Ch 13-14 Labor & Birth Processes

Question 1

Factors Influencing Labor Initiation

Answer 1

• Uterine stretch
• Progesterone withdrawal- pregnancy mx hormone
  uterus gets crampy and then goes into labor
• Increased oxytocin sensitivity
  
  • body’s natural hormone that is UTERUS specific and makes it contract
  • nipple stimulation is #1 method to increase oxytocin
    Pro: When done in moderation, it can get labor going
    Con: no control on amount of oxytocin you produce. Can hyperstimulate uterus
• Increased release of prostaglandins
  
  • softens cervix and thins it out, effaces

Question 2

Premonitory signs of labor

Answer 2

cervical chgs
lightening (relief)
increased energy (nesting)
bloody show (mucus plug)
braxton hicks
spontaenous rupture of membranes (water break)

Question 3

Regular
Stronger over time
Increasing discomfort
UC’s continue despite position
5 min apart x2 hours

Answer 3

true labor

Question 4

Irregular
No increase in intensity
Localized pain (front)
UC’s come and go with position changes
Fluids helps

Answer 4

false labor

Question 5

5 p’s

Answer 5

Passenger - this is where position of baby is covered
Passageway
Powers
Position - most confusing - of the MOTHER, not of fetus
Psyche (psychological response)

Question 6

Passenger (fetus)

Answer 6

size (macrosomia)
presentation
lie
attitude
position
placenta

Question 7

what can you ask mom to do if baby is LOT?

Answer 7

positioning

Question 8

If diamond is closer to anterior and triangle is posterior, it is …

Answer 8

OP

Question 9

If diamond is L and triangle is R, it is …

Answer 9

LOT

Question 10

most desirable position & presentation

Answer 10

cephalic, OA

Question 11

the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother

(longitudinal vs transverse)

Answer 11

Lie

Question 12

which is most subjective

Answer 12

station

Question 13

is true cephalopelvic disproportion common or rare?

Answer 13

COMMON

Question 14

who would have problems w/ cervical dilation?

Answer 14

those w/ a leap
anyone w/ HPV w/ tissue removal
anyone w/ D&C or D&E (scar tissue)

Question 15

what is a good indication that someone’s pelvic msks are strong?

Answer 15

good shape

Question 16

effacement

Answer 16

shortening

Question 17

dilation

Answer 17

opening of cervix

Question 18

Cardinal movements

Answer 18

EDFI

ExExEx

Question 19

entering of the biparietal diameter (widest) into the pelvic inlet.

Answer 19

Engagement

Question 20

The baby’s head (presenting part) moves deep into the pelvic cavity and is commonly called lightening. – greatest at deceleration phase of 1st stage and during 2nd stage of labor

Answer 20

descent

Question 21

occurs during descent, brought about by resistance felt by the baby’s head against the soft tissues of the pelvis. Smallest diameter of the baby’s head presents into the pelvis

Answer 21

flexion

Question 22

head reaches pelvic floor & rotates to accommodate for changes in diameter of the pelvis. Baby must move from sideways to facing posterior

Answer 22

internal rotation

Question 23

head passes through pelvis at nape of neck and there is a rest. Occurs as head, face, and chin are born

Answer 23

extension

Question 24

after baby’s head comes out, it sucks back in a little & rotates to face down

Answer 24

external rotation

Question 25

last big relieving push which results in baby

Answer 25

expulsion

Question 26

Involuntary uterine contractions

Answer 26

primary powers

Question 27

PUSHING Bearing-down efforts Augment the primary powers

Answer 27

secondary powers

Question 28

responsible for effacement and dilation divided into frequency duration intensity

Answer 28

primary

Question 29

not letting the patient push so that primary powers can work baby down further into pelvis effective for only 1 hr longer the labor, the greater the risk of infx.

Answer 29

laboring down

Question 30

epidurals before what CM increases csection rate?

Answer 30

3 cm

Question 31

during transition, what position should they not be in? what postition should they be in?

Answer 31

NOT lithotomy. OK to have counterpressure and squatting, hands & knees = takes weight off back (can deliver baby on hands & knees)

Question 32

What affects psyche?

Answer 32

``` Maternal exhaustion Length of labor Labor support Fear Chronic illness Pregnancy related illness ```

Question 33

``` Lightening Braxton Hicks contractions Increased vaginal mucous Weight loss (0.5-1.5kg) Energy surges Diarrhea N/V Indigestion Loss of operculum ```

Answer 33

preceding labor

Question 34

Uterine distention Increasing intrauterine pressure Regular, rhythmic contractions Loss of operculum

Answer 34

onset of labor

Question 35

Stage 1 labor - from _____________ to __ cm | 3 sub stages & their cm

Answer 35

onset of labor to 10 cm Latent- 0-3 cm Active- 3-7 cm Transition- 7-10 cm

Question 36

Stage 2 labor - from ____ to _________

Answer 36

10 cm through delivery of fetus Latent- passive descent and rotation Active- active expulsion efforts Completed within 2-3 hours

Question 37

Stage 3 labor: delivery of ______ through ______

Answer 37

delivery of fetus through placenta | Completed within 30 minutes

Question 38

Stage 4 labor: first _____ of postpartum recovery. what is a big complication in stage 4?

Answer 38

first 1-2 hours of postpartum recovery; reestablishment of homeostasis - big thing right now b/c hemorrhage

Question 39

little cuts around periurethral area and skin. biggest problem: getting them to void - give warm soapy bottle for periurethral - may not require repair b/c vag is vascular and heals quickly. may heal b/c it’s bleeding + cosmetic

Answer 39

1st degree

Question 40

goes through skin, portion of vag wall & anal wall

Answer 40

3rd degree

Question 41

goes through perineal skin & msk - always gets repaired

Answer 41

2nd degree

Question 42

tear between vag floor & rectum - must be repaired through each layer of muscle.

Answer 42

4th degree

Question 43

biggest fear in 4th degree tear? | interventions

Answer 43

going to the bathroom | Give them sitz bath, medications, stool softener, hydrate, ice packs, tucks, foley

Question 44

greatest risk in 3rd/4th degree tears?

Answer 44

risk of infection - -good hygiene - -wipe front to back - -NOTHING in the vagina for at least 6 weeks (tampons, penises, etc)

Question 45

What can you do to prevent perianal tearing?

Answer 45

stretch | mineral oil/baby shampoo