Week 2: Labor & Birth Part 1

Intrapartum

period of labor and birth

Labor

uterine contractions resulting in cervical change

TOLAC

trial of labor after cesarean

VBAC

vaginal birth after cesarean

What are the 4 Ps of labor?

Powers

Passage

Passenger

Psyche

What are primary powers?

involuntary uterine contractions signaling the start of labor

What are secondary powers?

voluntary and involuntary bearing-down efforts during 2nd stage of labor

Augment the force of involuntary contractions

What is effacement?

thinning and shortenings of the cervix; helps make room for baby to pass through birth canal

0% effaced

cervix is thick and long

50% effaced

cervix is halfway thinned

100% effaced

cervix is completely thinned

What is cervical dilation?

the gradual opening of the cervix to allow passage of baby

0cm dilated

cervix is closed (thick)

4cm dilated

Early/latent labor

6cm dilated

active labor

10cm dilated

Fully dilated, ready for pushing

What is the fetal station?

position of the baby's head in relation to mother's ischial spine

Negative stations

baby is higher in the pelvis (not engaged)

0 station

baby is at level of ischial spine -> engaged

Positive stations

baby is descending further into birth canal, closer to delivery

What are uterine contractions?

rhythmic tightening and relaxation of the uterine muscle that helps thin and open the cervix

Contraction Frequency

time from start of one contraction to start of next

Contraction Duration

How long each contraction lasts (seconds)

Contraction Intensity

Strength of the contraction

Contraction Resting Tone

Uterine relaxation between contractions

Which pelvic type is most ideal for childbirth?

Gynecoid (round)

What is fetal head molding?

the shaping of fetal head by overlapping of cranial bones to allow movement through birth canal

Cephalic presentation

head first, most common

Breech presentation

buttocks/feet first

Shoulder presentation

transverse lie, rare

requires intervention

Frank Breech

legs up by the head

Complete Breech

cannonball position

Footling Breech

Feet first; can be one of both

What are the risks with breech presentation?

Umbilical cord prolapse

Prolonged birth or trauma

Increased need for c-section

What is the fetal lie?

relationship of the fetus spinal column to mother's spinal column (longitudinal or transverse)

What is fetal attitude?

Relationship of fetal parts to one another

Normal attitude

Flexion; head flexed, chin to chest

Arms/legs flexed towards body

Extension attitude

Head/limbs extended

How can fetal presentation and position be determined?

Inspect patient's abdomen

Leopold's maneuver

Ultrasound

Vaginal exam

What makes up the Psyche?

Mental/physical prep for childbirth

Sociocultural values

Previous childbirth experience

Support from loved ones

Emotional status

What factors can affect a patient's response to pain?

Childbirth prep

Individual pain tolerance

Culture norms

Fatigue/sleep deprivation

Anxiety

Support from loved ones

What are some pharmacologic pain management interventions during childbirth?

Systemic analgesia

regional anesthesia

General anesthesia

What are common systemic analgesia provided for laboring patients?

Morphine, Stadol, Nubain, Fentanyl

What is important to consider with systemic analgesia?

Monitor for respiratory depression

Consider fetal well-being

Cross-placenta barrier

What are common regional anesthesia types provided for laboring patients?

Epidural

Intrathecal (spinal)

Pudendal

Local

Epidural

injection of local anesthesia into epidural space; complete pain relief

What are the advantages of an epidural?

Patient is fully awake

Continuous dosing

Allows for dose adjustments

What are the risks associated with an epidural?

Maternal hypotension

Cost

Infection risk

Spinal headache

What are contraindications for an epidural?

Local/systemic infection

Spine abnormalities

Coagulation disorders

increased ICP

Uncooperative patient

What is an intrathecal block?

anesthetic is injected into subarachnoid space

used for c-sections; immediate onset

higher risk for spinal headache

total pain releif

Pudendal block

anesthetic injection to provide perineal pain relief

used for vaginal delivery or perineal repair

Does not relieve contraction pain

Local anesthesia (lidocaine)

Direct infiltration of anesthetic into tissues of perineum

Used for repairs

Does not reduce contraction or labor pain

When is general anesthesia used with childbirth?

only severe cases; an emergency