Maternal Care (Midterms)

labor

begins when fetus mature to cope with extrauterine life yet not too large to cause mechanical difficulty

uterine muscle stretching

results in release of prostaglandins

pressure on the cervix

stimulates release of oxytocin from posterior pituitary

oxytocin stimulation

works with prostaglandins to initiate contractions

placental age

triggers contractions at a set point

rising fetal cortisol levels

reduces progesterone formation and increases prostaglandin formation

fetal membrane production of prostaglandin

stimulates contraction

preliminary signs of labor

before labor, woman experiences subtle signs signals labor is imminent

lightening / descent of the fetal presenting part (37-42 weeks)

in pelvis, occurs 10 to 14 days (primiparas) before labor begins

increase level of activity

related to increase in epinephrine release initiated by decrease in progesterone produced by placenta

slight loss of weight

progesterone level falls, body fluid easily excreted

braxton hicks contraction

extremely strong contraction

ripening of the cervix

at term, cervix softer (butter-soft) and tips forward

cervical ripening

internal announcement that labor is very close

uterine contraction

surest sign that labor has begun; productive uterine contractions

nursing intervention : breathing exercises

offers sense of well-being

rupture of membranes

sudden gush or scanty, slow seeping of fluid from vagina

early rupture of membranes

advantageous; causing head to settle snugly into pelvis = shortens labor

(bloody) show

as cervix softens and ripens, mucus plug filling cervical canal during pregnancy operculum (mucus plug) is expelled

blood with mucus

pink tinge referred to as show or bloody show

TRUE CONTRACTIONS

• begin regularly but becomes irregular and predictable

• felt first in lower back and sweep around abdomen in a wave

• continues no matter what level of activity

• increases in duration, frequency, and intensity

• achieves cervical dilatation (10cm)

FALSE CONTRACTIONS

• begins and remain irregular

• felt first abdominally and remains confined to abdomen and groin

• often disappears with ambulation or sleep

• doesn’t increase in duration, frequency, or intensity

• doesn’t achieve cervical dilatation

passage

route fetus travel from uterus → cervix and vagina → external perineum

pelvic inlet

anteroposterior diameter (not narrowest diameter)

pelvic outlet

transverse diameter (narrowest)

gynecoid

typical female pelvis

android

male / funnel shaped pelvis

anthropoid

long, narrow, & oval shaped

platypelloid

wide pelvis flattened at brim

gynecoid

most favorable for vaginal birth

android

make labor difficult; baby might move slowly through birth canal

anthropoid

may be able to have vaginal birth, but labor might last longer

platypelloid

baby may have trouble passing

body part of the fetus

widest diameter (head), least likely to be able to pass through pelvic ring

fetal skull

pass depending on structure bones, fontanelles, and suture lines and its alignment with pelvis

fetal lie

longitudinal, transverse or oblique

fetal presentation

vertex (head), breech (butt), shoulder (when baby is oblique), compound vertex and hand, and funic umbilical cord

attitude

degree of flexion or extension of head

position station

degree of descent of the presenting part of the fetus, measured in centimeters from the ischial spines

presence of fetal anomalies

hydrocephalus / sacrococcygeal teratoma

molding (returns to normal after 24 hours)

change in shape of skull produced by force of uterine contractions pressing vertex of head against not-yet-dilated cervix

engagement

refers to the setting of the presenting part of a fetus far enough level of the ischial spines, a midpoint of the pelvis

station

relationship of presenting part & level of ischial spines

0 station / engagement

when presenting fetal part levels with ischial spines

-1-4 cm / minus station

presenting part is above spines (“floating”)

+1 to +4 / plus station

presenting part below ischial spines

+3 or +4 station

presenting part is at perineum (crowning)

fetal attitude

degree of flexion a fetus assumes during labor / relation of fetal parts to each other

normal fetal position (advantageous for birth)

helps fetus present smallest anteroposterior diameter of skull to pelvis

moderate flexion

chin isn’t touching chest but in an alert or military position

partial extension

presents brow of the head to birth canal

lie

relationship between long cephalocaudal axis of woman’s body; whether the fetus is lying

fetal presentation

body part first contacting cervix / born first

cephalic presentation

most frequent type; head first contacts the cervix

presence of fetal anomalies

hydrocephalus / sacrococcygeal teratoma

presence of fetal anomalies

hydrocephalus / sacrococcygeal teratoma

molding (returns to normal after 24 hours)

change in shape of skull produced by force of uterine contractions pressing vertex of head against not-yet-dilated cervix

normal fetal position (advantageous for birth)

helps fetus present smallest anteroposterior diameter of skull to pelvis

moderate flexion

chin isn’t touching chest but in an alert or military position

partial extension

presents brow of the head to birth canal

fetal presentation

body part first contacting cervix / born first

cephalic presentation

most frequent type; head first contacts the cervix

breech presentation

either buttocks / feet firstly contacts cervix; can be difficult birth (presenting point influencing degree of difficulty)

LABOR COMPONENTS : POWERS OF LABOR

• second important requirement for successful labor

• force supplied by fundus implemented by uterine contractions

POWERS OF LABOR : UTERINE CONTRACTIONS

mark of effective uterine contractions; rhythmicity and progressive lengthening and intensity

POWERS OF LABOR : UTERINE CONTRACTIONS

mark of effective uterine contractions; rhythmicity and progressive lengthening and intensity

increment

intensity of contraction increases

acme

contraction is at its strongest

decrement

intensity decreases

frequency

time from beginning of contraction → beginning of next contraction

duration

time from beginning of contraction → end of same contraction

as labor progresses

relaxation intervals decrease from 10 minutes → 2 to 3 minutes

duration of contractions

increasing from 20 to 30 seconds → 60 to 90 seconds

LABOR COMPONENTS : PSYCHE

woman’s psychological outlook / psychological state / feelings that woman brings into labor

dilatation stage

true labor contractions initiate & ends when cervix is fully dilated (8-10cm)

expulsion stage

time of full dilatation until infant is born

placental stage

time infant is born until after delivering placenta

postpartum / recovery stage

first 1-4 hours after placenta delivery; emphasizing importance of close maternal observation

DILATATION : LATENT PHASE

onset of regular uterine contractions, ends when rapid cervical dilatation begins

DILATATION : TRANSITION PHASE

peak intensity of contractions, reaching 10cm

assessments & monitoring

• physical exam

• vital signs

• internal exam

• FHR

• uterine contractions 

health teaching

• bath

• empty bladder

• ambulation 

• sim’s position

• NPO

• discourage pushing

• breathing 

preparing for birth

• perineal prep

• perineal shave

• administer analgesics as ordered

• assist in administering anesthesia

• assist In transporting to DR

STAGES OF LABOR : EXPULSION

full dilatation & cervical effacement to birth of infant; with uncomplicated birth, stage takes about an hour (Archie, 2007)

as the mother pushes

using abdominal muscles to aid involuntary uterine contractions, the fetus pushes out of birth canal

STAGES OF LABOR : PLACENTAL STAGE

when infant is delivered, ending with delivery of placenta

2 phases

placental separation & placental expulsion

after infant birth

uterus palpated as firm & round mass, inferior to umbilicus level

after few minutes of rest

uterus contractions begin & organ becomes discoid shape

PLACENTAL : NURSING CARE

• inspect perineum for lacerations

• perineal care

• provide additional blankets

• allow sleep to regain lost energy

assessments

fundus, vital signs, lochia, & perineum

health interventions

rooming in concept, early ambulation, & dangling of legs

FOURTH TRIMESTER OF PREGNANCY

• 6-week interval between newborn birth & return of reproductive organs to non-pregnant state

TAKING-IN PHASE

• 1-2 days after delivery; time of reflection as 2-3 day period → woman is passive

• woman dependent on healthcare provider / support person with some daily tasks & decision-making

• woman talks about experiences during labor & pregnancy

• encouraging woman to talk about experiences during labor & birth - helps mother adjust & incorporate it into their life

TAKING HOLD PHASE

• 2-4 days after delivery; woman initiates actions on own & makes decisions without relying on others

• woman focuses on newborn than self & begins to actively participate in newborn care

• woman needs positive reinforcements even if independent

LETTING GO PHASE (POSTPARTUM DEPRESSION)

• woman accepts new role & gives up old roles like a childless woman / mother of one child

involution

reproductive organs return to nonpregnant state

area where placenta was implanted

sealed off to avoid bleeding

cervix (immediately after birth)

soft & malleable; when cervix contracts, cervix returns to prepregnancy state

immediately after birth

uterus at midline (2 cm below umbilicus level, like 16 weeks of gestation); weighing 1000g