The Nurse’s Role in Labor, Birth, and Postpartum Care

What are the two types of birth settings mentioned?

Hospital and home or birthing center.

Who typically leads care in a hospital setting?

Obstetrician-led care.

What is the purpose of a birth plan?

To communicate patient and support-person priorities to the care team.

What should culturally responsive care honor?

Values, beliefs, practices, and traditions of the patient.

What are the signs that a first-time mother should come to OB triage?

Contractions every 5 minutes lasting 1 minute for 1 hour or if water breaks.

S/S you need to come to OB triage NOW?

- water breaks

- bleeding

-fetal movement is under 10 in 2 hours

- intense pain

What is the first priority for a nurse in OB triage?

Assess immediate maternal and fetal stability.

What are the signs of eclampsia?

Severe headache, visual changes, epigastric pain, or marked swelling (GO TO ER)

What is true labor

True labor contractions occur at regular intervals and lead to cervical changes.

What is false labor

when contractions are not regular and do not become more intense or stronger (braxton hicks) and cease with walking or rest. These DO NOT cause cervical changes

(Pain is only in abdomen)

What are Braxton-Hicks contractions?

Irregular and mild uterine contractions that do not lead to cervical changes. Associated with false labor

What maternal factors can trigger labor?

- Uterine muscles stretch

- increased pressure on the cervix.

- increase in estrogen levels

- decrease progesterone; allowing for release of oxytocin & prostaglandins

What fetal factors can trigger labor?

- contractions occur (decr. prostaglandin)

- Placental release of corticotropin-releasing hormone (CRH)

- fetal cortisol levels increase (causing inflammation response on placenta adn stimulates contractions)

What is lightening in the context of labor?

The baby drops into the pelvis, allowing the mother to breathe easier but increases urination.

What is the significance of losing the mucus plug?

It indicates that the cervix is beginning to open in preparation for labor.

what is nesting

a burst of energy

Signs of impending labor

- lightening

- braxton hicks contractions

- cervical changes

- losing mucous plug

- increase vaginal discharge ("bloody show")

- nesting

- ROM (membranes may or may not break)

*Rare: D/N, indigestion, 1-3Ibs weight loss

What are the four distinct stages of labor?

Stage 1: Regular contractions and cervical dilation; Stage 2: Birth of the baby; Stage 3: Delivery of the placenta; Stage 4: Recovery.

Stage one fo labor

regular contractions and cervical dilation. Complete dilation 10cm

3 levels within stage one of labor

- Latent: 0-5cm

- Active: 6-10cm

- Transition: 8-10cm

Stage two of labor

Complete dilation of 10cm. At this stage we are pushing and baby is born

Stage three of labor

From birth of baby to delivery of the placenta

Stage four of labor

From delivery of placenta to 2 hours postpartum care

What are the 5 P's that influence labor and birth?

- Powers (contractions & push effort)

- Passage (pelvis & birth canal)

- Passenger (fetus & placenta)

- Psychological response (psyche of mom)

- Position (of mother to birth child)

Primary vs secondary powers

Primary = involuntary

Secondary = voluntary

What role do rhythmic uterine contractions play in labor?

They cause cervical effacement and dilation. This is a primary power

What is the role of bearing down in labor?

Voluntary efforts such as pushing that augment the force of involuntary contractions.

What is the gynecoid pelvic type?

The most common type, considered optimal for childbearing due to its rounded shape and wider outlet.

what is platypelloid pelvic type?

Least common: flat inlet and short anteroposterior diameter. Difficult for childbirth and passage

What is effacement?

The shortening and thinning of the cervix from 2-3 cm long to paper-thin.

What is dilation in the context of labor?

The opening and widening of the cervix from closed to fully open (0-10 cm).

What factors determine how a passenger moves through the birth canal?

Size and shape of the fetal skull, fetal presentation, lie, attitude, position, and size.

What is the role of the placenta during labor?

It is also considered a passenger that must pass through the birth canal.

What are the sutures of the fetal skull?

Sagittal, lambdoidal, coronal, and frontal sutures.

anterior fontanel

diamond-shape; closes by 18 months; determines head position

posterior fontanel

triangular; closes by 6-8 weeks

What is molding?

Overlapping of skull bones adapts the fetal head to the maternal pelvis

What is the role of oxytocin in labor?

It stimulates uterine contractions and is released in response to fetal pressure on the cervix.

What does the term 'bloody show' refer to?

Pink or red-tinged discharge that may occur as the cervix begins to change.

What is the purpose of patient-directed pushing?

To optimize progress during labor and reduce the likelihood of cesarean birth.

What is the significance of the transition phase in labor?

It is the phase where cervical dilation reaches 8-10 cm, marking the end of Stage 1.

What does the term 'nesting' refer to during labor?

A burst of energy where the mother feels the need to prepare for the baby.

What is meant by 'fetal presentation'?

The position of the fetus entering the pelvic inlet first during labor.

What are the three main types of fetal presentation?

Cephalic (headfirst), Breech (pelvis first), and Shoulder (shoulder first).

What is the significance of fetal lie?

It refers to the long axis of the fetus in relation to the long axis of the mother, which can be longitudinal, transverse, or oblique.

What is longitudinal (vertical) fetal lie

long axis of fetus and mom are parallel (can be cephalic or breech)

what is transverse (horizontal) fetal lie?

long axis of fetus is perpendicular to long axis of mom (vaginal birth cannot occur)

What is oblique fetal lie?

- fetus at slight angle

- not ideal (there shoulder is at birth canal)

What does 'fetal attitude' refer to?

The relationship of fetal parts to one another, typically noted by flexion or extension of the fetal joints.

What is the ideal fetal attitude for labor?

General flexion, where the fetus is rounded with the chin flexed to the chest.

What is deviation fetal attitude?

chin extended away from chest adn extremities extended, making vaginal birth difficult

What are fontanels?

Soft spots on the fetal skull at the intersections of sutures that allow for molding during birth.

Fetal position abbreviation

(look back at slides for example)

Three-letter code indicating fetal position.

- first letter is the location of presenting part of fetus

- middle letter is the specific presenting part of fetus

- third letter is the location fo presenting part in relation to moms pelvis

What does the term 'station' refer to in labor?

The relation of the presenting part of the fetus to an imaginary line drawn between the ischial spines.

What does a positive station indicate?

The presenting part is below the ischial spines, indicating descent towards birth.

What is the purpose of Leopold's Maneuvers?

To determine the number of fetuses, presenting part, fetal lie, fetal attitude, and degree of descent into the pelvis.

**location of fetus' back is best to assess fetal heart tone

What is the risk associated with rupture of membranes (ROM)?

Increased risk of infection for both mother and fetus after membranes rupture.

What is speculum

pooling of amniotic fluid in vaginal vault (nurses cannot perform this)

What is nitrazine

litmus paper turns blue if positive (ROM)

What is ferning

dried amniotic fluid will have fern like appearance under microscope

What is meconium and why is it significant?

A viscous green-black substance that can indicate fetal distress if present in amniotic fluid.

What is the difference between induction and augmentation of labor?

Induction is the deliberate stimulation of contractions before labor onset, while augmentation is the stimulation of the uterus to increase contractions after labor has started.

What are uterotonic medications used for?

To induce labor, aid in cervical ripening, or manage postpartum hemorrhage.

What is the role of maternal position during labor?

To support labor progress, improve comfort, and enhance uteroplacental blood flow.

What positions are considered effective for delivery?

Squatting, standing and leaning forward, hands and knees, and lateral positions.

What is the least effective position for delivery?

Lithotomy position.

What does 'fetal size' refer to in the context of labor?

The dimensions of the fetus that can affect its ability to pass through the birth canal.

What is the significance of fetal position?

It describes the relationship of the presenting part to the four quadrants of the mother's pelvis.

What does the first letter in the fetal position abbreviation represent?

The location of the presenting part relative to the mother's pelvis (R for right, L for left).

What does the middle letter in the fetal position abbreviation represent?

The specific presenting part of the fetus (O for occiput, S for sacrum, M for mentum, Sc for scapula).

What does the third letter in the fetal position abbreviation indicate?

The location of the presenting part in relation to the mother's pelvis (A for anterior, P for posterior, T for transverse).

What is the effect of maternal stress during labor?

It can slow labor progress and increase the likelihood of interventions.

What are some factors affecting a patient's psyche during labor?

Preparation through childbirth classes, prior experiences, and support from nurses and partners.

What are progressive contractions?

Contractions that cause cervical dilation, effacement, and the fetus to descend into the pelvis.

What is augmentation in labor?

The process of stimulating the uterus to increase the frequency, duration, and intensity of contractions after the onset of spontaneous labor.

What is Cytotec (Misoprostol) used for?

Used for cervical ripening and induction, can induce abortions, or aid in postpartum hemorrhage. (given oral, vaginally, or rectally

How is Oxytocin (Pitocin) administered during labor?

Always administered IVPB and titrated to establish and maintain progressive induction or augmentation of labor.

What is the purpose of Dinoprostone, Prepadil, or Cervidil?

These medications are applied to the cervix to ripen it for induction and may cause labor, fetal distress, or uterine tachysystole.

What is the focus of nursing care during the third stage of labor?

To assess maternal vital signs after birth and promote placental expulsion. Recognize placental separation: a gush of blood and cord lengthening

What are the cardinal movements of labor?

The positional changes of the fetal presenting part required to navigate the birth canal.

What is the fourth stage of labor?

Begins after delivery of the placenta and typically ends with stabilization of the mother, usually about 2 hours.

What are nursing actions during the fourth stage of labor?

Monitor vital signs, assess for bladder distention, and promote paternal-newborn bonding.

What is the 'Golden Hour' after birth?

The first 60 minutes after birth, critical for the transition of the neonate and bonding with the family.

What are the three concepts of Baby-Friendly practices?

- Delayed cord clamping (until cord stops pulsating)

-Maternal skin-to-skin contact,

- early breastfeeding

What is APGAR scoring?

A rapid physiological assessment of a newborn's adjustment to the extrauterine environment, scored at 1 and 5 minutes after birth.

What does a score of 0-3 on the APGAR indicate?

Severe stress in the newborn.

What does a score of 4-6 on the APGAR indicate?

indicates moderate difficulty w/transition

What does a score of 7-10 on the APGAR indicate?

indicates stable status

What are the immediate newborn assessments?

Temperature, pulse, respirations, skin color, peripheral circulation, and activity, assessed every 30 minutes for the first 2 hours.

What actions are taken for newborn thermoregulation?

Skin-to-skin contact, swaddling in warm blankets, and placing the newborn under a preheated radiant warmer.

What medications are given to newborns immediately after birth?

Erythromycin ointment for eyes, Vitamin K for hemorrhagic disease prevention, and Hepatitis B vaccine.

What is the importance of pain management during labor?

To assist laboring women in managing pain while ensuring safety for both mother and fetus.

What is the patient's prerogative during labor?

To change her pain management plan as needed.

What factors can influence pain intensity during labor?

Uterine contractions, cervical stretching, bony pelvis pressure, perineal stretching, descent of fetal head, sleep deprivation, support received, previous birth experience, extent of childbirth preparation, and expectations of birth experience.

What are the sources of pain during labor?

Internal visceral pain, somatic pain, pain caused by dilation and effacement, pressure during fetal descent, and pain with expulsion.

What is the first stage of labor characterized by?

Uterine contractions, dilation of the cervix, and visceral pain.

What sensations are typically felt during the second stage of labor?

Burning, splitting, and tearing sensations due to distention of the vagina and perineum.

What occurs during the third stage of labor?

Uterine contractions continue as the placenta is expelled.

How can anxiety and fear affect labor pain?

They can increase muscle tension, which intensifies the experience of pain and slow the progression of labor.

What should be assessed regarding a client's pain during labor?

Level, quality, frequency, duration, intensity, and location of pain through verbal and nonverbal cues.