CH 13 - Summary Maternity and Pediatric Nursing

11/19/23, 9:39 AM CH 13 - Summary Maternity and Pediatric Nursing



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!!!OB!EXAM!2!STUDY!GUIDE!!!!!!!!!!!!!!!!!!!!!!!!!!!SUSSET!H.!ALCOVER! !
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CH#13#-#Labor#and#Birth#Process#
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Factors#Influencing#the#Onset#of#Labor!
• Uterine!stretch!
• Progesterone!withdrawal!
• Increased!oxytocin!sensitivity!
• Increased!release!of!prostaglandins!
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Premonitory#Signs#of#Labor!
• Cervical!changes!(cervical!softening,!possible!cervical!dilation)!!
• Lightening:!when!the!fetal!presenting!parts!begin!to!descend!into!the!true!pelvis!
§ Breathing!becomes!easier,!decrease!gastric!reflux!
§ Increase!pelvic!pressure,!leg!cramping,!dependent!edema,!low!back!pain!
§ Primiparas!may!feel!it!two!weeks!in!advance!
• Increased!energy!level!(nesting)!–!there!is!an!increase!in!energy!24-48!hrs.!before!d/t!increase!epinephrine!
–!women!begin!to!prepare!for!labor!
• Bloody!show!!
• Braxton!Hicks!contractions!
§ Not!true!contractions!until!cervical!dilation!occurs!
§ BHC!last!about!30!seconds!
§ If! last! more! than! 30! seconds! and! more! than! 4-6! /hr.! à! contact! HCP,! especially! if! <! 37! weeks!
àpossible!premature!labor!
• Spontaneous!rupture!of!membranes!!
§ Increase!risk!for!infection!
§ Risk!for!cord!prolapse!if!engagement!has!not!occurred!!
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True#Versus#False#Labor!
• Contraction!timing!
• Contraction!strength!
• Contraction!discomfort!
• Change!in!contraction!activity!
• Stay!home!or!go!to!the!hospital?!!




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, 11/19/23, 9:39 AM CH 13 - Summary Maternity and Pediatric Nursing



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!!!OB!EXAM!2!STUDY!GUIDE!!!!!!!!!!!!!!!!!!!!!!!!!!!SUSSET!H.!ALCOVER! !
!
Critical#Factors#Affecting#Labor#and#Birth#(“Five#Ps”)!
• Passageway!(birth!canal:!pelvis!and!soft!tissues)!
• Passenger!(fetus!and!placenta)!
• Powers!(contractions)!!
• Position!(position!of!the!fetus!in!relation!to!the!maternal)!!
• Psychological!response!!
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Five#Additional#Factors#Affecting#the#Labor#Process!
• Philosophy!(low!tech,!high!touch)!!
• Partners!(support!caregivers)!!
• Patience!(natural!timing)!!
• Patient!preparation!(childbirth!knowledge!base)!
§ Learning!about!labor!and!birth!allows!women!and!couples!to!express!their!needs!and!preferences,!
enhance!their!confidence!and!improve!communication!between!themselves!and!the!staff!
• Pain!control!(comfort!measures)!!
§ Pain!during!labor!is!a!universal!experience!
§ The!goal!is!to!control!the!discomforts!w/o!harming!the!fetus!or!labor!process!!
§ The! challenge! for! care! providers! is! to! find! the! right! combination! of! pain/coping! management!
methods!to!keep!the!discomfort!manageable!while!minimizing!the!negative!effects!on!the!fetus,!the!
normal!physiology!of!labor,!maternal-infant!bonding,!and!a!woman’s!perception!of!labor!itself!
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Passageway:#Bony#Pelvis!
• Linea!terminalis:!division!of!false!and!true!pelvis!
• True!pelvis!(below!linea!terminalis)!
§ Inlet!
§ Midpelvis!
§ Outlet!(pelvic!measurements)!
• False!pelvis!(above!linea!terminalis)!
§ Upper! flared! parts! of! two! iliac! bones! and!
concavities!
§ Wings!of!base!of!sacrum!
• Pelvic! shape! –! pelvic! measurement! occurs! in! the! first!
trimester!!
§ Gynecoid:! favorable! for! vaginal! delivery.! Allows!
early!and!complete!fetal!rotation!during!labor.!
§ Android:!male!shaped,!not!favorable!!
§ Anthropoid:!usually!adequate!!
§ Platypelloid:!not!favorable!!
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Passageway:#Soft#Tissues!
• Cervix!
§ Thins!through!effacement!to!allow!presenting!part!to!descend!into!vagina!
• Pelvic!floor!muscles!
• Vagina!
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