Process of Labor Flashcards
Theories of Onset Labor - Maternal Factors
Stretching of uterine muscles
Estrogen/Progesterone changes
Oxytocin (“Love” hormone)
Release of prostaglandins
Theories of Onset Labor - Fetal Factors
- Fetal cortisol changes
• Shunts blood away from the uterus causing the uterus to contract and become irritable
• Increases RR & HR - Placenta ages
- Prostaglandins increase causing contractions
Signs of Impending Labor
Lightening Increased Vaginal D/C Increased Energy GI Symptoms (Diarrhea) Cervical Change ROM Lower Back Pain Weight loss Uterine Contractions
True Labor
- Contractions bring about changes in cervical effacement and dilation
- Regular contractions increase in frequency and intensity
- Continues despite comfort measures
- Cervix: moves to anterior position; bloody show
False Labor
- Irregular contractions with little or no cervical changes
- Decrease in frequency, duration, and intensity with walking or position changes
- Hydration or sedation slows/stops contractions
Stages of Labor
First stage – 3 parts: Latent, Active, Transition Phase
Second stage – delivery of baby
Third stage – delivery of placenta
Fourth stage – recovery
Latent Phase
Primip = 9 – 19 hours Multip = 6 – 14 hours Cervix: •effacing •dilating from 0 cm to 4 cm Contractions: •Frequency: 5 – 15 minutes •Duration: 10 – 30 seconds •Intensity: mild/bearable Bloody show occurs with cervical change Membrane usually intact, but can rupture
Latent Phase Characteristics
Cramps, backache, talkative and eager
Latent Phase - Nursing Interventions
Assessment:
o VS q1-2 hrs
o Assess cervical changes by SVE
o Assess FHR and UC q30 minutes
o Ascertain presence of blood show and ROM
Encourage activity
o Helps in fetal placement and cervical change
Encourage controlled breathing
Distraction activities
Position changes (off patient’s back) and ambulation
Active Phase
Primip: 5 hours, Multip: 2 – 3 hours Cervix: • Effacing, • Dilating from 4 cm to 7 cm Contractions: • Frequency: 3–5 min • Duration: 30–45 sec • Intensity: mod/strong • More D/C or blood show ROM or still intact
Active Phase Characteristics
- rapid dilation and effacement
- some fetal descent
- feelings of hopelessness
- anxiety and restlessness increase as contractions grow stronger
Active Phase Interventions
Assessment: o VS q1-2 hrs o Assess cervical changes by SVE PRN o Assess FHR and UC q15-30 minutes o Ascertain presence of blood show and ROM Encourage controlled breathing Distraction activities (back rub) Position changes (off patient’s back) and ambulation
Transition Phase
Primip: average 4 hours Multip: average 1 hour Cervix: • Complete effacement • Dilation from 7 cm to 10 cm Contractions: • Frequency: 1–2 min • Duration: 40–60min • Intensity: strong • Heavy blood show ROM
Transition Phase Characteristics
- tired
- restlessness
- irritable
- feeling out of control “cannot continue”
- N/V
- urge to push
Transition phase Nursing Interventions
Assessment: o VS q1 hrs o Assess cervical changes and fetal position by SVE o Assess FHR and UC q15 minutes o Ascertain presence of blood show and ROM o Check bladder distention Encourage controlled breathing Reassurance Position changes (off patient’s back)
Second Stage of Labor
Begins with cervical dilation 10 cm and ends with delivery of the baby Primip: 1 – 2 hours Multip: > 1 hour Cervix: fully dilated and effaced Contractions: • Frequency: 1–2 min • Duration: 50–60 min • Intensity: less painful, expulsive • Heavy blood show ROM Station: Primip: +2 to +4; Multip: +2 to +4
Second Stage of Labor Characteristics
intra-abdominal pressure (bearing down)
urge to push
perineum bulges and flattens
perineal burning and stretching
Second Stage of Labor Interventions
Assessment:
o VS q1 hrs
o Assess position, station and progress by SVE
o Assess FHR after every contraction
o Assess pt’s readiness and urge to push
Encourage controlled breathing and rest between contractions
Reassurance
Support legs, chest, arms, and back
Position changes (off patient’s back): upright
Third Stage of Labor
Begins with the delivery of neonate and ends with delivery of placenta
Duration 1 – 20 minutes
Less painful
Characteristic: relieved
Third Stage of Labor Nursing Interventions
Maternal VS q15 minutes Assess for bleeding and complete placental detachment Encourage relaxation Fluid intake Assess condition of newborn at birth Apgar scoring 1 minute and 5 minutes Maintain fetal body heat (skin-to-skin) Baby I.D Reassurance, praise Explain after delivery procedures
Fourth Stage of Labor
First 2 – 4 hours after birth
Characteristics: post-partum chills, hunger, thirst, drowsy, moderate to heavy lochia, painless contraction
Fourth Stage of Labor Nursing Interventions
VS q15 minutes for the first hour then every 1 hour (for the next 2 – 4) then every 4 hours
Assessment of fundus and lochia q 15 min X 1 hour then q30 minutes
Repositioning for comfort
Diet and fluid as tolerated
Assessment of Fetus:
• VS q15 min X 1 hour then q30 min
• Keep on skin to skin contact for at a least one hour after birth
• Initiate breast feeding
• Give routine meds
• Maintain thermoregulation
• Initial head to toe assessment
Five “P”s of Labor
Power Passenger Passageway Position Pyschology
Power
- Primary – maternal pushing during the second stage of labor
- Secondary – contractions occur in the second stage of labor
- Blood supply to the cervix 800 – 1000mL/min
Passenger
Fetal descent through the birth canal is determined by: Size of fetal head Fetal lie Fetal attitude Fetal position Fetal presentation
Size of Fetal Head
If too big (macrosomia) then a vaginal birth will not happen
Molding of the fetal head will happen during a vaginal birth