Week 1 Process of Labor Flashcards
What are some common s/s of respiratory alkalosis?
- Tingling of hands and feet
- Numbness
- Dizziness
What are the characteristics of active labor
- starts around 5-6cm dilation
- Accelerated rate of cervical change
- Descent and Internal rotation occur
- Ctx every 2-5 minutes
- Mother is anxious, helpless, focused
- Pain meds are usually given now
How can the psyche be kept healthy during pregnancy?
Prenatal education and support groups
What is a cephalic presentation?
head-first
What occurs during the first stage of labor?
- Cervical dilation
- Cervical effacement
- There are three phases
What are the 5 major aspects of the passenger?
HFAPP
- Head diameter
- Fetal lie
- Attitude
- Presentation
- Position
What is a normal leukocyte count for a woman who is pregnant in labor?
20-30k
What are two substances that stimulate contractions?
- Fetal prostaglandins
- Oxytocin
What are some factors that may have a role in starting labor?
Changes in the ratio of maternal estrogen to progesterone
What GI considerations should be made to the woman in labor
- Restricting intake during labor is not EBP
- The mother needs calories for the work of labor
Discomfort in false labor is ___
- Is felt in the abdomen and groin
* May be more annoying than truly painful
When is the “Passenger” considered engaged/When is engagement positive?
-The fetus is at zero station (head is at ischial spine)
Discomfort in true labor is ___
- May persist as back pain in some women
* Often resembles menstrual cramps during early labor
What are some comfort measures for the mother in her second stage of labor?
- Lighting
- Temp
- Cleanliness
- Oral care (dry mouth and lips)
How do cervical changes differ in a nullipara?
Effacement occurs earlier due to a thinner cervix
What role do catecholamines play in the fetal response to labor related to the CV and pulmonary systems?
- Epi and norepi are produced by the fetus during labor
- This stimulate cardiac contractions and Breathing
- Quicken the expulsion of lung fluid
- Help regulate temp.
What are the four common causes of postpartum discomfort?
- Lacerations
- Episiotomy
- Edema
- Hematoma
How can the mothers UI system be affected during labor?
-Reduced sensation of a full bladder(especially with an epidural)
What is laboring down?
- Active pushing
- Allowing the uterine contractions to cause most fetal internal rotation and descent after dilation
What is the role of fetal prostaglandin?
To prepare the uterus to receive oxytocin
What are the benefits of frequent positioning changes in the second stage of labor?
- Decreased pain
- Improved circulation
- Improved strength and effectiveness of contractions
- Decreased labor time
- Facilitates fetal descent
- Decreases perineal trauma and episiotomies
What are the characteristics of the fourth stage of labor?
-Firm contracted uterus
What are the four signs that indicate placental separation?
- Uterus is sperical shaped
- Uterus rises upwards as the placenta descends
- cord descends further from vagina
- Gush of blood after release of placenta
What does the increased fibrinogen create a risk for?
This risk is increased with the presence of a ___
How can this be prevented?
- DVT
- Epidural
- Change positions during labor
What are the 4 parts of the contraction cycle?
- Increment
- Acme
- Decrement
- Interval
What happens to mothers temperature directly after birth?
The become chilled
How do stress and anxiety diminish contractions?
elevated adrenaline levels cause uterine relaxation
During what portion of the contraction cycle should you palpate for relaxation?
interval period
True Labor is characterized by
Contractions
Discomfort
Cervical change
The cervix in true labor ____
• Includes progressive effacement and dilation (most important characteristic)
What is a IUPC?
Inter uterine pressure catheter
How is contractions frequency measured?
Beginning of one contraction to the beginning of the next
What is the ideal AP diameter of the fetal head at birth?
9.5 cm
What is the intensity of a contraction? How is it measured?
-The strength of the contraction
-The fundus is palpated
Chin = mild
Nose = moderate
Forehead = strong
In most cases, the fetal lie is ___ but can sometimes be ___
Longitudinal
Transverse
What is the normal appearance of lochia after birth?
- Rubra for 3-4 days
- Serosa
- Alba
What is the position of the passenger?
The location of a fixed reference point on the presenting part in relation to the 4 quads of the maternal pelvis.
What are the three phases of labor?
- Latent
- Active
- Transition
What falls under “Power” in the birth process?
- Uterine contractions
- Maternal Pushing
What is the acme portion of the contraction cycle?
Moment of highest intensity
What are the three possible presentations of the passenger?
- Cephalic
- Breech
- Shoulder
How much does blood volume increase during pregnancy?
30-60%
The most important difference between true labor and false labor is ____
Cervical changes
What are some signs of a PPH that can be felt on palpation?
-soft (boggy) and enlarging uterus
How are clotting factors changed during pregnancy?
-Fibrinogen increases during and after pregnancy
Describe the fetal head.
Comprised of 5 bones separated by sutures. The sutures are not solid and allow for the skull to be flexible when passing through the pelvic opening
What are the three possible presenting positions of the presenting part of the fetus
- Occiput (top of head first)
- Mentum (chin first)
- Sacrum (but first)
what is Uterine hypertonus?
A contraction lasting more than 2 minutes
What is aortocaval hypotension?
Low maternal blood pressure caused by the compression of the major blood vessels under the weight of the gravid uterus.
Happens when the pregnant woman lies on her back
Why is maintaining an empty bladder important during labor?
Because if the bladder is full it will act as a stopper and will obstruct the cervix
(inhibits fetal decent)
Describe the maternal response to labor as it relates to the CV system?
- During contractions, the maternal spiral arteries are constricted reducing blood flow to the fetus
- This increases the mother BP and decreased her pulse via the shunting of maternal blood back into her system
Where does the exchange of O2, nutrients, and wastes between the mother and the fetus occur?
in the intervillous space of the placenta
What is effacement?
Cervix becomes shorter and thinner
Fully thinned cervix is 100% effaced / complete
What are the characteristics of a 3rd degree laceration?
injury to perineum and the anal sphincter complex
What is the role of progesterone during pregnancy?
Promotes smooth muscle relaxation
What are some things that can interfere with the fourth stage uterine contraction?
A full bladder or a blood clot
What is lightening?
When the fetus begins to drop into its birthing position. The mother is able to breath better, has to pee more, has more edema and leg cramps. Occurs 2-3 weeks before natural birth -increased vaginal mucus secretions -cervical ripening and blood show -energy spurts -Weight loss
During which portion of the contraction cycle should intensity be measured?
Acme
Why is it important that the uterus contracts after the release of the placenta?
Because it allows the now separated spiral arteries to close. If this does not occur, than PPH is likely
What are the characteristics of latent labor?
- Up to 5-6cm dilation
- Mother is sociable, excited, cooperative
What are the characteristics of the transition phase of the first stage of labor?
- 8 to 10cm dilation
- Bloody show
- Ctx every 1.5 - 2 minutes lasting for 60-90 seconds
- Urge to push begins
- Leg tremmors, nausea, vomiting
- Mother is irritable and may lose control
What are some premonitory signs of labor?
- Braxton Hicks contractions
- Lightening
levels of the hormone ___ increase, closer to the onset of labor. Once this hormone is more abundant than the other, what occurs?
Estrogen
-Once it is more abundant, the sensitivity to substances that cause contractions increases
What is the fetal reference point in the position?
Left or right of mothers pelvis
How is contraction intensity described?
- Palpation
- Mild, Moderate, Strong
Normal Labor contractions are what three things?
- Coordinated
- Involuntary
- Intermittent
What is a normal expected blood loss during a vaginal birth?
500mL
What are the two main cervical changes?
- Effacement
- Dilatation
The cervix in false labor ____
• Does not significantly change in effacement or dilation
What are the four P’s of the birth process?
- Power
- Passage
- Passenger
- Psyche
What are the 6 principles r/t maternal positioning according to AWHONN?
- Promote spinal flexion
- Promote an increase in the uterospinal drive angle (open the pelvis)
- Facilitate stronger expulsive forces
- promote good fit
- increase the pelvic diameter
- Facilitate occiput posterior rotation
How is frequency of contractions measured?
How is duration expressed?
number of contractions in 10 minutes averaged over 30 minutes
-Expressed in seconds
Describe normal fetal attitude.
One of flexion
- Head flexed forward
- arms and legs flexed over the thorax
- back in a convex C
What are the characteristics of a first degree laceration?
Injury to the perineal skin only
What is the main role of oxytocin?
To initiate labor
What is the decrement portion of the contraction cycle?
Decreasing intensity as the uterus relaxes
When does the fourth stage of labor begin and end?
-begins with passing of placenta ends 1-4 hours after birth
What influences the psyche?
Anxiety, Culture, expectations, experiences, support
What are some factors that influence the existing contractions?
- Movement/activity can stimulate it
- Stress/anxiety can diminish it
How is contraction duration measured?
Period from the start of one contraction to the end
When should maternal vital signs be taken?
Between contractions
When does the third stage of labor begin and end?
Begins with birth and ends with expulsion of plecenta
What does the Friedman curve plot?
Dilation vs Descent. Used as an average to measure the likely time of delivery/active labor
How can respiratory alkalosis be reversed?
- Slow the mothers breathing
- Cup hands/Paper bag
What are Braxton Hicks contractions?
irregular, mild, uterine contractions that occur throughout pregnancy
What is the attitude of the passenger?
The relation of the fetal body parts to one another
How do cervical changes differ in a Parous?
Cervix is thicker may not efface as fast
True labor contractions ___
- Usually have a consistent pattern of increasing frequency, duration, and intensity
- Tend to increase with walking
- Begin in lower back and gradually sweep around to lower abdomen
What are the 7 cardinal movement/mechanisms
- Engagement
- Descent
- Flexation
- Internal rotation
- Extension
- External rotation
- Expulsion
What is cervical ripening?
- Relaxin softens the cervix
- The fetal head caused some capillaries to burst to cause some blood show
What is Dilatation?
As cervix is pulled upward and the fetus is pushed downward, the cervix dilates
How can anxiety/fear affect labor and birth?
Catecholamines from the mom can inhibit uterine contractility and placental blood flow
What are the characteristics of a 2nd degree laceration?
Injury to the perineum involving perineal muscles but not the anal sphincter
When does the second stage of labor begin?
at 10cm dilation and full effacement
How does fetal size influence labor?
as the fetus grows, it stretches the uterus and that stretching eventually causes the release of oxytocin
Contractions start in the ___ and move towards the ___
Fundus to the cervix
If contraction frequency is more than ___ in 10 minutes it is referred to as___
Tachysystole
Describe the maternal response to labor as it relates to the Pulm system?
- Depth and rate of breathing increases
- May lead to Resp. Alkalosis
What is a fetal lie?
The fetuses orientation to the long axis of the mother
If a mother is in a lot of pain it can ____ labor r/t ___
prolong
-Diminished contractions
Why is weight loss common before labor?
The shifting of hormones causes the loss of water weight
What does it mean for a contraction to be involuntary?
-Mother cant control it’s occurence
When contractions are coordinated, what three things are measured?
- Frequency
- Duration
- Intensity
What is the increment portion of the contraction cycle?
Period of increasing strength
What is estrogens role in contractions?
It allows for coordinated contractions
If blood loss is over 500mL during vaginal birth it is considered a ___
Postpartum Hemmorage
How does the fetus react to CV changes during labor?
Quickly
How can an infection in the mother induce preterm labor?
The release of prostaglandins in response to inflammation
How can aortocaval hypotension be relieved?
Laying the mother on her side.
left is best
What is “Psyche”?
The psychological response to labor and childbirth
What are the complications of Uterine hypertonus
Increased length of contraction will restrict fetal blood flow for an extended period and will lead to the child losing tissue perfusion.
This can cause permanent damage or death
False labor contractions are ____
- Inconsistent in frequency, duration, and intensity
* Do not change or may decrease with activity (such as walking)
Describe the fetal response to labor as it relates to the pulmonary system?
- During gestation, the fetus breaths in AF and produces fluids in the lungs themselves to aid in development
- These fluids need to be eliminated to allow normal breathing after birth
- The fluid is absorbed into the interstitial space of the lungs
- Absorption is increased during labor
- 35% of the fluid remains after birth
- Remaining fluid is expelled with compression of labor
- This does not occur in C-sections
What are the characteristics of 4th degree laceration?
injury to perineum and the anal sphincter complex and the anal epithelium.
If there is no fetal descent in 2 hours of laboring down, what should be done?
an evaluation
What are the characteristics of the second stage of labor?
- Duration varies based on para status and if the mother has a epidural
- Ctx are strong, every 2-3 minutes lasting 40-60 seconds
- Involuntary pushing
- possible BM
Describe the usual “Passage” in the birth process.
- The maternal pelvis and soft tissue
- The boney pelvis needs to relax to allow passage
- Relaxin softens the cartilage at the pubic symphysis. This begins near term
What are the 3 possible facing positions of the passenger?
- Anterior
- Posterior
- Transverse
What are two interventions for a woman in the second stage of labor?
- Ensure an empty bladder
- Frequent position changes
What can reduce power during the birth process?
- Epidurals
- Malnutrition
- Illness in the mother
How is fetal head diameter measured?
By measuring the major transverse diameter at the biparietal diameter.
If fetal membranes are stripped ___ is released and can induce labor
Prostaglandin
How does the fetal head usually enter the birth canal?
In cephalic presentation
What makes up the “Passenger”
The fetus, membranes, and placenta
