Labor & Birth

What are some factors that influence labor onset?

uterine stretch, progesterone withdrawal, increased oxytocin sensitivity, increased release of prostaglandins

What occurs in the beginning stages of labor?

cervical changes, lightening, increased energy levels, bloody show, mucous plug, ROM, braxton hicks

True Labor

regular, strong, and continuous contractions that often radiate from back to front

False Labor

irregular, weak, come and go contraction which are usually just felt in the front

5 Ps of Birth

passageway, passenger, powers, position, psychological response

Passageway

the bony pelvis and soft tissues

True Pelvis

inlet, midpelvis, outlet

False Pelvis

upper, flared parts of the iliac bones and wings at the base of the sacrum

Which pelvic shapes are most favorable?

gynecoid, anthropoid

Which pelvic shapes are less favorable?

android, platypelloid

Soft Tissues

cervix, pelvic floor, vagina

Passenger

fetus

Which part of the fetus is the largest?

skull

Fetal Attitude

baby's body in relationship to itself (flexion, extension)

Fetal Lie

the way baby is laying within the uterus (transverse, longitudinal)

Fetal Presentation

which part of the baby presents first in the birth canal (cephalic, breech, shoulder)

Fetal Station

longitudinal location of the baby in relation to the pelvis (-4 through +4)

Fetal Engagement

signifies babies descent into the pelvis

Cardinal Movements

engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

Powers

uterine contractions

What are some important factors regarding uterine contractions?

frequency, intensity, duration

Maternal Response to Contractions

increased HR, BP, CO, increased WBC, increased RR and O2 consumption, decreased gastric motility at emptying, increased BMR, decreased blood glucose

Fetal Response to Contractions

variability in HR, decreased circulation and perfusion, increase in arterial CO2, decrease in O2, decreased breathing movements

What are some factors that influence pain?

physiologic, spiritual, psychosocial, environmental, medications

What are some indications that the placenta has detached from the wall of the uterus?

uterus rises into a globular shape, cord lengthens, trickle of blood

What are some assessments for mom during labor?

vitals, pain, vaginal exam, ROM, contractions, leopolds maneuvers

What are some assessments for baby during labor?

fluid analysis, HR monitoring and variability

Leopolds Maneuvers

palpation to determine presentation and position of the fetus

What does fetal HR variability indicate?

good oxygenation

What are the parameters we want for fetal HR variability?

moderate; fluctuating range from 6-25 bpm

Intrauterine Resuscitation

attempts to improve fetal oxygenation

Strategies for Intrauterine Resuscitation

decrease pitocin, administer O2 (10L facemask), increase fluids, identify cause, change maternal position

VEAL CHOP MINE

tool for HR variability

V - C - M

variable decels, cord compression, move client

E - H - I

early decels, head compression, identify labor

A - O - N

accelerations, ok, nothing

L - P - E

late decels, placental insufficiency

Nonpharmacologic Pain Management in Labor

continuous support, hydrotherapy, ambulation, accupuncture, attention focusing, imagery, therapeutic touch, breathing techniques

Pharmacologic Pain Management in Labor

systemic, regional/local, neuraxial, general