🌷🎀👶🎀🌷
NUR 202 — Week 2 Complete Study Guide
Labor & Birth Process · Maternal/Fetal Response · Medications · Emergencies · Cesarean Birth · Postpartum
Care · Practice Quiz
📊 Exam 2 (Week 2) Test Plan Weighting
Learning Objective Weight
LO1 — Normal physiologic/psychological changes across all stages of labor 25%
LO2 — Maternal & fetal responses to labor and birth 30%
LO3 — Medications commonly used during labor 20%
LO4 — Nursing interventions for complications during labor/birth 25%
🌸 I. STAGES OF LABOR & PREMONITORY SIGNS
🌷 Premonitory Signs of Labor
Sign What's Happening
Cervical softening/dilation Can occur 1 month to 1 hour before actual labor
Fetal head descends into the true pelvis, typically 38–40 weeks; easier breathing,
less reflux, BUT ↑ pelvic pressure, leg cramping, dependent edema, low-back
Lightening
discomfort, urinary frequency; primips ~2+ weeks before labor, multips maybe not
until labor starts
Sudden burst of energy 24–48h before labor — thought to be from ↑ epinephrine as
Nesting (energy surge)
progesterone drops
Bloody show Mucus plug expelled + ruptured cervical capillaries → pink-tinged mucus
Irregular, felt at the top of uterus/abdomen/groin; DECREASE with walking,
Braxton Hicks (stronger/more frequent)
voiding, hydration, position change
Spontaneous rupture of membranes Prelabor ROM (PROM) occurs in 8–10% of term pregnancies; most begin labor
(SROM) within 24h; risk = ascending infection + cord prolapse if not engaged
⚖️ True vs. False Labor
Feature True Labor False Labor
Regular, ↑ frequency/duration/intensity, last
Contraction pattern Irregular, does not progress, don't last longer
longer over time
Felt all over / starts in lower back, radiates
Location of discomfort Mainly abdomen/groin/front only
to abdomen
Effect of activity (walking, Contractions DECREASE or stop; walking
Contractions CONTINUE / intensify
voiding, hydration) has no effect or worsens true labor
Progressive dilation & effacement — cervix
Cervical change No cervical change
opens and thins
🅿️ The Original 5 P's
P Key Points
Passageway Maternal bony pelvis (true vs. false pelvis, divided by the linea terminalis) + soft tissues.
True pelvis = below the linea terminalis (inlet, mid-pelvis, outlet); False pelvis = above it
, (upper flared iliac bones + wide base of sacrum). 4 pelvis shapes: Gynecoid (favorable,
round — most favorable for vaginal birth), Android (male-shaped, poor prognosis),
Anthropoid (oval, favorable), Platypelloid (flat, least common, poor prognosis)
Fetus + placenta — includes fetal head/skull, attitude, lie, presentation, position, station,
Passenger
engagement
Primary = involuntary uterine contractions (1st stage); Secondary = voluntary abdominal-
Powers
muscle pushing (2nd stage)
Maternal position during labor — upright/lateral positions shorten labor, reduce assisted
Position
deliveries & episiotomies vs. supine
Maternal state of mind; anxiety/fear → catecholamines → inhibited uterine blood flow;
Psychological response
support & preparation improve coping
🅿️ The 5 Additional P's
• Philosophy: Low-tech/high-touch vs. intervention-intensive approach to birth; CNMs champion physiologic birth with
fewer unnecessary interventions.
• Partners: Continuous support (partner, doula) reduces need for pain meds, vacuum/forceps, and cesarean birth.
• Patience: Allowing natural timing reduces cesarean rates; elective induction (~20% of US pregnancies) carries its own
cascade of interventions/risks.
• Patient preparation: Prenatal/childbirth education increases sense of control, may reduce need for analgesia/cesarean.
• Pain management: Pain is subjective — influenced by past experience, culture, anxiety; goal is manageable comfort
without harming the fetus/labor progress.
👶 The Fetal Head & Landmarks
• Sutures: Membranous spaces between the 5 cranial bones (2 frontal, 2 parietal, 1 occipital) — allow overlapping for
molding.
• Fontanelles: Intersections of sutures — landmarks used to determine fetal position on vaginal exam.
• Molding: Overlapping of cranial bones → elongated head shape from birth pressure — temporary, self-resolving; may
decrease skull dimensions by 0.5–1cm.
• Caput succedaneum: Edema/fluid collection ON TOP of the scalp — CROSSES suture lines, present at birth, resolves
in 3–4 days.
• Cephalohematoma: Blood collection BENEATH the periosteum/scalp — does NOT cross suture lines, appears hours
after birth, resolves in 6–8 weeks, ↑ jaundice risk.
🧭 Fetal Lie, Presentation, Position & Station
• Lie: Relationship of the fetal spine to the maternal spine: longitudinal (most common), transverse, or oblique.
Transverse/oblique CANNOT deliver vaginally.
• Presentation: The body part entering the pelvis first: cephalic (~95%), breech (~3%), or shoulder (~2%). Breech types:
Frank (50–70%, extended legs, can be vaginal), Complete (5–10%, cross-legged), Footling/Incomplete (10–30%) —
complete & footling generally need cesarean.
• Position: 3-letter code = side (L/R) + presenting part (O-occiput, S-sacrum, M-mentum/chin, A-acromion) +
anterior/posterior/transverse. Common examples: LOA, LOT, LOP, ROA, ROT, ROP. Example: LOA = left occiput
anterior.
• Station: Relationship of the presenting part to the ischial spines, in cm. 0 station = at the level of the ischial spines.
Negative (−1 to −4) = above the spines; Positive (+1 to +4) = below the spines/closer to birth.
• Station by descent phase: Floating = −4 to −1 · Engaged = 0 to +3 · Outlet = +4.
• Engagement: Occurs when the biparietal diameter passes through the pelvic inlet — usually corresponds to 0 station.
🔄 Cardinal Movements of Labor (in order)
# Movement What Happens
1 Engagement Biparietal diameter passes the pelvic inlet
2 Descent Downward movement of the fetal head through the pelvis
, 3 Flexion Chin meets chest — presents the smallest diameter (suboccipitobregmatic, 9.5cm)
4 Internal rotation Head rotates ~45° to align with the AP diameter of the pelvic outlet
5 Extension Head extends under the symphysis pubis as it's born
6 External rotation (restitution) Head untwists/realigns with the shoulders after birth
7 Expulsion Rest of the body is born
📏 Contraction & Cervical Assessment
• Frequency: How OFTEN — measured start of one contraction to start of the next.
• Duration: How LONG — measured start to end of the SAME contraction.
• Intensity: Strength of the contraction to acme — by palpation (mild = tip of the nose; moderate = chin; strong =
forehead — cannot indent) or by intrauterine pressure catheter (IUPC, in mmHg).
• Acme: The peak of the contraction.
• Increment / Decrement: Increment = buildup from start to acme; Decrement = descent/relaxation from acme to end of
contraction.
• Effacement: 0% = cervix 2cm long; 50% = 1cm long; 100% = obliterated/paper-thin.
• Dilation: 0cm = closed; 5cm = halfway open; 10cm = complete/fully open.
🎀 The 4 Stages of Labor
Stage Begins/Ends Contractions Key Points
Regular contractions → rapid q5–10min, 30–45 sec, Effacement 0–40%; talkative,
1st — Latent
dilation begins (0–6cm) MILD excited/apprehensive; may still be at home
End of latent → complete q2–5min, 45–60 sec, Dilates ~1.2–1.5cm/hr; more inward-
1st — Active
dilation (6–10cm) MODERATE–STRONG focused, uses coping techniques
Complete dilation → birth of
2nd — q2–3min, 60–90 sec, Pushing stage; longer 2nd stage = ↑ risk of
newborn (pelvic & perineal
Expulsive STRONG infection, lacerations, PPH
phases)
Placenta expelled in 5–30 min; active
Birth of newborn → delivery of
3rd — management (uterotonic + controlled cord
placenta (separation & Continued contractions
Placental traction + fundal massage) helps prevent
expulsion phases)
PPH
Fundus firm, midline, between umbilicus
4th — Placenta delivered → 1–4h after Cramp-like, uterus & symphysis → rises to umbilicus over 1st
Restorative birth contracting hour; VS/fundus/lochia checked q15min
x1hr
🩸 Placental Separation & Delivery
• Signs of separation: Uterus rises upward, cord lengthens, sudden trickle of blood, uterus becomes globular in shape.
• Schultz mechanism ("shiny Schultz"): Fetal (shiny gray) side presents first — most common.
• Duncan mechanism ("dirty Duncan"): Maternal (red, raw) side presents first.
• Normal blood loss: ~500 mL vaginal birth, up to 1,000 mL cesarean birth. >1,000 mL = severe/hemorrhage.
💓 Maternal Physiologic Adaptations During Labor
System/Value Change
Heart rate ↑ 10–20 bpm
Cardiac output ↑ 12–31% in 1st stage; ↑ 50% in 2nd stage
Blood pressure ↑ up to 35 mmHg DURING contractions
WBC count ↑ to 25,000–30,000/mm³ (tissue trauma)
Respiratory rate ↑ (increased O2 consumption/metabolism)
NUR 202 — Week 2 Complete Study Guide
Labor & Birth Process · Maternal/Fetal Response · Medications · Emergencies · Cesarean Birth · Postpartum
Care · Practice Quiz
📊 Exam 2 (Week 2) Test Plan Weighting
Learning Objective Weight
LO1 — Normal physiologic/psychological changes across all stages of labor 25%
LO2 — Maternal & fetal responses to labor and birth 30%
LO3 — Medications commonly used during labor 20%
LO4 — Nursing interventions for complications during labor/birth 25%
🌸 I. STAGES OF LABOR & PREMONITORY SIGNS
🌷 Premonitory Signs of Labor
Sign What's Happening
Cervical softening/dilation Can occur 1 month to 1 hour before actual labor
Fetal head descends into the true pelvis, typically 38–40 weeks; easier breathing,
less reflux, BUT ↑ pelvic pressure, leg cramping, dependent edema, low-back
Lightening
discomfort, urinary frequency; primips ~2+ weeks before labor, multips maybe not
until labor starts
Sudden burst of energy 24–48h before labor — thought to be from ↑ epinephrine as
Nesting (energy surge)
progesterone drops
Bloody show Mucus plug expelled + ruptured cervical capillaries → pink-tinged mucus
Irregular, felt at the top of uterus/abdomen/groin; DECREASE with walking,
Braxton Hicks (stronger/more frequent)
voiding, hydration, position change
Spontaneous rupture of membranes Prelabor ROM (PROM) occurs in 8–10% of term pregnancies; most begin labor
(SROM) within 24h; risk = ascending infection + cord prolapse if not engaged
⚖️ True vs. False Labor
Feature True Labor False Labor
Regular, ↑ frequency/duration/intensity, last
Contraction pattern Irregular, does not progress, don't last longer
longer over time
Felt all over / starts in lower back, radiates
Location of discomfort Mainly abdomen/groin/front only
to abdomen
Effect of activity (walking, Contractions DECREASE or stop; walking
Contractions CONTINUE / intensify
voiding, hydration) has no effect or worsens true labor
Progressive dilation & effacement — cervix
Cervical change No cervical change
opens and thins
🅿️ The Original 5 P's
P Key Points
Passageway Maternal bony pelvis (true vs. false pelvis, divided by the linea terminalis) + soft tissues.
True pelvis = below the linea terminalis (inlet, mid-pelvis, outlet); False pelvis = above it
, (upper flared iliac bones + wide base of sacrum). 4 pelvis shapes: Gynecoid (favorable,
round — most favorable for vaginal birth), Android (male-shaped, poor prognosis),
Anthropoid (oval, favorable), Platypelloid (flat, least common, poor prognosis)
Fetus + placenta — includes fetal head/skull, attitude, lie, presentation, position, station,
Passenger
engagement
Primary = involuntary uterine contractions (1st stage); Secondary = voluntary abdominal-
Powers
muscle pushing (2nd stage)
Maternal position during labor — upright/lateral positions shorten labor, reduce assisted
Position
deliveries & episiotomies vs. supine
Maternal state of mind; anxiety/fear → catecholamines → inhibited uterine blood flow;
Psychological response
support & preparation improve coping
🅿️ The 5 Additional P's
• Philosophy: Low-tech/high-touch vs. intervention-intensive approach to birth; CNMs champion physiologic birth with
fewer unnecessary interventions.
• Partners: Continuous support (partner, doula) reduces need for pain meds, vacuum/forceps, and cesarean birth.
• Patience: Allowing natural timing reduces cesarean rates; elective induction (~20% of US pregnancies) carries its own
cascade of interventions/risks.
• Patient preparation: Prenatal/childbirth education increases sense of control, may reduce need for analgesia/cesarean.
• Pain management: Pain is subjective — influenced by past experience, culture, anxiety; goal is manageable comfort
without harming the fetus/labor progress.
👶 The Fetal Head & Landmarks
• Sutures: Membranous spaces between the 5 cranial bones (2 frontal, 2 parietal, 1 occipital) — allow overlapping for
molding.
• Fontanelles: Intersections of sutures — landmarks used to determine fetal position on vaginal exam.
• Molding: Overlapping of cranial bones → elongated head shape from birth pressure — temporary, self-resolving; may
decrease skull dimensions by 0.5–1cm.
• Caput succedaneum: Edema/fluid collection ON TOP of the scalp — CROSSES suture lines, present at birth, resolves
in 3–4 days.
• Cephalohematoma: Blood collection BENEATH the periosteum/scalp — does NOT cross suture lines, appears hours
after birth, resolves in 6–8 weeks, ↑ jaundice risk.
🧭 Fetal Lie, Presentation, Position & Station
• Lie: Relationship of the fetal spine to the maternal spine: longitudinal (most common), transverse, or oblique.
Transverse/oblique CANNOT deliver vaginally.
• Presentation: The body part entering the pelvis first: cephalic (~95%), breech (~3%), or shoulder (~2%). Breech types:
Frank (50–70%, extended legs, can be vaginal), Complete (5–10%, cross-legged), Footling/Incomplete (10–30%) —
complete & footling generally need cesarean.
• Position: 3-letter code = side (L/R) + presenting part (O-occiput, S-sacrum, M-mentum/chin, A-acromion) +
anterior/posterior/transverse. Common examples: LOA, LOT, LOP, ROA, ROT, ROP. Example: LOA = left occiput
anterior.
• Station: Relationship of the presenting part to the ischial spines, in cm. 0 station = at the level of the ischial spines.
Negative (−1 to −4) = above the spines; Positive (+1 to +4) = below the spines/closer to birth.
• Station by descent phase: Floating = −4 to −1 · Engaged = 0 to +3 · Outlet = +4.
• Engagement: Occurs when the biparietal diameter passes through the pelvic inlet — usually corresponds to 0 station.
🔄 Cardinal Movements of Labor (in order)
# Movement What Happens
1 Engagement Biparietal diameter passes the pelvic inlet
2 Descent Downward movement of the fetal head through the pelvis
, 3 Flexion Chin meets chest — presents the smallest diameter (suboccipitobregmatic, 9.5cm)
4 Internal rotation Head rotates ~45° to align with the AP diameter of the pelvic outlet
5 Extension Head extends under the symphysis pubis as it's born
6 External rotation (restitution) Head untwists/realigns with the shoulders after birth
7 Expulsion Rest of the body is born
📏 Contraction & Cervical Assessment
• Frequency: How OFTEN — measured start of one contraction to start of the next.
• Duration: How LONG — measured start to end of the SAME contraction.
• Intensity: Strength of the contraction to acme — by palpation (mild = tip of the nose; moderate = chin; strong =
forehead — cannot indent) or by intrauterine pressure catheter (IUPC, in mmHg).
• Acme: The peak of the contraction.
• Increment / Decrement: Increment = buildup from start to acme; Decrement = descent/relaxation from acme to end of
contraction.
• Effacement: 0% = cervix 2cm long; 50% = 1cm long; 100% = obliterated/paper-thin.
• Dilation: 0cm = closed; 5cm = halfway open; 10cm = complete/fully open.
🎀 The 4 Stages of Labor
Stage Begins/Ends Contractions Key Points
Regular contractions → rapid q5–10min, 30–45 sec, Effacement 0–40%; talkative,
1st — Latent
dilation begins (0–6cm) MILD excited/apprehensive; may still be at home
End of latent → complete q2–5min, 45–60 sec, Dilates ~1.2–1.5cm/hr; more inward-
1st — Active
dilation (6–10cm) MODERATE–STRONG focused, uses coping techniques
Complete dilation → birth of
2nd — q2–3min, 60–90 sec, Pushing stage; longer 2nd stage = ↑ risk of
newborn (pelvic & perineal
Expulsive STRONG infection, lacerations, PPH
phases)
Placenta expelled in 5–30 min; active
Birth of newborn → delivery of
3rd — management (uterotonic + controlled cord
placenta (separation & Continued contractions
Placental traction + fundal massage) helps prevent
expulsion phases)
PPH
Fundus firm, midline, between umbilicus
4th — Placenta delivered → 1–4h after Cramp-like, uterus & symphysis → rises to umbilicus over 1st
Restorative birth contracting hour; VS/fundus/lochia checked q15min
x1hr
🩸 Placental Separation & Delivery
• Signs of separation: Uterus rises upward, cord lengthens, sudden trickle of blood, uterus becomes globular in shape.
• Schultz mechanism ("shiny Schultz"): Fetal (shiny gray) side presents first — most common.
• Duncan mechanism ("dirty Duncan"): Maternal (red, raw) side presents first.
• Normal blood loss: ~500 mL vaginal birth, up to 1,000 mL cesarean birth. >1,000 mL = severe/hemorrhage.
💓 Maternal Physiologic Adaptations During Labor
System/Value Change
Heart rate ↑ 10–20 bpm
Cardiac output ↑ 12–31% in 1st stage; ↑ 50% in 2nd stage
Blood pressure ↑ up to 35 mmHg DURING contractions
WBC count ↑ to 25,000–30,000/mm³ (tissue trauma)
Respiratory rate ↑ (increased O2 consumption/metabolism)
