Module 5A: Normal Labour and Birth Flashcards
(105 cards)
1
Q
What does “bloody show” mean?
A
- vaginal discharge that originate in the cervix
- consist of blood and mucous
2
Q
What is the positive sign labour has commenced (2)?
A
- regular contractions that are accompanied by cervical changes
- changes include the cervix moving from a posterior to anterior position, shortening and thinning (effacing), and dilating
- contractions become progressively stronger (intensity), more frequent (frequency), and last longer (duration)
3
Q
What are some hormonal physiology of labour and birth that involves maternal preparation? oxytocin? estrogen?
A
- Rising estrogen levels: activating the uterus for labour
- increases in oxytocin and prostaglandin activity: cervical ripening
- Increasing inflammation: activate the cervix and uterus
- Elevations in mammary and central oxytocin and prolactin receptors: promote breastfeeding and maternal infant attachment
4
Q
What are some hormonal physiology of labour and birth that involves fetal preparation?
A
- Pre-labour maturing of lungs and other organ systems
- Pre-labour increase in epinephrine-norepinephrine receptors, giving protection from labour hypoxia
- in- labour, preservation of blood supply to heart and brain, via the catecholamine surge, with neuroprotective effects
5
Q
What is oxytocin? 4 Roles?
A
- hormone
- secreted by posterior pituitary gland
Plays a role in :
- preparing the body for labour and
- optimizing labour by causing rhythmic contractions,
- promoting calm,
- reducing fear and stress
- promoting maternal-infant attachment
6
Q
After birth, what roles (2) does oxytocin play for mother?
A
- promoting uterine contractions after birth which helps postpartum bleeding
- aid in uterine involution
7
Q
What is the role of beta-endorphines in labour?
A
- secreted by posterior pituitary gland
- by providing analgesic and adaptive responses to stress and pain
8
Q
What are the 5 hormones of labour?
A
- beta-endorphines
- catecholammines
- cortisol
- estrogen
- oxytocin
9
Q
What is the role of Catecholamines (epinephrine, norepinephrine, and dopamine)?
A
- Elevations in epinephrine/norepinephrine in late labour also support newborn transition to extrauterine life
- Catecholamines are the primary mediators that prepare the fetus for birth and support the multi-organ transition to extrauterine life
10
Q
What are 4 roles of cortisol (stress hormone) during labour?
A
- elevated during labour
- may promote contractions
- increase central oxytocin effects on maternal adaptations and attachment
- enhance postpartum mood
- prepares fetus for birth
- promote lung maturation and clearance of fetal lung fluid
11
Q
What are 4 signs of true labour?
A
- vaginal exam to assess whether cervix is effaced and dilated
- Contractions occur regularly, become stronger, longer, and more frequent
- Contractions become more intense with walking
- Contractions usually felt in lower back, radiating to lower abdomen.
- Contractions continue despite use of comfort measures and rest
- Cervix softens, moves from posterior to anterior position, thins (effaces) and dilates
- Presenting part of fetus usually engaged in pelvis now
- May or may not see bloody show
12
Q
What are 4 signs of false labour?
A
- Contractions occur irregularly or stop and start
- Contractions may stop with activity such as walking or stop with rest
- Contractions can be felt in low back or abdomen above the umbilicus.
- Contractions slow or stop with comfort measures
- Cervix does not change, may still be posterior
- Fetus may not yet be engaged in pelvis
13
Q
What are the 5 P’s of labour?
A
- passager
- passageway
- powers
- position
- psychological factors (psyche)
14
Q
What is the passenger of the 5 P’s?
A
- passenger relates to the fetus
- the way the fetus moves through the birth canal determined by: size of fetal head, fetal presentation, fetal lie, fetal attitude, fetal position
- placenta could also be considered a passenger since it must be expelled through the birth canal after the birth of the baby
15
Q
What is the fetal presentation? What are the 3 presentation?
A
- the part of the fetus that enters the pelvic inlet first and leads through the birth canal
- cephalic: head first
- breech: buttocks, feet or both first
- shoulder
16
Q
What is the fetal lie? What are the 3 fetal lie?
A
- the relationship between the long axis (spine) of fetus and the long axis (spine) of women
Lies:
- longitudinal or vertical: long axis of fetus is parallel to the long axis of mother
- transverse, horizontal
- oblique or diagonal: long axis of fetus is at a right angle diagonal to the long axis of mother
17
Q
What is the fetal attitude?
A
- the relation of the fetal body parts to one another
- normal attitude is general flexion
- chin flexed onto chest and thighs/legs flexed, arms crossed over body
18
Q
What is the fetal position?
A
- the relationship of the reference point of presenting part (occiput, sacrum, mentum [chin], or sinciput) to the 4 quadrants of maternal pelvis
- denoted by three-part abbreviation
- (R) right or (L) left
- (O) occiput or (S) scarum, (M) mentum or Sc for scapula [shoulder]
- (A) anterior, (P) posterior, (T) transverse
- left occiput anterior (LOA): means occiput is the presenting part in the left anterior quadrant of maternal pelvis
- the presentation or presenting part indicates that portion of the fetus overlies the pelvic inlet
19
Q
What is the fetal station?
A
- relationship of presenting part to an imaginary line drawn between the maternal ischial spines
- is a measure degree of descent of presenting part of fetus through birth canal
- when the lowermost portion of the presenting part is 1cm above the spine, it is noted as being minus (-) 1
- at the level of spine, station is referred as zero (0)
- birth is imminent when presenting part is at +4 or +5
= -5 floating body
= 0 is engaged in pelvis
= +2 for spontaneous pushing
= +5 crowning
20
Q
What is engagement in terms of fetal position?
A
- the term used to indicate the largest transverse diameter of presenting part has passed through maternal pelvic brim or inlet into the true pelvis
- usually corresponds to station 0
21
Q
What is the passageway of the 5Ps? Composed of (5)?
A
- the passageway or birth canal composed of mothers:
- rigid bony pelvis,
- soft tissues of cervix,
- pelvic floor muscles
- vagina, and
- introitus (external opening of vagina)
22
Q
What is the powers of the 5Ps?
A
- relates to the uterine contractions that are needed to dilate the cervix and push the fetus down and out the passage
- labour contractions are involuntary but included in the powers are voluntary bearing down efforts of the women during second stage and birth
- primary powers: involuntary uterine contractions (signal the beginning of labour)
= once cervix is dilated, voluntary bearing-down efforts by woman –> secondary powers - secondary powers: Maternal pushing efforts during uterine contractions
23
Q
What are 3 terms to described primary powers (involuntary contractions)?
A
- frequency: the time from the beginning of one contraction to the beginning of the next
- duration: the length of contraction
- intensity: strength of contraction at its peak
- primary powers are responsible for the effacement and dilation of cervix and descent of fetus
24
Q
What is the position of the 5 P’s?
A
- refers to the woman’s position as she labours
- certain positions facilitate and enhance the labour process
25
What are 4 Psychological factors (psyche) of the 5 P's include?
- individual woman's strength,
- past Hx,
- ability to cope with labour pain,
- perception of pain,
- level of fear/anxiety,
- her values/beliefs,
- intentions as they related to labour and birth
26
What are the 6 bones of the fetal skull?
- frontal bone: forehead region
- two parietal: bilateral skull bones form the lateral walls of cranium
- two temporal: the sides and base of brain
- occipital bone: covers the back of the head
27
What are the names of the fontanelles and how can you tell the difference between them?
- anterior and posterior
- anterior: diamond shaped
- posterior: tranigular shaped
28
What happens to the fetal skull as it moves through the maternal pelvis?
- bones of fetal skull not attached: ability to move during the birthing and can overlap slightly (molding)
- other feature that enables the fetal skull to accommodate its way through the birth canal is that it normally flexes to present its narrowest diameter
29
What are the three planes/parts of the true pelvis that play a role in labour?
- inlet or brim: upper border of true pelvis
- midpelvis or cavity: curved passage
- outlet: lower border of true pelvis
30
What does the soft tissue of passageway includes (5)?
Soft tissues in the pelvis (passageway) include:
- the lower uterine segment,
- the pelvic floor muscles,
- the cervix,
- the vagina, and
- the introitus
31
What are considered the primary powers?
- involuntary uterine contractions
- primary powers are responsible for effacement and dialtion of cervix and descent of fetus
32
What are considered the secondary powers?
- maternal pushing efforts during uterine contractions
- as soon as presenting part reach pelvic floor, contractions change in character and become expulsive
- labouring woman experience an involuntary urge to push
- she uses secondary powers (bearing down efforts) to aid in expulsion of fetus as she contracts her diaphragm and abdominal muscles and pushes
- secondary powers have no effect on cervical dilation but importance in the expulsion of infant from uterus and cercix is fully dilated
33
What are 4 advantages of changing women's position during labour?
Frequent changes of position during labour
- relieve fatigue,
- increase comfort, and
- improve circulation.
- Certain positions are anatomically beneficial in allowing gravity to advance the fetus through the birth canal and may help in opening the pelvic diameters to allow fetal descent and rotation.
34
What are 4 gravity enhancing positions that can be used during labour?
- walking
- standing
- sitting
- squatting
35
What is the cardinal movements?
- in normal labour and birth: the passenger moves through the passage with a series of maneuvers, called the cardinal movements
- cardinal movements are part of the mechanism of labour
- are a combination of movements with some occurring simultaneously
- the power of uterine contractions accompanied by maternal positioning aid the fetus in its descent and rotation through the pelvis.
- For most labours it is the fetal head that leads the way as the fetus maneuvers through the maternal pelvis
36
What are the two interventions that promote, protect and support normal birth?
- upright postures
- freedom of movement
37
What are the 7 cardinal movements?
- Engagement
- Descent
- Flexion
- Internal rotation
- Extension
- Restitution and external rotation
- Expulsion - The birth of the entire body marks the time of birth for the baby
38
What are the 3 phase of the first stage of labour?
- the latent phase: starts when contractions are regular, painful and cervical effacement and dilate commences (from 0 to 3 cm dialated)
- the active phase: refers to the time when labour is well established becoming more painful and usually more frequent and longer (cervix thins and dilates from 4 cm to 7 cm)
- the transition or accelerated phase: usually occur when cervix is 8-10cm (women feels she wants to bear down)
39
What is effacement and dilation?
- effacement: shortening and thinning of cervix during first stage of labour (ex. 50% effaced)
- dilation: the enlargement of widening of cervical opening that occurs during labour (ex. diameter is from closed to 10cm dilated)
40
The first stage of labour is commenced by what? Ends when?
- commences with the onset of regular contractions accompanied by cervical changes
- ends when the cervix is fully dilated
41
What are 3 steps that happens during the first stage of labour?
- the presenting part of the fetus (most often the occiput) descends and rotates through the birth canal.
- flexed fetal head: flexion allows a narrower diameter of the head to move through the pelvis
- by the time full dilatation of the cervix is accomplished the presenting part is usually at the outlet of the bony pelvis, starting to make its way under the pubic arch
42
How are the uterine contractions at each phase of the first stage of labour?
- Uterine contractions increase: (time for nullip woman)
- latent phase: every 5-30 minutes (last approximately 6-8 hours)
- active phase: every 3-5 minutes (averages between 3-6 hours)
- transition phase: every 2-3 minutes (may last 1-2 hours)
- Times are generally shorter for a multiparous woman
43
When does the second stage of labour commences? When does it end?
- commences with full dilatation of cervix
- ends with the birth of the baby
44
What are 4 steps that happens during the second stage of labour?
- fetal head descends under the pubic arch and gradually thins and stretches the vaginal opening
- When the widest diameter of the head (the biparietal diameter) distends the opening this is called crowning.
- Shortly after crowning the head is born: it briefly rotates to the position it was in when it entered the pelvis (restitution).
- The head then externally rotates further as the shoulders engage and descend and pass the pubic arch
- This rotation is necessary as it allows the shoulders to rotate so they are aligned with the head and able to pass under the pubic arch.
45
What is crowning?
- happens during active phase of second stage of labour
- When the widest diameter of the head distends the vaginal opening
46
How many phases is the second stage broken down into?
- latent or passive phase: cervix is fully dilated but the women may not have the urge to push but the fetus continues to descend
- active phase: some stretch receptors in the pelvic floor trigger a strong urge to push called the Ferguson's reflex
47
What is the Ferguson's reflex?
- During the active phase of the second stage of labour, stretch receptors in the pelvic floor trigger a strong urge to push
- when presenting part of fetus reaches perineal floor, mechanical stretching of cervix occurs
- stretch receptors in the posterior vagina cause release of oxytocin that triggers maternal urge to bear down
48
How often are the contractions occurring and how long is the second stage of labour?
- contractions occur every 2-3 minutes
- second stage can last up to 3 hours for a nullip although the median duration is 50-60 minutes
- second stage for a multip is much quicker and it is possible for a multip to progress from 8 cm to fully dilated to delivery of the infant in less than 20 minutes
- nullip: a woman who has not completed a pregnancy beyond 20 weeks
- multip: a woman who has completed 2 or more pregnancies past 20 weeks of gestation or more
49
When does the third stage of labour commences? How long does it last?
- commence with birth of the baby
- ends with delivery of placenta and membranes
- once the infant is born, the uterus contracts and retracts which causes the placenta to pull away from the walls of the uterus.
- usually occurs within 2-30 minutes from delivery of the infant
50
What are 4 signs that the placenta has separated after the birth of infant?
- firmly contracted fundus
- change in shape of uterus from discoid to globular
- sudden gush of blood
- apparent lengthening of cord
- a feeling of vaginal fullness
51
What defines the fourth stage of labour?
- defined variably from one to four hours after birth
- although two hours after birth is the commonly accepted time
52
What does the fourth stage of labour entails for the women (3)?
- time for physiologic adjustment and stabilization for the mother
- uterus should be well contracted and
- uterine involution: there should be a moderate amount of vaginal bleeding as her uterus returns to the pre-pregnant state
53
What are 4 questions nurse ask when a woman in possible labour calls the birthing unit?
- Gestational age (when is her baby due)?
- Is this her first baby? If not, what was her other labour(s) like?
- How is her general health?
- Has there been any health issues or concerns during the pregnancy?
- When did her contractions start? How often are they occurring?
- Have her membranes ruptured, if so what time, and what is the color and odor of the fluid?
- Does she know the presentation of the fetus (head down)?
- Has there been any bleeding?
- Is the baby moving as much as normal?
- Who is her care provider? Has she spoken with her/him?
54
What 4 regular assessments are included in the first stage of labour?
- performing Leopold’s maneuvers
- maternal vital signs q1h
- assessment of fetal well-being q15-30 minutes by intermittent auscultation (IA) or continuous electronic fetal monitoring
- assessing frequency, duration and intensity of contractions (q1h or more frequently if situation is changing)
- assessing the progress of labour (ongoing)
- assessing maternal coping/response to labour (ongoing)
55
What is the Leopolds maneuvers?
- also be known as abdominal palpation.
- the assessment is performed on admission, when taking over care at shift change, and as needed to assist the nurses to identify the presentation, lie, and position of the fetus
56
What is assessed/monitored to determine fetal's response to labour?
- monitoring the fetal heart rate (FHR)
- normal term fetus has a HR between 110-160 bpm
57
What does the SOGC (2007) recommend in terms of fetal surveillance during labour?
- recommends that intermittent auscultation (IA) following an established protocol of surveillance and response is the preferred method of fetal surveillance in healthy term pregnancies during the active stage of labour.
- the recommended frequency of listening to the FHR is every 15 to 30 minutes in active first stage labour and every 5 minutes in the second stage of labour
58
How are contractions assessed?
- palpating uterine tone at the fundus of uterus before, during, and after a contraction
- the strength: contractions measured by palpation can be mild, moderate or strong
- the duration: measured from the onset to end of the contraction
- the frequency: measured from the onset of one contraction to the onset of another
- are assessed and timed over several contractions
59
What is "resting tone"
- imperative to determine that the uterine muscle relaxes between contractions
- Rest between contractions requires the uterus to be “soft” when touched or palpated, having a decreased tone
60
Why is it valuable to ask if the woman where she is feeling the contraction?
- to determine if uterine pain is accompanied with backache
- may be a sign that the presenting part is in a posterior position in the pelvis
61
What is a toco-manometer?
- continuous electronic fetal monitoring, the frequency and duration of uterine contractions will be recorded
- monitor does not accurately measure the strength of contractions therefore it is still important to manually palpate the strength of contractions
62
What does vaginal exam (VE) determine (4)?
- the position of the cervix (posterior/mid/anterior),
- consistency (soft, firm),
- effacement: shortening and thinning of cervix during first stage of labour
- dilation: enlargement or widening of the cervical opening that occurs during labour
- station of the presenting part: relationship of the presenting part to an imaginary line drawn between is ischial spine of pelvis. it is a measure of degree of descent of the presenting part of fetus through birth canal (minus 3, 2, 1, 0, plus 1, 2, 3)
- determine fetal position,
- status of membranes (bulging) and
- the presence of caput or molding
63
At what stage of labour does spontaneous rupture of membrane (SROM) happen? What must be documented in that event?
- membranes will rupture spontaneously, usually during the transition phase of the first stage of labour
- time of rupture,
- the colour of the fluid
- the amount of fluid draining
- FHR must be assessed
- when woman is in active labour, a vaginal exam can help determine the status of membrane
64
Can a vaginal exam be done when membranes have ruptured prior to labour starting (PROM)?
- no
- a sterile speculum (silver apparatus) exam is done instead
65
What is amniotomy or artificial rupture of membranes (ARM)?
- performed by primary caregiver in order to start labour (induction) or to facilitate progress in labour (augmentation)
- during normal labour: this procedure done only once the fetal head is well engaged and cervix is dilating
- after ROM, nurse must assess: FHR, colour, amount and odour of fluid
66
What are 3 subjective signs you observed that would indicate labour is progressing?
- contractions become uncomfortable.
- woman not be able to talk during a contraction
- women breathing deeply and possibly moaning
- contractions should be every 3-5 minutes and palpating as moderate to strong
- may have some bloody show
67
How often would you do a vaginal exam (VE)?
- The frequency of vaginal exams varies among care providers.
- A good rule of thumb is to perform a VE when the information is needed to make a decision.
- For example, if Marnie needs pharmacologic pain relief, then cervical dilatation helps determine which option is the best one.
- If Marnie has an urge to push, a VE helps to decide when to call the primary care provider.
68
What 4 data can be assessed during a vaginal exam (VE)?
- cervical position, and consistency,
- effacement and dilatation,
- station (minus 3,2,1, 0, plus 1,2, 3)
- presenting part (occiput)
- position of the fetus (LOA)
69
What are 6 care practices Lamaze outline to protect, promote and support normal birth?
- Labour begins on its own
- Freedom of movement and upright postures
- Continuous labour support
- Challenging routine interventions
- Spontaneous pushing in second stage
- No separation of mother and infant
70
What information nurses provide woman to encourage them to remain upright and moving around the room? What positions to be recommended to take advantage of upright posture and movement?
- let her know that baby needs to descend and rotate through the pelvis
- let her know that upright postures utilize gravity to make contractions stronger and more effective
- let her know that women tends to feel less pain when upright and require less interventions to promote labour progress
- upright positions include: walking, lunging, slow dancing (leaning on partner), sitting on birthing ball, sitting in a rocking chair
71
What are 4 factors included in Continuous Labour Support (CLS)? Who (4)?
Includes:
- physical and emotional support,
- education,
- advocacy,
- encouraging movement and vocalization, and
- attending to the care practices
- assisting the woman to manage the pain of labour
CLS shared by:
- nurse,
- partner,
- midwife and/or
- doula
72
What are 2 roles of nurses in supporting the woman's partner during labour process?
- demonstrating labour support strategies,
- providing reassurance and positive feedback, and
- encouraging the partner to get involved as much as they are willing and able
- reassure everyone on the room that things are progressing as they should be and that the woman is safe, strong and capable
73
What are doulas?
- doulas provide non-medical support to women and their families during labour, birth and postpartum.
- do not have any role or responsibilities in regards to assessments or documentation
- do provide advocacy, support for decision making, and hands on comfort measures
- ability to establish a relationship with their doula prior to labour enhances their coping ability
74
What is acronym P.A.I.N. in regards to understanding the pain of labour?
- P: purposeful
- A: anticipated
- I: intermittent
- N: normal
- care providers believe that we should not even use the word pain and should use words such as sensations, rushes, or surges to describe contractions
75
What are 4 non-pharmacological options should be employed during labour?
- relaxation
- breathing techniques
- massage
- effleurage
- application of heat and cold
- acupressure and acupuncture
- transcutaneous electrical nerve stimulation (TENS)
- water therapy
- various position changes
- intradermal sterile water injections
- music
- hypnosis
76
What are 4 advantages of using non-pharmacological options during labour?
- inexpensive
- not adverse neonatal effects
- provide woman with sense of control over her labour
- can be utilized by support people and doulas either at home or in hospital
77
What are 4 factors to be considered when deciding upon pharmacological method of pain management?
- gestational age of fetus
- any known compromises to fetal health
- reaction and well being of fetus during labour prior to drug administration
- projected length of labour
- timing and dosage of drug
- subsequent birth
78
What are the 3 pharmacological methods used during labour is divided into?
- inhalation analgesia (Enotonox: laughing gas)
- narcotic analgesia (morphine, fentanyl)
- regional analgesia/anaesthesia (epidural)
Analgesia is the relief of pain without the loss of consciousness or sensation using analgesics
- Anesthesia is the loss of physical sensation with or without loss of consciousness using anesthetics
- anaesthetics: Medicines that cause anaesthesia
79
What are 2 inhalation analgesia used for pain labour?
- Examples: Nitronox or Entonox consists of a mixture of 50% oxygen and 50% nitrous oxide.
- Entonox can provide moderate pain relief as well as relaxation and a sense of control
- The gas is rapidly excreted, the effects are not cumulative, and there are no known fetal/newborn effects.
- Administration is through a mask or mouthpiece, held by the labouring woman.
- Entonox takes approximately 50 seconds to reach maximum effect so women are instructed to start inhaling at the onset of a contraction, continue until the contraction starts to subside, then to stop using between contractions
80
What are 3 side effects of Entonox (inhalation analgesia)? 2 Advantages?
- side effects: dizziness, drowsiness, nausea, and vomiting
- advantages: increasing endorphins and dopamine which diminish pain and anxiety
81
What are 2 narcotic analgesia for pain labour? 4 Side effects? When is it useful to be used?
- opioids: fentanyl, morphine, demerol (same effect as morphine)
- side effects: sedation, nausea, vomiting, dizziness, hypotension, and respiratory depression
- useful in early stages of labour to help woman relax and even rest
82
What are 2 effects of woman using narcotic analgesia have on neonates?
- cross the placenta which may result in changes to the fetal heart rate and respiratory depression in the neonate
- can compromise the first few hours of life for the newborn
83
In early labour, what 4 non-pharmacological and 1 pharmacological interventions can be used?
- movement and positioning,
- hot and cold therapy
- touch: massage
- shower and bath
- TENS
MORPHINE (IM)
- provide pain relief and help woman rest during early labour
- works within 20-30 minutes and pain relief lasts up to 4 hours
- fetal effects should be minimal since Morphine has no active metabolites. Studies have shown no detectable umbilical cord levels if delivery is 3 hours or more after Morphine dosage.
- morphine can not be given during active labour b/c it stays in your body for several hours after and can have prolonged effect on baby
84
During active labour, what 4 non-pharmacological and 2 pharmacological interventions can be used?
- movement and positioning,
- hot and cold therapy
- touch: massage
- shower and bath
- TENS
STERILE WATER INJECTIONS:
- four doses of sterile water into lower back under skin
ENTONOX/ GAS or "laughing gas:"
- no risk to baby
FENTANYL IV
- crosses placenta and goes to your baby (baby may be sleep and not breathe well at birth).
- baby may have respiratory depression
- Works within minutes, but only lasts about 45-60 minutes
- shorting acting narcotic
PUDENDAL BLOCK
- local anesthetic (freezing): by needle into your vagina during second stage of labour just before baby is born.
- works rapidly
85
What is an epidural? 2 Benefits? 3 side effects?
- anesthesiologist insert a tube with small needle in the lower part of your back to deliver pain relief medicine during labour.
- epidural does not completely block all pain or pressure (particularly if you are in the late stages of labour)
Benefits:
- Fast pain relief (works within 10-40 mins)
- Allows you to walk around with support
- Allows you to rest and relax during parts of your labour
Side effects:
- itching,
- fever,
- shivering,
- lightheaded
- risks to baby: babys HR may decrease in first 30 minutes after an epidural
86
What is regional analgesia?
- epidural analgesia: ability to completely eliminate the sensation of pain for most women
- epidurals are used for pain relief,
- small doses of dilute solutions of local anesthetic, with or without a narcotic, are injected into the epidural space either in the form of intermittent injections (provider administered or patient controlled) or as a continuous infusion
87
What are 4 risks associated with epidurals?
- longer second stage of labour,
- increased risk of instrumental delivery,
- increased need for oxytocin
- augmentation,
- urinary retention, and
- maternal fever
- limited maternal mobility which may impact the progress of labour
- necessity for IV fluids and possibility of urinary catheterization
- increased risk of prolonged labour and instrumental delivery
- maternal and/or neonatal hyperthermia, and associated use of IV antibiotic therapy for possible/speculated infection
- maternal hypotension, respiratory distress, seizures or unconsciousness
- drug toxicity
- inadvertent spinal injection and post-anesthetic spinal headache lasting a few days
- infection
- nerve injury (very rare)
88
What are 4 nursing responsibilities associated with epidural analgesia?
- Assess progress of labour before the procedure
- Ensuring informed/signed consent prior to insertion
- Ensuring IV access
- Positioning of the woman during and after insertion
- Ongoing assessments of vital signs
- Ongoing assessments of fetal well-being
- Hourly assessment of sensory and motor block
- Ongoing assessment of pain relief
- Ongoing assessment of labour progress
89
How should a nurse determine what the best pain management option is for the women?
- need to know her intentions/birth plans
- inform her of all her options: risks and benefits
- start with the least intervention and continually assess the effect
- maternal and fetal well -being must be assessed along with the stage/progress of labour
- For example, a narcotic would not be a good option for a multip who is progressing quickly
90
What are 4 signs that second stage of labour has commenced?
- primary indicator of progress in the second stage is the descent of the fetal presenting part.
- woman feels rectal pressure, needs to push or wants to have BM
- shaking, restlessness, sweat on upper lip and vomiting
- woman may involuntarily bear down or grunt with contractions
- nurse may notice bloody show, bulging perineum, passage of stool
- Unless the fetal head is already visible, a VE may be done to determine that the cervix is fully dilated and that second stage has arrived
91
What are 4 assessment done by nurses during the second stage of labour?
- ongoing assessments of maternal and fetal well-being, labour progress, and maternal adaptation and coping
- Maternal vital signs hourly
- Fetal heart rate q5minutes or after every contraction
- Monitoring contraction strength, frequency, duration
- Monitoring descent of the presenting part
- Monitoring the woman’s pushing strength and effectiveness
- Assessing pain and coping
92
What indicators supports physiologic spontaneous pushing? Station? Position of presenting part?
- the presenting part (occiput) should be at station +2
- the position of the presenting part should be occiput anterior (OA), and
- the woman should have an urge to push
- Without these indicators, she can wait up to 2 hours before pushing commences
93
What are 4 positions woman can be in to push effectively?
- lying on her side
- sitting on the toilet
- squatting
- semi-fowlers position
- important to try a variety of positions in order to promote rotation and descent of the fetus
- good idea to change her position frequently (approximately every 20 minutes) and assess the effectiveness of her pushing in different positions
94
What is the difference of spontaneous pushing and direct pushing?
- encouraged to push spontaneously rather than to hold their breath and push for as long as they can
- Directed pushing is associated with increased maternal fatigue, fetal hypoxia, perineal trauma, and increased risk of pelvic floor damage which can affect women later in life
- Spontaneous pushing leads to more effective pushing and less time actively pushing than directed pushing
95
What marks the onset of third stage of labour? Lasting how long?
- birth of the baby marks the onset of the third stage of labour, lasting until delivery of the placenta and membranes.
- This stage may last only a few minutes; however, it could last for up to 30 minutes.
96
What are 4 signs of placental separation?
- A firmly contracted fundus
- Change in shape of uterus from discoid to globular
- A sudden gush of blood
- Apparent lengthening of the cord
- A feeling of vaginal fullness
- A woman who wants to push again
97
What is involve in active management of preventing postpartum hemorrhage (PPH)?
- administering 10 IU oxytocin with delivery of anterior shoulder to contract the uterus
- gentle controlled traction of the cord
- counter pressure to support uterus to assist with delivery of placenta
98
What are 2 benefits of delayed cord clamping as per SOGC (2015)?
- enhanced placental transfusion at birth (more blood volume going to infant)
- increased Hgb, hematocrit and ferritin levels up to 6 months of age
99
What maternal assessments must a nurse do right after birth of baby?
- Assess for signs of placental separation
- Vital signs q15minutes for the first hour
- Assess fundus and flow q15 minutes
- Assess for pain
100
What neonatal assessments must a nurse do right after birth of baby?
- Apgar score at 1 and 5 minutes
- Vital signs within 15 minutes of birth
- Vital signs hourly until stable temperature
- Head to toe assessment
- Assess readiness to feed
101
What is the APGAR score?
- Within one minute of birth, a rapid assessment of the infant’s breathing effort, tone, heart rate, reflex irritability, and color are assessed.
-an APGAR scored is assigned
- APGAR scoring is completed again at 5 minutes of life
102
What is skin to skin? What does skin to skin promote?
- where the naked infant is placed on the naked chest of the mother, then covered with a warm blanket
- promotes physiologic stability and transition to extra-uterine life for the neonate
- physiologic stability for the mother
- promotes the release of oxytocin which encourages uterine contraction, attachment, and supports successful breastfeeding
103
What is considered the fourth stage of labour?
- the first few hours after birth (2hours common the accepted time)
- this period is one of acquaintance, adjustment, and stabilization
104
Labour is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which are the other four factors?
- Passageway,
- powers (contractions),
- maternal position,
- psychological response
105
Where is the best place for the healthy term infant to be in the first hour of life is?
- Skin to skin with his/her mother to support transition
