The Labor & Birth Process: Nurse's Role - Practice Flashcards

A comprehensive set of practice flashcards covering hormones, labor physiology, assessment, stages, fetal monitoring, pain management, cultural considerations, and nursing roles from the lecture notes.

What hormone is primarily responsible for stimulating uterine contractions during labor?

Oxytocin

Which hormone modulates pain and is released during labor as a natural analgesic?

Endorphins

Which hormone stimulates milk production after birth?

Prolactin

Which group of hormones (epinephrine and norepinephrine) increase during stress and influence labor?

Catecholamines

What does Angela’s birth story illustrate about birth hormones?

They guide you and your baby through labor, birth, and the early days together.

Which characteristics define true labor contractions?

Regular contractions with progressive frequency and intensity, back-to-abdomen discomfort, contractions increase with activity, cervix shows progressive effacement/dilation, bloody show usually present.

What happens to contractions with activity during true labor?

They tend to intensify or become more frequent with activity (e.g., walking).

What cervical changes occur with true labor?

Progressive effacement and dilation.

Can sedation stop true labor contractions?

No.

Is bloody show usually present in true labor?

Yes, usually.

What distinguishes false labor contractions?

Irregular contractions that do not progress with activity and usually do not cause cervical change.

Is bloody show usually present in false labor?

Not usually.

What questions help determine why a labor patient came to the hospital?

Bloody show? Contractions? Leaking fluid? Can’t feel the baby move? Vomiting? Pain? Fever? Bleeding?

What data are gathered during Gathering Initial Personal Data for labor patients?

Name, age, ethnicity; G/P and OB history; Obstetric care provider; Presenting complaint & Birth Plan; Gestational age/EDD; Height & Weight; Allergy history; Prenatal course & labs; Medical & Surgical history; Current medications.

What are the expected outcomes (EOs) for labor and birth?

Maintain physiologic stability; Ensure progress in labor and birth; Ensure fetal wellbeing; Cope with pain of labor; Maintain psycho-social/emotional/spiritual wellbeing.

Name a physiologic adaptation during labor affecting the cardiovascular system.

Increased cardiac output and blood pressure.

What respiratory change occurs during labor?

Increased oxygen demand and consumption.

What endocrine change occurs during labor?

Decreased blood glucose and insulin requirements.

What immune change occurs during labor?

Increased white blood cell count (WBCs).

What are components of the intrapartal physical assessment?

Maternal BP, HR, RR, Temp; Resp; CV & hydration status; Skin (perineum, vaginal discharge); Acute and chronic pain; Cognitive; GI/GU; Musculoskeletal.

What common lab tests are ordered in labor?

CBC, UA; Type and Screen/Cross; Coags; Renal & Liver panels.

What does 2+ protein on urinalysis may indicate?

Preeclampsia.

What does glucosuria on UA may indicate?

Gestational diabetes.

What does ketonuria indicate?

Vomiting or poor PO intake.

What CBC pattern suggests dehydration?

Increased hematocrit.

What CBC finding suggests active bleeding or anemia?

Decreased hemoglobin.

What CBC finding suggests bleeding problems?

Decreased platelets.

What does increased WBCs on CBC indicate?

Infection or sepsis.

Define SROM.

Spontaneous rupture of membranes.

Define PROM.

Rupture of membranes at >37 weeks with ROM before labor onset.

Define PPROM.

Membrane rupture before 37 weeks gestation.

Define Prolonged ROM.

ROM duration >24 hours before onset of labor.

What test helps confirm amniotic fluid and ROM?

Ferning test (amniotic fluid ferning) on a slide.

What is PAMG-1 ROM test (Amnisure)?

FDA-approved ROM test with ~99% sensitivity and ~100% specificity; collected at bedside by a nurse; results by lab; blood can interfere; used with other clinical information.

Name nursing interventions to maintain physiologic stability.

Hygiene; Perineum care; Limit SVEs; Sepsis screening every 8 hours; Admin antibiotics if indicated; Evaluate blood loss; Fluid resuscitation; Administer blood products; Positioning; Hydration; Reduce anxiety; Voiding; Bladder management; Fundal massage; Oxytocin administration after placental separation.

What are essential actions during the third/fourth stage after birth?

Frequent vitals (BP/HR q15m); Fundus and Lochia checks (q15m); Temp once; Bladder management; Perineum care; Ice to perineum; Monitor blood loss.

Name the stages of labor and their definitions.

1st stage: 0-10 cm (latent 0-6 cm, active 6-10 cm); 2nd stage: 10 cm to birth; 3rd stage: birth to placenta expulsion; 4th stage: immediate recovery (1-4 hours).

What are the four classic types of pelvis?

Gynecoid, Android, Anthropoid, Platypelloid.

Which pelvis type is most favorable for labor?

Gynecoid.

What is fetal lie?

The relation of the fetus’s long axis to the mother’s long axis; longitudinal or transverse.

What is fetal attitude?

The relation of fetal body parts to one another, especially the degree of head flexion (general flexion is normal).

What does LOA stand for in fetal position?

Left Occipitoposterior? (Note: LOA stands for Left Occipitoanterior – the common position; LOA is the familiar example.)

Where is FHR best heard relative to fetal position?

Over the fetal back.

What structures comprise the birth canal (passageway)?

Bony pelvis, soft tissues of cervix, pelvic floor, vagina, introitus.

What are the four P’s that influence labor and birth?

Passenger (fetus), Passageway (birth canal), Power (contractions and pushing), Psychological response of the mother.

What are the three common fetal presentations at term?

Cephalic (most common), Breech, Shoulder.

What is the most common fetal presentation at term?

Cephalic presentation (head enters pelvis first).

What is Leopold’s maneuvers used for?

Determining fetal position and presentation before applying electronic fetal monitoring.

What is the normal baseline FHR?

110-160 bpm.

What does baseline variability indicate?

Fluctuations in the FHR baseline; normal range is 5-25 bpm; Absent/minimal variability may indicate fetal compromise; Marked variability (>25) may indicate acute hypoxia.

Define early decelerations.

Gradual decrease in FHR that mirrors the contraction pattern.

Define late decelerations.

Gradual decrease in FHR that begins after the start of a contraction and recovers after the contraction ends; suggests uteroplacental insufficiency.

Define variable decelerations.

Abrupt decrease in FHR with variable timing, often due to cord compression.

Define prolonged deceleration.

Deceleration lasting longer than 2 minutes.

Name nonpharmacologic pain coping strategies in labor.

Controlled breathing, distraction, position changes, environmental adjustments, music, imagery, warmth/cold, massage, water immersion.

What does TEACH stand for in labor support tools?

Labor Tools and Positions used to cope (breathing, visualization, affirmations, birth ball, massage, walking, position changes, etc.).

What are the four Labor Support Behavior categories?

Physical, Emotional, Instructional/Informational, Advocacy.

What is the nurse’s role in advocacy during labor?

Convey respect, protect privacy, provide complete information, nonjudgmental care, protect patient rights, ensure safety, emotional safety; support patient to express emotions.

How should modesty be protected during labor?

Assume modesty is important; provide privacy; drape for exams; expose as little as possible; prefer female caregivers when possible; respect cultural needs.

Give examples of cultural birth practices mentioned (Hmong, Latina, Muslim).

Hmong: may be active in labor; amniotic sac broken just prior to birth; hot foods and warm drinks. Latina: partner support expectations; reassurance from partner. Muslim: modesty and female caregiver preference; companionship; adhan recited in newborn’s right ear; family involvement.

What is the role of the epidural catheter position in neuraxial anesthesia?

Block height and symmetry depend on catheter position; an ideal position provides bilateral adequate density.

What is a Bromage score used for?

Assess motor block after neuraxial anesthesia.