OB Labor and Birth Part 1

What is lightening?

Fetus drops into the pelvis

Patient will report "easier to breathe" and "harder to walk"

Increase in Braxton Hicks contractions=push the fetus further into ready position

What are signs of impending labor?

Lightening

Loss of cervical mucous/mucous plug (bloody show)

Weight loss due to increase in stool (prostaglandins)

Burst of energy

Nesting

Changes in sleep patterns

Nausea and vomiting

Irregular contractions (cramping/uncomfortable/painful) or backache

Prelabor rupture of membranes (PROM)

What is considered true labor?

Regular contractions-becoming stronger and closer together

Nothing will make them go away (hydration, position)

Contractions cause CERVICAL CHANGE

What is considered false labor?

Irregular contractions lasting different lengths of time

Contractions will go away with movement, rest, position change, hydration

No Cervical change

When should clients go to the hospital?

Contractions are 4-5 minutes apart AND lasting for 1 minute AND have been happening like this for an hour

OR

Water breaks

OR

Pain is intolerable

What is the first stage of labor?

Cervical Change

Onset of regular contractions to complete dilation and effacement

3 stages (early, active, and transition)

What is the second stage of labor?

Birth of the Baby

Complete dilation and effacement to birth the baby

What is the third stage of labor?

Birth of the placenta

Delivery of the baby to delivery of the placenta

What is the fourth stage of labor?

Recovery

Postpartum stabilization: first 4 hours after delivery

Maternal-newborn bonding and breastfeeding

What are the 5 P's of labor?

Passenger: assessed through FHR

Passageway: can pelvis support delivery?

Powers: strength of contractions

Position: is it enabling for baby to go through naturally?

Pysche: how is patient coping/managing labor?

What is dilation?

Opening of cervix

0cm(closed)-10 cm (fully dilated)

Assessed via sterile vaginal exam (SVE)

What is effacement?

Thinning of cervix

0%-100%

Assessed via sterile vaginal exam (SVE)

What is fetal station?

Position of the fetal head in relation to the ischial spines of the maternal pelvis

Measures the descent of the fetus into birth canal

Range of -5 to +5

Assessed by sterile vaginal exam (SVE)

What do the fetal station readings mean?

-5: fetal head not engaged

0: fetal head at the level of the ischial spines

+3, +4, +5: observe for crowning

+5: fetal head at the perineum

What is the fetal position?

Position of the baby within the pelvis

Determined by location of fetal occiput (back of head)

3 Letter System

-Right or left

-O= occiput

-Anterior or posterior

Why does fetal position matter?

If baby's head is not anterior, then the diameter is larger for trying to get through the pelvis.

We want baby to be anterior, posterior will cause a longer labor duration and longer pushing time

What is the first stage of early labor?

0cm-5cm

Cervix begins to dilate and efface

Contractions begin with and irregular pattern and become more regular and stronger (5-10 mins X 30 seconds)

Scant amount of brownish/pink discharge or mucus plug

Lasts on average 6-12 hours

What are the physical symptoms of early labor?

Loose stool

Headache

What is the maternal affect in early labor?

Excited

May be apprehensive

Ability to talk or walk through contractions

What support is needed during early labor?

Encourage alternating rest/activity

Distraction: showering, walking

Hydration

Light meals

Changing positions (yoga ball, stretching)

What is induction of labor (IOL)?

Patient admitted to induce labor

2 parts:

-Cervical ripening

-Induction

What is augmentation of labor?

Medication (Pitocin) administered to augment or help labor progress, but client is already in labor

Used when labor is progressing slowly or stalled

What assessments are conducted when patient is being triaged to determine if they are in labor?

Vitals, Head to Toe

Obtain NST

Urine sample

Labor status:

- Contractions

-Membranes status (ruptured/intact)

-Amniotic fluid (clear/bloody/meconium stained)

-Cervical assessment (dilation, effacement, station)

What interventions may be performed in triage?

Notify provider of assessment findings

IV Placement

Lab Collection (CBC, Type and Cross)

Admit to labor unit

What assessments are performed in labor?

EFM continuously (unless on intermittent auscultation)

Vital Sign monitoring (q2-Q4)

Maternal coping/reaction to pain

Cervical exams (per policy)

What patient centered care should be conducted during labor?

Discuss birth plan

Doula?

Provide education to patient and support persons

Encourage ambulation and position changing

Positions should be changed at least every 30 minutes

Encourage non-pharmacologic pain relief

Empty Bladder q2 hours

What are some non-pharmacological pain relief tactics that can be used in labor?

Shower/birthing tub

Massage

Back rub with counter pressure (double hip squeeze)

Rocking/Dancing with support people

Rebozo (belly sling)

Breathing techniques

What interventions may be performed during labor?

Admin antibiotics, pain meds, IV fluids, Pitocin

Labor support: breathing, encourage movement, encourage non-pharm pain relief

EFM interventions based of FHR

What changes can be expected during active labor (6cm-8cm)?

Cervix continues to dilate and efface

Contractions are strong and regular (Q3-5 mins X60 seconds)

Continued scant amount of pink discharge

Possible spontaneous rupture of membranes (SROM)

Lasts on average 4-8 hours

What physical symptoms can be observed during active labor?

Pelvic pressure

Possible backache

What is the maternal affect during active labor?

More serious/apprehensive

Focused on contractions

Breathing, moaning, rocking, working through contractions

What support may be needed during active labor?

Active support

Breath coaching

Position changes

Massage

Encouragement and praise

Offering PO hydration

How is pain managed during labor?

Pain in labor is different from all other pain

Role of nurse: support patient during contraction

Offer pain management per patient preference/birth plan

P: purposeful

A: anticipated

I: intermittent

N: normal

What are the causes of pain in the first stage of labor?

dilation/effacement/stretching of cervix

Distention of the lower uterine segment

Contractions resulting in uterine ischemia

What are the causes of pain in the second stage of labor?

pressure and distention of vagina and perineum

Pressure and pulling on pelvic structures

Lacerations of soft tissues

What are the causes of pain in the third stage of labor?

Uterine contractions to expel placenta

Pressure and pulling of pelvic structures as placenta is expelled

What are the causes of pain in the fourth stage of labor?

Recovery from the birth

Contractions of uterus due to oxytocin from medicine/breastfeeding,

Uterus trying to get back down to size