NSPN 7100 ACTUAL EXAMS SCRIPT QUESTIONS
AND ANSWERS SET A+
✔✔Explain some things that happen during fetal preparation during birth. - ✔✔•Pre-
labour maturing of lungs and other organ systems
•Pre-labour development of oxytocin neuroprotective processes
•Pre-labour increase in epinephrine-norepinephrine receptors, giving protection from
labour hypoxia
•In- labour, preservation of blood supply to heart and brain, via the catecholamine
surge, with neuroprotective effects
•In-labour catecholamine-mediated preparations that will promote newborn breathing,
energy and glucose production and heat regulation
✔✔Explain oxytocin - ✔✔-ripens the cervix for labour
•released in pulses to cause rhythmic uterine contractions
•promotes uterine contractions to prevent post partum bleeding
•released during breastfeeding to assist with milk ejection
•promotes sense of calm "love hormone"
•promotes bonding/attachment
✔✔Explain Estrogen - ✔✔-promotes growth of uterus and breasts
•increases blood flow to uterus
•smooth muscle relaxation (impacts every system)
•activates and regulates other hormones of pregnancy
✔✔Explain Cortisol - ✔✔-late pregnancy surge prepares fetus for birth
•promotes fetal lung maturation and clearance of lung fluid
•supports integrated transition of all neonatal systems
•may promote contractions and increase central oxytocin effects
•higher levels linked with positive mothering behaviours
✔✔Explain Catecholamines - ✔✔-released during labour in response to fear, stress,
and perceived danger
•elevations in late stages of labour support newborn transition
,•increase neonatal blood pressure after birth
•responsible for initiation of thermogenesis
✔✔Explain Beta-endorphins - ✔✔-released under conditions of pain or stress
•naturally occuring opiate/ decreases pain
•suppresses maternal immune response
•facilitates the release of prolactin
✔✔Explain True labor - ✔✔•Contractions occur regularly, become stronger, longer, and
more frequent
•Contractions become more intense with walking
•Contractions usually felt in lower back, radiating to lower abdomen.
•Contractions continue despite use of comfort measures and rest
•Cervix softens, moves from posterior to anterior position, thins (effaces) and dilates
•Presenting part of fetus usually engaged in pelvis now
•May or may not see bloody show
✔✔Explain False labour - ✔✔•Contractions occur irregularly or stop and start
•Contractions may stop with activity such as walking or stop with rest
•Contractions can be felt in low back or abdomen above the umbilicus.
•Contractions slow or stop with comfort measures
•Cervix does not change, may still be posterior
•Fetus may not yet be engaged in pelvis
✔✔Recall that Marnie has been experiencing irregular cramping that comes and goes.
is this true labor or false labor? - ✔✔Based on the description of irregular cramping that
comes and goes I would say she is not yet experiencing True Labour. If I was talking to
Marnie I would reassure her that what she is experiencing is normal and a sign that her
body is preparing for labour. She will know she is in true labour when her contractions
last longer, are more frequent, and stronger in intensity.
✔✔What are the 5 P's of labour? - ✔✔5 P's; passenger, passage, powers, position, and
psyche
✔✔Explain P: Passenger - ✔✔Passenger relates to the fetus and in particular the fetal
size, presentation, lie, attitude, and the position of the fetus in the maternal pelvis. The
placenta could also be considered a passenger since it must be expelled through the
birth canal after the birth of the baby.
✔✔Explain P: Passage - ✔✔Passage relates to the maternal pelvis and includes the
bones of the pelvis (known as the hard or bony pelvis). The soft tissues include the
lower uterine segment, the cervix, the pelvic floor muscles, and the vagina.
✔✔Explain P: Powers - ✔✔Powers relate to uterine contractions that are needed to
dilate the cervix and push the fetus down and out the passage. Labour contractions are
,involuntary but included in the powers are voluntary bearing down efforts of the woman
during second stage and birth.
✔✔Explain P: Position - ✔✔Position refers to the woman's position as she labours.
Certain positions facilitate and enhance the labour process.
✔✔Explain P: Psyche - ✔✔Psychological factors (psyche) refer to the individual
woman's strength, past history, ability to cope with labour pain, perception of pain, level
of fear/anxiety, and may also include her values, beliefs, and intentions as they relate to
labour and birth.
✔✔What are the 6 bones of the fetal skull? - ✔✔Two parietal, two temporal, the occipital
bone, and the frontal bone.
✔✔What are the names of the fontanelles and how can you tell the difference between
them? - ✔✔There is an anterior and posterior fontanel. The anterior is diamond shaped
and the posterior is triangular.
✔✔What happens to the fetal skull as it moves through the maternal pelvis? - ✔✔Since
the bones of the fetal skull are not attached, they have the ability to move during birthing
and can overlap slightly; this is known as molding. The other feature that enables the
fetal skull to accommodate its way through the birth canal is that it normally flexes to
present its narrowest diameter.
✔✔Name the three planes of the true pelvis that play a role in labour. - ✔✔The inlet or
brim, the midpelvis or cavity, and the outlet
✔✔What tissues can be found in the soft pelvis? - ✔✔The soft pelvis includes the lower
uterine segment, the pelvic floor muscles, the cervix, the vagina, and the introitus.
✔✔What are considered the primary powers? - ✔✔Involuntary uterine contractions
✔✔What are considered the secondary powers? - ✔✔Maternal pushing efforts during
uterine contractions
✔✔What are the advantages of changing women's position during labour? -
✔✔Frequent changes of position during labour relieve fatigue, increase comfort, and
improve circulation. Certain positions are anatomically beneficial in allowing gravity to
advance the fetus through the birth canal and may help in opening the pelvic diameters
to allow fetal descent and rotation. In early labour contractions may also be improved by
upright positions and ambulation.
✔✔Name some gravity enhancing positions that can be used during labour? -
✔✔Gravity enhancing positions could include walking, standing, sitting, and squatting.
, ✔✔What two care practices support and promote normal birth? - ✔✔include upright
postures and freedom of movement. These care practices are linked to the cardinal
movements as gravity and movement assist the presenting part of the fetus to descend
and rotate through the maternal pelvis.
✔✔What are the seven cardinal movements? - ✔✔•Engagement
•Flexion
•Descent
•Internal rotation
•Extension
•Restitution and external rotation
•Expulsion - The birth of the entire body marks the time of birth for the baby
✔✔What happens during the first stage of labour? - ✔✔The first stage of labour
commences with the onset of regular contractions accompanied by cervical changes
and ends when the cervix is fully dilated. Cervical dilatation is determined by vaginal
examination, and full dilatation is considered to be 10 cm, or at the point when no cervix
is felt. The first stage of labour is further divided into three phases: latent phase, active
phase, and transition.
✔✔The latent phase - ✔✔starts when contractions become regular and painful and
cervical effacement and dilation commences. Although arbitrary, the latent phase is
generally considered completed when the dilatation of the cervix is 3 cm.
✔✔The active phase - ✔✔refers to the time when labour is well established, with
contractions becoming more painful and usually more frequent and longer. The cervix
thins and dilates from 4 cm to 7 cm. Note: there is emerging discussion in the literature
and in practice about considering active phase to start at 6cm not 4cm
✔✔The transition or accelerated phase - ✔✔usually occurs when the cervix is 8-10 cm
and signals the approach of the second stage of labour. Contractions during this phase
may also take on a more expulsive nature and the labouring woman may feel that she
wants to bear down.
✔✔How long does each phase last and how often do contractions occur? - ✔✔Uterine
contractions increase from every 5-10 minutes in the latent phase, to every 2-3 minutes
in the active phase, and every 1-2 minutes during transition. The length of first stage
varies for each woman. The latent phase can last approximately 6-8 hours (for a
nullipara (nullip), active phase averages between 3-6 hours, while the transition phase
may last 1-2 hours. Times are generally shorter for a multiparous woman
✔✔The second stage of labour is when... - ✔✔commences with full dilatation of the
cervix and ends with the birth of the baby
AND ANSWERS SET A+
✔✔Explain some things that happen during fetal preparation during birth. - ✔✔•Pre-
labour maturing of lungs and other organ systems
•Pre-labour development of oxytocin neuroprotective processes
•Pre-labour increase in epinephrine-norepinephrine receptors, giving protection from
labour hypoxia
•In- labour, preservation of blood supply to heart and brain, via the catecholamine
surge, with neuroprotective effects
•In-labour catecholamine-mediated preparations that will promote newborn breathing,
energy and glucose production and heat regulation
✔✔Explain oxytocin - ✔✔-ripens the cervix for labour
•released in pulses to cause rhythmic uterine contractions
•promotes uterine contractions to prevent post partum bleeding
•released during breastfeeding to assist with milk ejection
•promotes sense of calm "love hormone"
•promotes bonding/attachment
✔✔Explain Estrogen - ✔✔-promotes growth of uterus and breasts
•increases blood flow to uterus
•smooth muscle relaxation (impacts every system)
•activates and regulates other hormones of pregnancy
✔✔Explain Cortisol - ✔✔-late pregnancy surge prepares fetus for birth
•promotes fetal lung maturation and clearance of lung fluid
•supports integrated transition of all neonatal systems
•may promote contractions and increase central oxytocin effects
•higher levels linked with positive mothering behaviours
✔✔Explain Catecholamines - ✔✔-released during labour in response to fear, stress,
and perceived danger
•elevations in late stages of labour support newborn transition
,•increase neonatal blood pressure after birth
•responsible for initiation of thermogenesis
✔✔Explain Beta-endorphins - ✔✔-released under conditions of pain or stress
•naturally occuring opiate/ decreases pain
•suppresses maternal immune response
•facilitates the release of prolactin
✔✔Explain True labor - ✔✔•Contractions occur regularly, become stronger, longer, and
more frequent
•Contractions become more intense with walking
•Contractions usually felt in lower back, radiating to lower abdomen.
•Contractions continue despite use of comfort measures and rest
•Cervix softens, moves from posterior to anterior position, thins (effaces) and dilates
•Presenting part of fetus usually engaged in pelvis now
•May or may not see bloody show
✔✔Explain False labour - ✔✔•Contractions occur irregularly or stop and start
•Contractions may stop with activity such as walking or stop with rest
•Contractions can be felt in low back or abdomen above the umbilicus.
•Contractions slow or stop with comfort measures
•Cervix does not change, may still be posterior
•Fetus may not yet be engaged in pelvis
✔✔Recall that Marnie has been experiencing irregular cramping that comes and goes.
is this true labor or false labor? - ✔✔Based on the description of irregular cramping that
comes and goes I would say she is not yet experiencing True Labour. If I was talking to
Marnie I would reassure her that what she is experiencing is normal and a sign that her
body is preparing for labour. She will know she is in true labour when her contractions
last longer, are more frequent, and stronger in intensity.
✔✔What are the 5 P's of labour? - ✔✔5 P's; passenger, passage, powers, position, and
psyche
✔✔Explain P: Passenger - ✔✔Passenger relates to the fetus and in particular the fetal
size, presentation, lie, attitude, and the position of the fetus in the maternal pelvis. The
placenta could also be considered a passenger since it must be expelled through the
birth canal after the birth of the baby.
✔✔Explain P: Passage - ✔✔Passage relates to the maternal pelvis and includes the
bones of the pelvis (known as the hard or bony pelvis). The soft tissues include the
lower uterine segment, the cervix, the pelvic floor muscles, and the vagina.
✔✔Explain P: Powers - ✔✔Powers relate to uterine contractions that are needed to
dilate the cervix and push the fetus down and out the passage. Labour contractions are
,involuntary but included in the powers are voluntary bearing down efforts of the woman
during second stage and birth.
✔✔Explain P: Position - ✔✔Position refers to the woman's position as she labours.
Certain positions facilitate and enhance the labour process.
✔✔Explain P: Psyche - ✔✔Psychological factors (psyche) refer to the individual
woman's strength, past history, ability to cope with labour pain, perception of pain, level
of fear/anxiety, and may also include her values, beliefs, and intentions as they relate to
labour and birth.
✔✔What are the 6 bones of the fetal skull? - ✔✔Two parietal, two temporal, the occipital
bone, and the frontal bone.
✔✔What are the names of the fontanelles and how can you tell the difference between
them? - ✔✔There is an anterior and posterior fontanel. The anterior is diamond shaped
and the posterior is triangular.
✔✔What happens to the fetal skull as it moves through the maternal pelvis? - ✔✔Since
the bones of the fetal skull are not attached, they have the ability to move during birthing
and can overlap slightly; this is known as molding. The other feature that enables the
fetal skull to accommodate its way through the birth canal is that it normally flexes to
present its narrowest diameter.
✔✔Name the three planes of the true pelvis that play a role in labour. - ✔✔The inlet or
brim, the midpelvis or cavity, and the outlet
✔✔What tissues can be found in the soft pelvis? - ✔✔The soft pelvis includes the lower
uterine segment, the pelvic floor muscles, the cervix, the vagina, and the introitus.
✔✔What are considered the primary powers? - ✔✔Involuntary uterine contractions
✔✔What are considered the secondary powers? - ✔✔Maternal pushing efforts during
uterine contractions
✔✔What are the advantages of changing women's position during labour? -
✔✔Frequent changes of position during labour relieve fatigue, increase comfort, and
improve circulation. Certain positions are anatomically beneficial in allowing gravity to
advance the fetus through the birth canal and may help in opening the pelvic diameters
to allow fetal descent and rotation. In early labour contractions may also be improved by
upright positions and ambulation.
✔✔Name some gravity enhancing positions that can be used during labour? -
✔✔Gravity enhancing positions could include walking, standing, sitting, and squatting.
, ✔✔What two care practices support and promote normal birth? - ✔✔include upright
postures and freedom of movement. These care practices are linked to the cardinal
movements as gravity and movement assist the presenting part of the fetus to descend
and rotate through the maternal pelvis.
✔✔What are the seven cardinal movements? - ✔✔•Engagement
•Flexion
•Descent
•Internal rotation
•Extension
•Restitution and external rotation
•Expulsion - The birth of the entire body marks the time of birth for the baby
✔✔What happens during the first stage of labour? - ✔✔The first stage of labour
commences with the onset of regular contractions accompanied by cervical changes
and ends when the cervix is fully dilated. Cervical dilatation is determined by vaginal
examination, and full dilatation is considered to be 10 cm, or at the point when no cervix
is felt. The first stage of labour is further divided into three phases: latent phase, active
phase, and transition.
✔✔The latent phase - ✔✔starts when contractions become regular and painful and
cervical effacement and dilation commences. Although arbitrary, the latent phase is
generally considered completed when the dilatation of the cervix is 3 cm.
✔✔The active phase - ✔✔refers to the time when labour is well established, with
contractions becoming more painful and usually more frequent and longer. The cervix
thins and dilates from 4 cm to 7 cm. Note: there is emerging discussion in the literature
and in practice about considering active phase to start at 6cm not 4cm
✔✔The transition or accelerated phase - ✔✔usually occurs when the cervix is 8-10 cm
and signals the approach of the second stage of labour. Contractions during this phase
may also take on a more expulsive nature and the labouring woman may feel that she
wants to bear down.
✔✔How long does each phase last and how often do contractions occur? - ✔✔Uterine
contractions increase from every 5-10 minutes in the latent phase, to every 2-3 minutes
in the active phase, and every 1-2 minutes during transition. The length of first stage
varies for each woman. The latent phase can last approximately 6-8 hours (for a
nullipara (nullip), active phase averages between 3-6 hours, while the transition phase
may last 1-2 hours. Times are generally shorter for a multiparous woman
✔✔The second stage of labour is when... - ✔✔commences with full dilatation of the
cervix and ends with the birth of the baby
