NURS 2002 - Maternity - Labour and Childbirth

labour

process of moving the fetus, placenta, and membranes out of the birth canal; involves a process of uterine contractions which leads to progressive effacement and dilation of the cervix to allow the moving of the fetus, placenta, and membranes out of the uterus and through the birth canal

first stage of labour

the period of the birth process lasting from the first regular uterine contractions until the cervix is fully dilated

a fully dilated cervix is ___ cm

10

second stage of labour

from complete dilatation of the cervix until the birth of the infant

third stage of labour

from the birth of the infant until the placenta and membranes are delivered

fourth stage of labour

after delivery of placenta, a few hours after birth

theories of labour

-progesterone withdrawal
-estrogen stimulation
-prostaglandins
-oxytocin release - prostaglandin release
-fetal influence
-mechanical / traumatic events

cardiac responses to labour

-major effects
-CO, cardiac workload, HR and BP all increase
-CO increases more in the second stage as compared to the first
-peripheral vascular resistance increases with each contraction
-second stage = higher increase in BP
-pulse increases slow and steadily

things that affect cardiac system during labour

-dehydration
-hemorrhage
-anxiety & fear
-pain
-drugs

fear and anxiety increase release of catecholamine which leads to transient ___

tachycardia

why does CO increase in labour?

transfer of maternal blood from uterus and vascular system of placenta into maternal circulatory system with each contraction

what happens to blood flow during a contraction?

it is restricted in the uterine artery then redirected to peripheral vessels

___ position leads to decreased CO and SV with increased HR

supine

the ___ increases intrathoracic pressure, decreases venous return, and increases venous pressure resulting in increased CO, increased BP, decreased pulse, and potential fetal hypoxia

Valsalva maneuver

blood loss of ___ml during labour

300-500

___ helps compensate for blood loss

hypervolemia (increased blood volume)

___ count increases during labour

WBC

physical work of labour leads to decreased ___ levels d/t body expending energy

blood glucose

blood coagulation decreases, while ___ increases

fibrinogen levels

peripheral vascular changes may cause maternal ___ and / or ___

-flushed cheeks
-hot / cold feet

onset of labour triggered by decreasing levels of ___

progesterone

onset of labour triggered by increasing levels of ___, ___, and ___

-estrogen
-prostaglandins
-oxytocin

__ increases with physical work of labour and ___ decreases with physical work of labour

-metabolism
-blood glucose

uterine muscle activity ___ oxygen consumption

increases

greater oxygen consumption causes ___ in CO2, ___ demand for O2 leading to ___ rate and depth of respirations that can lead to ___

-decrease
-increase
-increase
-hyperventilation

hyperventilation can cause

-tingling of feet and hands
-numbness
-dizziness

prolonged breath holding while pushing during labour leads to ___ CO2

decreased

greater ___ and distention of ___ in vaginal area during labour

-elasticity
-tissues

during labour, GFR ___ with ___ CO, therefore ___ is common

-increases
-increased
-polyuria

spontaneous voiding may be difficult d/t ___

tissue edema

may not recognize need to void d/t

-contractions
-pressure

a ___ can impede descent of fetus, and possibly cause trauma to bladder

full bladder

___ insensible loss, increased ___

-increased
-diaphoresis

what happens d/t breakdown of muscle tissue from physical work of labour?

proteinuria

___, ___, and ___ cause increased muscle activity

-diaphoresis
-fatigue
-increased temp

___ can occur due to fetal positioning (MSK)

backache

___ can occur in order to allow room for fetus to exit pelvis

joint ache / laxity

most joint ache felt in ___ region

iliosacral

motility and absorption ___

decrease

stomach emptying ___

decreases

___ and ___ are provided during labour to eat (d/t decreased motility)

-ice chips
-frozen popsicles

may see ___ and ___ once cervix is fully dilated (GI)

-nausea
-belching

may get ___ between contractions when pushing (neuro)

amnesia

___ raise pain threshold and produce sedation

endogenous endorphins

after birth the pain perception is ___

decreased

fetal respiratory movements __ during labour

decrease

as baby pushes through birth canal, ___ is squeezed from lungs

fluid

baby relies on reserves in ___ spaces

intervillous

if stressful labour, will see significant changes in ___

fetal heart pattern

normal acid-base balance of fetus during labour should be pH

7.25-7.35 (normal)

pre adicotic pH

7.2-7.25

acidotic pH - NEEDS DELIVERY ASAP

less than 7.2

lightening

the sensation of the fetus moving from high in the abdomen to low in the birth canal (dropping into pelvis)

impending signs of labour

-lightening
-Braxton Hicks contractions
-bloody show
-backache
-SROM
-diarrhea
-spurt of energy / nesting
-weight loss
-plug is gone, water has broken already

nesting

excessive cleaning and rearranging, natural urge getting ready for baby to come

why does diarrhea occur before labour?

it's the body's way to preserve energy during the labour process

latent phase of labour

- 0-3 cm
-around 7-8 hrs
-usually overall good mood

active phase of labour

- 4-7cm
-around 3-5 hrs
-phase where pain meds should be given (if indicated)

transition phase of labour

- 8-10cm
-around 30 mins-2 hrs
-big change of emotions, upset, a lot of pain
-very scared, anxious, physically sick
-anger, abnormal emotions for what is usually expected from someone

5 Ps

-powers
-position
-passenger
-passageway
-psyche

primary contractions

involuntary uterine contractions that result in effacement and dilatation of cervix

secondary contractions

involuntary urge to push

powers

ability to push / body's inherent abilities to expel a child

FDI

-frequency
-duration
-intensity
of contractions

how to measure FDI

-pressure catheter
-insert fingers

mild contraction

feels kinda squishy kinda firm, like nose cartilage

moderate contraction

feels more firm, like a chin

strong contraction

feels very firm like a forehead

most women have a ___ shaped pelvis d/t evolution

gynecoid

cervical effacement

-measured in percentage (0-100)
-thinning of the cervix

cervical dilation

-measured in cm (0-10)
-full = 10cm

must have full ___ and ___ before moving onto second stage of labour (pushing)

-dilation
-effacement

average primiparous woman dilates ___ and has effacement ___ dilation

1cm/hr
-before

average multiparous woman dilates ___ and has effacement ___ dilation

1.5cm/hr
-with

passageway

refers to maternal pelvis

passenger

fetus and placenta

3 fetal sutures

-sagittal
-coronal
-lambdoidal

we want to ___ biparietal diameter

decrease

biparietal diameter

diameter from each of the parietal bones; widest part of baby's head

fetal position

-head down
-chin to chest
-knees bent
-arms tucked in

longitudinal

-head or bum down

bum down = ___

breech

external cephalic version

optional method to rotate baby in a breech presentation to cephalic presentation; baby is manipulated and rotated externally through mother's abdomen; must occur at the end of the pregnancy or close to it, but before labour starts

if breech, presenting part =

sacrum

smallest biparietal diameter

9.25cm

baby should come out looking at mom's ___

bum

lie

long axis of fetus in relation to long axis of mother

presentation

part of fetus that is overlying maternal pelvic inlet

presenting part / denominator

part of the baby that leads the way through the birth canal

attitude

posture of fetus during labour (head / neck flexion)

station / engagement

relationship of presenting part to ischial spines, measured in cm above (-) or below (+) ischial spines; descent of fetus into pelvis

descent of fetus

measured by abdominal palpation and expressed in terms of fifths above pelvic brim

Frank breech (incomplete)

-longitudinal or vertical lie
-breech presentation
-presenting part: sacrum
-attitude: flexion, except for legs at knees

single footling breech

-Longitudinal or vertical lie
-Breech presentation
-Presenting part= sacrum
-Attitude: flexion, except for one leg extended at hip and knee

complete breech

-longitudinal or vertical lie
-presentation: breech (sacrum and feet presenting)
-attitude: general flexion

shoulder presentation

-Transverse or horizontal lie
-Shoulder presentation
-Presenting part= scapula
-Attitude: flexion

fetal positioning

relationship between presenting part and 6 imaginary points on pelvic brim

___ are important in establishing fetal position

fontanelles

if vertex, use ___ to describe position

occipital bone

if breech, use ___ to describe position

sacrum