q

Face presentation

A

Face of the baby presents first; neck is hyperextended and they come out looking pretty bruised up.

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5
Q

Nuchal hand

A

hand presents next to the baby’s face

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6
Q

Double nuchal hand

A

both hands present next to the face

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7
Q

Single footling breech

A

one food presents first

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8
Q

Frnak breech

A

butt presents first

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9
Q

Does presentation or position usually change during labor?

A

Presentation usually doesn’t change, position can.

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10
Q

Position

A

Refers to the direction towards which the back of the baby’s head or other presenting part is lying in mom’s body

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11
Q

When does descent take place for primip mothers?

A

Several weeks before the onset of labor

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12
Q

What does descent take place for multip mothers?

A

It is not unusual for labor to begin with the baby still floating or high in the pelvis

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13
Q

What station do many women begin labor at?

A

-1 to 0, meaning some descent has already taken place.

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14
Q

Which way do babies typically turn in labor?

A

clockwise

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15
Q

What are the six cardinal movements?

A 
descent
flexion
extension
external rotation
expulsion
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16
Q

Descent

A

Baby moving into the pelvis, as it reaches the pelvic floor is must rotate so that it goes through the mother’s pelvis side to side

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17
Q

Flexion

A

baby’s head is flexed chin to chest; the resistance from the pelvis forces the baby’s head to flex

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18
Q

Internal rotation

A

once the baby’s head is engaged the head turns 45 degrees. This rotation causes the baby to face the mother’s back

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19
Q

Extension

A

The force of the contractions push the baby downward as the head moves under the pubic arch there is no longer any resistance and extension takes place

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20
Q

External rotation

A

the shoulders are in contact with the pelvis floor and the baby’s head rotates to line up with the shoulders.

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21
Q

What are the jobs of mom and baby during labor?

A

The baby’s job is to rotate, the mother’s job is to dilate.

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22
Q

What chances take place in the cervix during labor?

A
  1. The cervix moves forward.
  2. The cervix ripens, or softens
  3. The cervix effaces, thins or shortens
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23
Q

When does cervical ripening happen?

A

For some, it can happen weeks before labor, while for others it happens only a few days before. This explains why some women have strong and frequent contractions late in labor without dilation.

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24
Q

What is cervical effacement

A

Cervical effacement refers to the thickness of the cervix and is determined through a vaginal exam.

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25
Q

How is cervical effacement measured?

A

percentage of effacement or length of cervix in centimeters

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26
Q

What does 0% effacement mean?

A

Cervix is 3-4 cm and has not begin to thin

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27
Q

What does 50% effaced mean?

A

The cervix is 2 cm, and has thinned about halfway

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28
Q

What does 100% effacement mean?

A

“paper thin”, the cervix has thinned completely

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29
Q

What is cervical dilation?

A

When the cervix opens.

30
Q

How much dilation can take place before labor begins?

A

1-2 cm in a primip mom and up to 4cm in a multip mom

31
Q

When does most dilation take place?

A

During active labor

32
Q

How many centimeters is the cervix when it is opened only a fingertip?

A

1 centimeters

33
Q

How did the rule of 10 come about?

A

In 1951 Greenhill and DeLee studied women under the influence of drugs and found that no abdominal pushing should be allowed until the cervix was 10cm because of the risk of rupturing the cervix.

34
Q

What is new information regarding the rule of 10?

A

A non medicated woman will not push so hard against her un-dilated cervix that is tears. When done correctly, pushing to help rotate a baby and dilate oneself can actually eliminate a great deal of pain and cut hours off one’s labor and birth.

35
Q

What are sphincters?

A

Circular muscle groups that remain contracted so that the opening of certain organs are held closed until something needs to pass through.

36
Q

What is the sphincter’s job?

A

To relax and expand so that it can open comfortably and wide enough to allow the passage of whatever must be expelled or move through.

37
Q

How do sphincters function best?

A

They are affected by the emotions. They function bet in a relaxed atmosphere.

38
Q

What are the four sphincter laws?

A
  1. Excretory, cervical, and vaginal sphincters function best in an atmosphere of intimacy, familiarity and privacy–for example a bathroom with a locking door or a bedroom where interruption is unlikely or impossible.
  2. Sphincters cannot be opened at will and do not respond well to commands such as push or relax.
  3. When a person’s sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious.
  4. The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open full capacity
39
Q

What factors help a sphincter open in labor?

A
  1. Laughter helps open the sphincters.
  2. A smile is good. A chuckle is better. A Good belly laugh is one of the most effective forms of anesthesia.
  3. Slow deep breathing aids the opening of sphincters–deep abdominal breathing causes a general relaxation of the muscles of the body, especially the muscles of the pelvic floor.
  4. Immersion in warm water
  5. Positive and loving words spoken.
  6. Love is a very healing and easing emotion. Trust and love make relaxation possible.
  7. When a mother loves and trusts her midwife or physician, she is going to find it far easier to relax her bottom in the presence of this person.
40
Q

What are the 3 categories of the signs of labor?

A

possible signs
preliminary signs
positive signs

41
Q

What are the possible signs of labor?

A

Backache that comes and goes and may resemble the backache often experience before a menstrual period
A restless backache may occur off and on for days before or along with other signs
Abdominal cramping
Frequent soft bowel movements
A nesting urge

42
Q

What are the preliminary signs of labor?

A

Non-progressing contractions of the uterus (Braxton hicks)
Bloody Show
Leaking of amniotic fluid

43
Q

What are braxton hicks contractions?

A

They are likely to be mild and 8-20 minutes apart.

They are preparing the cervix for dilation by bringing it forward, causing ripening and effacement.

44
Q

What is bloody show?

A

If the discharge is more mucous than blood it is “show”, if it is more blood than mucous, or if the blood is dripping out, it may be due to a larger blood vessel breaking.
Bloody show can appear before any other signs of labor and ay not appear until hours after contractions have begun.

45
Q

What is the leaking of amniotic fluid?

A

If a mom notices a leak, as opposed to a gush, it may mean that a small hole in the bag has developed high in her uterus.
If mom’s underwear seems damp and she notices leaking when walking or changing of position, her fore bag of waters may have ruptured.
If mom is GBS positive, caregiver will want mom to be given IV antibiotics.

46
Q

What are positive signs of labor?

A

Progressing contractions of the uterus
Rupture of membranes to a gush (1/2-1 cup of amniotic fluid with the gushes)
Cervical change confirmed by vaginal exam

47
Q

What should you tell a mom whose membranes rupture before labor has begun?

A

Note the time, color, order, and the general amount of fluid
Notify the caregiver
Do not put anything into your vagina
On rare occasions, cord prolapse can occur.

48
Q

What is the controversy surrounding friedman’s curve?

A

Evidence says that the rate of dilation from 4 to 6 cm was far slower than was previously thought. Increase in c-section may be caused by clinging to the normal Freidman’s curve, even though “6 is the new 4.”

49
Q

What is failure to progress?

A

More than 4 in 10 women who were diagnosed with failure to progress and had c-section had not even reached 5cm dilation before they were taken to surgery, meaning they were still in early labor.

50
Q

What is the phase of maximum slope?

A

According to barney, it is defined as dilation occurring most rapidly from 4-8 cm, but many are now saying this is between 6-8 centimeters.

51
Q

What happens in the first stage of labor?

A

dilation and effacement

52
Q

What are the three phases of the first stage?

A

Early or latent phase
Active labor
Transition

53
Q

How do the phases change as labor progresses?

A

They become shorter and mroe intense

54
Q

What are the stage characterized by?

A

Each stage has its own physiological and emotional signs. If a mom and her partner understand the process they will be better prepared to recognize and cope.

55
Q

Describe early labor

A

“shiny, happy people”
Emotional stage: excited, anticipatory
Typically the longest phase of the first stage
parents should be encouraged not to overemphasize or overanalyze this stage because it can be mentally exhausting
Contractions are usually short and not very intense
Postpone immersion in water, as it can slow things down.
Do something fun
Eat easy to digest foods

56
Q

Describe active labor

A

More intense and focus, needs comfort and focus, more inward.
dilation speeds up and more is accomplished with each contraction
Usually the time when most leave for hospital
Primips: 4-1-1 or 3-1-1
Multips: 5-1-1
Can be emotionally challenging
Mom should be alternating activity with rest, eating, drinking, and peeing
She should be changing positions frequently
Mom’s birth partner may need to become more involved in supporting her physically.
Some moms may not want to be touched
Some want silence while others prefer music
Some women may weep as they notice they can’t turn back

57
Q

What should mom know about arrival at the hospital?

A

Birth partner should call ahead to let them know she is coming.
Mom should have bag, birth plan, pillows, and any last minute needed items.
Once at the hospital, mom can take a wheelchair, but it may help her progress to walk
If mom appears to still be in early labor, midwife may suggest she leave for a while. DOULA should suggest is midwife doesn’t
If mom get admitted early in labor she may become prematurely exhausted and/or become victim to the expectation on her to labor and birth in a certain amount of time.
If waters have broken, vaginal exam should be kept to a minimum.

58
Q

Describe transition

A

Third phase of the first stage of labor
Most intense and shortest
Contractions are close together, right on top of each other, and might double peak because baby is getting ready to slip through the cervix
Mom’s diaphragm may be stimulated by involuntary spasms and as a result may be hiccuping, belching, grunting, or having nausea and vomiting
Mom may feel the urge to push
Mom may feel confused about if she should push or not, if she is not at 10cm.
She may feel aching in her back or thighs as baby moves down
She may be frightened by the intensity of labor.
She may feel like it will last forever
This is when you start preparing things that will aid her with the intensity.
There is not single correct way to handle transition. Correcting a mom isn’t necessary unless she is doing something that might be harmful (Shrill tones)

59
Q

What are two keys to coping with transition?

A

Recognition: when mom knows the signs of transition and is ready for them they tend to be encouraged by progress and she the pain and challenge of transition in a more positive light.
Understanding the normal feelings

60
Q

What are the normal feelings of transition?

A

pain, fear, nausea, trembling, despair, crying urge to push. They are associated with the surge of adrenaline

61
Q

What are the three categories of the second stage of labor?

A

latent resting phase
descent
crowning and birth

62
Q

Latent phase

A

This phase is option
A mom should push with contractions, so if they experience the latent phase she will shouldn’t have to push, as she is not having contractions.

63
Q

What two concepts will guide a mom during the second stage?

A

The importance of not rushing.

The importance of different positions.

64
Q

What should mom obey regarding position?

A

What her body is telling her to do

65
Q

What will a mom do when she obeys her urge to push?

A

Bear down for 5-7 seconds and take several deep breaths in between. usually gets 3 sets of those pushes during one contractions. Focusing downward, moving with the pressure can help

66
Q

When should prolonged maximal pushing, directed pushing, Valsalva pushing, or purple pushing be reserved for?

A

When progress is inadequate or the baby is already in distress and other interventions like forceps, vacuum or cesarean are being considered.

67
Q

What can prolonged maximal bearing down in normal labor cause?

A 
Maternal exhaustion
fetal distress
failure of the baby to rotate
arrest of descent
over-stretching of the pelvic ligaments and muscles
possible perineal tears
68
Q

What can changing positions help to do?

A

If the position she is in adversely affects the baby’s heart rate
Often a new position will make medical intervention unnecessary.
If the second stage is going very fast, mom can try a gravity neutral position, such as side lying, to slow down.
Positions that use gravity they help progress and descent.

69
Q

What are ways to protect the perineum for serious tear or episiotomy?

A

Choosing a caregiver who prefers to avoid episiotomies
Eating nutritious foods during pregnancy, because good nutrition promotes healthy tissues
Performing perineal massage regularly for a few weeks before births (helps mom recognize the burning sensation and know to slow down rather than push through)
Spontaneous pushing
Positions that make birth more efficient during delivery
Working with your caregiver and using light panting to avoid pushing while the baby’s head and shoulders are born.

70
Q

What can “holding back” cause?

A

Holding back can be caused by: fear that it will hurt worse of damage her vagina
Modesty issues
fear of pooping
fear the baby will come out so fast that the baby cannot catch it.
Almost every woman goes through a period in which she tense her pelvic floor. she must allow herself to let go.

Labor and Birth (12 decks)

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