UNIT 3 LABOR AND DELIVERY CHAPTER 13 PART 1

Question 1

What are the 5 factors affecting birth

Answer 1

Passenger (fetus)
Passageway (birth canal)
Powers (contractions)
Position of the Mother
Psychological response

Question 2

The nurse is caring for a client in labor. Which as- sessment findings indicate to the nurse that the cli- ent is beginning the second stage of labor? Select all that apply.
1. The contractions are regular.
2. The membranes have ruptured.
3. The cervix is dilated completely.
4. The client begins to expel clear vaginal uid.
5. The Ferguson reex is initiated from perineal
pressure.

Answer 2

1. Answer: 3, 5
   Rationale: The second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. The client has a strong urge to push in stage 2 when the Ferguson reflex is activated. Options 1, 2, and 4 are not specific assess- ment findings of the second stage of labor and occur in stage 1.

Question 3

What can affect labor and delivery times?

Answer 3

1. Epidural/Augmentation
   2.Maternal or infant size
   3.Maternal age
   4.Gravida status
   5.Elective induction
   6.Persistent postierior
2. Victim of sexual assault
   8.Maternal Movement and position
   9.Maternal Hydration

Question 4

The nurse in the labor room is caring for a client in the active stage of the rst phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action?
1. Administer oxygen via face mask.
2. Place the client in a supine position.
3. Increase the rate of the oxytocin intravenous in-
fusion.
4. Document the findings and continue to monitor
the fetal patterns.

Answer 4

1. Administer oxygen via face mask.

Rationale: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions.

An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from the stimulation of contractions by this medication.

Question 5

The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. Which assessment nding indicates the need to contact the primary health care provider (PHCP)?
1. Hemoglobin of 11 g/dL (110 mmol/L)
2. Fetal heart rate of 180 beats per minute
3. Maternal pulse rate of 85 beats per minute
4. Whitebloodcellcountof12,000/mm3(12×109/L)

Answer 5

2. Fetal heart rate of 180 beats per minute

A normal fetal heart rate is 110 to 160 beats per minute. A fetal heart rate of 180 beats per minute could indi- cate fetal distress and would warrant immediate notification of the PHCP.

Question 6

The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. Which assessment finding indicates the need to contact the primary health care provider (PHCP)?
1. Hemoglobin of 11 g/dL (110 mmol/L)
2. Fetal heart rate of 180 beats per minute
3. Maternal pulse rate of 85 beats per minute
4. Whitebloodcellcountof12,000/mm3(12×109/L)

Answer 6

2. Fetal heart rate of 180 beats per minute

A normal fetal heart rate is 110 to 160 beats per minute. A fetal heart rate of 180 beats per minute could indi- cate fetal distress and would warrant immediate notification of the PHCP.

Question 7

A client arrives at a birthing center in active labor. After examination, it is determined that the client’s membranes are still intact and the client is at a −2 station. The primary health care provider prepares to perform an amniotomy. What will the nurse relay
to the client as the most likely outcomes of the am- niotomy? Select all that apply.

1. Less pressure on the cervix
2. Decreased number of contractions
3. Increased eficiency of contractions
4. The need for increased maternal blood pressure
   monitoring
5. The need for frequent fetal heart rate monitor-
   ing to detect the presence of a prolapsed cord

Answer 7

3. Increased eficiency of contractions
4. The need for frequent fetal heart rate monitor-
   ing to detect the presence of a prolapsed cord

amniotomy
- Articial rupture of the membranes is per-
formed by the obstetrician or nurse-midwife to
stimulate labor.
-Amniotomy is performed if the fetus is at 0 ora
plus station.
-. Amniotomy increases the risk of prolapsed cord
and infection.
-. Monitor FHR before and after amniotomy.
-. Recordtimeofamniotomy,FHR,andcharacter-
istics of the uid.

Question 8

What is the priority action when a HCP is prematurely rupturing the Amniotic sac

Answer 8

PRIORITY nursing
intervention is to assess
fetal heart rate!

monitor amniotic fluid

-Meconium-stained amniotic uid may be asso-
ciated with fetal distress.
-Bloody amniotic uid may indicate abruptio
placentae or fetal trauma
-An unpleasant odor to amniotic uid is associ- ated with infection.

Question 9

What color should amniotic fluid be?

A. Clear
B. Brown
C. Port wine stained
D. Yellow

Answer 9

A. Clear

Question 10

What does the Passager deal with?

A. Mom
B. Fetus

Answer 10

B. Fetus

The way the passenger—or fetus—moves through the birth canal is determined by several interacting factors: the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position.

Question 11

What is fetal presentation?

Answer 11

the part of the body of the fetus that is engaged first with the pelvic passagway

Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. The three main presentations are cephalic presentation (head first), occurring in approximately 97% of births (Fig. 13.2); breech presentation (but- tocks, feet, or both first), occurring in approximately 3% of births (Fig. 13.3A–C); and shoulder presentation, seen in fewer than 1% of births (see Fig. 13.3D)

Question 12

What is fetal attitude?

Answer 12

head or general flexion of baby’s head

Vertex- chin chucked to chest(preferred)

Sinciput - head at a 90 degree angle

Brow presentation- head with brow presenting

Question 13

What is fetal position? What is the recommended position of the fetus for a vaginal birth?

Answer 13

LOA
Left occiput anterior

Question 14

Which of the following stations indicate that the baby head is engaged foe a vaginal birth?

A. -5
B. -3
C. 1
D. 0

Answer 14

D. 0

Engagement is the term used to indicate that the largest transverse diameter of the presenting part (usually the biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0. It often occurs in the weeks just before labor begins in nulliparas and may occur before or during labor in multiparas. Engagement can be determined by abdominal or vagi- nal examination.

Question 15

Which of the following fetus presentation is most preferred when a vaginal birth is present. Which also represents 97% of births?

A. Breech Presentation
B. Cepahlic Presentation
C. Shoulder presentation

Answer 15

B. Cepahlic Presentation

Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. The three main presentations are cephalic presentation (head first), occurring in approximately 97% of births

Question 16

What is a presenting part?

Answer 16

The presenting part is that part of the fetus that lies closest to the internal os of the cervix. It is the part of the fetal body first felt by the examining finger during a vaginal examination. In a cephalic presentation, the presenting part is usually the occiput; in a breech presentation it is the sacrum; in the shoulder presentation it is the scapula. When the presenting part is the occiput, the presentation is noted as vertex (see Fig. 13.2). Factors that determine the presenting part include fetal lie, fetal attitude, and extension or flexion of the fetal head.

Question 17

What would be the presenting part when the fetus is in a breach presentation?

Answer 17

SACRUM-buttocks or feet

Question 18

What would be the presenting part when the fetus is in a shoulder presentation?

Answer 18

SCACUPLA-shoulder

Question 19

What would be the presenting part when the fetus is in a cephalic presentation?

Answer 19

OCCIPUT- head

Question 20

What is fetal lie?

Answer 20

Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother.

Types

Vertical/ longitude
Transverse/horizontal
Oblique

Question 21

Is there a difference between longitudinal vs vertical lie

A. Yes
B. No

Answer 21

B. No

The two primary lies are longitudinal—or vertical—in which the long axis of the fetus is parallel with the long axis of the mother

Question 22

Can vaginal births occur with horizontal or transverse lies?
A. Yes
B. No

Answer 22

B. No

. Vaginal birth cannot occur when the fetus stays in a transverse lie. An oblique lie, one in which the long axis of the fetus is lying at an angle to the long axis of the mother, is less common and usually converts to a longitudinal or transverse lie during labor

Question 23

What does the passageway (birth canal) consist of?

Answer 23

• Bony pelvis
• Cervix
• Pelvic floor muscles
• Vagina
• Introitus (external opening to vagina)
• Adjacent soft tissues

The passageway, or birth canal, is composed of the mother’s rigid bony pelvis and the soft tissues of the cervix, the pelvic floor, the vagina, and the introitus (the external opening to the vagina). Although the soft tissues, particularly the muscular layers of the pelvic floor, contribute to vaginal birth of the fetus, the maternal pelvis plays a far greater role in the labor process because the fetus must successfully accommodate itself to this relatively rigid passageway. The size and shape of the pelvis can be determined at the initial prenatal visit or on admission in labor. This information can then be used in the assessment of labor progress

Question 24

When can the size and shape of a mothers pelvis be determined?

A. First prenatal visit
B. during 34-36 weeks
C. During labor
D. at 24 weeks

Answer 24

A. First prenatal visit

The size and shape of the pelvis can be determined at the initial prenatal visit or on admission in labor. This information can then be used in the assessment of labor progress

Question 25

What does Powers consist of?

Answer 25

Involuntary and voluntary powers combine to expel the fetus and placenta from the uterus. Involuntary uterine contractions, called the primary powers, signal the beginning of labor. Once the cervix has di- lated, voluntary bearing-down efforts by the woman, called the second- ary powers, augment the force of the involuntary contractions.\

Primary Powers - involuntary
Secondary Powers- Voluntary
External Powers- gravity, medical interventions

Question 26

Which of the following pelvic shape is most preferred for a vaginal birth?

A. Gynecoid
B. Anthropoid
C.Android
D. Platypelloid

Answer 26

A. Gynecoid

1. Gynecoid(theclassicfemaletype) 50%
2. Android(resemblingthemalepelvis)
   3.Anthropoid(ovalshaped,withawideranteroposteriordiameter)
3. Platypelloid(theflatpelvis)

Question 27

Primary Powers

Answer 27

-effacement- thinning and shorting of cervix’

-dilation- opening of the cervixDilation of the cervix is the enlargement or widening of the cervi- cal opening and the cervical canal that normally occurs once labor has begun. The diameter of the cervix increases from less than 1 cm to full dilation (approximately 10 cm) to allow birth of a term fetus.

-Ferguson reflex- When the presenting part of the fetus reaches the perineal floor, mechanical stretching of the cervix occurs. Stretch receptors in the posterior vagina cause release of endogenous oxytocin that trig- gers the maternal urge to bear down, or the Ferguson reflex.

Question 28

Secondary Powers

Answer 28

-bearing down efforts - pushing

She uses secondary powers (bearing- down efforts) to aid in expulsion of the fetus as she contracts her dia- phragm and abdominal muscles and pushes. These bearing-down efforts result in increased intraabdominal pressure that compresses the uterus on all sides and adds to the power of the expulsive forces.

The secondary powers have no effect on cervical dilation, but they are of considerable importance in the expulsion of the infant from the uterus and vagina after the cervix is fully dilated.

Question 29

Positioning of labor Woman

Answer 29

Position affects anatomic &
physiologic adaptations to labor

Frequent changes in position
*Relieve fatigue of labor
* Increase comfort of labor
* Improve circulation of labor

Encouraged to find most
comfortable positions

Question 30

Process of Labor

Answer 30

Labor: process of moving fetus, placenta,
membranes out of uterus through birth
canal
* Mechanisms of Labor: process & stages
mother moves through
* Maternal changes start days to weeks
before labor onset
* Lightening (fetus dropping into pelvis)
* Bloody show (pink or blood streaked mucous)

• Onset of labor
• No single cause initiates labor: changes in
  uterus, cervix, pituitary gland

Question 31

How many stages of Labor are there?

Answer 31

4

First stage
-The first stage of labor is considered to last from the onset of regu- lar uterine contractions to full dilation of the cervix.

Second stage
-The second stage of labor lasts from the time the cervix is fully dilated to the birth of the infant. It is composed of two phases: the latent (pas- sive fetal descent) phase and the active pushing phase. During the latent phase, the fetus continues to descend passively through the birth canal and rotate to an anterior position as a result of ongoing uterine contrac- tions. The urge to bear down during this phase is not strong, and some women do not experience it at all. During the active pushing phase, the woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor.

Third stage
-The third stage of labor lasts from the birth of the infant until the placenta is delivered. The placenta normally separates from the uterine wall with the third or fourth strong uterine contraction after the infant has been born. After it has separated, the placenta can be expelled with the next uterine contraction.

Fourth stage
-The fourth stage of labor begins with the delivery of the placenta and lasts until the woman’s condition is considered stable in the immediate postpartum period, usually within 1 hour after giving birth (Simpson & O’Brien-Abel, 2021). During this stage, the woman begins to recover physically from birth, so it is an important time to observe for compli- cations, such as abnormal bleeding (see Chapter 21).

Question 32

What are the seven cardinal movements of labor?

Answer 32

A. Engagement &
Descent
B. Flexion
C. Internal rotation
D. Extension
E. Restitution &
external rotation
F. Expulsion (birth)
Mechanisms of labor Seven cardinal
movements of labor:
vertex presentation

Question 33

Maternal changes during labor?

Answer 33

• Cardiacoutputincreases12%–31%in the first stage and even more during the second stage.
• Heart rate increases slightly in first and second stages.
• Blood pressure (both systolic and diastolic) increases during contractions and returns to baseline levels between contractions. Systolic values increase more than diastolic values.
• White blood cell(WBC)count increases.
• Respiratory rate increases.
• Temperature may be slightly elevated.
• Proteinuria mayoccur.
• Gastric motility and absorption of solid food are decreased; nausea and vomiting may occur during transition to second stage labor.
• Blood glucose level decreases.

Question 34

Is this a normal finding for women during labor?

” WBC 15,000”

A. Yes
B. No

Answer 34

A. Yes

during labor

• White blood cell (WBC)count increases.

Question 35

Would you recommend your patient in labor to do the valsa maneuver method during the second stage of labor?

A. No
B. Yes

Answer 35

A. No

The woman should be discouraged from using the Valsalva maneuver (holding one’s breath and tightening abdominal muscles) for pushing during the second stage. This activity increases intrathoracic pressure, reduces venous return, and increases venous pressure. Cardiac output and blood pressure increase, and the pulse slows temporarily. During the Valsalva maneuver, fetal hypoxia may occur. The process is reversed when the woman takes a breath.