Uncomplicated Labor&Delivery

Question 1

What are the hormones involved in labor?

Answer 1

• Progesterone: suppress uterine activity (is withdrawal)
• Oxytocin: [Contractions, happy hormone] released from the pituitary gland
• Prostaglandins: produced by placenta, stimulates smooth muscles contractions (can cause uterine contractions at any point of the pregnancy)
• Estrogen Stimulations: (around 34-35 wks) estrogen aids as receptors for oxytocin

Question 2

What are the signs of approaching labor?

Answer 2

• Lightening
• Braxton-Hicks Contractions (irreg, painless, uterus tightening, can be resolved by movement and position change)
• Backache
• Blood show (mucousy d/c, cervix plug)
• SROM

Question 3

Types of Rupture of Membranes?

Answer 3

PROM: Premature ROM (breaks before contractions started)
SROM: Spontaneous ROM (breaks with contractions)
PPROM: Premature Preterm ROM (breaks without contractions before 37wks) RISK FOR INFECTION
AROM: Artificial ROM (DR breaks the water, makes stronger contractions)

Question 4

What are the parts of a true pelvis?

Answer 4

True Pelvis: Bony Canal
Inlet: [more inner] border of the pelvis
Outlet: [most outlet] border of the pelvis

Question 5

As the passenger, what factors can ensure safe delivery?

Answer 5

Molding: cranial bones overlapping
Need the smallest head diameter
- Bitemporal (8cm)
- Biparietal (9.25cm)
- Submentobregmatic, suboccipitobregmatic (9.5cm)

Question 6

As a part of passage, what are the shapes of pelvis?

Answer 6

• Gynecoid (more circular) - best
• Android (more heart shape)
• Anthropoid (Vertical oval shape)
• Platypelliod (more flatten heart shape)

Question 7

What is Lie?

Answer 7

The baby in relation to the spine
Longitudinal: Baby aligned with mother’s spine
Transverse: horizontal

Question 8

What is attitude?

Answer 8

The way the baby’s face is placed that contributes to head diameter
Flex: chin tucked in (best)
Military: face straight
Brows: Brows presentation
Face: Face presentation

Question 9

What is Presentation?

Answer 9

Which part is coming out first
Vertex/Cephalic: head first
Breech: Bum first
Shoulder: Back, shoulder, arms first

Question 10

What is position?

Answer 10

The way the baby is facing in relation to mother’s spine. The occiput is found at the back of baby’s head
Anterior Occiput: Baby facing mom’s spine
Posterior Occiput: Baby facing to the sky

ROA/LOA is ideal
ROP/LOP can still result in vaginal delivery, may require OVD

To auscultate for FHR, follow the side which occiput is. Ex: If LOA, then the back is facing the left side

Question 11

What is Station?

Answer 11

To indicate how far the baby is in the pelvis

The ischial point is station 0
Above ischial point is: Negative
Below Ischial point is: Positive

Question 12

What is difference between primary and secondary powers?

Answer 12

Primary: contractions
Secondary: mother’s ability to push

Question 13

What hormones are involved in primary power?

Answer 13

• Prostaglandins (helps dilate cervix)
• Progesterone withdrawal
• Estrogen
• Connective Tissue

Question 14

How to assess contractions?

Answer 14

• Frequency: how many in 10 mins
• Duration: how long is each contractions
• Intensity: mild, moderate, strong

Question 15

1st Stage of Labor: Early Phase

Answer 15

0-3cm Dilation, 0-40% effacement

Characterized as:
- Regular, mild contractions
- increase in intensity and frequency
- Dilation and effacement starts
- Psycho: Exciting, relief, some anxiety
- Send home and given medication

Nursing Care
- In hospital, FHR q4hrs (Auscultate)
- Teach/model/encourage support person
- Movement/walking, warm bath/shower
- Distraction: Slow breathing, focusing, counting, encourage relaxing b/w contractions

Question 16

1st Stage of Labor: Active Phase

Answer 16

4-7cm Dilation, 40-100% effacement

Characterized as:
- longer and stronger contractions
- Forming regular pattern
- Pain increases
- Psycho: fear, and increased anxiety

Nursing Care:
- FHR q15-30 mins (auscultation)
- Urination q2hrs
- Encourage fluid intake
- no questions during contractions
- Feedback in positive language
- Encourage movement

Question 17

1st Stage of Labor: Transition Phase

Answer 17

8-10cm Dilation/ 80-100% effacement

Characterized as:
- Stronger contractions
- Fetus descends
- Rectal pressure
- Urge
- N&V
- Shakiness
- Increased blood show/fecal matter
- Psycho: eager, irritable, increase need for support person

Nursing Care:
- FHR q15-30 mins
- Focus on 1 contractions at a time
- Reassurance
- Allow mother to relax/doze b/w contractions
- STAY!

Question 18

2nd Stage of Labor:

Answer 18

Characterized as:
- increase urge to push (sometimes uncontrollable)
- Perineum begins to bulge, flatten, and move anteriorly
- Minutes to several hours
- Crowning - head visible (reaching perineum, stretching, burning)
- Perineal stretching and burning

Pushing:
- ++ Support required
- Coach pushing, push down with contractions
- Rest b/w contractions
- Coach/support the support person
- FHR q contractions (auscultation)

Nursing Care:
- FHR auscultation
- Set up room, resus equipment, DR extra helper
- Reassurance

Question 19

3rd Stage of Labor:

Answer 19

Expelling the placenta
Oxytocin (IV or IM) used to help with contractions and help placenta to come off the uterine wall and be expelled

Indications of placental delivery: (usually 5-10mins, up to 30 mins)
- Lengthening of the umbilical cord
- Sudden gush of blood
- Change in uterine shape (globular and ascent in abdomen)

Nursing Care: (Right after placental delivery)
- Monitor q15mins x 4
- Fundus @ umbilical point
- Blood flow
- Bp, pulse
- Psycho: relief, concerns/bonding with newborn, may not recognize placental delivery

Question 20

4th Stage of Labor

Answer 20

Characterized as:
- 2-4hrs postpartum
- increased pulse, decreased BP
- Uterus: contracts, located b/w umbilicus and symphysis pubis
- Shakiness
- Distension Bladder (can l/t PPH)
- Naproxen and Tylenol to take home (SAM)
- Pyscho: excited, relief, anxious, tired, hungry, irritable, anything

Nursing Care:
- v/s q15mins for 1st hour
- v/s q1hr for the next 4 hours
- Baby v/s q1hr for 4 hours
- Encourage to move (coagulation process)
- Abd muscles: soft tone, slow intro back to exercise
- Heartburn: sphincter and stomach pressure increases
- Constipation: BM after 2-3 days