NURS 2866 - Chapter 13 - Labor and Birth Processes

What are the 5 Ps that affect labor and birth?

Passenger; Passageway; Powers; Position; Psychologic Response

What does the "Passenger" refer to in labor?

The fetus (including size, position, and presentation)

What does the "Passageway" refer to in labor?

The maternal pelvis, cervix, pelvic floor, vagina, and vaginal opening

What does "Powers" refer to in labor?

Uterine contractions (primary) and maternal pushing (secondary)

What does "Position" refer to in labor?

The mother’s physical positioning during labor

What does "Psychologic Response" refer to in labor?

The patient’s emotional state (anxiety, stress, coping)

Why is the fetal head important in labor?

The size of the fetal head affects the ability to pass through the pelvis

What are fontanelles?

Areas where fetal skull bones meet

Why are fontanelles clinically important?

They help determine fetal position during a vaginal exam

Describe the anterior fontanelle shape, size, and closure time.

Diamond-shaped; 3 cm x 2 cm; closes at 18 months

Describe the posterior fontanelle location, shape, size, and closure time.

Between parietal bones and occipital bone; triangular; 1 cm x 2 cm; closes at 6–8 weeks

What is fetal presentation?

The part of the fetus entering the pelvis first

What are the types of fetal presentation?

Cephalic (head first); Breech (buttocks, feet, or both); Shoulder presentation

What is the presenting part?

The part closest to the cervix felt during a vaginal exam

What is vertex presentation?

A cephalic presentation where the head/occiput is presenting

What is fetal lie?

The relationship of the fetal spine to the maternal spine

What are the types of fetal lie?

Longitudinal; Transverse (perpendicular)

What is required for a transverse lie?

C-section OR version (manual repositioning)

What is fetal attitude?

The relationship of fetal body parts to each other

What is the memory tip for fetal attitude?

Like a child “giving attitude” → posture/body position

What is fetal position?

The relationship of the presenting part to the 4 quadrants of the maternal pelvis

What does the 1st letter in fetal position notation represent?

Location in the mother’s pelvis (R = right, L = left)

Important rule for fetal position notation?

Always reference the mother’s pelvis (not yours)

What does the 2nd letter represent in fetal position notation?

The presenting part

What do O, S, M, and SC stand for?

O = occiput; S = sacrum; M = mentum (chin); SC = scapula (shoulder)

What does the 3rd letter represent in fetal position notation?

Direction (A = anterior, P = posterior, T = transverse)

What does ROP mean?

Right Occiput Posterior

What does LOA mean?

Left Occiput Anterior

What does OA mean?

Occiput anterior (straight anterior)

What does OP mean?

Occiput posterior (straight posterior, “sunny side up”)

What are characteristics of a posterior baby (OP)?

Baby facing up; mother has severe back pain

Why does a posterior baby cause back pain?

Baby’s spine is aligned with the mother’s spine

What interventions help rotate a posterior baby?

Frequent position changes; standing; “hula hoop” hip movement

Why is labor more difficult with a posterior baby?

Difficulty with flexion and extension makes movement through pelvis harder

What structures make up the passageway?

Pelvis; cervix; pelvic floor; vagina; vaginal opening

When is pelvic assessment done?

At the first prenatal visit

What does pelvic assessment determine?

Vaginal delivery vs C-section and risk if baby is too large

What are primary powers in labor?

Involuntary uterine contractions

What do primary powers cause?

Effacement (thinning) and dilation (opening)

What are secondary powers in labor?

Maternal pushing (bearing down)

What are benefits of maternal position changes during labor?

Decreases fatigue; increases comfort; increases circulation; helps labor progress

What is the nurse’s role in psychologic response during labor?

Educate patient; explain what’s happening; prepare for next steps; support patient and partner

How do anxiety, stress, and pain affect labor?

They slow labor

What is lightening?

Baby descends into pelvis; abdomen “drops”

What causes urinary frequency before labor?

Pressure on the bladder

What is a common musculoskeletal sign before labor?

Backache

How do Braxton Hicks contractions present before labor?

Strong and painful but do NOT change the cervix

What amount of weight loss may occur before labor?

1–3.5 lbs

What energy change may occur before labor?

Surge of energy

What happens to vaginal discharge before labor?

It increases

What is a bloody show?

Pink-tinged discharge caused by cervical capillaries breaking

What does rupture of membranes mean?

Amniotic sac breaks

\What occurs in Stage 1 of labor?

Contractions to full dilation (10 cm)

What occurs in Stage 2 of labor?

Full dilation to birth of fetus

What occurs in Stage 3 of labor?

Birth to placenta delivery

What occurs in Stage 4 of labor?

Placenta delivery to stabilization (first 2 hours postpartum)

What are the cardinal movements of labor?

Engagement; Descent; Flexion; Internal rotation; Extension; External rotation; Birth

Do you need to memorize all cardinal movements?

No, just understand they occur

What is the normal fetal heart rate range?

110–160 bpm

What factors affect fetal circulation during labor?

Maternal position; uterine contractions; maternal BP; umbilical cord blood flow

What are common umbilical cord issues?

Nuchal cord (around neck); cord compression

What is the effect of cord issues?

Decreased circulation

What triggers respiratory adaptation at birth?

Multiple factors stimulate breathing

How does cardiac output change during labor?

Increases 10–15% (Stage 1) and 30–50% (Stage 2)

What happens to HR and BP during labor?

HR slightly increases; BP increases during contractions

What happens to WBC during labor?

Increases Respiratory

What respiratory changes occur during labor?

Increased O2 consumption; increased respiratory rate

What complication should be monitored?

Hyperventilation

What breathing technique should be taught?

Inhale through nose, exhale through mouth

What urinary change may occur during labor?

Protein may appear due to muscle breakdown

What musculoskeletal symptoms occur during labor?

Back pain; joint aches; post-delivery soreness

What neurologic/emotional changes occur during labor?

Euphoria → seriousness → fatigue

What GI changes occur during labor?

Decreased motility; decreased absorption; slower gastric emptying

What hormonal changes trigger labor?

Decreased progesterone; increased estrogen; increased prostaglandins; increased oxytocin

What metabolic changes occur during labor?

Increased metabolism; decreased blood glucose

Why does a posterior baby cause difficult labor?

Causes back pain and difficulty with flexion/extension

What is the role of primary powers?

Contractions cause dilation

What is the role of secondary powers?

Pushing

Why are position changes important?

They help labor progress

How does anxiety affect labor?

Slows labor

Why are placenta and cord issues critical?

They affect fetal oxygen supply