1350 Exam 1 Labor and
delivery
1. What could exclude someone from a birthing center?: The birth center
respects and facilitates a woman's right to make informed choices about her health care and her
baby's health care based on her values and beliefs.
⁍A birthing center may exclude someone if they have:
⁍A high-risk pregnancy
⁍Previous C-section
⁍Health complications, preterm labor, labor complications (like breech), or multiple pregnancies.
These situations typically require the specialized care available in a hospital
2. Normal Labor: Onset?: In most pregnancies, the uterus begins the process of labor once
the fetus is matured and ready for birth.
The theories fall, into two main categories: those based on mechanical changes and those based on
hormonal changes.
⁍One mechanical theory involves uterine stretching. It is based on the principle that once a hollow-
body organ reaches a certain state of distention, it spontaneously contracts and empties. For
example, a full bladder empties by incontinence and a distended stomach empties by vomiting. The
hypothesis is that when the uterus stretches to a certain size, it empties spontaneously.
⁍Hormonal theories for the onset of labor are based on either an increase or a decrease in hormones.
In some theories, the source of the hormones is the mother; in other theories, it is the fetus. Some of
the more common (but still unproven) theories relating to hormones are (1) oxytocin stimulation; (2)
progesterone withdrawal; (3) estrogen stimulation; and (4) fetal cortisol.
3. Signs of Impending labor?: SIGNS OF IMPENDING LABOR
⁍Approximately 2 weeks before the onset of labor, the woman may notice that the fetus seems to
have settled, or
"dropped," into the pelvis. This is called lightening and is seen most often in nulliparas. Once
lightening has occurred, the woman often notices that urinary frequency returns. She may be able to
breathe more normally because the abdominal cavity holds more space.
⁍Multi-paras may not experience this change until they are in active labor.
, 1350 Exam 1 Labor and
delivery
⁍The gravid woman may experience a slight leakage or even a larger flow of fluid vaginally. Although
urine does not seep from the vagina, the close proximity of the urinary meatus may cause the woman
to believe that it is amniotic fluid. Evaluation should be performed to determine what the fluid is. A
simple test with nitrazine paper can distinguish between fluids. The paper is moistened with discharge
from the unwashed area. If the paper reacts (turns blue), the discharge is likely amniotic fluid. If the
test is nonreactive, the discharge is urine and the membranes are more likely intact.
⁍The amniotic sac generally ruptures after labor has begun. If it ruptures before labor starts, medical
attention is essential. If labor does not occur within a few hours of the rupture of the membranes, the
physician usually will attempt to induce (initiate) labor with administration of medication.
⁍Delivery should occur within 24 hours after membranes rupture. Prolonged rupture of membranes puts
the woman and her fetus at risk for infection. Inability of delivery to take place within the specified time
likely results in birth via cesarean section.
4. Signs of impending labor continues?: ⁍The amount of vaginal drainage typically
increases as
term approaches, and a blood-tinged mucus called bloody show may be observed. This mucus
occludes the cervical
os (the opening of the cervix) during pregnancy (mucous plug). The health care provider will likely
perform a vaginal examination during the last weeks of the pregnancy. Findings that the cervix has
begun to soften, ettace (thin), and open (dilate) are normal.
⁍Backache and contractions of the uterus, called Braxton Hicks contractions irregular tightening of the
pregnant uterus that begins in the first trimester and increases in frequency, duration, and intensity
as pregnancy progresses), are common as the pregnancy approaches term. The severity of these
contractions varies from mild to moderate.
They remain irregular and do not dilate the cervix.
⁍Some women notice a slight loss of weight (1 to 3 pounds) a few days before labor. Reports of
nausea and diarrhea are not uncommon during this period. An energy burst often is experienced.
Expectant mothers report cooking, cleaning, and preparing for the baby's arrival with renewed
energy; this can be compared with the nesting behaviors noted in pregnant animals.
⁍True labor is marked by the onset of regular, rhythmic contractions that cause progressive
, 1350 Exam 1 Labor and
delivery
cervical dilation and ettacement (thinning and shortening or obliteration of the cervix that occurs
during late pregnancy, labor, or both).
, 1350 Exam 1 Labor and
delivery
5. Impending signs of labor in short?: 1) Lightening: Baby drops into the pelvis and
becomes engaged in the pelvic bones.
2) Bloody show: blood and mucus discharged from the vaginal indicate loss of the cervical mucus
plug in preparation for delivery
3) Weight loss: 1-3 pound loss of water weight
4) Nesting: Mother demonstrates a spurt of energy and strong desire to have everything ready for
the baby
5) Loose bowels movements: 24-48 hours before labor
6) Braxton Hicks contractions: irregular contractions
7) Ettacement: Cervix becomes softer, shorter and thinner(estimated with percentage- ex. 50% ettaced)
8) Dilation: opening of the cervix (Measured in centimeters- ex. 7cm dilated)
When writing out the vaginal exam; typically written like this:6/50%/+1: meaning the pt. is 6 cm
dilated, 50% ettaced and the fetus if at +1 station- 1 cm below ischial spines
6. Nitrazine test for rupture of membrane?: ⁍Explain the procedure to the woman
or couple.
⁍Wash hands
⁍Put on sterile gloves
⁍Use nitrazine test paper, a dye-impregnated test paper for determination of pH(Ditterentiates
amniotic fluid, which is slightly alkaline, from urine and purulent material [pus], which are acidic).
⁍While wearing a sterile glove lubricated with water, place a piece of test paper on the cervical
opening. OR with a sterile, cotton-tipped applicator, dip deep into the vagina to pick up fluid; touch
applicator to test paper.
READ RESULTS:
Membranes probably intact: Identifies vaginal and most body fluids that are acidic:
⁍Yellow, pH 5.0
⁍Olive-yellow, pH 5.5
⁍Olive-green, pH 6.0
Membranes probably ruptured: Identifies amniotic fluid that is alkaline:
⁍Blue-green, pH 6.5
⁍Blue-gray, pH 7.0
⁍Deep blue, pH 7.5
delivery
1. What could exclude someone from a birthing center?: The birth center
respects and facilitates a woman's right to make informed choices about her health care and her
baby's health care based on her values and beliefs.
⁍A birthing center may exclude someone if they have:
⁍A high-risk pregnancy
⁍Previous C-section
⁍Health complications, preterm labor, labor complications (like breech), or multiple pregnancies.
These situations typically require the specialized care available in a hospital
2. Normal Labor: Onset?: In most pregnancies, the uterus begins the process of labor once
the fetus is matured and ready for birth.
The theories fall, into two main categories: those based on mechanical changes and those based on
hormonal changes.
⁍One mechanical theory involves uterine stretching. It is based on the principle that once a hollow-
body organ reaches a certain state of distention, it spontaneously contracts and empties. For
example, a full bladder empties by incontinence and a distended stomach empties by vomiting. The
hypothesis is that when the uterus stretches to a certain size, it empties spontaneously.
⁍Hormonal theories for the onset of labor are based on either an increase or a decrease in hormones.
In some theories, the source of the hormones is the mother; in other theories, it is the fetus. Some of
the more common (but still unproven) theories relating to hormones are (1) oxytocin stimulation; (2)
progesterone withdrawal; (3) estrogen stimulation; and (4) fetal cortisol.
3. Signs of Impending labor?: SIGNS OF IMPENDING LABOR
⁍Approximately 2 weeks before the onset of labor, the woman may notice that the fetus seems to
have settled, or
"dropped," into the pelvis. This is called lightening and is seen most often in nulliparas. Once
lightening has occurred, the woman often notices that urinary frequency returns. She may be able to
breathe more normally because the abdominal cavity holds more space.
⁍Multi-paras may not experience this change until they are in active labor.
, 1350 Exam 1 Labor and
delivery
⁍The gravid woman may experience a slight leakage or even a larger flow of fluid vaginally. Although
urine does not seep from the vagina, the close proximity of the urinary meatus may cause the woman
to believe that it is amniotic fluid. Evaluation should be performed to determine what the fluid is. A
simple test with nitrazine paper can distinguish between fluids. The paper is moistened with discharge
from the unwashed area. If the paper reacts (turns blue), the discharge is likely amniotic fluid. If the
test is nonreactive, the discharge is urine and the membranes are more likely intact.
⁍The amniotic sac generally ruptures after labor has begun. If it ruptures before labor starts, medical
attention is essential. If labor does not occur within a few hours of the rupture of the membranes, the
physician usually will attempt to induce (initiate) labor with administration of medication.
⁍Delivery should occur within 24 hours after membranes rupture. Prolonged rupture of membranes puts
the woman and her fetus at risk for infection. Inability of delivery to take place within the specified time
likely results in birth via cesarean section.
4. Signs of impending labor continues?: ⁍The amount of vaginal drainage typically
increases as
term approaches, and a blood-tinged mucus called bloody show may be observed. This mucus
occludes the cervical
os (the opening of the cervix) during pregnancy (mucous plug). The health care provider will likely
perform a vaginal examination during the last weeks of the pregnancy. Findings that the cervix has
begun to soften, ettace (thin), and open (dilate) are normal.
⁍Backache and contractions of the uterus, called Braxton Hicks contractions irregular tightening of the
pregnant uterus that begins in the first trimester and increases in frequency, duration, and intensity
as pregnancy progresses), are common as the pregnancy approaches term. The severity of these
contractions varies from mild to moderate.
They remain irregular and do not dilate the cervix.
⁍Some women notice a slight loss of weight (1 to 3 pounds) a few days before labor. Reports of
nausea and diarrhea are not uncommon during this period. An energy burst often is experienced.
Expectant mothers report cooking, cleaning, and preparing for the baby's arrival with renewed
energy; this can be compared with the nesting behaviors noted in pregnant animals.
⁍True labor is marked by the onset of regular, rhythmic contractions that cause progressive
, 1350 Exam 1 Labor and
delivery
cervical dilation and ettacement (thinning and shortening or obliteration of the cervix that occurs
during late pregnancy, labor, or both).
, 1350 Exam 1 Labor and
delivery
5. Impending signs of labor in short?: 1) Lightening: Baby drops into the pelvis and
becomes engaged in the pelvic bones.
2) Bloody show: blood and mucus discharged from the vaginal indicate loss of the cervical mucus
plug in preparation for delivery
3) Weight loss: 1-3 pound loss of water weight
4) Nesting: Mother demonstrates a spurt of energy and strong desire to have everything ready for
the baby
5) Loose bowels movements: 24-48 hours before labor
6) Braxton Hicks contractions: irregular contractions
7) Ettacement: Cervix becomes softer, shorter and thinner(estimated with percentage- ex. 50% ettaced)
8) Dilation: opening of the cervix (Measured in centimeters- ex. 7cm dilated)
When writing out the vaginal exam; typically written like this:6/50%/+1: meaning the pt. is 6 cm
dilated, 50% ettaced and the fetus if at +1 station- 1 cm below ischial spines
6. Nitrazine test for rupture of membrane?: ⁍Explain the procedure to the woman
or couple.
⁍Wash hands
⁍Put on sterile gloves
⁍Use nitrazine test paper, a dye-impregnated test paper for determination of pH(Ditterentiates
amniotic fluid, which is slightly alkaline, from urine and purulent material [pus], which are acidic).
⁍While wearing a sterile glove lubricated with water, place a piece of test paper on the cervical
opening. OR with a sterile, cotton-tipped applicator, dip deep into the vagina to pick up fluid; touch
applicator to test paper.
READ RESULTS:
Membranes probably intact: Identifies vaginal and most body fluids that are acidic:
⁍Yellow, pH 5.0
⁍Olive-yellow, pH 5.5
⁍Olive-green, pH 6.0
Membranes probably ruptured: Identifies amniotic fluid that is alkaline:
⁍Blue-green, pH 6.5
⁍Blue-gray, pH 7.0
⁍Deep blue, pH 7.5
