NUR 202 Women’s Health Nursing Week 2 Part 1 Transcript
Questions with Verified Answers
1. Learning Objectives:
● Conducts oneself as a professional student providing clinical care in the
clinical care
setting to improve nursing care and outcomes of a woman diagnosed as
having a “high risk pregnancy”
● Observe how interdisciplinary team members develop and implement a
patient-centered
plan of care based on national clinical guidelines resulting in positive
patient outcomes for women with gestational diabetes, preeclampsia,
eclampsia, and HELLP syndrome
● Identify the premonitory signs of labor
● Discuss in detail the five P’s that affect the labor process:
o Passageway
o Passenger
o Powers
o Position
o Psychological response
● Review research to identify the stages of labor and the critical events in
each stage
● Explain the role of the nurse in relief of pain and anxiety during labor
● Assess obstetric emergencies that can complicate labor and birth
including appropriate management for each
● Summarize the plan of care for a woman who is to undergo a cesarean birth
2. Labor and birth are physiologic processes that can often proceed with
support, monitoring, and education from nurses without extensive medical
intervention. The process of labor and birth involves more than the birth of a
newborn. Numerous physiologic and psychological events occur that
ultimately result in the birth of a newborn and the creation or expansion of
the family. This lecture describes labor and birth as a process. It addresses
initiation of labor, the premonitory signs of labor, including true and false
labor, critical factors affecting labor and birth, maternal and fetal response to
the laboring process, and the four stages of labor. The lecture also identifies
, critical factors related to each stage of labor: the “10 Ps of labor.”
3. Initiation of labor involves a complex interplay of maternal, fetal, and genetic
factors as well as endocrine signaling. Labor involves a sequential and
integrated set of changes within the myometrium, decidua, and cervix that
occurs gradually over a period of days to weeks in order to expel the fetus
from the uterus. It is difficult to determine exactly why labor begins and what
initiates it. Although several theories have been proposed to explain the onset
and maintenance of labor, none of these has been scientifically proved. It is
widely believed that labor is influenced by a cascade of events, including
uterine stretch from the fetus and amniotic fluid volume, progesterone
withdrawal to estrogen dominance, increased oxytocin sensitivity, and
increased release of prostaglandins.
4. Before the onset of labor, a pregnant woman’s body undergoes several
changes in preparation for the birth of the newborn. The changes that occur
often lead to characteristic signs and symptoms that suggest that labor is near.
These premonitory signs and symptoms can vary, and not every woman
experiences every one of them.
, ● Cervical changes (cervical softening, possible cervical dilation): The rigid
cervix of
pregnancy must become distensible to expel the fetus. Before labor begins,
cervical softening and possible cervical dilation with descent of the
presenting part into the pelvis occur. These changes can occur 1 month to 1
hour before actual labor begins.
● Lightening: Lightening occurs when the fetal presenting part begins to
descend into the
true pelvis. The uterus lowers and moves into a more anterior position. The
shape of the abdomen changes as a result of the change in the uterus.
With this descent, the woman usually notes that her breathing is much
easier and that there is a decrease in gastric reflux. However, she may
complain of increased pelvic pressure, leg cramping, dependent edema in
the lower legs, and low back discomfort. She may notice an increase in
vaginal discharge and more frequent urination. In primiparas, lightening
can occur 2 weeks or more before labor begins; among multiparas, it may
not occur until labor starts
● Increased energy level (nesting): Some women report a sudden increase in
energy
before labor. This is sometimes referred to as nesting, because many women
will focus this energy toward childbirth preparation by cleaning, cooking,
preparing the nursery, and spending extra time with other children in the
household. The increased energy level usually occurs 24 to 48 hours before
the onset of labor. It is thought to be the result of an increase in
epinephrine release caused by a decrease in progesterone
● Bloody show: At the onset of labor or before, the mucus plug that fills the
cervical canal
during pregnancy is expelled as a result of cervical softening and increased
pressure of the presenting part. These ruptured cervical capillaries release
a small amount of blood that mixes with mucus, resulting in the pink-
tinged secretions known as bloody show.
● Braxton Hicks contractions: Braxton Hicks contractions, which the woman
may have
been experiencing throughout the pregnancy, may become stronger and more
frequent. Braxton Hicks contractions are typically felt as a tightening or
pulling sensation of the top of the uterus. They occur primarily in the
abdomen and groin and gradually spread downward before relaxing. In
contrast, true labor contractions are more commonly felt in the lower back.
Questions with Verified Answers
1. Learning Objectives:
● Conducts oneself as a professional student providing clinical care in the
clinical care
setting to improve nursing care and outcomes of a woman diagnosed as
having a “high risk pregnancy”
● Observe how interdisciplinary team members develop and implement a
patient-centered
plan of care based on national clinical guidelines resulting in positive
patient outcomes for women with gestational diabetes, preeclampsia,
eclampsia, and HELLP syndrome
● Identify the premonitory signs of labor
● Discuss in detail the five P’s that affect the labor process:
o Passageway
o Passenger
o Powers
o Position
o Psychological response
● Review research to identify the stages of labor and the critical events in
each stage
● Explain the role of the nurse in relief of pain and anxiety during labor
● Assess obstetric emergencies that can complicate labor and birth
including appropriate management for each
● Summarize the plan of care for a woman who is to undergo a cesarean birth
2. Labor and birth are physiologic processes that can often proceed with
support, monitoring, and education from nurses without extensive medical
intervention. The process of labor and birth involves more than the birth of a
newborn. Numerous physiologic and psychological events occur that
ultimately result in the birth of a newborn and the creation or expansion of
the family. This lecture describes labor and birth as a process. It addresses
initiation of labor, the premonitory signs of labor, including true and false
labor, critical factors affecting labor and birth, maternal and fetal response to
the laboring process, and the four stages of labor. The lecture also identifies
, critical factors related to each stage of labor: the “10 Ps of labor.”
3. Initiation of labor involves a complex interplay of maternal, fetal, and genetic
factors as well as endocrine signaling. Labor involves a sequential and
integrated set of changes within the myometrium, decidua, and cervix that
occurs gradually over a period of days to weeks in order to expel the fetus
from the uterus. It is difficult to determine exactly why labor begins and what
initiates it. Although several theories have been proposed to explain the onset
and maintenance of labor, none of these has been scientifically proved. It is
widely believed that labor is influenced by a cascade of events, including
uterine stretch from the fetus and amniotic fluid volume, progesterone
withdrawal to estrogen dominance, increased oxytocin sensitivity, and
increased release of prostaglandins.
4. Before the onset of labor, a pregnant woman’s body undergoes several
changes in preparation for the birth of the newborn. The changes that occur
often lead to characteristic signs and symptoms that suggest that labor is near.
These premonitory signs and symptoms can vary, and not every woman
experiences every one of them.
, ● Cervical changes (cervical softening, possible cervical dilation): The rigid
cervix of
pregnancy must become distensible to expel the fetus. Before labor begins,
cervical softening and possible cervical dilation with descent of the
presenting part into the pelvis occur. These changes can occur 1 month to 1
hour before actual labor begins.
● Lightening: Lightening occurs when the fetal presenting part begins to
descend into the
true pelvis. The uterus lowers and moves into a more anterior position. The
shape of the abdomen changes as a result of the change in the uterus.
With this descent, the woman usually notes that her breathing is much
easier and that there is a decrease in gastric reflux. However, she may
complain of increased pelvic pressure, leg cramping, dependent edema in
the lower legs, and low back discomfort. She may notice an increase in
vaginal discharge and more frequent urination. In primiparas, lightening
can occur 2 weeks or more before labor begins; among multiparas, it may
not occur until labor starts
● Increased energy level (nesting): Some women report a sudden increase in
energy
before labor. This is sometimes referred to as nesting, because many women
will focus this energy toward childbirth preparation by cleaning, cooking,
preparing the nursery, and spending extra time with other children in the
household. The increased energy level usually occurs 24 to 48 hours before
the onset of labor. It is thought to be the result of an increase in
epinephrine release caused by a decrease in progesterone
● Bloody show: At the onset of labor or before, the mucus plug that fills the
cervical canal
during pregnancy is expelled as a result of cervical softening and increased
pressure of the presenting part. These ruptured cervical capillaries release
a small amount of blood that mixes with mucus, resulting in the pink-
tinged secretions known as bloody show.
● Braxton Hicks contractions: Braxton Hicks contractions, which the woman
may have
been experiencing throughout the pregnancy, may become stronger and more
frequent. Braxton Hicks contractions are typically felt as a tightening or
pulling sensation of the top of the uterus. They occur primarily in the
abdomen and groin and gradually spread downward before relaxing. In
contrast, true labor contractions are more commonly felt in the lower back.
