W4: Labor & Delivery Flashcards
when does labour begin?
between 37 - 42 weeks
What happens before labor begins?
increase braxton hick’s
cervicla ripening
increase excitability in uterine musculature
mechanical stretching of the uterus increases contractility
ferguson reflex: increase oxytocin receptors & level of oxytocin
Signs of Onser of labour
lightening/dropping
increase in vaginal d/c- bloody show
stronger braxton hick’s contraction
weight loss of 0.5-1.5kg
signs preceding labor
surge of energy (nesting)
flulike symptoms
cervical ripening
possible rupture of membrane
true labor signs
contractions: increase in intensity + duration, discomfort in back –> abdomen, closer together, don’t go away w/ walking
cervix: begins to efface & dilate
show: may/may nor dilate
false labor signs
contractions: do not increase in intensity, duration, frequency, discomfort in abdomen, may disappear with walking
cervix: none
show: none
5 Ps of Labor
Power (contractions)
Passageway (birth canal)
Passenger (fetus and placenta)
Position of mother
Psychological Response
Powe
primary powers: contraciton, effacement, dilation, ferguson reflex
secondary powers: bearing down efforts
Passenger: 3 Fetal Presentations
cephalic/vertex- head presenting part
breech: buttocks presenting prt
shoulder/transverse- shoulder as presenting part
Components of the Passenger
fetal presentation
fetal head size
fetal lie
fetal attitude
fetal position (station, engagement)
Ideal Fetal presentation
ROA- right occiput anterior (back of head)
LOA is okay as well
Fetal Lie
reltionship of long axis of fetus to long avis of mother
longitudinal - parallel
transverse- perpendicular
oblique - at an angle
Fetal Atittude
relationship of fetal head to its spine
complete flexion- chin of fetus flexed, touching sternum
moderate flexion- military (chin not touching chest, alert)
deflection, extenion- back arches & head extended
Fetal Station
relationship of presenting part to an imaginary line drawn between maternal ischial spines
(above) - 5 –> + 5 (below)
O = head at level of spine
Passageway
types of pelves:
- gynecoid
- android
-anthropoid
- platypelloid
soft tissue of cervix
pelvic floor
vagina
introitus
Positon
position affects woman’s adaptation to labor
changes in posiiton = relief of fatifue, more comfort, improves circulation
woman should find position most comfortable to her
gravity promotes descent of fetus
descibe all 4 stages of labor
1: onset of contractions to full dilation of cervix (latent & active)
2: full dilation of cervix - birth, pushing
3: birth of the fetus until delivery of the placenta
4: 2 hrs post delivery of placenta
describe the latent phase of the first stage of labor
onset of regular contractions, effacement, descent
3-4 cm dilation
describe the active stage of first stage of labor
rapid dilation of cervix, descent
4-10 cm dilation
Assessment of Uterine Contraction
by: palpation, external + internal monitoring
intensity:
- mild: indented with general pressure (nose)
- moderare firm pressure (chin)
- strong: no indentation (forehead)
frequency: # of contraction in 10min period over 10 mins
dulation: time between onsent and end of contraction
restinf tone: tension in uterine muscle btw contractions (relaxation?)
NC; 1st Stage
relaxation, distractions
breathing techniques
praise
inform
oral care (n/v)
inform partner that pt might act abnormally
2nd Stage
full dilation –> infant born
nulliparous pt: 3 hours w/o anesthesia, 4 hrs w/ anesthesia
multiparous: 2 hrs w/o anesthesia, 3 hrs w/ anesthesia
2nd Stage: Passive Phase
delayed pushing, laboring down, passive descent
0-2+
2nd Stage: Active Phase
active pushing, urge to bear down
ferguson reflex
4-5 contractions q10m, for 90s
fetal head +2-+4
rate fo descent increases
fetal head is crowning
crowning
widest part of the head distends the vulva
Changes in feta skull during birth
parital bones overlap
occipital bone go under pareital
= cone shape head
Cardinal Movements of the mechanisms of labor
engagement: head into pelvic inlet
descent: fetal head is forced downwards on the crvix
flexion: fetusflexes head so that the vertex is leading (chin-chest)
internal rotation: of fetal head (usually to OA)
extension: delivery of head (occiput, face, chin)
restitution & external rotation: realigns head w/ back & shoulders
NC: Passive Phase of 2nd Stage
comfort
prmote fetal descent (ambulation, position change, pelvic rock)
NC: Active Phase of 2nd Stage
change position & encourage bearing down
relac, conserve energy btw contractions
pain-relief + comfort
cleanse perineum (fecal matter)
coach pt to pant
push between contractions (gently)
keep informed
offer mirror to watch / feel top of head as they push
Assesment & Care of Newborn
APGAR score
immediate skin-skin (infant bonding, breastfeeding duration, cardiorespiratory stability, bodytemp)
delayed cord clamping (1-3 min after birth/ after it stops pulsating)
Why is delaeyd crod clamping recommended
improces hematologcla status
transfer of blood
Instructing partner to cut cord
approx 2.5 cm above the clamp
3rd Stage of Labor
placental seperation + expulsion (contracting fundus, change in uterus shape, gush of blood, lengthning of cord, vaginal fullness)
occurs 15 mins after the birth of the baby
when is placenta considered retained
if it has not come out by 30 mins
Expectant Mgt 3rd Stage
watching for signs for placental seperation
no oxytocic meds given
facilitated bt gravity or nipple stimulation
Active Management: 3rd Stage
oxytocic meds
decreases rate of PP hemorrhage d/t uterine atony
gentle cord traction following contractions
Examination of Placenta
ensure no portion remains in the uterine cavity
contains 15-20 lobes
vessels: 2 arteries, 1 vein
membrane should have no holes
4th Stage of Labor
begins with expulsion of placenta and lasts until pt is stable within the first 2 hours (time for parent-infant bonding)
vital signs frequency @ 4th stage
q15mins fro 1st hour
stable: q2hrs
Uterine Assesment after birth
firm w/ uterus located midline
- if not firm, massage to contract
observe perniuem for size & amt of + size of clots
expel clots while keeping hands placed over uterus (downwards pressure)
tell pt to take deep breaths throughout
Bladder Assessment after birth
distension (firmness of fundus)
- rounded bulge, dull to percussion, fluctuated like water balloon
distended bladder: boggy uterus, above umbilicus, deviated to R side
asess pt to void + measure amt (catheter if needed)
reassess after voiding/catheter to make sure bladder is not palpable, fundus is midline & firm
Pain threhold vs tolerance
threshold is the same in everyone
tolerance differs
Factors influencing pain response
physiological
culture
anxiety + fear
previous experience
gate control theory
environment
trauma
childbirth prep
expressions of pain
anxiety
writhing
crying
groaning
gesturing
excessive muscular excitability
Non-Pharmacological Pain Mgt
relaxation
imagery + visualization
music
touch + massage
breathing techniques
effleurage & counterpressure
hydrotherapy (water bath)
TENS
heat/cold
hypnosis
biofeedback
aromatherapy
sterile water block
maternal position & movement
Epidural Induced Hypotension
f:
fetal bradycardia
absent/minimal FHR
impaired placental perfusion
ineffective breathing pattern
Interventions for Epidural Induced Hypotension
turn pt to lateral positon, place pillow under one hip (displace weight on aorta)
maintain IV fluid
O2 (8-10)- hypovolemia, hypoxia
IV vasopressor
baseline FHR
110-160BPM
Fetal tahcycardia
160+ bpm for longer than 10 mins
fetal bradycardia
baseline less than 110 bpm for 10 mins
VEAL CHOP acronym
V: variable deceleration = C: cord compression –> reposition pt
E: early deceleration = H: head compression –> fetus descent
A: accelerations = O: OK!
L: late deceleration = P: problem –> fetal resus, Oxygenation
