Essential of Maternity, Newborn, and Women's Health Nursing, 3rd Edition Chapter 13 Labor and Birth Process

attitude - ANSWERS*refers to the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another *the most common fetal attitude when labor begins is with all joints flexed-the fetal back is rounded, the chin is on chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees dilation - ANSWERSthe opening or enlargement of the external cervical os duration - ANSWERSrefers to how long a contraction lasts and is measured from the beginning of one contraction to the end of the same contraction doula - ANSWERSis a Greek word meaning "woman servant" or "caregiver" effacement - ANSWERS engagement - ANSWERSsignifies the entrance of the largest diameter of the fetal presenting part (usually the fetal head) into the smallest diameter of the maternal pelvis frequency - ANSWERSrefers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction intensity - ANSWERSrefers tot he strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter, lie - ANSWERSrefers to the relationship f the long axis (spine) of the fetus to the long axis (spine ) of the mother lightening - ANSWERSoccurs when the fetal presenting part begins to descend into the maternal pelvis molding - ANSWERSthe changed (elongated) shape of the fetal skull at birth as a result of overlapping of the cranial bones position - ANSWERS*describes the relationship of a given point on the presenting part of the fetus to a designated point of the maternal pelvis occipital bone (O) - ANSWERSwhich designates a vertex presentation chin (mentum [M]) - ANSWERSwhich designates a face presentation buttocks (sacrum [S]) - ANSWERSwhich designate a breech presentation scapula (acromion process [A]) - ANSWERSwhich designate a shoulder presentation presentation - ANSWERS*refers to the body part of the fetus that enters the pelvic inlet first (the "presenting part") *cephalic (head first) 95% of birth *breech (pelvic first) 3% of birth *shoulder (scapula first) 2% of birth station - ANSWERS*refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines *measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spine Premonitory Signs of Labor - ANSWERS*Cervical changes *Lightening *Increased energy level *Bloody show *Braxton Hicks Contractions *Spontaneous Rupture of Membrane Cervical changes before labor begins - ANSWERS*cervical softening and possible cervical dilation with descent of the presenting part into the pelvis *changes can occur 1 month to 1 hour before actual labor begins Cervical changes as labor approches - ANSWERS*cervix changes from an enlongated structure to a shortened thinned segment Lightening - ANSWERS*uterus lowers and moves into a more anterior position *shape of the abdomen changes as a result of the change in the uterus *woman usually can breath easier *complain of increased pelvic pressure, cramping, and low back pain *increase in vaginal discharge and more frequent urination *edema of the lower extremities may occur as a result of the increased stasis of pooling blood *In primiparas (first pregnancy) lightening can occur 2 weeks or more before labor begins, among (multiparas it may not occur until labor starts) Increased energy levels - ANSWERS*referred to as nesting, because many women focus this energy toward childbirth preparation by cleaning, preparing the nursery, and spending extra time with other children inn the household *usually occur 24 to 48 hours before the onset of labor *result of an increase in epinephrine release caused by a decrease in pregesterone Blood show - ANSWERS*onset of labor or before, the mucous plug that fills the cervical canal during pregnancy is expelled as a result of cervical softening and increased pressure of the presenting part *resulting in the pink-tinged secretions known as bloody show Braxton Hick Contractions - ANSWERS*may become stronger and more frequent *typically felt as a tightening or pulling sensation of the top of the uterus *primarily occur on the abdomen and groin and gradually spread downward before relaxing *help in ripening and softening the cervix *irregular and can be decreased by walking, voiding, eating, increasing fluid intake, or changing position *usually last about 30 second but can persist for as long as 2 minutes Spontaneous Rupture of Membranes - ANSWERS*1 in 4 women will experience spontaneous rupture of the membrane before the onset of labor *can result in either a sudden gush or a steady leakage of amniotic fluid *a continuous supply is produced to ensure protection of the fetus until birth *after rupture, the barrier to infection is gone and an ascending infection is possible *there is a danger of cord prolapse if engagement has not occurred with sudden release of fluid and pressure with rupture *advise women to notify their health care provider and go in for an evaluation Contraction timing of true labor - ANSWERSRegular, becoming closer together, usually 4-6 min apart, lasting 30-60 sec Contraction timing of false labor - ANSWERSIrregular, not occurring close together Contraction strength of true labor - ANSWERSbecome stronger with time, vaginal pressure is usually felt Contraction strength of false labor - ANSWERSfrequently weak, not getting stronger with time or alternating (a strong one followed by weaker ones) Contraction discomfort of true labor - ANSWERSstarts in the back and radiates around towards the front of the abdomen Contraction discomfort of false labor - ANSWERSusually felt in the front of the abdomen Any changes in activity of true labor - ANSWERScontractions continue no matter what positional change is made Any changes in activity of false labor - ANSWERScontractions may stop or slow down with walking or making a position change Stay or go when in true labor - ANSWERSStay home until contractions are 5 min apart, last 45-60 sec, and are strong enough so that a conversation during one is not possible-then go to the hospital or birthing center Stay of go when in false labor - ANSWERSDrink fluids and walk around to see if there is any change in the intensity of the contractions; if the contractions diminish in intensity after either or both-stay home Traditionally, the critical factors that affect the process of labor and birth our outlined as the "five P's" - ANSWERS1. Passageway (birth canal) 2. Passenger (fetus and placenta) 3. Powers (contractions) 4. Positions (maternal) 5. Psychological response These critical factors are commonly accepted and discussed by health care professional. However five additional "P's" can also affect the labor process - ANSWERS1. Philosophy (low tech, high touch) 2. Partners (support caregivers) 3. Patience (natural timing) 4. Patient (client) preparation (childbirth knowledge base) 5. Pain management (comfort measures) Passageway - ANSWERS*is the route through which the fetus must travel to be born vaginally *consists of the maternal pelvis and soft tissues *as the pregnancy progress, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth Bony pelvis - ANSWERS*can be divided into the true and false portions The false pelvis - ANSWERS*is composed of the upper flare parts of the two iliac bones with their concavities and the wings of the base of sacrum *divided from the true pelvis by an imaginary line drawn from the sacral prominence at the back to the superior aspect of the symphysis pubis as the front of the pelvis The true pelvis - ANSWERS*is the bony passageway through which the fetus must travel *it is made up of three planes: the inlet, the mid-pelvis (cavity), and the outlet Pelvic inlet - ANSWERS*allows entrance to the true pelvis *bounded by the sacral prominence in the back, the ilium on the sides, and the superior aspect of the symphysis pubis in the front *is wider in the transverse aspect (sideways) than it is from front to back Mid-pelvis - ANSWERS*occupies the space between the inlet and outlet *snug, curved space that the fetus must travel to reach the outside *as the fetus passes through this small area, its chest is compressed, causing lung fluid and mucus to be expelled *expulsion removes the space-occupying fluid so that air can enter the lungs with the newborn's first breath Pelvic outlet - ANSWERS*is bound by the ischial tuberosities , the lower rim of the symphysis pubis, and the tip of coccyx *for the fetus to pass through the pelvis, the outlet must be large enough To ensure the adequacy of the pelvic outlet for vaginal birth, the following pelvic measurement are assessed: - ANSWERS*Diagonal conjugate of the inlet *Transverse or ischial tuberosity diameter of the outlet *True or obstetric conjugate Diagonal conjugate of the inlet - ANSWERSdistance between the anterior of the sacral prominence and the anterior surface of the inferior margin of symphysis pubis Transverse or ischial tuberosity diameter of the outlet - ANSWERSdistance at the medial and lowest aspect of the ischial tuberosities, at the level of the anus, a known hand span or clenched-fist measurement is generally used to obtain this measurement True or obstetric conjugate - ANSWERSdistance estimated from the measurement of the diagonal conjugate, 1.5 cm is subtracted from the diagonal conjugate measurement Pelvic shape is into four main shapes - ANSWERS*Gynecoid *Anthropoid *Android *Platypelloid Gynecoid pelvis - ANSWERS*considered the true female pelvis *occurring in about 50% of all women *less common in men *vaginal birth is most favorable because the inlet is round and the outlet is roomy *offers the optimal diameters in all three planes of the pelvis *allows early and complete fetal internal rotation during labor Anthropoid pelvis - ANSWERS*common is men *occurs in 25% of women *pelvic inlet is oval and the sacrum is long, producing a deep pelvis *vaginal birth is more favorable with this pelvis shape compared to the android or platypelloid shape Android pelvis - ANSWERS*considered the male-shape pelvis *characterized by a funnel shape *occurs in approximately 20% of women *pelvic inlet is heart shaped and the posterior segments are reduced in all pelvic planes *descent of the fetal head into the pelvis is slow, and failure of the fetus to rotate is common *prognosis for labor is poor, subsequently leading to cesarean birth Platypelliod or flat pelvis - ANSWERS*least common type of pelvic structure among men and women *pelvic cavity is shallow but widens at the pelvic outlet *labor prognosis is poor the fetus with placenta - ANSWERSis the passenger fetal head - ANSWERSsize and presence of molding fetal attitude - ANSWERSdegree of body flexion fetal lie - ANSWERSrelationship of body parts fetal presentation - ANSWERSfirst body part fetal position - ANSWERSrelationship to maternal pelvis The fetal head - ANSWERS*the largest and least compressible fetal structure, making it an important factor in relation to labor and birth *compared with an adult, the fetal head is large in proportion to the rest of the body, usually about one quarter of the body surface area First stage of labor description - ANSWERSfrom 0-10 cm dilation, consists of three phases First stage of labor three phases - ANSWERS*Latent phase *Active phase *Transition phase Latent phase (0-3 cm dilation) of the first stage of labor - ANSWERS*cervical dilation from 0 to 3 cm *cervical effacement from 0% to 40% *nullipara, lasts up to 9hrs; multipara, lasts up to 5-6hrs *contraction frequency every 5-10 min *contraction duration 30-45 sec *contraction intensity mild to palpation Active phase (4-7 cm dilation) of the first stage of labor - ANSWERS*cervical dilation from 4 to 7 cm *cervical effacement from 40% to 80% *nullipara, lasts up to 6hr; multipara, lasts up to 4hr *contraction frequency every 2-5 min *contraction duration 45-60 sec *contraction intensity moderate palpation Transition phase (8-10 cm dilation ) of thee first stage of labor - ANSWERS*cervical dilation from 8 to 10 cm *cervical effacement from 80% to 100% *nullipara lasts up to 1 hr, multipara, lasts up to 30min *contraction frequency every 1-2 min *contraction duration 60-90 sec *contraction intensity strong by palpation Second stage of labor - ANSWERSfrom complete dilation (10 cm) to birth of newborn;may last up to 3hr Second stage of labor phases - ANSWERS*pelvic phase *perineal phase Pelvic phase of the second stage of labor - ANSWERSperiod of fetal descent Perineal phase of the second stage of labor - ANSWERS*period of active pushing *nullipara, lasts up to 1 hr; multipara last up to 30 min *contraction frequency every 2-3 min or less *contraction duration 60-90 sec *contraction intensity strong by palpation *strong urge to push during the later perineal phase