Week 4: Labour and Birth Flashcards
What is Stage 1 of labor?
Onset of regular contractions and lasts until full dilation and effacement of the cervix.
What are the characteristics of the Latent Phase/Early phase in Stage 1?
0-3cm dilation, cervical length less than 1cm, 75% effaced, duration of 6-8 hours, contractions mild-moderate and irregular, occurring every 5-30 minutes for 30-45 seconds, with brownish discharge.
What defines the Active Phase in Stage 1?
4cm in nulliparous, 4-5cm in multiparous, duration of 3-6 hours, moderate to very strong contractions every 2 minutes lasting 40-90 seconds, with pink to bloody-mucous discharge.
What should a nurse do when a patient presents in the first stage of labor?
Use a family-centered approach, perform a triage assessment, collect admission data, and orient the patient to the unit and healthcare team roles.
What admission data should be collected for a patient in Stage 1 labor?
GTPAL, EDD, risk factors, GBS history, OB history, adverse reactions, medications, vitals, contractions, symphysis height, FHR, cervical exam, membranes, Bishop’s score, and plan of care.
Is GBS considered a normal vaginal flora in non-pregnant women and poses minimal risk to newborns?
False. It is part of the normal flora but poses risk to newborns.
How is a GBS sample collected?
Wash hands, use a collection tube, separate labia, swab vagina and then rectum, and send the tube to the lab for testing.
Why are we concerned about GBS and when does screening take place?
Screening takes place at 35-37 weeks due to concerns about vertical transmission from an infected mother to the infant during birth. Risk factors include preterm birth, PROM, and intrapartum maternal fever.
How do we treat GBS?
IV antibiotics prophylaxis (penicillin G).
Can you give birth with HSV and not pass on the infection to the child?
Yes, as long as there are no lesions present. If there are lesions, children born through an infected vagina are at risk.
What drugs can be used to reduce symptoms of HSV in pregnancy?
Acyclovir and Valacyclovir.
How do we assess for a client’s ruptured membranes?
SROM; report sudden gush/leak. COAT: Colour, odour, amount, time. Use sterile speculum exam, Nitrizine or fern test.
What should be included in a physical assessment upon admission?
Vitals, Leopold’s maneuver, FHR/pattern, uterine activity, vaginal exam, urinalysis, and blood work.
What physiological changes are expected in a mother in labor?
CO increase, HR and RR increase, BP increase during contractions, WBC increase, temperature increase, proteinuria, decreased gastric motility, blood glucose levels drop, endorphins raise pain threshold and produce sedation.
It is similar to intense exercise
What physiological changes are expected in a fetus as the mother prepares to go into labor?
Fetal O2 pressure decreases, arterial CO2 pressure increases, arterial pH decreases, bicarbonate levels decrease, fetal lung respiration movement decreases, and lung fluid is cleared from the air passage as the infant passes through the birth canal.
Describe Stage 2 of labor.
Full dilation (10cm) and 100% effacement. Duration influenced by parity, maternal size, fetal weight, position, and descent.
Baby is actually ready to come. NOW.
How long can a patient expect the second stage of labor to take?
Nulliparous: 50-60 minutes, Multiparous: 20-30 minutes.
What effect does an epidural have on the second stage of labor?
It lengthens the stage as it reduces the urge to bear down.
What signs and symptoms indicate a patient is likely entering the second stage of labor?
Urge to push, need to have a bowel movement, episodes of vomiting, increased bloody show, shaking extremities, increased restlessness, verbalizing ‘I can’t do this.’
When should a diagnosis of failure to progress (FTP) be made?
In the second stage after pushing for 3 hours in nulliparous and 2 hours in multiparous.
Avoid using “failure to progress” in front of client
What are the 7 cardinal movements of labor in the vertex position?
Engagement, descent, flexion, internal rotation, extension, restitution, and external rotation, expulsion.
Imagine: ENGAGEMENT ring, points DOWN (descent), FLEX their arm, ROTATE hand, EXTEND hand out, ROTATE opposite; They’ll be able to perform RESITUTION to make their husband live with them again before they decide to EXPEL them from the marriage.
How should a nurse care for a patient in the second stage of labor?
Vitals every 5-30 minutes, assess FHR every 5 minutes or continuously, assess contraction pattern and bearing down efforts. During the passive phase, help the patient rest in a comfortable position and promote fetal descent. During the active phase, assist with bearing down efforts and create a calm environment.
Describe Stage 3 of labor.
Following the birth of the baby and delivery of the placenta. The goal is prompt separation and expulsion of the placenta, typically within 15 minutes of birth. If longer than 30 minutes, consider retained placenta.
30’? Retained !
How would a nurse provide care in the 3rd stage of labor?
Skin to skin, delay cord clamping, monitor maternal vitals every 15 minutes, assess bleeding and signs of placental separation, and instruct the client to push when signs of placental separation occur.
Cord clamping delayed by 1-2’ for more blood to baby (vampire)
What are some signs of placental separation in Stage 3?
Sudden gush of dark blood, lengthening of the cord, shape of the uterus becomes globular.
What is Stage 4 of labor?
1-2 hours after birth, following the delivery of the placenta where the uterus contracts and the mother’s body functions begin to stabilize.
How would you care for a client in the 4th stage of labor?
Vitals every 15 minutes, fundal assessment or massage if boggy, encourage voiding and follow BMP, observe lochia, assess perineum, and assess for lacerations.
What does REEDA stand for in relation to lacerations or episiotomy?
Redness, edema, ecchymosis, drainage, approximation.
