Process Of Birth Flashcards
What are the 4 ps
- power
- passage
- passenger
- psyche
What are the 2 powers
- contraction
- maternal pushing
What is primary force
uterine muscular contractions
What is secondary force
abdominal muscles to push during the second stage of labor
What is Increment:
The rise of contraction, a tightening feeling
What is peak: how is it rated
Known as the ACME of contraction
- Mild
- Moderate
- Strong
What is decrement
The decrease or release of a contraction
Why is the relaxation/ resting phase important
to get oxygenated blood to fetus
What is Duration
length of contraction (measured in sec)
What is frequency
Beginning of one to beginning of another; how often are they occurring
The pelvis is made up of which 3 parts
- Inlet
- mid pelvis
- outlet
The size of the maternal pelvis (true pelvis) is measured how
Diameter of the pelvic:
- inlet
- mid pelvis
- outlet
Favorable types of pelvis shape:
- Gynecoid
- Anthropoid
What is considered as the passenger
- fetus
- placenta
What is fetal lie?
What are the 2 types
- Relationship of the fetal spine to the maternal spine
— refers to the relationship of the cephalocaudal axis (spinal column) of the fetus to the cephalocaudal axis of the woman - longitudinal
- Transverse
Which type of fetal lie is favorable
Longitudinal
- (the occipital is presenting and the body is flexed
What is fetal attitude
The relation of fetal parts to the fetus
- Flexion or extension of the fetal body and extremities
What is the preferred fetal attitude?
We prefer the fetus to be flexed
- The head and neck is flexed forward with the chin almost resting on the chest
- the arms and legs are flexed
What is fetal presentation
The body part of the fetus entering the pelvis in a single or multiple pregnancy
- this is known as the presenting part
How is fetal presentation determined?
Fetal lie & the presenting part
Which presentation is most common and favorable?
Vertex presentation/ complete flexion
- (neck is flexed)
- or Frank breech
What is a breech
Anytime the presenting part isn’t the head
Types of breach
- Complete (full)
- Frank breech
- footling breech- single/ double
- shoulder presentation
What is a complete breech (full)
- The fetal knees and hips are both flexed, the thighs are on the abdomen, and the calves are on the posterior aspect of the thighs.
- It is the reversal of the usual cephalic presentation (head down)
- The buttocks and feet of the fetus present to the maternal pelvis
What is a frank breech?
- The fetal hips are flexed, and the knees are extended.
- The fetal legs are extended across the abdomen toward the shoulders.
- The buttocks of the fetus presents to the maternal pelvis.
What is a footling breech?
- Fetal hips and legs are extended
- The feet of the fetus present to the maternal pelvis
- In a single footling, 1 foot presents; and a double footling both feet present
What is a shoulder presentation?
- Shoulder presentation is also called a transverse lie
- Most frequently, the shoulder is the presenting part, and the acromion process of the scapula
- Maybe due to relaxed abdominal wall due to grand multiparity
What is fetal position?
- refers to the relationship of the landmark on the presenting fetal part to the front (anterior), back (posterior), or sides, (right or left) of the maternal pelvis.
- The landmark on the fetal presenting part is related to for imaginary quadrants of the maternal pelvis: left/right x anterior/posterior
— These designate whether the presenting part is directed toward the front back left or right of the maternal pelvis - These positions influence both the labor and the birth of the baby
What are the three notations of fetal position?
- right or left side
- The landmark of the fetal presenting part
- Landmark direction (of fetal presenting part) in relationship to maternal pelvis
What are the landmarks of the fetal presenting parts?
- Occiput (O)= back of head
- Mentum (M) chin (in a pic, it looks like the face)
- Sacrum (S)= sacrum/ buttocks
- Acromion process (A)= shoulder (seen in transverse lie)
What are the landmark DIRECTIONS in relation to pelvis?
- Anterior (A) front= you can see it
- Posterior (P) back= cant see it/ faces away
- Transverse (T) side of pelvis= side
What are the most common and most preferred fetal positions
ROA
LOA
Why is it important to know the fetal position?
- Because it tells us what kind of delivery it will be
- Documentation
- Placement of fetal heart monitors
What is Psyche?
Psychological response, based on anxiety, culture, experiences, and support
- This is critical because marked anxiety, fear, or fatigue decrease a woman’s ability to cope with pain in labor.
- Maternal Catecholamines secreted in response to anxiety or fear, inhibit, uterine in contractability and placenta blood flow
- Relaxation, however, increases the natural process of labor
What is engagement?
- as the fetal head moves through the birth canal once they get to a certain position in the pelvis the head gets stuck, and the head is engaged. (This position is in the pelvic inlet.)
- engagement of the presenting part occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet
Engaged is when:
the biparietal diameter (BPD) of the fetal head is in the inlet or the occupit is at the level of the ischial spines.(* or at 0)
When does engagement often occur in nulliparous patients?
Before the onset of labor
- labor comes 2 weeks later
What happens when the fetus begins to engage into the pelvic inlet and cause symptoms?
What are those symptoms?
When do they occur?
What is this known as?
Lightning:
- Leg cramps/ pains
- Increase pelvic pressure
- Increased venous stasis= causing edema in lower extremities
- Increased urinary frequency- bladder is pushed on/ can’t expand as much
- Increased vaginal secretions
- Mother may begin feeling these symptoms 7-10 days before she is ready to deliver
- This is also known as the baby “dropping”
- Early sign of labor
What is station?
- refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis
In a normal pelvis, what marks the narrowest diameter through which the fetus must pass
Ischial spines
If the presenting part is higher than the ischial spines, what kind of number is assigned
A negative number
- noting centimeters above 0 station
Where is -5 station
At the inlet
Where is 0 station
Ischial spine
- engagement
Where is +4 station
At the outlet
At what station will you see the fetal head
What is this called?
Station +5
Crowning
During Fetal stations above 0 station, the fetus is described as being what?
Ballotable
What is Ballottable
- the presenting part is said to be floating when it is freely movable above the inlet. Not yet engaged.
- Before the head is engaged, you can push the head, and the baby will float up and down
What is dipping
- when the presenting part begins to descend into the inlet, before engagement has truly occurred, it is said to be dipping into the pelvis
In regards to documentation, how do you read:
+3/9/90%
- +3: station
- 9: cm dilation
- 90%: effacement
Mom pushes at_____ dialation/effacement/ station
- 10 cm dilation
- 100% effaced
- Station: +5
How is dilation measured
In cm
- 1 cm = 1 finger tip
What is effacement?
Thinning of the cervix
- The cervix changes progressively from a long, thick structure to a structure that is tissue paper thin
What causes cervical dialation
- effacement &
- the hydrostatic pressure of the fetal membranes
- at the beginning of labor, there’s no cervical effacement or dilation
- beginning cervical effacement. As the cervix begins to efface, more amniotic fluid, collects below the fetal head
What starts labor?
- We don’t know what starts labor. We think withdrawal of progesterone, build up of prostaglandin, or corticotropin releasing hormone therapy
Imminent signs of labor:
- Braxton Hicks contractions
- Cervical changes
- Bloody show
- Rupture of membranes (ROM)
- Sudden burst of energy
Others: - Weight loss
- pain
- N/V/D, indigestion
What are Braxton Hicks contractions?
Contractions that:
- are random, irregular, & intermittent
- not progressively getting stronger
- may go away if she lays down and rests
- may become regular, only to decrease spontaneously
- may become uncomfortable prior to onset of labor
What cervical changes are signs of labor
Ripening: The softening of the cervix.
- Happens naturally with progesterone.
- Can give meds directly onto the cervix to help
- At the beginning of pregnancy, the cervix is rigid and firm, and it must soften so that it can stretch in dilate to allow fetal passage
What is a bloody show?
What is a mucus plug/ purpose?
- During the pregnancy, cervical secretions have accumulated in the cervical canal to form a mucus plug
- Mucous plug: protects the moms uterus from infection
- About 24-48 hours before birth: Softening of the cervix allows the plug to be expelled, small amounts of blood loss from the exposed cervical capillaries.
- Pink tinged in color/ spotting amount
What is Rupture of membranes (ROM):
Rupture of the amniotic membrane
- 24-48 hrs before birth
- spontaneous Labor can occur 24 hrs after rupture
- If membranes rupture and labor does not begin spontaneously within 12 to 24 hours, labor may be induced
- If engagement has not occurred, the danger exist that the umbilical cord may be expelled with the fluid (prolapsed cord)
What is the sudden burst of energy?
Why?
What do they do?
- Some women report, a sudden burst of energy approximately 24-48 hours before labor. (Can happen 1-2 weeks long prior)
- Begin to nest.
- Due to the increase of epinephrine caused by decreasing in progesterone production by the placenta
How much weight loss is a sign of labor
- Weight loss of, 2.2 - 6.6 kg (1-3 lbs) resulting from fluid loss and electrolyte shifts produced by changes in estrogen and progesterone levels
What kind of pain is a sign of labor
Increased backache, and Sacroiliac pressure from the influence of relaxin hormone on the pelvic joints
What is true labor
- shows a consistent pattern of increasing frequency, duration and intensity of labor.
Contractions are:
- regular
- increase in frequency, duration and intensity
- Increase with walking
- Discomfort begins in the back and radiate around to abdomen
- cervical dilation and effacement progressive
cervical dilation and effacement progressive can only be seen how?
with a vaginal exam
What is False labor?
Contractions are:
- irregular
- Usually no change in frequency, Duration, or intensity
- Discomfort is usually in abdomen
- Walking has no effect on or lessens contraction
- *No change in cervical dilation or effacement
What are the stages of labor?
- 1: cervical ripening
- 2: fetal expulsion
- 3: placental expulsion
- 4: maternal homeostatic stabilization
When does the 1st stage of labor begin?
onset of regular (true labor) contractions
When does the 1st stage of labor end?
with complete cervix dilation at 10cm and is 100% effaced.
How many phases is the 1st stage of labor divided into?
What are they?
It has three phases: Latent/ active/ transitional
If epidural is used, the total duration of the 1st stage of labor maybe increased by how long?
1 hour
S/S of 1st stage of labor?
- Hyperventilation; as the woman increases her breathing rate- causes mild respiratory acidosis
- Restlessness
- Difficulty understanding directions
- A sense of bewilderment and anger at the contractions
- Statements that she “can’t take it anymore”
- Requests for medication
- Hiccuping, belching, nausea, or vomiting
- Increasing rectal pressure
- Very strong contractions
- Urge to push down during contractions as the fetal presenting part reaches her pelvic floor?
- Leg tremors
- N/V common
- Women often lose control
— This may be very confusing to the partner
Who has quicker labor/ deliveries?
Nulliparous or multiparous?
Multiparous (MP)
Latent phase of 1st stage of labor
- Cervical Dilation
- Contraction Frequency/ Duration/ intensity
- Cervical Dilation: 0-3 cm
Contraction:
- Frequency: Q 10-30 min
- Duration: 30-40 secs
- Intensity: mild to moderate
Active phase of 1st stage of labor
- Cervical Dilation
- Contraction Frequency/ Duration/ intensity
- Cervical Dilation: 4-7 cm
Contraction:
- Frequency: Q 2-3 min
- Duration: 40-60 seconds
- Intensity: moderate to strong
Transition phase of 1st stage of labor
- Cervical Dilation
- Contraction Frequency/ Duration/ intensity
- Cervical Dilation: 8-10 cm
Contraction:
- Frequency: Q 1.5 - 2 min
- Duration: 60- 90 secs
- Intensity: strong
In what stage of labor do contractions begin to hurt
1st stage: Active Phase
In which stage of labor does internal rotation begin?
1st stage: Active phase
When is an epidural no longer an available option
After 7 cm dilation
When does cervical dilation show
As it progresses from 8-10 cm
Diet of laboring mother
We only give laboring mom’s ice chips and keep them NPO just in case they need a C-section
Most intense stage of labor
1st stage: transitional phase
(Intense pain)
When does the 2nd stage of labor start?
complete cervical dilation (10cm)
- crowning occurs in the beginning of the second stage (+5 station)
When does the 2nd stage of labor end?
Delivery of fetus
Use of epidural anesthesia may extend the duration of the 2nd stage by how long?
additional 1 hour
S/S of second stage of labor?
- taxed cardiovascular, increased BP just before contraction
- protruding anus
- stretched perineium
- sweating, low fluid and Na
- increasing hyperventilation
- G.I. motility reduced
- Increased WBC
- As the head distends the vulva with each contraction, the perineum becomes extremely thin, and thus the anus stretches and pertrudes
- Cardiovascular system is taxed by the uterine contractions, pain, and anxiety.
- Each contraction greatly decreases or completely stops the blood flow in the branches of the uterine artery that supply the placenta
- About 300-500 ml of blood is re-distributed into the peripheral circulation, increasing systolic and diastolic BP, and decreasing pulse rate.
- This all leads to elevated cardiac output until about 24 hours after birth
- BP is also increased during pushing, and just before a contraction. And returns to baseline when contraction ends.
- BP may drop when in supine position due to aortocaval pressure
- Fluid and electrolyte imbalance, due to diaphoresis during labor- loss of water and Na
- Increasing Hyperventilation= too much O2 retention/ too much CO2 expulsion
— Returns to normal in fourth stage when breathing patterns slow down and is corrected by 24 hours - G.I. motility reduced
- Increased WBC during labor, primarily increase in neutrophils in response to stress
When does the 3rd stage of labor start?
Immediately after fetus is born
When does the 3rd stage of labor end?
delivery of placenta
When is a placenta considered retained?
if 30 minutes have elapsed since the birth of the baby w/o delivery of placenta
- We surgically remove it, if it hasn’t come out in 30 minutes because it will cause hemorrhage and infection
- fragments cause release of some hormone that makes the body think its pregnant
- thus the uterus wont contract/shrink= causing more bleeding
- body wont start breastfeeding bc it thinks its pregnant still
- pieces can become ischemic and rot leading to infection
When does placental separation usually occur?
5 mins after delivery
- After the infant is born the uterus contracts firmly, diminishing its capacity and the surface area of the placental attachment
Placental separation is indicated by what
- lengthening of the umbilical cord
- a small spurt of blood
- change in uterine shape
- a rise of the fundus in the abdomen.
. - When the signs of placental separation appears, the woman may bear down to aid in placental expulsion.
pulling on the umbilical cord causes what?
- hemorrhage
- Inverted uterus
- may leave placental fragments
When does the 4th stage of labor begin?
after delivery of placenta and continues for 1-4 hours after delivery
What happens during the 4th stage of labor?
- physiologic readjustment of the mother’s body begins
- Maternal systemic responses to labor involve the cardiovascular, respiratory, renal, gastrointestinal, and immune systems
- The uterus effectively contracts to control bleeding at the placental site
Normal blood loss during vaginal delivery?
Up to 500 mL
Normal blood loss during C-section delivery?
Up to 1L
The return of blood back to the maternal venous beds causes what?
- Moderate drop in both systolic and diastolic BP
- increased pulse pressure
- moderate tachycardia
Why do women feel a chill after birth?
- Mothers usually experience a chill which can last 20 min- major cardiovascular shift due to loss of weight in fluid
- Offer heated blanket
What is involution?
The shrinkage of an organ in old age or went in active
E.g the uterus after childbirth
Why is pain normal after birth?
- After birth pain is normal- uterus is contracting a lot (involution)
- Especially with breast feeding, nipple stimulation causes release of oxytocin, causing more contractions
What is the Golden hour
- 1st hour after birth): baby is most alert, good for skin to skin, bonding, first breast feeding
