NURS 2866 - Labor and Birth Processes

What are the Five P’s affecting labor?

Passenger, Passageway, Powers, Position, Psychologic Response

How does the fetal head affect labor progression?

The size and shape of the fetal head can influence how easily the fetus navigates through the birth canal.

What are fontanels and why are they important during labor?

Fontanels are openings where two or more fetal skull bones meet, used to assess fetal position during vaginal exams.

What are the characteristics of the anterior fontanel?

Diamond-shaped, about 3 cm x 2 cm, closes by 18 months after birth.

What are the characteristics of the posterior fontanel?

Triangular, about 1 cm x 2 cm, closes by 6–8 weeks after birth.

What is fetal presentation?

The part of the fetus that enters the pelvis first; types include cephalic (head), breech (buttocks/feet), and shoulder.

What is the most common fetal presentation?

Cephalic (head first)

What is the presenting part in a cephalic presentation?

The vertex (head)

What is fetal lie?

The relationship of the fetus’s spine to the mother's spine.

What is a longitudinal or vertical fetal lie?

Fetal spine is parallel to the mother’s spine.

What is a transverse fetal lie?

Fetal spine is perpendicular to the mother’s spine; often requires C-section.

What is fetal attitude?

The relationship of the fetus's body parts to one another; normally flexed.

What does “fetal attitude” typically look like?

Chin tucked to chest, arms and legs flexed toward body.

What is fetal position?

The relationship of the presenting part to the four quadrants of the mother’s pelvis.

How is fetal position documented?

Three-letter notation (e.g., ROP = Right Occiput Posterior)

What do the letters in fetal position stand for?

1st: Side of mother’s pelvis (L/R); 2nd: Presenting part (O/S/M/Sc); 3rd: Position (A/P/T)

What does ROP stand for?

Right Occiput Posterior – baby’s head facing mom’s right side and back.

What problems can a posterior fetal position cause?

Intense back labor due to baby’s spine pressing on mom’s spine.

How is posterior fetal position managed?

Position changes, standing, and hip rotations to help rotate baby anteriorly.

What does the passageway in labor refer to?

The mother’s bony pelvis and soft tissues (cervix, pelvic floor, vagina, vaginal opening)

Why is pelvic assessment done at the first prenatal visit?

To anticipate any birth complications due to pelvic size or shape.

What are the primary powers in labor?

Involuntary uterine contractions that cause effacement and dilation.

What are the secondary powers in labor?

Voluntary bearing-down (pushing) efforts by the mother.

What is the purpose of effacement?

Thinning and shortening of the cervix.

What is dilation?

Opening/enlargement of the cervix, measured in cm (0–10 cm).

Why are position changes important for a laboring woman?

They relieve fatigue, improve comfort and circulation, and aid fetal descent.

What does the psychologic response in labor involve?

The mother’s emotional and mental state during labor.

How does emotional support affect labor?

Reduces anxiety and stress, leading to better outcomes.

What are signs preceding labor (Box 13.1)?

Lightening, backache, strong Braxton Hicks contractions, weight loss, energy surge, discharge/bloody show, ROM.

What is lightening?

When the fetus descends into the true pelvis, often causing more frequent urination.

What causes the bloody show?

Capillary rupture in the cervix, leading to pink-tinged mucus.

What is ROM?

Rupture of membranes – when amniotic fluid leaks out (water breaks).

What are the four stages of labor?

First (onset to full dilation), Second (dilation to birth), Third (birth to placenta), Fourth (postpartum monitoring)

What happens during the first stage of labor?

Regular contractions begin and continue until full cervical dilation (10 cm).

What happens during the second stage of labor?

Full dilation to the birth of the fetus.

What happens during the third stage of labor?

Birth of the baby to the delivery of the placenta.

What happens during the fourth stage of labor?

First 2 hours postpartum to monitor mom’s recovery and stability.

What are the seven cardinal movements of labor?

Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, Expulsion

What is the general idea behind cardinal movements?

They describe how the fetus navigates through the birth canal.

What are key fetal adaptations to labor?

FHR (110–160 bpm), changes in fetal circulation, and stimulated fetal respiration.

What can affect fetal circulation during labor?

Maternal position, uterine contractions, blood pressure, and cord compression.

How is fetal respiration stimulated at birth?

Through mechanical and chemical factors, like compression and fluid expulsion.

What are maternal cardiovascular changes during labor?

Increased cardiac output (10–50%), elevated BP and HR during contractions.

What are maternal respiratory changes during labor?

Increased oxygen demand and respiratory rate; risk of hyperventilation.

What is a breathing technique taught during labor?

Slow, controlled breathing – inhale through the nose, exhale through the mouth.

What are renal system changes during labor?

Possible protein in urine due to muscle breakdown.

What are musculoskeletal changes during labor?

Common back and joint aches post-delivery.

What neurologic changes occur during labor?

Emotional transitions from euphoria to seriousness to fatigue.

What GI changes occur during labor?

Slowed GI motility and decreased gastric emptying.

What endocrine changes occur during labor?

Decreased progesterone, increased estrogen/prostaglandins, and drop in blood glucose.

What is a summary of the Five P’s?

Passenger (fetus), Passageway (pelvis and soft tissues), Powers (contractions and pushing), Position (of the mother), Psychologic Response (emotional state)