Young families Childbirth

What are the 5 P's (main)

1. Passenger
2.Passageway
3. Powers
4.Position
5. Psychological response

What trimester is the pelvic size assessed

1st trimester

What is the most common type of pelvis in women

Gynecoid

What is the thinning of the cervix called

effacement

What is dilation?

widening of the cervix

how many cm is the complete dilation to birth?

10 cm

fetal presentation

the manner in which the fetus appears to the examiner during delivery

When assessing the passenger in birth what do we look at

1. fetal presentation
2. fetal Lie
3. Head size
4. fetal attitude
5. fetal Position

fetal lie

the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother

How long is the anterior fontanel open

12-18 months

How long is the posterior fontanel open

8-12 weeks

breech presentation

when the baby's buttocks or both legs appear first during birth

What is the most common fetal lie

longitudinal

fetal attitude

Refers to posturing (flexion or extension) of the joints and the relationship of fetal parts to one another

What is station?

relationship of the ischial spines to the presenting part of the fetus and assists in assessing for fetal descent during labor.

What is engagement?

The largest transverse diameter of the presenting part (typically the head) has passed through the maternal pelvic brim or inlet

What number is associated with engagement

0

What is primary power

involuntary uterine contractions

What is secondary power

pushing

Psychological response

Maternal stress, tension, and anxiety

Normal fetal heart rate

110-160 bpm

What is a GI response to cervical dilation

Nausea

Why do we assess blood pressure between contractions

Blood pressure rises during an active contraction

Braxton Hicks contractions

intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses

Prelabor

contractions are not regular and often stop with position change or movement,

true labor

regular contractions, discomfort radiates from the back, intensity increases with walking,
cervix effaced and dilated is true or false labor

What is bloody show?

It is a small amount of blood at the vagina that appears at the beginning of labor and may include a plug of pink-tinged mucus that is discharged when the cervix begins to dilate.

first stage of labor

the initial stage of childbirth in which regular contractions begin and the cervix dilates

What hormones increase during the 1st stage of labour

Oxytocin, Estrogen, prostaglandins

latent phase of labor

Cervix 0-3 cm (non pharmacological pain management)

Active phase of labor

4-7 cm
moderate to strong contractions
regular q 3-5 min lasts 40-70 sec

transitional phase of labor

Phase of 1st stage of labor with 8-10 cm dilation patient has: strong contractions every 2-3 minutes - mother is irritable, anxious, and self-oriented

admission to L&D

Physical assessment
Progression of labor
allergies
birth plan
characteristics of pregnancy

Herpes simplex virus during birth

Vaginal birth is not allowed when mother has visible symptoms

Amniotic fluid assessment

COAT (color, odor, amount, time)

labor induction

the process of initiating labor by artificial means

How is oxytocin administered?

IV

Risks associated with labor induction

Risk of preterm labour​
Long labour​
Lengthy exposure to high alert medications (with potential side effects)​
Higher rate of cesarean delivery​

rupture of membranes

spontaneous rupture of the amniotic sac with release of fluid preceding childbirth OR artificial rupture of membranes

artificial rupture of membranes (AROM)

artificial rupture of amniotic sac by outside means

spontaneous rupture of membranes

broken water, Natural rupture of the amniotic sac, which usually occurs at the height of an intense contraction with a gush of fluid out of the vagina.

assessment of amniotic fluid

- should be watery and clear
- odor should not be foul
- 500-1200 mL
- Nitrazine paper (if amniotic fluid, paper will turn dark blue because it is alkaline)

Leopold Maneuvers (Abdominal Palpation)

a series of four types of abdominal palpitation for determining fetal position

Fetal tachycardia

>160 bpm

Causes of fetal tachycardia

Maternal fever
Infection
Drugs (caffeine, cocaine, methamphetamines)

Fetal bradycardia

Causes of fetal bradycardia

Fetal hypoxia
maternal position
heart block
medications

Why would an HCP do a vaginal examination

cervical effacement
dilation
fetal descent

second stage of labor

Full dilation
Intense contractions
BIRTH!!

How long does labor last for a women that is nulliparous

50-60 minutes

How long does labor last for a women that is multiparous

20-30 minutes

Non Pharmacological therapy during labor

Hydrotherapy​
Ambulation and position changes​
Acupuncture and acupressure​
Hot/ cold application​
Attention focusing and imagery​
Effleurage and massage​
Breathing techniques

Pharmacological pain management during labor

Systemic analgesia
-Opioids (butorphanol, nalbuphine, meperidine, fentanyl)
-Ataractics (hydroxyzine, promethazine)
-Benzodiazepines (diazepam, midazolam)
Regional or local anesthesia
-epidural block

Where is the placement for an epidural

L3-L4 of the spine

epidural injection

Involves injection of a local anesthetic AND an opioid analgesic

pros of epidural

Fully Awake
Can be adjusted
Ideally, allows for urge to push

Cons of epidural

hypotension
intravascular injection
respiratory depression

episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth

operative vaginal birth

performed using either forceps or a vacuum extractor

How long should a women hold her breath while pushing

no more than 5-7 seconds

What is crowning?

It is the appearance of the infant's head at the vaginal opending during labor.

third stage of labor

delivery of placenta

How long can placenta delivery occur

Typically 3-5 minutes but can last upwards of 1 hr

fourth stage of labor

First 2 hours when mother and baby bond
Skin -skin contact and breastfeeding is initiated
Close monitoring for complications

What is perineal trauma

Damage is usually more pronounced in nulliparous women (tissues are firmer and more resistant)

risk factors for perineal trauma

maternal position,
pelvic inadequacy,
fetal malpresentation,
macrosomia,
use of forceps or vacuum,
rapid labor,
prolonged 2nd stage of labor