Labor and BIrth

Premonitory Signs of Labor

Braxton Hicks contractions, lightening, nesting, bloody show, cervical changes, ROM

Nesting

Sudden increase in energy shortly before labor, making them motivated to clean, cook, prepare nursery, etc.

Bloody Show

Cervical softens and effaces/dilates→ small vessels rupture → mucus plug expelled + small amount of blood

How does activity affect contractions during false labor?

Contractions may slow down or stop with walking, hydration, or changing position

False Labor

Irregular contractions that do not cause progressive cervical effacement/dilation that can slow or stop with discomfort felt only in front of abdomen

True Labor

Contractions that become regular and progressively stronger with progressive cervical effacement/dilation with discomfort moving from lower back to front of abdomen

When should someone go to the hospital during true labor?

Contractions are 5 minutes apart, lasts 35-60 secs, and patient unable to comfortably speak through them

Pelvis Passageway

Pelvic inlet → midpelvis/cavity (tight, curved, expels fluids from fetus for air) → fetus exits from pelvic outlet

Soft Tissues Passageway

Pelvic floor muscle, vagina, cervix (10 cm and efface 100% for birth)

Molding

Temporary adaptive shaping of fetal skull bones as head passes through pelvis to exit

Fetal Attitude

Relationship of fetal body parts to each other (flexion/extension)

Fetal Lie

Relationship of fetus spine to the mother’s spine w/ longitudinal being parallel and transverse perpendicular to maternal spine

Fetal Presentation

Fetal body part that enters maternal pelvis first

Fetal Position

Relationship of presenting fetal landmark to the mother’s pelvis (3 letters)

First Letter of Fetal Positioning

Left or Right Side

Second Letter of Fetal Positioning

O = occiput, S = sacrum, M = mentum, A = acromion/shoulder

Third Letter of Fetal Positioning

Presenting part is toward anterior (A), posterior (P), or transverse/side (T)

What is the most ideal fetal positioning for vaginal birth?

LOA

What do negative fetal stations mean?

Presenting part is above ischial spines and is high/not engaged (-2 = 2 cm above ischial spine)

What do positive fetal stations mean?

Presenting part is below ischial spines and past the pelvic inlet and engaged (+3 = 3 cm below ischial spine)

Cardinal Movements of Labor

Series of movements the fetus makes as it moves through mother’s pelvis during labor (engagement → expulsion)

Types of Presentation

Cephalic/vertex, breech/butt/feet, shoulder/scapula

2 Powers of Labor

Uterine contractions and maternal intra-abdominal pressure (bearing-down)

When does maternal pushing contribute to labor?

Contributes during second stage after full cervical dilation (10 cm) and adds force

Why is there relaxation between contractions?

Allows uterus to relax and helps restore blood flow and oxygen delivery to placenta and fetus

Why can upright positions help labor?

Squatting, side-lying, hands/knee positioning can allow gravity to assist fetal descent and increase pelvic outlet size

What is a disadvantage for lithotomy positioning?

Lying on back with legs is easier for examinations, but doesn’t have physiological benefits and compresses vena cava

Physiological Responses of Labor

↑ HR, CO, BP, RR, WBCs; ↓ gastric motility/emptying (digestion slows labor)

How does labor affect fetal oxygenation?

Uterine contractions temporarily decrease uteroplacental blood flow, decreasing fetal oxygenation briefly but improves inbetween contractions

First Stage of Labor

Begins when true labor contractions (effacement/dilation) → ends when cervix dilated to 10 cm; longest stage of labor

How long is the first stage of labor for primigravida (first pregnancy)?

Can last up to 20 hours

How long is the first stage of labor for multigravida?

Can last up to 14 hours

Latent Phase of First Stage

Contracts every 5-10 mins, 30-45 secs, mild strength; 0-6 cm dilation

Active Phase of First Stage

Contracts every 2-5 mins, 45-60 secs, moderate-strong strength

Second Stage of Labor

Contracts every 2-3 mins, 60-90 secs, strong strength; Lasts from 10 cm dilation → birth of newborn

Why should patient not push before complete dilation?

Pushing against partially dilated cervix (<10 cm) can cause swelling/trauma and interfere with labor progress

Crowning (2nd stage)

Fetal head remains visible at vaginal opening and no longer retracts between contractions with bulging perineum

Open-Glottis Pushing

While following natural urge to push (not forced/prolonged), exhale with grunting/vocalization to keep glottis open

Third Stage of Labor

Lasts from birth of newborn → delivery of placenta when uterine contracts and separates placenta from wall

Signs of Placental Separation

Firm/globular uterus, sudden gush of blood (<500mL), and lengthening of umbilical cord

What is major concern during third and fourth stage?

Postpartum hemorrhaging

How long does placental delivery usually take?

About 5-30 mins

Fourth Stage of Labor

Lasts 1-4 hours after delivery of placenta

What should be focused on during fourth stage of labor?

Maternal stabilization, assess fundus/lochia/bladder and hemorrhaging, promote skin-to-skin contact bonding and breastfeeding if stable