Giving birth Chpt 16
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Apperence of the fetal presenting part at the vaginal opening?
Estimated date of delivery?
Descent of widest fetal presenting part to zero station?
Change in the shape of the fetal head during birth?
Umbilical cord around the fetal neck?
Measurement of descent of the fetal presenting part
Describe differences in how tge upper uterus and lower uterus contract during labor. Why is it important that the upper and lower parts of the uterus have different contraction characteristics?
The upper uterus contracts actively to push the fetus downward while the lower uterus is more passive to reduce resistance to fetal passage. Any other pattern would be ineffective at pushing the fetus out.
WHy should the nurse regularly check the womans bladder during labor?
A full bladder increases pain and interferes with fetal descent.
What maternal and fetal conditions may reduce fetal tolerance for the intermittent interruption in placental blood flow that occures during contractions?
Any maternal condition that reduces perfusion of the placenta such as diabetes or hypertension or fetal anemia which reduces oxygen carrying capacity can reduce tolerance even for normal labor contractions.
What are two powers of labor? when during labor do they come into play?
- Uterine contractions-
- first stage : uterine contractons and
- second stage: maternal pushing.
Why are the sutures and fontanels of the fetal head important during birth?
They allow molding to adapt the fetal head to the size and shape of the maternal pelvis
Describe the most common variations in : fetal lie
- Longitudinal (common)
- transverse (rare)
Describe the most common variations in: Fetal attitude
- Flexion (common)
- extension (uncommon)
Describe the most common variations in: fetal presentation?
- Chephalic (common)
- breach or shoulder (rare less than 0.2%)
What fetal anatomic reference point is used for each presentation or position: Vertex
What fetal anatomic reference point is used for each presentation or position: Face
What fetal anatomic reference point is used for each presentation or position: Breech
How can nursing measures help increase a womans sense of control during labor?
They promote relaxation and the ability to work with her body's efforts rather than working against the natural forces.
Describe common premonitory signs of labor. Are are there differences between a nullipara and a parous woman?
Braxton hicks contractions- irregular mild contractions intensify near term more noticeable in parous women.
Lightening- Descent of fetus toward pelvic inlet increases pressure on bladder but allow easier breathing more noticeable in nulliparas
Increased vaginal secretions- with congestion of vaginal mucosa caused by fetal pressure
BLoody show- mixture of cervical mucus and blood as teh mucous plug is releases seen earlier and in greater quantity in nulliparas
Energy spurt- weigh loss of 1-3 pounds
Why must the fetal head and shoulders undergo rotation within the pelvis?
After the fetal head is born, the fetal shoulders are transverse (crosswise) in the pelvis and must rotate to pass under the pubic arch.
What are the three labor phases within stage one, What cervical dilation marks each phase?
Latent phase- up to 3 cm dilation
active phase- 4-7cm
transition phase- 8-10 cm
How do average durations of labor vary between nulliparas and multiparas for 1st and 2nd stages of labor?
nullipara 8-10 hrs (range 6-18 hrs)
Parous women- 6-7 hrs ( range 2-10 hrs)
Nullipara- 50 min
Parous- 20 min
List four signs that suggest that the placenta has separated?
Uterus has spherical shape
uterus rises upward in abdomen
cord descends fruther from vagina
gush of blood
Why is it important that the uterus remain firmly contracted after birth?
Firm uterine contraction compresses bleeding vessels at the placental site to prevent hemorrhage.
The two nursing priorites when a woman enters a birth center are to determine _____and _____?
Condition of the mother
to establish a therapeutic relationship
When should the nurse not perform a vaginal examination and why?
Vaginal examintation should not be performed if the woman is bleeding activley (not Bloody show) because the examination may increase bleeding.
List important nursing assessment after teh membranes rupture. Describe normal and abnormal assessments as appropriate.
time of rupture
whether rupture was spontaneous or artificial
fetal heart rate (FHR) for atleast 1 min
Color (clear, possibly with bits of vernix, is normal. Green indicates fetal meconium passage , yellow suggests infection.)
Odor ( foul strong odor suggest infection)
Why is it important to place a small pillow under one hip if the mother must lie on her back?
to prevent supine hypotension from aortocaval compression by heavy uterus.
What maternal vital signs may indicate problems: Blood pressure
Blood pressure higher than140/90
What maternal vital signs may indicate problems: Temperature
Temp of 30 degrees C (100.4 ) or higher
Describe basic comfort measures the nurse can provide during labor?
Use soft indirect lighting.
Keep the temp comfortable with fan or damp cool washcloths.
Have the woman wear sock s for cold feet.
Keep the woman reasonably clean by changing her disposable underpad as often as needed.
Offer ice chips or a wet washcloth to wet her lips.
Remind her to empty her bladder at least every 2 hours
Encourage her to change positions frequently assuming the position of comfort ( except supine position)
offer a shower whirlpool or other water therapy.
When assessing a laboring womans blood pressure the nurse should?
Check the blood pressure between two contractions.
A woman is admitted in active labor. Her leukocyte count is 14,500. Based on this information, the nurse should?
Record the expected results in the womans chart.
THe most appropriate time for the nurse to encouraage a laboring woman to push is during?
2nd stage of labor
THe abbreviation LOA means that the fetal occiput is?
In the left front part of the mothers pelvis
What is the most reliable evidence that true labor has begun?
Change in the amount of cervical thinning
THe nurse should note how long the interval between contractions lasts because?
Most exchange of fetal oxygen and waste products occure then
what is the primary benefit of the stress of labor to the newborn?
It stimulates breathing and elimination of lung fluid.
Choose the abbreviation that represents teh fetal presentation and position that is most favorable for vaginal birth.
A station of +1 means that the?
Fetal presenting part is 1 cm below the mother's ischial spines
Bloody show differ from active vaginal bleding in that bloody show?
is dark red and mixed with mucus.
A laboring woman abruptly sotps her previous breathing techniques during a contraction and makes low pitched grunting sounds. the priority nusing action is to?
Look at her perineum
A womans membranes rupture during a contraction. the priority nursing action is to?
Assess the fetal heart rate.
When palpating labor contractions the nurse should?
Place the fingertips over the fundus of the uterus.
When doing Leopolds manuvers the nurse palpates a hard round object in the uterine fundus. A smooth rounded surface is on the mother's right side, and irregular movalbe parts are felt on her left side. An irregularly shaped fetal part is felt in the suprapubic area and is easily moved upward. how should these finding be interpreted.
The fetal presentation is breech, the position is RSA, and the presenting part is not engaged.
When doing the 4th leopolds manuver the nurse determines that the cephalic prominence is on the same side as the fetal back. How should this assessment be interpreted?
The fetus is in a face presentation with the head extended.
A woman who is having her third baby planned epidural analgesia for labor and birth. However her labor was so rapid that she did not have the epidural. What is the best nursing approach in this case?
Use open-ended questions to clarify her true feeling about the experience.
A woman having her first baby has been observed for 2 hours for labor but is having false labor contractions. Choose the most appropriate teaching before she returns home?
Your contractions will ususally be 5 minutes apart or closer for 1 hour if labor is real.
Can you eliminate pain during labor?
No it is an expected part of labor but it can be managed.
What are the characteristics of contractions?
NOrmal labor contractions are:
What are coordinated contractions?
The uterus can contract and relax in a coordintated way like the heart.
As she approches full term contractions become organized
They begin in the uterine fundus and spreads downward toward the cervix to propel the fetus through the pelvis.
What are involunatry contractions?
they are not under conscious control
a woman can not start or stop labor
anxiety and distress can diminish them.
WhAT ARE intermittent contractions?
They are come and go to allow relaxation of the uterine muscle and resumption of blood flow to and from the placenta.
What are the three phases of the contraction cycle?
What is the peak phase of a contraction?
Also called the acme is the period which contraction is most intense.
What is the increment phase of contraction?
occurs as the contraction begins and spreads throught the uterus.
What is the decrement period of a contraction?
the period of decreased intesity as the uterus relaxes.
What is used to record contractions?
Electronic Fetal monitor
What part of the uterus contracts activley to push the fetus down?
THe upper two thirds
WHt does the lower one third of the uterus do durning labor?
remains less active, allowing downward passage of the fetus.
What is myometrial?
What are the two cervical changes during labor?
Effacement (thinning and shortening)
Does effacement and dilation occur at the same time?
Yes but at diffrent rates
WHen does a nullipara complete her effacement?
Early in the process of cervical dilation.
What is effacement?
Befor labor the cervix is cylindric structor about 2cm long at the lower end.
During labor contractions push the fetus downward against the cervix.
It becomes shorter and thinner as it is drawn over the fetus and amniotic sac
the cervix merges with the thinning lower uterus.
What is dilation?
as the cervix is pulled upward and the fetus is pushed downward the cervix dilates
10 cm is full dilation
WHen are vital signs best assessed during labor?
the interval between contractions.
Why are food and large volumes of liquids restricted during labor?
to reduce the risk of aspiration, vomiting and if surgery is needed.
WHy is sugar not good durnig labor?
My cause rebound hypoglycemia in the newborn when the sugar supply abruptly ends at birth.
During labor the multgravida's cervix remains thicker than that of _______?
Most common change in urinary system durning labor?
Reduced sensation of full bladder.
Why can a full bladder inhibit fetal descent?
It occupies space in the pelvis.
What H/H levels are adequate for safety of blood loss during labor?
What is a normal leukocyte count in labor?
Where does exchage of oxygen, nutrients and waste products between mother and fetus occur in placental circulation?
What are the four P's of normal childbirth?
What are the two powers of labor?
maternal pushing efforts.
Uterine contractions in the first stage of labor do what?
Primary force of moving the fetus through teh maternal pelvis.
When does maternal pushing efforts take place?
in the second stage.
What does the passage for birth of the fetus consit of?
Maternal pelvis and soft tissues
THe bony pelvis is usually the more inmportant to the outcome of labor the bones and joints do not readily yield to the forces of labor.
What are the three subdivions of the true pelvis.?
The inlet- or upper pelvic opening
Midpelvis- or pelvic cavity
outlet- or lower pelvic opening
the true pelvis is curved cylinder with different diminsions at different levels .
What is the passanger?
the fetus plus membranes and placenta.
the fetus enters the birth canal in the ________ 96% of time.
What can fetal sutures and diffrent shapes of the fontanels provide during vaginal examination?
landmarks to determine fetal positon and head flexion.
What is longitudinal lie?
when either the head or buttocks of the fetus enter the pelvis first.
WHat is a transverse lie?
exists when the long axis of the fetus is at right angles to the womans long axis it occurs in less that 1% of prengnancies
What is an oblique lie?
at an angle between the longitudinal lie and the transverse lie.
What is the attitude of the fetus?
the relation of fetal body parts to each other.
the normal fetal attitude is one of flexion with the head flexed toward the chest and the arms and legs flexed over teh thorax. the back is curve in the concex C shape as labor starts.
What is fetal presentation?
the fetal part that enters the pelvis firsts.
Three catagories of presentation?
Cephalic is normal other my prolong labor and require cesarean birth.
What are the four types of cephalic presentation?
Vertex- the fetal head is fully flexed
military- or sinciput the head is in a neutral position neither flexed nor extened.
Brow- the fetal head is partly extended
Face - the head is fully extended and fetal occiput is near the fetal spine. the submentobregmatioc diameter is presenting.
What is a breech presentation?
occurs when the fetal buttocks or feet enter the pelvis first
What is a frank breech?
the fetal legs are extened across the abdomen toward the shoulders?
What is a full breech?
a reversal of teh usual cephalic presentation the head is flexed and the knees and hips are also flexed but the buttocks are presenting.
What is a footling breech?
when one or both feet are presenting
What is necessary with a shoulder breech?
What is fetal position?
describes a fixed reference point on the presenting pair in relation to the four quadrants of the maternal pelvis
Right and left- anterior
Right and left - posterior
the fetal position is not fixd but raterh changes during labor as the fetus moves downward and adapts to the pelvic contours
Premonitory signs of labor?
Braxton hicks contractions
small weightloss of 2.2kg
another name for false labor?
also called prodromal labor
Progressive changes in the cervix indicate?
What are the mechanisms of vertex presentation labor?
What is the first stage of labor?
Cervical effacement and dilation occur
begins with onset of true labor
ends with full dilation and effacement
maybe the longest part of labor
has three phase latent, active and transiton
the latent phase of the first stage of labor?
the early phase last from begining of labor until about 3-5cm dialtion
subtle fetal positon changes occur
the women is usually sociable and excited.
In the active phase of stage one of labor?
the cervix dilaties rapidly between 4-6cm
effacement and dilation of the cervix are completed
internal rotation occurs as the fetus descend in the pelvis
in the transition phase of first stage of labor?
bloody show increases
7-8 cm dilation
short but intense strong contractions
feels urge to push
the woman becomes more anxious and may feel irratible and helpless as the contracions intensify. the socialilty of early labor is gone replaced with serious inward focus.
The second stage of labor?
Expulsion-begins with complete dilation and effacement.
ends with birth of the baby.
The third stage of labor?
placental -begins with the birth of the baby and ends with expulsion of the placenta
four signs suggest placenta separation?
the uterus has spherical shape
the uterus rises upward in the abdomen as the placenta descends into the vagina and pushes the fundus upward
the cord descends further from the vagina
a gush of blood appears as blood trapped behind the placenta is released.
THe two ways the placenta can be expelled
the more common Schultze mechanism
The duncan mechanism is less common.
What is the Schultze mechanism
the placenta is expelled with the shiny fetal side first
What is the Duncan mechanism?
less common placental expulsion with the rough maternal side presenting.
What is the fourth stage of labor?
stage of physical recovery for the mother and infant.
It lasts from delivery of the placenta through the first 1-4hrs after birth.
the uterus can be palpated through the abd wall as a firm rounded mass about 10-15 cm (4-6 inches) in diameter at or below the umbilicus.
the vagina drains lochia rubra
many women have chills that last about 20 min
pain comes from birth trauma
Hypertension during pregnancy is?
a temp of how much is a sign of infection?
What are leopolds maneuvers?
used to determine presentation and position of the fetus and to aid in locating fetal heart sounds. They are less likely to yeild useful infomation if the woman has a thick abdominal fat pad, excessive amniotic fluid, or a very preterm fetus.
What is station?
measurement of fetal descent in the pelvis related to the ischial spines.
artificial rupture of membranes.
after the membrane is ruptured how long do you monitor the FHR?
What does cloudy, yellow foul smelling amniotic fluid suggest?
What does it mean if amniotic fluid is green?
Fetus has passed meconium before birth.
WHt color is normal amniotic fluid?
clear and may include bits of vernix
Why may have the baby passed meconium before birth?
Conditions associated with fetal compromise?
FHR outside of normal range 110-160 bpm
Meconium (green) thick amniotic fluid
Cloudy yellowish foul smelling amniotic fluid
excessive frequency or duration of contractions
incomplete uterine relaxation'
maternal hypotension ( may divert blood flow away from the placetnta)
Maternal hypertension (may be associated with vasospasm in spiral arteries whcih supply the intervillous spaces of the plancenta
Manternal fever 38 (100.4)
If an episiotomy is needed when will the attendent perform it and why?
when the head is well crowned, and to minimizes blood loss.
What is the Ritgen maneuver?
the attedant applies gentle pressure tothe womans perineum with one while applying counterpressure to the fetal head with the other hand.
What do you do with a nuchal cord during birth?
if it is loose you slip it over the head
if it is tight you clamp and but between two clamps before the rest of the baby is born.
During birth why does the attendent lift the head toward the mothers symphysis pubis?
permits the posterior fetal shoulder to be eased over teh perineum minimizing trauma to the maternal tissues.
how often should you take mothers vital signs after birth?
- 15 min during the first hour
- ever 30 for the second
then evey hour.
What is an apgar score?
a method for rapid evaluation of teh infants cardiorespiratory adaptation after birth
the nurse scores the infant 1 minute and 5 minutes in each of five areas
The infant is assigned a score of 0-2 in each of the five areas.
Labor contractions are intermittent allowing placental blood flow and exhange of oxygen nutrients and waste product between manternal and fetal ciruclation during the interval
The upper uterus contracts actively during labor as it pushes teh fetus down maintaining tension to pull the more passive lower uterus and cervix over the fetal presenting part . THese actions vring about cervial effacement and dilation.
Fetal lung fluid prodiction decreases and its absorption into lung tissue increases during late pregnancy and labor. THoracic compression duing labor aids in expulsion of additional fluid
as labor approches teh woman may notice one or more premonitory signs that precede its onset: an increase in the frequency and intensity of braxton hicks contractions lightineing increaes vaginal secretions bloddy show a spurt of energy and weight loss.
the conclusive difference between true labor and false labor is progressive effacement and dilation of the cervix
Normal labor is characterized by consistent progression of uterine contractions, cervical dilation, effacement and fetal descent
a maternal supine positon can reduce placental blood flow because the uterus compresses the aorta and inferior vena cava.
Regular changes in positon during lbaor promote maternal comfort and help the fetus adapt to the pelvis.
The priority nursing care fo the newborn immediatley after birth is to promote normal respirations, maintain normal body temp and promote attachment.
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