Term
| Define Antepartum, Intrapartum, and Postpartum |
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Definition
Antepartum: between conception and labor (prenatal)
Intrapartum: from onset of labor to moment of birth
Postpartum: from birth until women's body returns to prepregnancy condition |
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Term
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Definition
Causes Contractions
Increases
Love, trusting, calming, pain threshold, openness to touch, fosters love of infant and creates emotional bonds
Decreases
Muscle tension
Decreased by
Narcotics (demerol, stadol), Restricting food and drink (NPO in L/D is not evidence based practice), epidurals (increases length of labor), C/S, Pitocin, Separation from baby
--These interventions take away the body's ability to produce hormones to get through birth |
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Term
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Definition
Prolactin
– Stimulates endorphin release
– Milk production
– Assists with late fetal lung maturation
– Calming effect on mom and infant
• Decreased by
– Catecholamines (produced in response to stress; we need to decrease the mother's anxiety and stress for labor to progress)
– Separation from baby |
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Term
| Describe Beta-endorphins: |
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Definition
Beta-Endorphins – "runner's high"
– Body's pain killers
– Reduces pain perception
– Produces a “runners high”
– Activates the immune system
– Increases prolactin release
• Decreased by
– Narctoics (Stadol, Demerol)
– Opiate antagonists (drugs)
– Cesarean birth |
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Term
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Definition
Catecholamines
– Stress hormones "Fight or Flight" NOT helpful
– Increases HR and R
– Digestion slows
– Blood to skeletal
muscles and vital organs
– Maternal aggressiveness
– Forgetfulness
• Decreased by
– Opiates (need to find a balance between relieving anxiety with opiate drugs, but not so much that labor is slowed down)
– Cesarean birth |
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Term
| What are the critical factors of labor? |
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Definition
Power (contractions)
Passage:
Passenger
Psychosocial
Position |
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Term
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Definition
Three uterine muscle layers must contract in unison to be true contractions.
One or two layers contracting is Braxton Hicks.
Mild: Nose
Moderate: chin
Transitional labor: forehead
Contractions are measured by Duration (from beg to end) Frequency (from beg to beg) and intensity (nose, chin, forehead) |
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Term
| What are the three processes that must happen for labor to progress? |
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Definition
Contractions of the uterus, squeezes and results in dilation and effacement
Dilation of the cervix 0-10 cm
Effacement of the cervix (goes from 2.5 cm thick (like a donut) to completely effaced (like a crepe) |
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Term
| Why is resting period between contractions vital? |
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Definition
| The resting period is the time allowed for placental perfusion - oxygenation to baby |
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Term
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Definition
True Pelvis: through the pelvic inlet, past the ischial spines, past the coccyx
False: between the ileum
• Soft Tissues
– Cervix
– Vagina
– Pelvic floor |
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Term
| WHat are the types of pelvises? |
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Definition
Gynecoid: BEST (rounded)
ANdroid: narrow, like a boys, increased C/S, forceps
ANthropoid: oval, generally adequate
Platylelloid: flat, can delay labor |
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Term
| Passenger Considerations: |
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Definition
Fetal head diameter
Fetal attitude
Fetal lie
Fetal presentation |
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Term
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Definition
Best position is suboccipitobregmatic: easiest to fit, 9.5 cm
Supraoccipitomental is facial presentaion, 13.5 cm, C/S
Occipto-frontal diameter could delay labor: 11 cm |
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Term
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Definition
Relationship of how baby's head, arms and legs are in teh pelvis
Flexion: chin tucked into chest (WANT)
Extension: not conducive to vaginal delivery (increased C/S) head pulled back with chin up |
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Term
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Definition
RElationship between mom and baby's spine (long axis vs long axis)
Longitudinal lie : WANT
Transverse lie: no vaginal delivery this way, always a C/S |
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Term
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Definition
Vertex: (cephalic) 96% of births, complete flexion; can feel posterior fontanelle
Military: head and neck are more straight, longer labor; moderate flexion, can feel anterior fontanelle
Brow: Poor flexion, can feel anterior fontanelle adn some face
Face: full extension; can feel the face
Occiput:
-ROA and LOA are the best presentations
-RIght occipital posterior and Left occipital posterior are sunny side up |
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Term
| What are the fontanelles? |
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Definition
Anterior: diamond shaped
Posterior: triangle shape
These are landmarks used to determine baby's position in the pelvis (you want to feel the posterior fontanelle)
MOLDING of the head can occur as sutures overlap to allow baby through birth canal, and begins to resolve within 12 hours of birth |
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Term
| Describe breech presentatioN |
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Definition
Categorized as the flexion/extension of the hips/legs; occurs in 3-4% of births adn is rarely a surprise
Frank: hips flexed, knees extended (legs straight up, feet by face)
Footling: one foot down in birth canal (indian style except one foot is dangling); most serious complication is umbilical cord prolapse
Complete: flexion of hips and knees (sitting indian style on the cervix) |
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Term
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Definition
How far down is the baby's head engaging in the pelvis?
Baby's head does not go back up unless there is a problem! |
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Term
| What are the psychosocial aspects of labor? |
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Definition
Readiness of both parents; fears, anxiety, birth fantasies, support
Culture: sick state vs good process
Expectations: communication with the Dr
Previous experiences
Significant others: can be helpful or bad
Fear of losing control: nurse's role to reassure pt
Failure to meet expectations of others
THINKING can greatly impact labor
Fears, anxieties, birth fantasies (dreams of baby), support
Unexpected events/pain/Dr on call
Influences:
Childbirth prep class
coping mechanisms
Previous experience (research supports reltaionship between birth experience and mothering behavior)
--This includes fathers, hormones are released when they hold the baby!
Culture
Support system |
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Term
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Definition
Through history women labored upright
• Bed rest a 20th century norm
– hospitalization
– physician care
– medical/surgical interventions
Upright position – stronger more effective
contractions and addition of gravity
Frequent position changes
-relieves fatigue, improves circulation,
help the baby rotate and progress through
the birth canal
-The freedom to move spontaneously is
fundamental to maintaining normalcy in
birth
-Squatting straightens long axis, better bearing down reflex, increased oxytocin release (Ferguson Reflex)
Improve uteroplacental circulation
• Encourage stronger contractions
• Increase maternal comfort
• Fewer FHT abnormalities
From Research
– shorter labor (?), less pain meds, less
labor stimulation (pitocin), maternal control, greater satisfaction |
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Term
| Cardinal Movements of Labor: |
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Definition
Descent
Flexion
Internal Rotation
Extension
Restitution
External Rotation |
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Term
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Definition
Descent:
-Fetus moves downward and head rotates to OA
– Head enters inlet in OT position
– Measured by station
- Pressure from fundus and amniotic fluid pushed baby down |
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Term
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Definition
Flexion
– As baby descends she encounters the pelvic floor muscles
– The resistance helps flex the head (chin to chest) to bring the smaller diameter into and out of the pelvis
Extension: see with crowning
-Resistance of pelvic floor and mom's pushing (anterior opening) cause the head to go through the pubic arch toward the vaginal opening. Occiput is delivered, head extends, and head, face, and chin are delivered |
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Term
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Definition
Internal Rotation
– Baby's head turns further to face the
mother's back and enable passage
through the ischial spines
– OA is the optimal rotation to
help with the next step |
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Term
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Definition
Shoulders are still inside birth canal
(obliquely), due to internal rotation,
neck is twisted.
Once head emerges through the opening, the head starts to extend, and will rotate to one side and neck untwists to get back into alignment. |
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Term
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Definition
As the shoulders turn, you will see
the baby‟s head turn further to the
side to realign with the shoulders |
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Term
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Definition
see gentle pressure downward to allow
the the upper shoulder to pass
under the pubic arch and then
upward to deliver the rest of the
baby's body |
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Term
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Definition
| Shoulder of baby caught on the pubic symphysis, RARE but OB EMERGENCY |
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Term
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Definition
Signs of Impending Labor
– Lightening
– Braxton Hicks contractions
– Cervical Changes; softens, slight dilation
– Sudden burst of energy (meant for nesting)
– Bloody show
– Rupture of membranes
- PROM 37 weeks or earlier; does not mean birth has to happen within 24 hours, BUT increased risk of infection |
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Term
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Definition
-Contractions are irregular
-No change in interval, duration,
intensity
-Discomfort mainly in abdomen
-Walking has no effect or decrease in contractions
No cervical changes |
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Term
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Definition
- Regular contractions
- Interval are regular, and gradually increase
- Duration and intensity increase
- Discomfort in back and radiates to
front
-Progressive cervical dilation and effacement **
- Walking increases intensity (CARDINAL SIGN)
- Only way to know for sure is with a vaginal exam |
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Term
| True Labor Characterized by: |
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Definition
Progressive cervical dilatation and effacement
HALLMARK SIGN |
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Term
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Definition
1: Dilation: early, active, transition
2: Pushing and Birth (prolonged Stage II = increased PPH risk)
3: Placenta Delivery
4. 1-4 hours post delivery |
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Term
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Definition
1. Contractions
- 30 to 3 min X 20 to 40 sec
– Start mild and progressive stronger (nose feel to the fundus)
2. Dilatation 0-3 cm
-nullipara: 8.6 - 20 hours
-Multipara: 5.3-14 hours
Woman is excited, nervous, teachable |
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Term
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Definition
- Most moms come to the hospital in this stage
- Contractions 2-5 min x 40-60 seconds
- Dilation 4-7 cm
Time:
-Nullipara: 4.6 hours
-Multipara: 2.4 hours
Mom needs reassurance, support, introverted
Not so important to know the exact dilation of the mom because you treat the S/S, not the dilation |
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Term
| Stage I Transitional Phase |
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Definition
Contractions 1-2 min x 60-90 seconds
Dialtion 8-10 cm
Time:
-Nullipara: up to 3 hours
-Multipara: 0-30 min
Mom: totally on body/self/labor, needs focused care from the nurse (NOT a teachable time) |
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Term
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Definition
Begins with full 10 cm of the cervix
Ends with birth of baby
"Pushing" stage rectal pressure; increased bloody show, urge to push
Vaginal Birth has 300-500 cc less blood loss |
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Term
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Definition
Placental separation; rise of the fundus, sudden gush of blood, protrusion of the umbilical cord
-Typically within 10-30 min
-Pitocin may be given to increase contractions
-BF will increase oxytocin and contractions
"Shiny Shultze" smooth baby side
"Dirty Duncan" livery, beefy mom side
Ends with delivery of the placenta |
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Term
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Definition
1-4 hours post delivery
ASsess q15 min
-VS
-Fundus: should be midline, firm, between pubic symphosis and umbilicus
-Lochia, monitor for large clots
-Perineum: episiotomy = swelling, ice packs
-Bladder fullness; uterus will not involute with a full bladder
Time for mom/dad/baby to bond
BF important here!
HUGE risk for PPH
Can hemorrhage from a vaginal hematoma
Constant trickle of red blood indicates a cervical laceration |
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Term
| Cardiovascular response to labor: |
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Definition
Increased cardiac output with contractions: redistribution of 300-500 cc to periphery with each contraction = increased BP (do not take a blood during a contraction)
Position can increase output:
-side lying increases output by 22%
-Supine increases output by 25% and increases BP while decreasing HR
Pusing increases intrathoracic pressure = increased cardiac output and blood pressure with decreased HR
Increased BP by:
-Aortocaval compression
-Supine, multiple, narcotics, epidural, dehydration
-Nausea, increased HR, diaphoresis, weakness, air hunger, fear, pain, anxiety, tension |
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Term
| FLuid and Electrolyte changes in Labor |
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Definition
Water loss
-Diaphoresis
-Hyperventilation (increased muscle activity (increased temp)
Maintain hydration: oral or IV fluids |
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Term
| Respiratory changes in Labor |
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Definition
Oxygen demand and use increases
-Appx 50% is used by placenta in labor (contractions, pain/anxiety, hyperventilation)
-All add to mild metabolic acidosis compensated by respiratory alkalosis (resolves in Stage IV) |
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Term
| Renal changes system in labor |
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Definition
Base of bladder is pushed forward and upward
Proteinuria is possible
Urine may become concentrated or polyuria may develop (due to increased CO and increased filatration rate)
Slight hematuria may result and is normal (although hard to distinguish if not using a catheter) |
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Term
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Definition
Motility and absorption decrease (but never stop completely), emptying time increases due to narcotics (eat lightly)
Acidity increases
No hypertonic glucose in the IV = hypoglycemia 2-4 hours after birth for baby
Not uncommon to see the transition phase barf = unpleasant, but can help baby move down |
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Term
| Immune system changes in labor |
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Definition
WBC increase to 25,000 - 30,000 (especially neutrophils) due to physiologic stress (normal without other signs of infection)
Blood glucose decreases in labor = decreased need for insulin
-Glucose if the enegry source for contractions
-Diabetic pt is considered high risk |
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Term
| Maternal muscularskeletal system |
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Definition
Softening of cartilage
MOther may have increased back pain or achy pubic pain when walking or turning |
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Term
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Definition
Involves pain perception
Uterine and cervical nerve plexus in labor
Perineal nerves stimulated by birth |
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Term
| How labor affects the fetus |
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Definition
HR: decels can occur; may indicate a poor response to labor
ACid Base status: cord blood sample taken at birth
-decreased blood flow = decrease in fetal pH
-persistant acid-base imbalance = multi organ dysfunction
-pH below 7.2
-alkaline pH is good!
Hemodynamic changes: fetal/placental reserve
-perfusion happens during the rest between contractions
Behavioral states
-Quiet 40 min or less (decreased variability) can be okay, may be sleeping
-Active |
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