NUR114 CH9

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Author:
TomWruble
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182831
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NUR114 CH9
Updated:
2012-11-14 11:35:28
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nur114e2 Labor Birth Processes
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Labor and Birth Processes
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  1. The five Ps affect the processes of labor and birth:
    • Passenger (fetus)
    • Passageway (birth canal)
    • Powers (contractions)
    • Position of the mother
    • Psychologic response.
  2. Several factors affect the way the passenger, or fetus, moves through the birth canal:
    • the size of the fetal head
    • fetal presentation
    • fetal lie
    • fetal attitude
    • fetal position
  3. Presentations?
    Head, face (96%), breech (buttocks or feet 3%) or shoulder (1%)

    Note Occiput presentatons are noted as Vertex
  4. Fetal "Lies"
    • Longitudinal or vertical
    • Transverse, Horizontal or Oblique (uncommon and usually converts to longi during labor)
  5. Possible occiput Positions and frequency
    • LOA: left (baby's spine) Anterior - most common
    • ROA: 2nd most common
    • LOT: transverse
    • ROT
    • LOP: posterior
    • ROP

    Posteriors will usually result in maternal back pain during labor because of the spine to spine condtion.
  6. Fetal attitude (most common?)
    General flexion ("cannonball"), including head to chest so that the smallest diameter or Suboccipitobregmatic diameter enters the true pelvis.

    Other attitudes include "Flexion, except for legs at knees" and "Flexion, excvept for one leg extended at hip and knee)
  7. Fetal Position
    • Three letters:
    • 1st: R or L - side of the presenting part
    • 2nd: O/occiput, S/sacrum (bottom, including single footling breech), M/mentum (chin), and Sc/scapula
    • 3rd: relation of presentig part to maternal pelvis - Anterior, Transverse, or Posterior
  8. Station
    Position of lowest portion of presenting part relative to the ischial spines. Note 1 cm ABOVE is noted at -1.

    Birth is imminent when the presenting part is +4 to +5
  9. The mother’s rigid bony pelvis and soft tissues of the cervix, pelvic floor, vagina, and introitus make up the ___, or birth canal.
    passageway
  10. Involuntary uterine contractions, called the ___, signal the start of labor. After cervical dilation, voluntary bearing-down efforts, called the ___, augment the force of the involuntary contractions.
    • primary powers
    • secondary powers
  11. The ___ begins with the onset of regular uterine contractions and ends with complete cervical dilation.
    first stage of labor
  12. The ___ begins with complete cervical dilation and ends with the birth of the infant.
    second stage of labor
  13. The ___ are engagement, descent, flexion, internal rotation, extension, external rotation (or restitution), and birth by expulsion.
    cardinal movements of the mechanism of labor
  14. Fetal physiologic adaptations to labor include changes in ___, ___, and ___.
    • heart rate
    • circulation
    • respiration
  15. Maternal physiologic adaptations to labor include ___ changes.
    • cardiovascular
    • respiratory
    • renal
    • integumentary
    • musculoskeletal
    • neurologic
    • gastrointestinal
    • endocrine
  16. T/F: If mom ate before delivery she is likely to vomit.
    True
  17. Vital sign not to be collected dir UC?
    BP
  18. A primigravida asks the nurse about what signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe:

    A. Weight gain of 1 to 3 pounds.
    B. Fatigue and lethargy.
    C. Bloody show.
    D. Quickening.
    C. Bloody show.

    Riley says this is not a sign of impending labor, especially in primips.
    (this multiple choice question has been scrambled)
  19. Women usually experience a weight ___ of ___ when the onset of labor is getting close.
    • loss
    • 1 to 3 pounds
  20. Quickening is the perception of fetal movement by the mother, which occurs at ___.
    16 to 20 weeks of gestation
  21. T/F Women usually experience a burst of energy or the nesting instinct just before labor begins.
    True
  22. Passage of the mucous plug (operculum), also termed pink/bloody show, occurs as the ___.
    cervix ripens
  23. The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be:

    A. Progressive uterine contractions.
    B. Lightening.
    C. Rupture of membranes.
    D. Passage of the mucous plug (operculum).
    A. Progressive uterine contractions.
    (this multiple choice question has been scrambled)
  24. ___ are the definitive sign of true labor.
    Regular, progressive uterine contractions that increase in intensity and frequency
  25. Hormones produced by the ___ hypothalamus, pituitary and adrenal cortex probably contribute to the onset of labor.
    normal fetal
  26. Of the 4 stages of labor, the ___ is the longest.
    first
  27. A labor is considered "normal" when the woman is ___ term, there are no complications, a single fetus presents by ___, and the labor is completed within ___ hours.
    • at or near
    • vertex
    • 18
  28. Lightening is a premonitory sign indicating that the onset of labor is getting closer. It usually occurs ___ before the onset of labor in nulli's, but in multi's ___.
    • 2 weeks
    • it may not take place until after uterine contractions are established and true labor is in progress
  29. Lightening can ___, but will also ___.
    • make a woman feel less congested - make breathing easier
    • increase pressure on the bladder leading to a rerturn of urinary frequency
  30. Lightening
    is a sensation of decreased abdominal distention as the presenting part and uterus descend into the pelvis. Usually 2 weeks before onset of labor in nulli's.
  31. Rupture of membranes (ROM) usually occurs during ___.
    the transtion phase of the first stage of labor
  32. Passage of the mucous plug is a premonitory sign indicating that the ___.
    onset of labor is getting closer
  33. On completion of a vaginal examination of a laboring woman, the nurse records the following: 50%, 6 cm, –1. What is a correct interpretation of this data?

    A. The fetus has achieved passage through the ischial spines.
    B. Dilation is 50% completed.
    C. The fetal presenting part is 1 cm above the ischial spines.
    D. Effacement is 4 cm from completion.
    C. The fetal presenting part is 1 cm above the ischial spines.
    (this multiple choice question has been scrambled)
  34. What position would be least effective when the intent is to use gravity to assist in fetal descent?

    A. Lithotomy
    B. Kneeling
    C. Sitting
    D. Walking
    A. Lithotomy
    (this multiple choice question has been scrambled)
  35. Laboring positions that help align the fetus with the pelvic outlet and allows gravity to assist in fetal descent.
    Kneeling, sitting and walking
  36. With regard to factors that affect how the fetus moves through the birth canal, nurses should be aware that:

    A. The normal attitude of the fetus is called general flexion.
    B. The fetal attitude describes the angle at which the fetus exits the uterus.
    C. Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother.
    D. The transverse lie is preferred for vaginal birth.
    A. The normal attitude of the fetus is called general flexion.
    (this multiple choice question has been scrambled)
  37. Vaginal birth cannot occur ___.
    if the fetus stays in a transverse lie
  38. Which description and percentage of occurrence of a basic pelvis type in women is correct?

    A. Android: resembling the male; wider oval; 15%
    B. Platypelloid: flattened, wide, shallow; 3%
    C. Gynecoid: classic female; heart shaped; 75%
    D. Anthropoid: resembling the ape; narrower; 10%
    B. Platypelloid: flattened, wide, shallow; 3%
    (this multiple choice question has been scrambled)
  39. The ___ shape is the classic female shape, ___; about ___% of women have this shape.

    Usual mode of birth?
    • gynecoid
    • slightly ovoid and rounded
    • 50

    Vaginal spontaneous occipitoanterior
  40. An ___, or malelike, pelvis is ___; about ___% of women have this shape.

    Usual mode of birth?
    • android
    • heart shaped
    • 23

    Cesarean or vaginal, difficult w/ forceps
  41. An ___, or apelike, pelvis is ___; about ___% of women have this shape.

    Usual mode of birth?
    • anthropoid
    • oval and wider
    • 24

    Vaginal, forceps, or spontaneous occipitoanterior or posterior
  42. A ___  and uncommon pelvis is ___; about ___% of women have this shape.

    Usual mode of birth?
    • platypelloid
    • flattened, wide, and shallow
    • 3

    Vaginal spontaneous
  43. The slight overlapping of cranial bones, or shaping of the fetal head, that occurs during labor is called:

    A. Ferguson reflex.
    B. Lightening.
    C. Molding.
    D. Valsalva maneuver.
    C. Molding.
    (this multiple choice question has been scrambled)
  44. The ___ is the contraction urge of the uterus after stimulation of the cervix
    Ferguson reflex
  45. What factors influence cervical dilation? Choose all that apply.

    A. Strong uterine contractions
    B. The force of the presenting fetal part against the cervix
    C. The size of the female
    D. The pressure applied by the amniotic sac
    E. Scarring of the cervix
    A, B, D, E

    Pelvic size does not affect cervical dilation.
  46. Pelvic size does or does not affect cervical dilation.
    does not
  47. Pressure exerted by the amniotic fluid while the membranes are intact can or cannot promote cervical dilation.
    can
  48. Scarring of the cervix as a result of a previous infection or surgery may or may not slow cervical dilation.
    may
  49. Pressure exerted by the presenting part of the fetus promotes or does not promote cervical dilation.
    promotes
  50. Dilation of the cervix occurs by way of ___, which is caused by strong uterine contractions.
    the drawing upward motion of the musculofibrous components of the cervix
  51. asynclitism
    Oblique presentation of the fetal head at the superior strait of the pelvis; the pelvic planes and those of the fetal head are not parallel

    Instead of the baby putting their hat (pelvic) on straight or synclitic, it is cocked (hat closer to one ear than the other).
  52. fetal attitude
    Relationship of fetal parts to each other in the uterus (e.g., all parts flexed or all parts flexed except neck extended)
  53. fontanels
    Broad areas, or soft spots, consisting of a strong band of connective tissue contiguous with cranial bones and located at the junctions of the bones
  54. station
    Relationship of the presenting fetal part to an imaginary line drawn between the ischial spines of the pelvis

    -1 is 1 cm superior to ischial spins

    Birth is imminent when presenting part is +4 to +5
  55. fetal position
    Relationship of a reference point on presenting part of the fetus, such as the occiput-O, sacrum-S, chin-M, or scapula-Sc, to its location in the front, back, or sides of the maternal pelvis

    e.g. most common LOA Left Occipital Anterior
  56. Primary contractions change character and become ___ when the presenting part reaches the ___.
    • expulsive
    • pelvic floor
  57. T/F: Secondary powers are or are not more effective and the womand is less fatigued if the woman pushes only when she has the urge to do so versus intentional pushing when dislaton is complete.
    ARE
  58. T/F: In spite of the fact that care is easier to provide in the lithotomy position, changing positions frequently relieves fatique, increases comfort and improves circulation.
    True
  59. The "all fours" or "hands and knees" position can help in these two presentation cases: ___ and ___.
    • occipitoposterior
    • shoulder dystocia

    dystocia= an abnormal or difficult childbirth or labour
  60. Overweight or obese women can or cannot cause the active phase of labor to be longer compared to women of normal weight
    can
  61. Time-wise, the third stage of labor is the ___.
    shortest
  62. Turns and adusments made by a fetus during a vaginal birth are called ___.
    mechanism of labor
  63. The seven cardinal movements of the mechanism of labor are:
    • engagement
    • decent
    • flexion
    • internal rotation
    • extension
    • external rotation (restitution)
    • birth by expulsion
  64. A vertext Engagement of most nulliparous heads takes place ___ active labor begins. The reason for this is ___.
    • before
    • the firmir abdominal muscles of the nulliparous mother have directed the opresenting part into the pelvis.
  65. Frequently asynclitism occurs and this ___.
    can facilitate descent because the head is being position to accomodate the pelvic cavity.
  66. Extreme asynclitism can cause ___, which is ___.
    • Cephalopelvic disproportion
    • when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal
  67. Descent depends on these four forces:
    • Pressure of amniotic fluid
    • Primary forces
    • Secondary forces
    • extension and straightening of the fetal body
  68. The size of the fetal head and its ___ "modify" the four descent forces.
    capacity to mold
  69. Flexion often refers to the ___ so that the smallest diameter or ___ diameter enters the true pelvis.
    • head to chest
    • Suboccipitobregmatic
  70. Internal rotation occurs because the pelvic inlet if widest in ___, whereas the outlet is widest ___ The head must rotate to navigate this passage.
    • transverse
    • anterioposterior
  71. Neck ___ occurs for the birth of the head as the perineum deflects the head anteriorly.
    extension
  72. ___ occurs after the head has emerged and it briefly aligns with the shoulders.
    Restitution
  73. ___ occurs as the shoulders engage and descend in similar maneuvers to the head.
    External rotation
  74. Fetal heart rate at term is an average ___ in a normal range of ___. Earlier in gestation, at ___, the FHR would average ___.
    • 140
    • 110-160
    • 20 weeks
    • 160
  75. UC can decrease circulation in the ___, which are located in the ___. UC ___ affect the blood flow through the ___.
    • spiral arterioles
    • placenta
    • dos not generally
    • umbilicus
  76. Fetal adaptations for birth: All of the signs of acidosis occur in the fetus which stimulate ___ in the ___ and ___ bodies. In addition, these two changes occur: ___ and ___.
    • chemoreceptors
    • aorta & carotid
    • fetal lung fluid is cleared
    • respiratory movements decrease
  77. Maternal adaptations for birth include a ___% increase increase in cardiac output in the first stage and a ___% increase in the second.
    • 10-15
    • 30-50
  78. Maternal adaptations for birth include ___ increases during UC of the first stage and ___ during UC of the second.
    • systolic
    • systolic & diastolic
  79. Maternal adaptations for birth include increases in these three factors:
    • WBC
    • RR
    • T

    and a slight increase in HR
  80. Maternal adaptations for birth include ___.
    proteinuria, resulting from muscle breakdown from the physical work of labor
  81. Maternal adaptations for birth include decreases in these two factors:
    • gastric motility
    • blood glucose

    Note: nausea & vomiting may occur during transition to second stage.
  82. ___ may occur for the mother between contractions in the second stage
    Amnesia
  83. Physiologic ___ of the perineal tissues, caused by ___, decreases ___.
    • anesthesia
    • pressure from the presenting part
    • perception of pain

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