Module 1 Week 1: Antepartume, Labor and Delivery

Initial Prenatal Health Screening

Assesses medical/surgical history, teratogens, substance use, toxins, vaccines, and mental health.

Trauma-Informed Prenatal Care

Requires explicit consent before procedures, explaining exams clearly, and respecting patient autonomy.

Most Accurate Gestational Dating Method

Ultrasound is the most accurate method to verify the estimated date of delivery.

GTPAL: Gravida (G)

Gravida is total pregnancies including current

GTPAL: Term (T)

Term is births delivered between 38-42 weeks gestation

GTPAL: Preterm (P)

Preterm is births at 20-37 6/7 weeks gestation

GTPAL: Abortion (A)

Number of pregnancies ending before 20 weeks gestation

What is classed as a medical abortion

Ectopic pregnancies, miscarriages, elective abortions

GTPAL: Living (L)

Number of children currently living

Chadwick Sign

Bluish-purple discoloration of the cervix and vaginal mucosa seen on speculum exam.

Goodell Sign vs. Hegar Sign

Goodell sign is cervical softening; Hegar sign is lower uterine segment softening around 6-8 weeks

Normal BMI Prenatal Weight Gain

Recommended total weight gain is 25 to 35 lbs for normal weight.

Initial Prenatal Baseline Labs

Includes blood typing, Rh factor, antibody screen, infectious diseases, and GBS timing.

Preconception Folic Acid Timing & Purpose

Start ≥1 month prior to conception to prevent neural tube defects.

Neural Tube Closure Gestational Timing

The neural tube closes by approximately 4 weeks gestation.

Pre existing condition risk modification

Conditions like diabetes or hypertension are optimized

Pregnancy risk modifications

Teratogenic medications are adjusted, lifestyle modifications like diet, exercise, and avoiding harmful exposures are established

First Trimester Danger Signs

Vaginal bleeding, fever >100°F/dysuria, severe vomiting with weight loss, severe abdominal pain with dizziness and shoulder pain

Second Trimester Danger Signs

Regular uterine contractions, calf pain/swelling (DVT), fluid leakage (PROM), no fetal movement >12 hours.

What are the signs of preeclampsia during the third trimester?

Severe headache, facial edema, visual changes, sudden weight gain, upper abdominal pain

Third Trimester Danger Signs

Signs of preeclampsia/gestational hypertension, decrease in daily fetal movement >24 hrs, vaginal bleeding

Routine RhoGAM Timing (Prenatal)

Administered routinely at 26-28 weeks gestation for Rh-negative pregnant individuals.

Postpartum RhoGAM Timing

Given within 72 hours post-delivery if the newborn is Rh-positive.

Premonitory Labor Sign: Lightening

Fetus descends into the pelvis, relieving upper abdominal pressure.

Premonitory Labor Sign: Increased Braxton Hicks Contractions

Frequent, mild "practice" contractions that soften the cervix

Premonitory Labor Sign: GI changes

mild diarrhea, nausea, indigestion shortly before labor onset

Premonitory Labor Sign: Nesting

A sudden burst of energy to clean and prepare for the newborn

Premonitory Labor Sign: Weight Loss and Backache

Slight weight loss (1-3 lbs) and persistent lower backache

Premonitory Labor Sign: Bloody Show

Passage of the cervical mucus plug, appearing as pink or brownish discharge.

Spontaneous Rupture of Membranes (SROM)

Spontaneous gush or trickle of amniotic fluid requiring immediate evaluation.

True Labor: Contractions Pattern

Regular pattern; progressively closer, stronger, and longer over time.

False Labor: Contractions Pattern

Irregular pattern; no consistent increase in frequency, duration, or intensity.

True Labor: Effect of Walking or Activity

Contractions increase in intensity and duration with walking or movement.

False Labor: Effect of Walking or Activity

Contractions decrease, stop, or remain unchanged with walking, rest, or hydration.

True Labor: Discomfort Location

Felt in lower back or radiates from back to lower abdomen.

False Labor: Discomfort Location

Felt primarily in upper abdomen above the umbilicus.

True Labor: Cervical Changes

Progressive cervical dilation and effacement; definitive indicator of true labor.

False Labor: Cervical Changes

No change in cervical dilation or effacement.

Primary Powers of Labor

Involuntary uterine contractions causing cervical effacement and dilation during Stage 1.

Assessment of Uterine Contractions

Evaluated by frequency, duration, and intensity (mild, moderate, or strong fundal firmness).

Contraction Relaxation Interval Requirement

At least 60 seconds between contractions to maintain adequate placental perfusion.

Secondary Powers of Labor

Voluntary bearing-down efforts (pushing) by the laboring person during Stage 2.

Passage in Labor

The maternal rigid bony pelvis and soft tissues (cervix, vagina, pelvic floor).

Passenger in Labor

fetus and placenta

Fetal Skull Molding

Overlapping of cranial bones to adapt to the dimensions of the birth canal.

Optimal Fetal Attitude/Posture

Full flexion with the chin tucked to the chest.

Fetal Lie

Relationship of the fetal long axis/spine to the maternal spine (longitudinal/parallel vs. transverse).

Fetal Presentation

The fetal body part entering the maternal pelvic inlet first (e.g., cephalic vs. breech).

Fetal Position: OA vs. OP

Occiput Anterior (OA) is optimal; Occiput Posterior (OP) causes severe back labor.

Fetal Station and Engagement

Level relative to ischial spines; 0 station is engaged at the ischial spines, negative is above spines, positive is descending/crowning

Psyche Factor in Labor

Maternal emotional readiness, anxiety, coping mechanisms, support system, and birth preferences.

Position (maternal) in labor

postural position during labor (upright, side-lying, squatting, walking, birthing ball)

Benefits of Upright Maternal Positioning

Uses gravity to increase uterine efficiency, reduce pain, and facilitate fetal descent.

Maternal Cardiovascular Response to Labor

Cardiac output increases ~40%, pulse increases 10-15 bpm, and BP rises during contractions.

Supine Hypotensive Syndrome Cause & Intervention

Gravid uterus compresses inferior vena cava when lying flat; managed with a hip wedge.

How does labor affect maternal respiratory rate?

Respiratory rate increases with elevated diaphragm.

What happens to GI motility during labor?

GI motility and emptying are reduced.

What is a risk associated with reduced GI motility during labor?

Increased risk of nausea and vomiting.

Maternal Psychosocial Response Shift in Labor

Transitions from talkative and eager in early labor to serious, inward, and focused in active labor.

Normal Baseline Fetal Heart Rate

Ranges between 110 and 160 bpm.

Fetal Oxygenation and Contraction Rest Intervals

Placental blood flow halts at peak contractions, making rest intervals critical for fetal oxygenation.

Stage 1 of Labor: Definition & Boundaries

Begins with regular contractions and ends with complete cervical dilation (10 cm) and effacement (100%).

Stage 1 Latent Phase Characteristics

Dilation 0-6 cm; mild contractions every 5-15 min (10-30s); patient is talkative, eager, and anxious.

Stage 1 Active Phase Characteristics

Dilation 6-10 cm; moderate-to-strong contractions every 1-5 min (30-60+s); patient becomes inward and focused.

Stage 2 of Labor: Definition & Contractions

Full dilation (10 cm) to fetal birth; contractions every 1-2 min lasting 50-90 seconds.

Ferguson Reflex in Stage 2

An involuntary urge to bear down caused by fetal head pressure on the pelvic floor.

Stage 2: Perineal Burning ("Ring of Fire")

Intense burning sensation caused by stretching of the perineum as the fetal head crowns.

Order of Shoulder Delivery in Stage 2

The anterior shoulder delivers first, followed by the posterior shoulder and body.

Stage 3 of Labor: Definition & Duration

From birth of the infant to complete expulsion of the placenta (lasting 1-30 minutes).

Signs of Placental Separation

Umbilical cord lengthening, sudden gush of blood, and fundus rising in the abdomen.

Schultze vs. Duncan Mechanism

In placental delivery, Schultze presents the shiny fetal side first; Duncan presents the dull, rough maternal side first.

Stage 4 Postpartum Timing & Primary Risk

First 1 to 4 hours post-delivery; period of highest risk for postpartum hemorrhage (PPH).

Stage 4 Fundal & Comfort Assessment

Fundus must remain firm and midline; maternal chills/shivering are common and treated with warm blankets.

Maternal Admission & Ongoing Assessment

Review prenatal history, GBS status, vital signs, and pain scale scores.

Methods for Contraction Monitoring

Evaluate frequency, duration, and intensity via manual fundal palpation or external electronic monitoring.

Sterile Vaginal Examination (SVE) Guidelines

Assess dilation, effacement, and station; strictly minimize exams post-membrane rupture to prevent infection.

Nitrazine Paper Test for Membrane Rupture

Yellow paper turns blue in the presence of alkaline amniotic fluid.

TACO Acronym for Membrane Rupture

Time of rupture, Amount, Color (clear vs. meconium-stained), and Odor.

Temperature Monitoring Post-Membrane Rupture

Check maternal temperature every 1 hour after membranes rupture.

Group B Strep (GBS) Intrapartum Prophylaxis

Administer IV antibiotics during labor for GBS-positive status.

Bladder Evaluation Frequency during Labor

Assess and encourage voiding every 1.5-2 hours to prevent fetal descent obstruction and uterine atony.

Visceral vs. Somatic Labor Pain

Visceral pain occurs during contractions/dilation; somatic pain occurs from perineal stretching during pushing.

Non-Pharmacological Labor Comfort Measures

Frequent position changes, hydrotherapy, breathing techniques, effleurage, counterpressure, and continuous support.

Optimal Timing for Labor Pain Education

Educate about pain options between contractions when the patient is calm and attentive.

Continuous or Intermittent Fetal Surveillance

Monitor FHR baseline (110-160 bpm) before, during, and after contractions.

Trauma-Informed Intrapartum Care Principles

Provide non-judgmental care, maintain privacy, clearly explain procedures, and obtain consent prior to exams.

Laboring Down Intervention

Delay pushing until patient feels a spontaneous urge to bear down (Ferguson reflex).

Open Glottis Pushing Technique

Encourage pushing for 4-6 seconds per breath rather than prolonged closed glottis pushing.

Upright Positioning in Second Stage

Maintain HOB elevated at least 45° or utilize squat bars and birthing aids.

AMTSL: Oxytocin Timing & Purpose

Administer IV oxytocin immediately following anterior shoulder delivery to promote uterine contraction.

AMTSL: Placental Delivery Interventions

Assist provider with controlled cord traction and post-delivery uterine massage.

AMTSL: Placental Inspection Purpose

Verify all lobes and cotyledons are intact to rule out retained placental fragments.

Immediate Newborn Thermoregulation Care

Place newborn skin-to-skin on maternal chest immediately and dry thoroughly to prevent cold stress.

Apgar Score Timing & Parameters

Evaluates heart rate, respiratory effort, muscle tone, reflexes, and color at 1 and 5 minutes.

Delivery Room Infant Security Verification

Verify identical maternal and infant security identification bands before leaving delivery room.

The Post-Birth "Golden Hour"

Protects early uninterrupted maternal-infant bonding and facilitates initial breastfeeding.

Stage 4 Postpartum Assessment Frequency

Evaluate maternal vital signs, fundal firmness, and lochia every 15 minutes for the first hour.