Week 3: Labour and Birth Process Flashcards
def of labour
process of moving the fetus, placenta, and membranes out of the uterus and thru the birth canal
describe the preceding labour
- lightening or dropping
- urinary frequency
- backache
- stronger braxton hicks contractions
- wt loss of 0.5-1.5kg
- surge of energy
- increased vaginal discharge or bloody show
- cervical ripening
- possible rupture of membranes
on the onset of labour which hormones increase, and which decrease
increase:
estrogen, oxytocin, prostaglandins
decrease:
progesterone
lisa calls L&D unit indicating she is having irregular contractions in her abdomen, she indicates that the contractions get less painful when she moves around.
Prelabour or true labour?
She is in prelabour - probably Braxton hicks
- Want to know the frequency, duration
- Vaginal discharge, bleeding, fluid loss
- How far they are into their pregnancy are they
6 fetal movement?
signs of prelabour
contractions:
- irreg or temp reg
- often stop w walking
- felt in back or abdomen
cervix:
- may be soft but no significant dilation or effacement
- often posterior
signs of true labour
contractions:
- reg, stronger, lasting longer, and closer together
- more intense w walking
- felt in lower back, radiating to lower portion of abdomen
cervix:
- changes to softening, effacement, dilation
- anterior position
- bloody show
things to consider w a vaginal assessment
Never do a vaginal assessment if there is blood
Do not do one more than every 4 hrs to reduce infection
Ask her to urinate before the exam
Wash hands w soap and water
Use sterile gloves
Drape the pt
Wash front to back with clean water
Note for any infections or cuts that could affect delivery
Wait until she has finished a contraction
Take slow deep breaths to relax
Now separate the labia then insert two fingers
Even before labour the cervix can change, for example getting softer
Check position of cervix - early the cervix may be at the back, but it will move towards the front as they get closer to labour - is it firm like your nose, it will become very soft
You determine the dilation by spreading ur fingers and gently taking them out then measure
Presentation: part of fetus that is entering through the pelvis first - butt first, head first
in a vaginal exam 4cm is approx…
2 loose fingers
def of effacement
shortening and thinning of the cervix during 1st stage of labour. expressed from 0-100%
def of presentation
part of fetus that enters the pelvic inlet first and leads thru the birth canal
def of dilation
enlarging and widening of cervical canal
1cm to full 10cm
10cm marks the end of 1st stage of labour
def of engagement
largest transverse diameter of presenting part (biparietal diameter) has passed thru the pelvic inlet into pelvic cavity
def of crowning
head or the presenting part appears at the vaginal opening
describe station
relationship of presenting part to imaginary lines drawn btwn maternal ischial spines and measures the degree of decent
1cm above the spines = minus 1
at the level of the spine = 0
birth imminent presenting part is +4 to +5
5 P’s affecting labour
Passenger (fetus and placenta)
Passageway (birth canal)
Powers (contractions)
Position (of mother)
Psychological response
describe why passenger is important in determining if vaginal birth can occur
important in birthing vaginally - head is the largest part of baby’s body, bones in head are not fused together to allow some molding as baby goes thru birth canal
Want to be able to feel the (anterior or posterior) Fontenelle to determine which way the baby is facing
what is important to consider with “passenger”
size of fetal head
fetal presentation
fetal lie
fetal attitude
fetal position
what does lie mean and what are the 2 subcategories
longitudinal: cephalic or breech
transverse: long axis of fetus (spine) directly across maternal spine
transverse: long axis of fetus (spine) directly across maternal spine
describe attitude
relationship of fetal body parts to one another
flexion or extension
describe presentation
part of the fetus that enters the pelvic inlet first
cephalic (96%), breech (3%), or shoulder (less than 1%)
with a cephalic presentation what is the usual presenting part?
Occiput (back at the babies head)
can a pt deliver vaginally w a fetus in a transverse lie?
NO
describe fetal position
relationship of reference point part to the 4 quadrants of mothers pelvis
3 letter abbreviation for fetal positions
- right or left side of pelvis
- O for occiput, S for sacrum, M for mentum/chin, and Sc for scapula
- anterior (A), posterior (P), or transverse (T)
how are LOA and ROA positions
LOA and ROA are OKAY (they are best)
-OP’s are sunnyside up - less than ideal position for vaginal birth (OP-owie)
-OT’s occiputs are at transverse section
can reference the chart in slides
describe a frank breech
lie: longitudinal or vertical
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for legs at knees
single footling breech
lie: longitudinal or vertical
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for one leg extended at hip and knee
complete breech
lie: longitudinal or vertical
presentation: breech (sacrum and feet presenting)
presenting part: sacrum w feet
attitude: general flexion
shoulder presentation
lie: transverse or horizontal
presentation: shoulder
presenting part: scapula
attitude: flexion
vertex presentation
vertical: 9.25cm
horizontal: 9.5cm
sinciput presentation
horizontal: 12 cm
vertical: 9.25 cm
brow presentation
horizontal: 13cm
vertical: 9.25cm
describe whats included in the passageway
bony pelvis
lower uterine segment
cervix
pelvic floor muscles
vagina
introitus (external opening to the vagina)
describe powers; primary and secondary
primary:
- effacement
- dilation
- ferguson reflex - oxytocin is released -> uterine contractions occur - feedback loop
secondary powers:
- bearing-down efforts
describe position
- position affects anatomic and physiologic adaptations to labour
- frequent changes in position: relieve fatigue, increases comfort, improves circulation
- encourage to find positions most comfortable
describe psyche
-psychological state
- supports
- preparation
stage 1 of labour
begins w onset of regular contractions and lasts until full dilation and effacement of cervix
stage 1: latent phase/early phase
- 0-3cm dilation in primiparous
- cervical length less than 1cm or 75% effaced
- typically lasts 6-8 hrs
- contractions mild to moderate and irregular, q5-30 mins for 30-45 sec
- brownish discharge, mucous plug or pale pink
describe stage 1: active phase
beginning at 4 cm in a nulliparous or 4-5cm in a multiparous
- typically 3-6 hrs
- contractions are moderate to very strong, more regular, 12-5 min lasting 40-90 seconds
- pink to bloody mucous
GBS
culture @ 36-37 weeks
considered normal flora in pt not pregnant
concern about vertical transition from birth canal of mom to babe
IV antibiotics (most often penicillin G)
what are the risk factors for GBS
preterm birth, PROM >18hrs, intrapartum maternal fever, positive history of early onset neonatal GBS
HSV
if visible lesions not present, vag birth is acceptable
infants born thru infected vaginal are at risk of neonatal HSV
what 2 things can be used to help HSV
acyclovir and valacyclovir to reduce sympt of HSV and suppress them at time of birth
Evie is a G2P1 that presents to L&D at 38 weeks and 4 days. they believe that their “water has broke”
How do u confirm rupture of membranes?
FERN test: look at amniotic fluid under microscope and it looks like a fern that’s how you know its amniotic fluid** This is the gold standard
Sterile speculum exam will show any pooling of fluid
Nitrozene swab assess pH of fluid - if the individual is bleeding at all or had intercourse at all in the last 24 hours it can give false positives
If change in pH of fluid it will turn to a blue-ish green
Frequency of vaginal exams can increase the risk of infection.
during labour does cardiac output increase or decrease
increase
how to assess for rupture of membranes
pt may report sudden gush or slow leak
COAT
1. colour
2. odour
3. amount
4. time
- sterile speculum examination
- nitrazine or fern test to confirm ROM
during labour what happens to HR and RR
increases slightly
what happens to bp during labour
increase during contractions and return to baseline between contractions
what happens to WBC during labour
increase
what happens to temp in labour
slightly increased
what happens to proteinuria during labour
up to 1+ may occur
what happens to gastric mobility in labour
decreased, N&V in active pahase
what happens to blood glucose levels in labour
decrease
what happens to endorphins in labour
raise pain threshold and produce sedation
how does fetal o2 do at labour
pressure decreases
what happens to fetal arterial carbon dioxide pressure at labour
increases
what happens to arterial fetal pH at labour
decreases
what happens to bicarbonate levels to fetus during labour
decrease
what happens to fetal respiratory movements during labour
decrease
stage 2 labour
- begins w full dilation (10cm) and complete effacement and ends w birth of baby
- 2 phases: passive and active
- duration is influenced by parity, maternal size, fetal wt, position and descent
- median duration is 50-60 mins nulliparous and 20-30 mins multiparous clients
- use of epidural lengthens the 2nd stage as it blocks or reduces the urge to bear down
s/s suggesting stage 2 labour
urge to push or feeling need to have a bowel movement
episode of vomiting
increased bloody show
shaking extremities
whats the Dx of FTP
should not be made w/o pushing for at least 3 hrs in nulliparous and 2 hrs in multiparous, if maternal and fetal conditions permit
positions for 2nd stage labour for mom
side-lying, squatting, or sitting
7 cardinal movements of mechanism of labour that occur in vertex presentation
- engagement
- descent
- flexion
- internal rotation
- extension
- restitution and external rotation
- expulsion
nursing care in 2nd stage of labour
vitals q5-30 mins
assess FHR q5mins if IA or continuous electronic monitoring in high-risk
assess contraction pattern and bearing down efforts
passive: help rest in comfortable position, conserve energy, promote progress of fetal descent by position changes
active: bearing down efforts, cleanse perineum if BM, coach to pant and breath
administer oxytocin after birth of the anterior shoulder
stage 3 of labour
follows birth of baby and delivery of placenta
goal: prompt separation and expulsion of placenta
most placentas are expelled within 15 min after the birth
if longer than 30 min considered retained placenta
active management, placenta separation and expulsion are facilitated by oxytocin
nursing care in 3rd stage labour
- skin to skin and delayed cord clamping: maternal vital q15mins, assess bleeding and signs of placental separation
- instruct the client to push when signs of placental separation: sudden gush of dark blood, lengthening of the cord, shape of uterus becomes globular
stage 4 labour
1-2 hours after birth
after delivery of placenta in which the uterus effectively contacts
mother’s body functions begin to stabilize
nursing care in 4th stage of labour
- vitals q15 min for 1st hour
- fundal assessment
- fundal massage if fundus is boggy
- encourage voiding and follow BMP
- observe lochia
- assess perineum
- assess lacerations repair or episiotomy for REEDA: redness, edema, ecchymosis, drainage, approximation
- encourage breastfeeding in the 1st “golden hour”
vaginal exam are contraindicating during which of the following
- preterm labour
- placenta previa
- bulging membranes
- signs of fetal distress
2
a multiparous client arrives to the birth unit 3 cm dilated, contracting approx every 6 min lasting 30 sec w moderate intensity. client is in which stage of labour.
stage 1: latent
