Labor And Delivery Flashcards
Factors Affecting Labor Progress “The 5 P’s”
- Passageway (birth canal)
- Passenger (fetus)
- Powers (maternal)
- Position (maternal)
- Psyche (maternal)
Passageway
4 types
And cervical changes
• True pelvis (space enclosed by the pelvic girdle and below the pelvic brim: between the pelvic inlet and the pelvic floor)
– Inlet, midpelvis, outlet
• Four types – Gynecoid= wide – Android= narrower shape can make labor difficult – Anthropoid= elongated – Platypelloid= wide but shallow
• Cervical changes
– Dilation= Widening of cervix during first stage; 0-10 centimeters
– Effacement= Stretching and thinning of the cervix; 0-100%
Fetal head
– Fontanelles
• Intersections of the cranial sutures
• Anterior: diamond shape
• Posterior: triangle shape
– Molding
• Bones of fetal skull overlap to allow passage through birth canal
– Landmarks—mentum (chin), sinciput (brow), bregma (anterior fontanelle), occiput (back of head)
Fetal Attitude
– The relation of the fetal body parts to one another
– Normal attitude is flexion
Fetal Lie
– The relationship of spinal column of the fetus to that of the mother
– Longitudinal or transverse
Fetal Presentation
What you see first ?
What is engagement?
What is station?
Presenting part enters pelvic passage 1st
• Cephalic, Breech, Shoulder
- Cephalic broken down to vertex, sinciput, brow, face
– Engagement
• Largest diameter of presenting part reaches level of ischial spines
• Determined by vaginal exam
– Station
• Relationship of the presenting part to the ischial spines
• Ischial spines are zero station
• If presenting part above the ischial spine—negative number
• If presenting part below the ischial spine—positive number
Fetal Position
How do you get the 3 letters
– Relationship of presenting part to maternal pelvis
1) (R) or (L) side of the maternal pelvis
2) Landmark: occiput (O), mentum (M), sacrum (S), or acromion (scapula[Sc]) process (A)
3) Anterior (A), posterior (P), or transverse (T)
– Determine by inspection/palpation of maternal abdomen or vaginal exam
Powers
How is baby pushed out? Two ways?
• Primary forces—uterine muscular contractions. (Involuntary)
– Contraction phases
– Described with frequency, duration, and intensity
– Braxton-Hicks: irregular and intermittent contractions; false labor
• Secondary forces—abdominal muscles used in pushing
Position
- Whatever is comfortable
- Allow mom to listen to her body
- NEVER supine!
Psyche
- Fears
- Anxieties
- Excitement level
- Feelings of joy and anticipation
- Level of social support
Pre- Labor Signs
- Lightening
- Braxton Hicks contractions
- Cervical changes (effacement, dilation, ripening)
- Bloody show
- Mucous plug released
- Rupture of membranes (ROM)
- Sudden burst of energy
- Weight loss
- Backache
- Nausea and vomiting
- Diarrhea
True Labor
- Progressive dilation and effacement
- Regular contractions increasing in frequency, duration, and intensity
- Pain usually starts in the back and radiates to the abdomen
- Pain is not relieved by ambulation or by resting
False Labor
- Irregular contractions do not increase in frequency, duration, and intensity
- Contractions occur mainly in the lower abdomen and groin
- Pain may be relieved by ambulation, changes of position, resting, or a hot bath or shower
FIRST STAGE of labor
What are the 3 sub-stages?
from beginning of labor to complete dilation and effacement of cervix
1) Latent phase (0-3cm)
• Contractions every 10-30 min, lasting 30-40 seconds, mild
2) Active phase (4-7cm)
• Contractions every 2-3 min, lasting 40-60 seconds, moderate to strong
3) Transition phase (8-10cm)
• Contractions every 1 ½ - 2 min, lasting 60-90 seconds, strong
Interventions for 1st stage labor
- Complete Admission Assessment and Review History
- Assessment: Maternal VS, Response to Labor and Pain, Cervical Changes, Membrane Status, Fetal Position and Descent
- Diet and Hydration: Clear Liquids
- Activity and Rest: Frequent Position Changes/Ambulation/Pad Pressure Points
- Elimination: Frequent Emptying, Perineal Care
- Comfort: Meds and Non-Pharmacologic Strategies, Warm or Cool Cloths, Oral Care, Fresh Bed Linen
- Support: Keep Family Involved; Decrease Anxiety
- Education: About Labor, Procedures,
- Safety: Safe and Friendly Environment
SECOND STAGE of labor
Signs?
What may they need to help push?
begins with complete dilation of cervix and ends with birth of baby “PUSHING”
SIGNS= sudden increase in bloody show, uncontrolled bearing down efforts, bulging of the perineum, Crowning
• Episiotomy
– Midline
– Mediolateral
Interventions for 2nd stage labor
- Support and Encourage Spontaneous Pushing Efforts
- Monitor for Fetal Response to Pushing
- Provide Comfort Measures (Cool, warm cloths, sips of fluids or ice chips, change linens)
- Position Changes as needed
- Perineal Hygiene as needed
- Give Praise and Encouragement
- Encourage Rest between Contractions
- Teach Breathing Technique
- Teach Pushing Technique
- Meds as ordered
- Assist the Support Person
- Advocate on Woman’s Behalf
THIRD STAGE of labor
How long should this take ?
begins with birth of the baby and ends with delivery of placenta
• Should deliver within 30 minutes
• Considered a “retained placenta” if greater than 30 mins.
• May need to remove manually
Interventions for 3rd Stage
- Maternal VS per protocol
- Encourage Breathing
- Encourage Rest
- Palpate Uterus
- Initial Newborn Care
- Encourage Bonding with Neonate
- Meds as ordered
FOURTH STAGE of labor
What should uterus be doing ?
What are priority risk ?
initial recovery time
• First 1-4 hours after delivery of placenta
• Essential for uterus to remain contracted
• Uterus should remain midline
• Uterus typically b/n symphysis pubis and umbilicus
• Priority problems during this stage
- Risk for hemorrhage
- Risk for urinary retention
Interventions for 4th stage
• Maternal VS
• Assess Uterus Frequently: Position, Tone, Location
-Uterine Massage if needed
• Assess Lochia: Color, Amount, Clots
• Monitor Perineum for Swelling or Hematomas
• Meds as ordered
• Assist with Laceration/Episiotomy Repair
• Apply Ice to Perineum
• Monitor for Bladder Distention
- Promote Urinary Elimination
• Assess for motor-sensory function return if spinal or epidural used
• Encourage Bonding with Neonate
• May Eat and Drink Immediately if Vaginal Delivery
Discharge to Postpartum Care
• Discharge criteria
– Stable vital signs – Stable bleeding – Undistended bladder – Firm fundus – Sensations fully recovered from any anesthetic agent received during birth
Maternal Physical Responses during Labor
- ⬆️ cardiac output
- ⬆️ blood pressure, pulse
- Diaphoresis
- Hyperventilation
- Changes in acid-base balance
- Impaired blood and lymph drainage from base of bladder
- Reduced gastric motility and food absorption, and prolonged emptying time
- ⬆️ WBCs
- 🔽 maternal blood glucose
- Pain
Fetal Responses to Labor
- Head compression
- Decreased pH, anoxic periods
- Aware of sensations such as light, sound, touch, pressure
