N354 Childbirth education process of birth Chp.12

What are some method of pain management taught in childbirth classes?

• Positioning

• Relaxation

• Hydrotherapy

• Cutaneous Stimulation

• Mental Stimulation

• Breathing

• Support

What are some maternal physiological effects of labor? ( Characteristics of contractions)

• Coordinated

• Involuntary

• Intermittent

How do we measure contractions?

• Frequency (How often do they occur-the start of a contraction to the start of the next one)

• Duration (How long do they last?)

• Intensity (How strong are they?)

  • Subjective ( external- toco reading) vs. objective readings ( internal)

How do we measure a external contractions?

External: mild, moderate, strong: for intensity of contractions 

• mild: tip of your nose 

• moderate: chin 

• Strong: frontal bone

What are some physiological effects of labor with uterine muscle?

• Uterine Muscle

  • Opposing features of upper contraction and lower passivity

  • the contraction start at the top (fundus) of the uterus.

  • As the fundus contacts and muscle fibers pull upwards the cervix open up and thins out.

• Cervical Changes

  • Effacement- thinning of the cervix

  • Dilation- when the cervix opens up

How so Nullipara and Multipara dilation differ?

• Nullipara - may begin effacement before dilation

• Multipara - may dilate first then efface

What is Labor and Delivery?

• Labor

  • Coordinated sequence of involuntary uterine contractions

  • Results in effacement and dilation of cervix, followed by expulsion of products of conception

• Delivery 

  • Actual event of birth

What are some cardiovascular and respiratory effects of labor?

• Cardiovascular

  • Some blood from the placenta temporarily shunted to maternal circulation during contractions.

  • Blood volume increases for a short period of time.

• Respiratory

  • Depth and rate of respiration may increase.  

    • Risk for hyperventilation

What are some gastrointestinal and urinary effects of labor?

• Gastrointestinal

  • Gastric Motility decreased

    • Nausea and vomiting can occur

• Urinary

  • Reduced sensation

    • Full bladder inhibits fetal descent

What are some hematopoietic effects of labor?

• Hematopoietic 

  • 500-1000 mL of blood loss occurs

  • Additional clotting factors produced

What are some fetal response effect of labor? ( Placental circulation)

• Maternal blood supply decreases during contractions

  • Placental reserve usually sufficient.

What are some fetal cardiovascular and pulmonary effect of labor?

• Cardiovascular

  • The fetal cardiovascular system reacts quickly to events occurring during labor

• Pulmonary

  • Fluid present in the lungs as part of normal development

  • Labor speeds the absorption of fluid

  • Some fluid is expelled through the passage of the fetus through the birth canal

What are the 4 component of labor?

• powers

• passage

• passenger

• psyche

What is the power and passage component of labor?

• Powers- the forces acting to expel the fetus

  • Uterine Contractions

  • Maternal Pushing

    • Difficulty pushing: weak, or don’t know how to push

• Passage

  • Maternal pelvis and soft tissues

  • Passenger (fetus)

    • OA: occiput anterior- good ( face down)

      OP: Occiput posterior: not good ( face up)

What is the passenger and psyche components of labor?

• Passenger

  • Fetal Head

  • Presentation - The fetal part that first enters the pelvis

  • Position- head down

• Psyche

  • Anxiety

  • Culture/expectations

  • Birth as an experience

  • Support

  • Emotional status

What are some problems of the psyche?

• Increased risk for ineffective pushing 

• Increased anxiety etc.

• Fatigue

What is the Passenger - fetal lie component of labor?

• Relationship of the spine of the fetus to the spine of the mother

  • Longitudinal or vertical

  • Transverse or horizontal

  • Oblique

What is the importance of attitude of the Passenger?

• The relationship of the fetal body parts to one another

• Normal intrauterine attitude is flexion in which the fetal back is rounded, the head is forward on the chest, and the arms and legs are folded in against the body

Breech presentation?

• Frank: butt first

• Full: butt first and faced backwards

• single footing breech: one foot comes out first.

Influence of stress on labor?

• stress makes everything worse

what are some theories about contributions of labor beginning include"?

• Changes in ratio of maternal estrogen to progesterone.

• Prostaglandins 

• Increased secretion of natural oxytocin

• Oxytocin receptors in uterus increase

• Fetal membranes release prostaglandins

• Stretching, pressure, and irritation of the uterus.

What are some assessment/premonitory signs of labor?

• Braxton Hicks contractions increase

• Lightening or dropping: Fetus descends into the pelvis about 2-3 weeks prior to delivery

• Increased Vaginal mucous secretions

• Cervix ripening

• Bloody Show

• Energy Spurt

• Weight Loss

True vs False labor?

• False Labor

  • Inconsistent, irregular contractions

  • Discomfort more in abdomen or groin

  • No significant change in effacement or dilation

• True Labor

  • Contractions increase in frequency, duration and intensity

  • Increase with walking

  • Begin lower back and gradually sweep around lower abdomen – may also feel initially like menstrual cramps

  • *Cervical dilation and effacement are progressive

What is station?

• Measurement of descent of fetal presenting part in relation to the level of the ischial spines of the maternal pelvis.

•  station, how far down the head is in the pelvis. the more negative the number is the further away it is in the pelvis. Positive the more closer the baby is to being expelled.

What are the different stage of labor?

• STAGE 1-Labor

  • Latent/Early:

  • Active: 4cm or more

    • Transition: 8-10 cm where things go quickly and the body transition from labor to the next stage.

• Stage 2- Pushing/Delivery

• Stage 3- Placenta

• Stage 4- Recovery