Week 4: Labour and Birth Process

Question 1

what is labour

Answer 1

process of moving the fetus, placenta, and membranes out of the uterus and through birth canal

Question 2

signs of preceding labour (9)

Answer 2

1. lightening/dropping
2. urinary frequency
3. backache
4. stronger braxton hicks contraction
5. weight loss of 0.5-1.5kg
6. surge of energy/nesting
7. increased vaginal discharge, bloody show
8. cervical ripening
9. possible membrane rupture

Question 3

possible causes of onset of labour

Answer 3

• changes in maternal uterus, cervix, and pituitary gland (maternal and fetal)
• ↑ estrogen, oxytocin, prostaglandins
• ↓ progesterone

Question 4

what hormones are involved in onset of active labour

Answer 4

• ↑ endorphins (pain management)
• ↑adrenaline (alertness and energy)
• ↑prolactin (milk supply, maternal attachment)

Question 5

5-1-1 rule / 4-1-1 rule

Answer 5

• helpful for patients to know when to seek medical attention
• active labour
• contracting every 5 minutes
• contractions lasting at least 1 minute in length
• pattern is regular for 1 hour

Question 6

signs of pre-labour

Answer 6

contractions: irregular, stop with walking, felt in back or abdomen

cervix: soft but no significant dilation or effacement, posterior

Question 7

signs of true labour

Answer 7

contractions: regular, stronger, last longer, closer together. More intense with walking, lower back and radiate to lower abdomen

cervix: changes to softening, effacement, dilation. anterior, bloody show

Question 8

what are the 4 cardinal questions when assessing progress of labour

Answer 8

1. vaginal discharge
2. bleeding / membrane rupture
3. contractions
4. fetal movement

Question 9

effacement

Answer 9

shortening and thinning of cervix during 1st stage of labour

Question 10

presentation

Answer 10

part of fetus entering brith canal first

Question 11

dilation

Answer 11

enlarging and widening of the cervical canal

Question 12

engagement

Answer 12

largest transverse diameter of presenting part has passed through pelvic inlet into pelvic cavity

Question 13

crowning

Answer 13

head or presenting part appears at vaginal opening

Question 14

station

Answer 14

relationship of presenting part to imaginary lines between maternal ischial spines
- measures the degree of descent
- +5/-5

Question 15

5 factors affecting labour

Answer 15

5 Pees !!!

1. passenger (fetus and placenta)
2. passageway (birth canal)
3. powers (contractions)
4. position (of mother)
5. psychological response

Question 16

what factors do we need to consider when speaking about passenger

Answer 16

1. size of fetal head
2. fetal presentation
3. fetal lie
4. fetal attitude
5. fetal position

Question 17

fetal lie

Answer 17

• longitudinal: cephalic or breech (up/down)
• transverse: axis of fetal spine directly across maternal spine (sideways)

Question 18

fetal attitude

Answer 18

• relationship of fetal body parts to one another
• flexion / extension
• we want flexion

Question 19

explain the 3 letter abbreviation for fetal position

Answer 19

1. presenting part on right or left of mother’s pelvis
2. presenting part (O = occiput, S = sacrum, M = mentum/chin, Sc = scapula)
3. Location of the presenting part in relation to the anterior (A), posterior (P) or transverse (T) portion of the maternal pelvis.

Question 20

what is ROP

Answer 20

right occiput posterior
- spine along right side, occiput (back of head) is facing the posterior (back)
- sunny side up, coming out face UP

Question 21

What is ROA

Answer 21

Right occipitoanterior
- spine along right, occiput facing front of mom (baby face facing back)
- coming out face DOWN

Question 22

what are the more favourable positions of the head for vaginal birth and why

Answer 22

LOA and ROA
- due to the diameter of the head

Question 23

explain frank breech position (including lie, presentation, presenting part, attitude)

Answer 23

GYMNAST (pike jump) or think frank the diver
- lie: longitudinal/vertical
- presentation: breech incomplete
- presenting part: bum/sacrum
- attitude: flexion, except for legs at knees

Question 24

explain single footling breech (including lie, presentation, presenting part, attitude)

Answer 24

one leg out ruh roh
- lie: longitudinal/vertical
- presentation: breech incomplete
- presenting part: bum/sacrum
- attitude: flexion, except for one leg extended at hip and knee

Question 25

explain complete breech (including lie, presentation, presenting part, attitude)

Answer 25

- lie: longitudinal/vertical - presentation: breech complete - presenting part: bum with feet - attitude: general flexion

Question 26

explain shoulder presentation (including lie, presentation, presenting part, attitude)

Answer 26

- lie: transverse or horizontal - presentation: shoulder - presenting part: scapula - attitude: flexion

Question 27

explain the passageway / birth canal

Answer 27

- bony pelvis - lower uterine segment - cervix - pelvic floor muscles - vagina - introitus (external vagina opening)

Question 28

what is the difference between primary and secondary powers

Answer 28

primary: effacement, dilation, ferguson reflex - more of a innate/uncontrollable power secondary: bearing down efforts - individual is more in control

Question 29

how does positioning impact the labouring patient

Answer 29

- affects anatomic and physiologic adaptations to labor - frequent changes needed to relieve fatigue, increase comfort, improve circulation

Question 30

what are some important factors regarding psyche impacting labour

Answer 30

- supports - preparation - environment

Question 31

what is the duration of a contraction

Answer 31

from the beginning to the end of one contraction

Question 32

what is the frequency of contraction

Answer 32

from the beginning of one contraction to the beginning of the next one - so you include the duration and the relaxation periods

Question 33

why do we need relaxation inbetween contractions?

Answer 33

fetal oxygenation - placental perfusion is diminished due to contraction so when we relax it allows blood flow to baby and build up reserve for next contraction

Question 34

what are the 2 phases within stage 1 of labour?

Answer 34

latent/early phase - cervix dilation 1-3 cm - 6-8h - contractions mild/moderate, irregular, q5-30 min, 30-45 sec - brownish discharge, mucous plug active phase - 4cm in nulliparous - 4-5cm in multiparous - 3-6h - contractions moderate/strong, regular, q2-5 in, 40-90sec - pink/bloody mucous

Question 35

how do we confirm that it is amniotic fluid leaking?

Answer 35

nitrazine swab to pick up pH changes (yellow = intact, blue = ruptured) gold standard: ferning

Question 36

What are the 4 key points of nursing care in 1st stage?

Answer 36

- family centered approach (genogram) - triage assessment - admission data - unit and healthcare team orientation

Question 37

explain the key aspects of communication guidelines during labour and birth

Answer 37

- be calm and confident - determine how we can best support them - focus on speaking to patient: be attentive and spend time for 1:1 support - welcome patient family/support - ask about feelings and concerns - discuss birth plan - ask for permission before procedures

Question 38

what are some admission data we may collect?

Answer 38

- GTPAL status - confirm EDD - risk factors - GBS status, past OB history - medications - vitals, contractions, symphysis fundal height - fetal presentation - fetal heart rate, cervical exam - Bishops score

Question 39

Why and when do we screen for Grp B streptococcus ? what are the risk factors associated?

Answer 39

- 35-38 weeks - concerned with transmission from mother to baby - if +, we give prophylactic antibiotics to avoid neonatal sepsis - risk factors: preterm birth, PPROM > 18h, intrapartum maternal fever, early onset of neonatal GBS

Question 40

why do we examine for herpes simplex virus? what are some treatments?

Answer 40

- determine if vaginal birth is possible (if lesions are present = do not give vaginal birth due to transmission) - treatments: acyclovir, valacyclovir to suppress HSV close to birth - active HSV = undergo c-section

Question 41

Nursing care for membrane rupture

Answer 41

COAT - colour, odour, amount, time

Question 42

what are some physical assessment we do on admission?

Answer 42

- vitals - leopold's maneuver (determine position/lie) - FHR and pattern - uterine activity (contractions) - vaginal exam (dilation, effacement, internal os) - urinalysis (protein for eclampsia) - blood work (Rh factor, CBC, coagulation)

Question 43

what are the maternal physiological adaptations during labour

Answer 43

- ↑ CO, HR / RR (slight) - ↑ BP during contractions - ↑ WBC - ↑ TEMP (low grade - dehydration/epidural) - proteinuria up to +1 (concern preeclampsia +3/4) - ↓ gastric motility - N/V during active - ↓ blood glucose - ↑ endorphins

Question 44

what are the fetal physiological adaptations during labour

Answer 44

- FHR: 110-160, influenced by perfusion and maternal positions - circulation stops during contractions - fetal resp: oxygen pressure decreases, arterial CO2 increases, arterial pH decreases, bicarbonate levels decrease

Question 45

what is the importance of respiratory acidosis of the fetus before birth?

Answer 45

allows medulla to initiate respiratory effort after birth

Question 46

when does stage 2 of labour begin?

Answer 46

when fully dilated (10cm) and complete effacement (100%)

Question 47

what are the 2 phases of stage 2 labour

Answer 47

passive: fully dilated, waiting for further descent of fetus active: urge to bear down and push

Question 48

what is the duration influenced by and what are the durations of nulliparous and multiparous?

Answer 48

influences: - parity - maternal size - fetal weight - position and descent nulliparous: 50-60 min multiparous: 20-30 min

Question 49

what are the signs that suggest onset of 2nd stage

Answer 49

- urge to push - vomiting - increased blood show - shaking extremities - verbalizing "i cannot do this" - bowel movements

Question 50

explain labour arrest and when do decisions to birth plans change?

Answer 50

- prolonged 2nd stage - 3h in nulliparous - 2h in multiparous

Question 51

what does prolonged 2nd stage increase rates of?

Answer 51

- operative births and complications

Question 52

what is the nursing care in the second stage? (consider care in passive and active phases)

Answer 52

- vitals q5-30 min - FHR q5 min - contraction pattern, bearing down efforts - Passive: promote rest, position changes - active: bearing down efforts, pericare, coaching and supporting - calm and quiet environment - get oxytocin ready

Question 53

what occurs in the 3rd stage of labour

Answer 53

delivery of placenta goal is to promptly separate and expel placenta

Question 53

why is the oxytocin shot given?

Answer 53

to facilitate placenta separation and expulsion - active management

Question 53

when do we consider a retained placenta

Answer 53

if stage is longer than 30 mins - if we notice hemorrhaging

Question 54

what is the nursing care in 3rd stage

Answer 54

- skin to skin and delay cord clamping - maternal vitals q15 min - assess bleeding and signs of placental separation (abdominal shape change to globular and firm) - instruct push when sign of placental separation (dark blood gush, cord lengthening, uterus change)

Question 55

what does delayed clamping do?

Answer 55

allow for blood from placenta to go to baby - prevents anemia in newborns - life saving effort for preterm babies

Question 56

what is the 4th stage of labour

Answer 56

1-2h after birth and placenta delivery - mother's body functions begin to stabilize

Question 57

what is the nursing care in the 4th stage of labour

Answer 57

- vitals q15 min for 1st hour - fundal assessment (boggy = increased hemorrhage risk) - encourage voiding - observe lochia (vaginal discharge - if >500mL = hemorrhage) - assess perineum - assess lacerations - encourage breast feeding during first "golden hour"