maternal_ CARE OF THE MOTHER AND THE FETUS DURING PERINATAL PERIOD INTRAPARTAL CARE

Labor

is the series of events by which uterine contractions and abdominal pressure expel a fetus and placenta from a woman's body

37 and 42 weeks of pregnancy

is the series of events by which uterine contractions and abdominal pressure expel a fetus and placenta from a woman's body _______________ , when a fetus is sufficiently mature to adapt to extrauterine life, yet not too large to cause mechanical difficulty with birth.

(preterm birth)

labor begins before a fetus is mature

postterm birth

labor is delayed until the fetus and the placenta have both passed beyond the optimal point for birth

prostaglandins

The uterine muscle stretches from the increasing size of the fetus

oxytocin

fetus presses on the cervix, which stimulates the release of from the posterior pituitary.

progesterone withdrawal

Changes in the ratio of estrogen to progesterone occurs, increasing estrogen in relation to progesterone

placenta

reaches a set age, which triggers contractions

passage

(a woman's pelvis) is of adequate size and contour

passenger

(the fetus) is of appropriate size and in an advantageous position and presentation

powers of labor

(uterine factors) are adequate.

psyche

a woman's psychological state which may either encourage or inhibit labor. This can be based on her past life experiences as well as her present psychological state.

passage

refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum.

fetus is the cause of the disproportion, it is often not because the fetal head is too large but because it is presenting to the birth canal at less than its narrowest diameter.

, if a disproportion between fetus and pelvis occurs, the pelvis is the structure at fault.

passenger

is the fetus

cranium

the uppermost portion of the skull, is composed of eight bones

four superior bones

the frontal (actually two fused bones), the two parietal, and the occipital—are the bones important in childbirth.

Fetal Attitude

describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other

Fetal Lie

e is the relationship between the long (cephalocaudal) axis of the fetal body and the long (cephalocaudal) axis of a woman's body—in other words, whether the fetus is lying in a horizontal (transverse) or a vertical (longitudinal) position.

Longitudinal lies

are further classified as cephalic, which means the fetal head will be the first part to contact the cervix, or breech, with a foot or the buttocks as the first portion to contact the cervix

Fetal position

is the relationship of the presenting part to a specific quadrant and side of a woman's pelvis

vertex presentation

the occiput (O) is the chosen point.

face presentation

it is the chin (mentum [M]).

breech presentation

it is the sacrum (Sa)

shoulder presentation

it is the scapula or the acromion process (A)

Engagement

refers to the settling of the presenting part of a fetus far enough into the pelvis that it rests at the level of the ischial spines, the midpoint of the pelvis.

The degree of engagement is established by a vaginal and cervical examination

"dipping."

One that is descending but has not yet reached the ischial spines may be referred to as

A presenting part that is not engaged is said to be "floating."

Station

refers to the relationship of the presenting part of the fetus to the level of the ischial spines

If the presenting part is above the spines, the distance is measured and described as minus stations, which range from −1 to −4 cm.

If the presenting part is below the ischial spines, the distance is stated as plus stations (+1 to +4 cm).

At a +3 or +4 station, the presenting part is at the perineum and can be seen if the vulva is separated (i.e., it is crowning).

Descent

downward movement of the biparietal diameter of the fetal head within the pelvic inlet.

Descent

occurs because of pressure on the fetus by the uterine fundus.

Flexion

As descent is completed and the fetal head touches the pelvic floor, the head bends forward onto the chest, causing the smallest anteroposterior diameter (the suboccipitobregmatic diameter) to present to the birth canal.

Flexion

is also aided by abdominal muscle contraction during pushing

Internal Rotation

During descent, the biparietal diameter of the fetal skull was aligned to fit through the anteroposterior diameter of the mother's pelvis.

Extension

As the occiput of the fetal head is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head.

External Rotation

almost immediately after the head of the infant is born, the head rotates a final time (from the anteroposterior position it assumed to enter the outlet) back to the diagonal or transverse position of the early part of labor.

Expulsion

is the end of the pelvic division of labor.

The Powers of Labor

This is the force supplied by the fundus of the uterus and implemented by uterine contractions, which causes cervical dilatation and then expulsion of the fetus from the uterus.

It is important for women to understand that they should not bear down with their abdominal muscles to push until the cervix is fully dilated.

Contractions

are assessed according to frequency, duration, and strength.

Braxton Hicks contractions

that they are usually irregular and are painful but do not cause cervical dilation.

increment

when the intensity of the contraction increases

acme

when the contraction is at its strongest

decrement

when the intensity decreases.

As labor progresses, the relaxation intervals decrease from 10 minutes early in labor to only 2 to 3 minutes.

• The duration of contractions also changes, increasing from 20 to 30 seconds at the beginning to a range of 60 to 70 seconds by the end of the first stage

lower segment

which becomes thin-walled, supple, and passive so the fetus can be pushed out of the uterus easily.

Effacement

shortening and thinning of the cervical canal.

Dilatation

refers to the enlargement or widening of the cervical canal from an opening a few millimeters wide to one large enough (approximately 10 cm) to permit passage of a fetus

Dilatation

occurs first because uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus.

Psyche

refers to the psychological state or feelings a woman brings into labor.

first stage of dilatation

which begins with the initiation of true labor contractions and ends when the cervix is fully dilated

second stage

extending from the time of full dilatation until the infant is born.

third or placental stage

lasting from the time the infant is born until after the delivery of the placenta.

"fourth stage"

The first 1 to 4 hours after birth of the placenta is sometimes termed, to emphasize the importance of close maternal observation needed at this time.

Friedman (1978)

a physician who studied the process of labor extensively, used data to divide the first two stages of labor into phases: latent and active labor

1. a latent, 2. an active, and 3. a transition phase.

The first stage, which takes about 12 hours to complete, is divided into three segments:

latent or early phase

begins at the onset of regularly perceived uterine contractions and ends when rapid cervical dilatation begins.

Latent Phase (0-3 cm)

Contractions during this phase are mild and short, lasting 20 to 40 seconds.

The Active Phase (4-7 cm)

cervical dilatation occurs more rapidly. Contractions grow stronger, lasting 40 to 60 seconds, and occur approximately every 3 to 5 minutes.

Transition Phase (8-10 cm)

, contractions reach their peak of intensity, occurring every 2 to 3 minutes with a duration of 60 to 70 seconds, and a maximum cervical dilatation of 8 to 10 cm occurs.

Transition Phase (8-10 cm)

If the membranes have not previously ruptured, they will usually rupture at full dilatation (10 cm). By the end of this phase, both full dilatation (10 cm) and complete cervical effacement (obliteration of the cervix) have occurred. • During this phase, a woman may experience intense discomfort that is so strong, it might be accompanied by nausea and vomiting.

Dick-Read Method

Fear leads to tension and tension leads to pain. Goal is to decrease fear

Lamaze:

psychoprophylactic method based on conditioning; concentration on breathing is practiced. Use of distractions to reduce pain perception

Bradley Method

- husbands are encouraged to participate in labor as coach. During pregnancy muscle toning exercises are done and omits food with preservatives, animal fat and high salt content in the diet

Kitzinger method

emphasis on body awareness, innovative relaxation techniques & special breathing patterns. This is a program of conscientious relaxation and levels of progressive breathing.

second stage of labor

the time span from full dilatation and cervical effacement to birth of the infant.

Second Stage

A woman typically feels contractions change from the characteristic crescendo- decrescendo pattern to an uncontrollable urge to push or bear down with each contraction as if to move her bowels. • She may experience momentary nausea or vomiting

Women can choose a variety of positions for birth

a lithotomy position

was the preferred position for birth because it offers a clear view of the perineum, but it is no longer a position of choice as a woman lying flat on her back may slow, not help, fetal descent, and lying longer than 1 hour in a lithotomy position can lead to intense pelvic congestion and possibly thrombophlebitis

lateral or Sims position, a dorsal recumbent position (on the back with knees flexed), semi-sitting, or squatting

effective birth position

Pushing

is usually best done from a semi-Fowler's position with legs raised against the abdomen, squatting, or on all fours rather than lying flat to allow gravity to aid the effort.

To remove vaginal or rectal secretions and prepare the cleanest environment for the birth of the baby, the care provider may clean the perineum with a warmed antiseptic • such as Iodaphor (cold solution causes cramping) and then rinse the area with sterile water

If assisting with this, always clean from the vagina outward (so microorganisms are moved away from the vagina, not toward it), using a clean compress for each stroke. • Be certain to include a wide area (vulva, upper inner thighs, pubis, and anus

Apgar score

is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed

Appearance, Pulse, Grimace, Activity, Respiration

Apgar stands for

A baby who scores a 7 or above on the test is considered in good health. • A lower score does not mean that your baby is unhealthy.

1. Appearance (skin color)

2. Pulse (heart rate)

3. Grimace response (reflexes)

4. Activity (muscle tone)

5. Respiration (breathing rate and effort)

third stage of labor, the placental stage

begins with the birth of the infant and ends with the delivery of the placenta

Two separate phases are involved:

placental separation and placental expulsion.

There is lengthening of the umbilical cord. Ø A sudden gush of vaginal blood occurs. Ø The placenta is visible at the vaginal opening. Ø The uterus contracts and feels firm again

The placenta has loosened and is ready to deliver when:

Schultze presentation

If the placenta separates first at its center and lastly at its edges, it tends to fold on itself like an umbrella and presents at the vaginal opening with the fetal surface evident. • Approximately 80% of placentas separate and present in this way.

Duncan presentation

If the placenta separates first at its edges, it slides along the uterine surface and presents at the vagina with the maternal surface evident. • It looks raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces evident.

fourth stage of labor.

it is the most dangerous time of birth for the mother).

lochia

the vaginal discharge after giving birth, containing blood, mucus, and uterine tissue.