NM704 Trusted Study Guide With Accurate Answers
Some authors have conceptualized the difference in philosophies as two
contrasting approaches to the management of second stage: Right Ans - the
medical or active management model, and the physiologic model
Two ways of defining the onset of the second stage Right Ans - when the
cervix is completely dilated
OR
when the woman experiences a reflexive urge to push.
The use of complete dilation as the marker of the second stage requires
_______________ and is provider rather than woman focused. Right Ans -
vaginal exams for diagnosis
It is not uncommon for women to reach complete dilation and not feel
_______________. Right Ans - the urge to push
It is not uncommon for women to experience _________________ before complete
cervical dilation is achieved. Right Ans - a compelling urge to push
Complete dilation without an urge to push can occur in women with and
without _____________. Right Ans - epidurals
Alternative management with epidurals, in which active pushing is delayed for
some period of time, is called? Right Ans - delayed pushing or laboring
down
During delayed pushing, the woman rests and ________________ occurs. Right
Ans - Passive Descent
The lack of urge to push is particularly problematic in women with epidurals
because of? Right Ans - -difficulty women experience in pushing with
reduced or absent sensation
-increased risk of operative vaginal delivery associated with epidurals
Reasons for inconsistencies in evidence on delayed pushing Right Ans - -
different definitions of delayed pushing
-different study designs
, Much of the evidence on delayed pushing suggests that delayed pushing
results in longer second stages, but... Right Ans - -shorter periods of active
pushing
-fewer operative vaginal deliveries
-equal or superior outcomes in terms of maternal and neonatal complications
The suggestion in Varney that "it may be prudent to encourage active pushing
whenever the vertex reaches +1 station" (p. 922) is... Right Ans - not
evidence based and in fact is provided with no references.
(so this decision is YOUR judgment call)
Observational research describing physiologic second stage points to the
common occurrence of a _______________ at the beginning of second stage in
which _________________. Right Ans - natural lull; the contractions diminish
temporarily and there is no urge to push
It is widely thought that "Early pushing" before completely dilated should be
avoided because it may cause ___________. Right Ans - cervical edema or
cervical lacerations
(There is no evidence that supports this contention)
Roberts argues that by coaching a woman to resist the urge to push early,
when this woman does reach complete dilation, ________________. Right Ans -
she often finds it difficult to push with the urge
Women may be left with a sense of shame when ________________. Right Ans -
they are admonished to stop a reflex that is beyond their control
Re: early pushing, Rogers argues that "the woman's pushing at the height of a
contraction, when the urge to push is especially strong, will most likely lead to
______________." Right Ans - further cervical retraction, complete dilatation
and labor progress
__________________________ may be the causative factor for the occurrence of both
cervical edema and an early pushing urge in some situations Right Ans -
Malposition of the presenting part
Some authors have conceptualized the difference in philosophies as two
contrasting approaches to the management of second stage: Right Ans - the
medical or active management model, and the physiologic model
Two ways of defining the onset of the second stage Right Ans - when the
cervix is completely dilated
OR
when the woman experiences a reflexive urge to push.
The use of complete dilation as the marker of the second stage requires
_______________ and is provider rather than woman focused. Right Ans -
vaginal exams for diagnosis
It is not uncommon for women to reach complete dilation and not feel
_______________. Right Ans - the urge to push
It is not uncommon for women to experience _________________ before complete
cervical dilation is achieved. Right Ans - a compelling urge to push
Complete dilation without an urge to push can occur in women with and
without _____________. Right Ans - epidurals
Alternative management with epidurals, in which active pushing is delayed for
some period of time, is called? Right Ans - delayed pushing or laboring
down
During delayed pushing, the woman rests and ________________ occurs. Right
Ans - Passive Descent
The lack of urge to push is particularly problematic in women with epidurals
because of? Right Ans - -difficulty women experience in pushing with
reduced or absent sensation
-increased risk of operative vaginal delivery associated with epidurals
Reasons for inconsistencies in evidence on delayed pushing Right Ans - -
different definitions of delayed pushing
-different study designs
, Much of the evidence on delayed pushing suggests that delayed pushing
results in longer second stages, but... Right Ans - -shorter periods of active
pushing
-fewer operative vaginal deliveries
-equal or superior outcomes in terms of maternal and neonatal complications
The suggestion in Varney that "it may be prudent to encourage active pushing
whenever the vertex reaches +1 station" (p. 922) is... Right Ans - not
evidence based and in fact is provided with no references.
(so this decision is YOUR judgment call)
Observational research describing physiologic second stage points to the
common occurrence of a _______________ at the beginning of second stage in
which _________________. Right Ans - natural lull; the contractions diminish
temporarily and there is no urge to push
It is widely thought that "Early pushing" before completely dilated should be
avoided because it may cause ___________. Right Ans - cervical edema or
cervical lacerations
(There is no evidence that supports this contention)
Roberts argues that by coaching a woman to resist the urge to push early,
when this woman does reach complete dilation, ________________. Right Ans -
she often finds it difficult to push with the urge
Women may be left with a sense of shame when ________________. Right Ans -
they are admonished to stop a reflex that is beyond their control
Re: early pushing, Rogers argues that "the woman's pushing at the height of a
contraction, when the urge to push is especially strong, will most likely lead to
______________." Right Ans - further cervical retraction, complete dilatation
and labor progress
__________________________ may be the causative factor for the occurrence of both
cervical edema and an early pushing urge in some situations Right Ans -
Malposition of the presenting part
