Quiz #5 Labour & the Birthing Process, Postpartum, and Newborn Flashcards
give examples of false (prodromal) labour
• Contractions do not increase in frequency, duration, or intensity/strength
• Cervix does not dilate or efface
-Contraction pattern decreases with change of position
give examples of true labour?
• Contractions become rhythmic and regular (Q4-10min)
• Increase in frequency, duration, and intensity/strength
• Contraction pattern does not change in activity or position change
• Associated with increase in vaginal discharge or show (bright blood)
-Cervix begins to dilate (opening) and or efface (thinning)
what is the nurses role for mothers in labour?
• Assess onset and pattern of contraction
• Assess contraction frequency, duration, strength/intensity
• Provide info related to maternal self-care (nutrition and fluid intake)
-Provide reassurance
what is composed of the nurses assessment of labour?
Abdominal Palpation to determine:
• Lie (what is the position of fetus’ spine in relation to mothers spine- longitudinal, oblique, breach)
• Position
• Level of engagement (where the head is)
• Presenting part (legs or sacrum)
• Presence of contractions
-Foetal well-being-heart rate, movement
what are the four P’s of labour?
- Power: strength, duration, frequency
- Passage: dimension
- Passenger: position, size, lie
- Psyche connects to all 3 P’s
describe the passenger
• Foetal head is largest diameter of the foetus
• Head can pass through the pelvic ring
• Foetal head moulds, changes shape, and adapts as moves through maternal pelvis
-Moulds in response to pelvic floor muscle and boney pelvis
list the ways the passenger can usually be laying?
- longitudinal lie
- occiput (bone)
- Posterior fontanel
- usually occiput is anterior facing (face down)
- left occiput anterior
describe the power
• As presenting part reaches pelvic floor, contractions changes in character- become more expulsive
• Women 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
describe the psyche
The psyche and the goal of health care providers: • Psychological outlook is preserved (try to keep happy and supportive for patient as they may want to give up) • Knowledge • Address fear • Support • Trust ○ Self ○ Care provider ○ Support persons • Beliefs, values, cultures
what are some psychosocial factors with labour?
- transgender FTM
- gender non-conforming
- LBGTQ2+
- Cultural factors
there are 4 stages of labour, describe the first stage
3 phases
• Latent or early- 0-3cm
• Active- 3-7cm
-Transition- 7-10cm
there are 4 stages of labour, describe the second stage
• Cervix fully dilated (10cm) • Crowning- head delivers by extension • External rotation • Restitution -Shoulders rotate externally
there are 4 stages of labour, describe the third stage
• Birth to delivery of placenta
• Placenta separates from uterine wall with contraction
• Gush of blood and lengthening of cord at entroitus
• Women pushes and placenta appears at vaginal opening
-Uterine contraction to firm uterus
there are 4 stages of labour, describe the fourth stage
• 1-4hrs post partum • Mom and babe stabilizing • Maternal Vital signs • Check uterus • Newborn temp, resp, HR • Vaginal blood loss monitored -Breastfeeding
what are maternal responses to labour for cardiovascular?
• CO increases
• Increase WBC
• Peripheral vascular changes
-Compression of vena cava may cause dizziness, anxiety and nausea
what are maternal responses to labour for respiratory?
• Increase in O2 consumption due to uterine activity
-Increase in respiratory rate
what are the maternal responses to labour for gastrointestinal?
• Gastric motility decreases; emptying time of stomach increases
-Clear fluids and light diet recommended**
what are the maternal responses to labour for genitourinary and renal?
Glomerular filtration rate increases: polyuria
what are physiological changes that occur?
Uterus begins to involute
• Process involves contraction of the uterus immediately following delivery of the placenta (living ligature)
• Placental site thromboses to prevent bleeding
Lochia (vaginal bleeding)
• 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
• Lochia rubra-serosa-alba
what is the postpartum maternal assessment?
B- Breasts: colostrum present, milk in day 3-4 U- Uterus: fundus B-Bladder B-Bowels L- Lochia L- Legs E-Episiotomy/perineum/incision E- Emotional status
describe the differences in each lochia?
Rubra- dark red, lasts 3-4 days, mainly made up of blood and bits of fetal membranes
Serosa- pinkish brown, lasts 4-10 days, contains less RBC’s and more WBC’s and contains wound discharge from placenta
Alba- whitish yellow, lasts 10-28 days, whitish fluid mainly consists of decidual cells, WBC’s
what is the first stage of transition to motherhood?
Taking in
-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 the second stage of the transition to motherhood?
Taking hold
- 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 the third and final stage of transitioning into motherhood?
Letting go
- 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
what are 3 main presentations of baby at birth?
- Cephalic presentation (head first)
- Breech presentation (legs or butt first)
- Shoulder presentation
what is presentation determined by?
-presentation is determined by what the examiner feels first up there on check-up
what are preconception risk factors?
- Maternal age
- Pre-existing medical conditions: diabetes, hypertension, cardiac disease, anemia, thyroid disorder, renal disease, obesity
- Genetic factors: family history
- Obstetrical history: gravidity, parity, number of living children and their ages, history of stillborn, previous infant with congenital anomalies, recurrent abortions, use of assisted-reproductive technology, interpregnancy spacing
what are prenatal risk factors?
• Prenatal care: when started
• Nutrition: weight gain, diet, obesity, eating disorders
• Health compromising behaviours: smoking, alcohol or substance use
• Blood group or Rh sensitization
• Medications: prescription, over-the-counter, and complimentary/alternative medications
-History of infection: STI’s, TORCH infections, group B streptococci status
what are intrapartum risk factors?
• Length of gestation: preterm, late preterm, term, or post term
• First stage of labour: length, electronic fetal monitoring-internal or external, rupture of membranes (time, presence of meconium), signs of fetal distress, labour complications (bleeding [placental abruption or placenta prevail]), maternal analgesia or anesthesia
• Group B streptococci status: treatment during labour
Second stage of labour: length, vaginal or c section, instrument assisted-forceps, vacuum extractor, complications (eg. Shoulder dystocia, cord prolapse)
what is APGAR scoring?
-enables rapid assessment of newborn’s transition to extrauterine existence on basis of five signs indicating physiological state. The higher the number (out of 10), the better the newborn
what is each sign of the APGAR test?
- Heart rate, based on auscultation or palpation of umbilical chord
- Respiratory rate based on observed movement or auscultation of respiratory efforts
- Muscle tone based on degree of flexion and movement of extremities
- Reflex irritability based on response to stimulation
- Generalized skin colour, described as pallid, cyanotic, or pink
how soon is the APGAR test done?
1 and 5 min after birth
when should you do another re-assessment of the APGAR test?
if score is less than 7 at 5 min, reassess Apgar 10-20 min
if baby is having trouble breathing, what position can baby lie in and why?
side lying position to clear secretions
what type of breathers are newborns?
Obligatory nose breathers
what four conditions are essential for maintaining adequate oxygen supply?
- A clear airway
- Effective establishment of respirations
- Adequate circulation, adequate perfusion, and
- effective cardiac function
Adequate thermoregulation (exposure to cold stress increases oxygen and glucose needs). Signs of potential complications related to abnormal newborn breathing are listed in box 26-3
what are signs of potential complicated breathing for newborns?
• Bradypnea- respirations less than 30BPM
• Tachypnea- respirations greater than 60BPM
• Abnormal breath sounds- crackles (fine crackles may be heard in first few hrs after birth)
• Respiratory distress- nasal flaring, retractions, gasping
-O2 sats less than 95%
what is Ophthalmia neonatorum?
inflammation of eyes from gonorrheal or chlamydial infection, contracted by newborn during passage through mother’s birth canal
when should a detailed physical exam be performed and what entails an exam?
12-18hrs after birth
- Perform all procedures that require quiet first (observing position, skin colour, tone, condition)
- Next auscultate the lungs, heart and abdomen
- Perform more disturbing procedures (temp., testing reflexes, last)
- Measure head circumference and length as a baseline for further comparison
what are the major adaptations associated with transition from intrauterine to extrauterine life?
- Lasts up to 30-60 min after birth and is called the first period of reactivity (this is where crackles may be heard through auscultation, high HR and RR until it levels out. Second period of reactivity occurs 2-8hrs after birth
- Newborn either sleeps or has decrease in motor activity called the period of decreased responsiveness that lasts from 60-100 min
- Second period of reactivity occurs roughly between 2 and 8hrs after birth and lasts from 10 min to several hours. Brief moments of tachypnea/tachycardia occur
what are the four ways babies can lose heat?
- Convection is the flow of heat from body surface to cooler ambient air (room @ 24deg. And cap to keep head warm)
- Radiation is the loss of heat from the body surface to a cooler solid surface not in direct contact but in relative proximity (this is done by placing cribs away from windows where there’s a draft)
- Evaporation s the loss off heat that occurs when a liquid is converted to a vapour (failing to dry newborn where moisture occurs)
- Conduction is the loss of heat from the body surface to cooler surfaces in direct contact (scales should have a cover to minimize conductive heat loss)
what is the term engrossment?
father and mother gazing at baby for prolonged periods of time
what is the en face position?
direct eye contact which is the beginning of attachment
what are standard vital signs for newborns?
BP- 70/45
Pulse- 110-160 and 90/140
Temperature- 37.5
Oxygen Sat- 95-100
what is the desired length of baby?
45-55cm
what is vernix caseosa?
the waxy or cheese-like white substance found coating the skin of newborn human babies
what is acrocyanosis and lanugo?
acro- bluish or purple colouring of the hands and feet caused by slow circulation.
lanugo- fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.
what is milia?
small, bump-like cysts found under the skin.
what is erythmia toxicum?
common rash
what is caput succedaneum?
edema of the scalp, resolves in a few days
what is a cephalohematoma?
collection of blood between periosteum and skull bone due to birth trauma and may take weeks to resolve. may be more prone to jaundice
what are craniotabes?
softening of the cranial bones in utero that takes several months to resolve. normal in newborns but not in older infants etc
