Proctored-Final Study Guide MATERNAL, NEWBORN 100% TO ALL ANSWERS FALL-2021 SOLUTION GUARANTEED GRADE A+

1. PREMONITORY SIGNS OF LABOR a. Backache b. Weight loss (1-3 lbs.) c. Lightening i. Fetal head descends into pelvis ii. Around 14 days before labor iii. Feeling that fetus has “dropped” d. Easier breathing e. Increased bladder pressure i. Urinary frequency ii. More pronounced w/ primigravida f. Contractions i. Starts w/ Braxton Hicks (irregular) ii. Progresses in strength & regularity g. Bloody show i. Brownish, blood tinged mucus plug 1. Onset of cervical dilation & effacement h. Energy burst i. Gastrointestinal changes j. Rupture of membranes i. Can initiate labor or occur anytime during labor 1. FIVE FACTORS (“5 P’s”) a. Affect & define labor & birth process i. Passenger 1. Fetus & placenta 1. Fetal presentation i. Part of the fetus that is entering pelvic inlet first 1. Occiput – back of the head 2. Mentum – chin 3. Scapula – shoulder 4. Breech – sacrum or feet 2. Lie i. Relationship of maternal longitudinal axis (spine) to fetal longitudinal axis (spine) 1. Transverse: Fetal long axis is horizontal 2. Forms right angle to maternal axis 3. Cannot have vaginal birth 4. Shoulder is presenting part 5. Cesarean required if fetus doesn’t rotate 3. Attitude i. Relationship of fetal body parts to one another 1. Fetal flexion a. Chin flexed to chest b. Extremities flexed into torso 2. Fetal extension a. Chin extended away from chest b. Extremities extended 4. Fetopelvic/Fetal position i. Relationship of presenting part of fetus in reference to its position as it relates to one of the 4 maternal pelvic quadrants 1. Right (R) or left (L) a. References either side of maternal pelvis 2. Occiput (O), sacrum (S), mentum (M) or scapula (Sc) 5. Station a. 2nd letter references presenting part of fetus 3. Anterior (A), posterior (P) or transverse (T) a. 3rd letter references part of maternal pelvis ii. Passageway 1. Birth canal i. Measurement of fetal descent in centimeters 1. Station 0 being level of imaginary line at level of ischial spines 2. Minus stations superior to ischial spines 3. Plus stations inferior to ischial spines iii. Powers 1. Bony pelvis i. Must be adequate to allow fetus to pass thru 2. Cervix i. Must dilate & efface in response to contractions & fetal decent 3. Pelvic floor 4. Vagina 5. Introitus (vaginal opening) 1. Uterine contractions cause effacement during 1st stage of labor 2. Dilation of cervix occurs once labor has begun & fetus is descending 3. Involuntary urge to push 4. Voluntary bearing down in 2nd stage of labor 5. Helps in expulsion of fetus iv. Position 1. Client should engage in frequent position changes during labor 1. Increase comfort 2. Relieve fatigue 3. Promotes circulation 2. Position during 2nd stage is determined by: 1. Maternal reference 2. Provider preference 3. Condition of mother & fetus v. Psychological response 1. Maternal stress 2. Tension 3. Anxiety 1. Can produce physiological changes that impair labor progress 4. MECHANISM OF LABOR a. Engagement i. Presenting part passes pelvic inlet at level of ischial spines ii. Usually biparietal (largest) diameter of fetal head iii. Referred to as station 0 b. Descent i. Progress of presenting part through pelvis ii. Preferably occiput iii. Measured by station during vaginal exam as either: 1. Negative (-) station: measured in centimeters if superior to station 0 & not yet engaged 2. Positive (+) station: measured in centimeters if inferior to station 0 c. Flexion i. When fetal head meets resistance of cervix, pelvic wall or pelvic floor ii. Head flexes, bringing chin close to chest iii. Presenting smaller diameter to pass thru pelvis d. Internal rotation i. Fetal occiput ideally rotates to lateral anterior position as it progresses from ischial spines to lower pelvis ii. Corkscrew motion to pass thru pelvis e. Extension i. Fetal occiput passes under symphysis pubis ii. Head is deflected anteriorly iii. Born by extension of chin away from fetal chest f. External Rotation “Restitution” i. After head is born, it rotates to position it occupied as it entered pelvic inlet in alignment w/ fetal body ii. Completes a ¼ turn to face transverse as anterior shoulder passes under symphysis g. Birth by Expulsion i. After birth of head & shoulders, trunk of neonate is born by flexing towards symphysis pubis 5. STAGES OF LABOR a. First stage (12.5 hrs): onset of labor to complete dilation i. Latent phase (4-6 hrs) 1. Onset of labor 2. Contractions 1. Irregular 2. Mild to moderate 3. Frequency: 5-30 min 4. Duration: 30-45 sec 3. Dilation: 0-3 cm ii. Active phase (2-3 hrs) 1. Contractions 1. More regular 2. Moderate to strong 3. Frequency: 3-5 min 4. Duration: 40-70 sec 2. Dilation: 4-7 cm iii. Transition (20-40 min) 1. Contractions 1. Strong to very strong 2. Frequency: 2-3 min 3. Duration: 45-90 sec 2. Dilation: 8-10 cm 1. Complete dilation (10 cm) iv. Pain 1. Internal visceral pain 2. Back and leg pain 1. Caused by: i. Dilation ii. Effacement iii. Stretching of the cervix iv. Distention of the lower segment of the uterus v. Contractions of the uterus with resultant uterine ischemia b. Second stage (5 min – 2 hrs) i. Full dilation ii. Progresses to intense contractions every 1-2 min iii. Pain 1. Somatic 2. Occurs w/ fetal descent & expulsion 3. Caused by: 1. Pressure & distention of vagina & perineum 2. “Burning, splitting, tearing” 3. Pressure & pulling on pelvic structures i. Ligaments ii. Fallopian tubes iii. Ovaries iv. Bladder v. Peritoneum 4. Lacerations of soft tissues i. Cervix ii. Vagina iii. Perineum c. Third stage (5-30 min) i. Delivery of neonate ii. Pain 1. Expulsion of the placenta 2. Similar to the pain experienced during the first stage 3. Caused by: 1. Uterine contractions 2. Pressure and pulling of pelvic structures d. Fourth stage (1-4 hrs) i. Delivery of placenta ii. Maternal stabilization of vital signs iii. Pain 1. Caused by: 1. Distention and stretching of the vagina and perineum 2. Incurred during the second stage with a splitting, burning, and tearing sensation 3. PAIN MEDICATIONS a. Opioids i. Acts in CNS to decrease perception of pain without loss of consciousness 1. Meperidine Hydrochloride (Demerol) 2. Fentanyl (Sublimaze) 3. Butorphanol (Stadol) 1. Pain relief without significant respiratory depression in mother or fetus 4. Nalbuphine (Nubain) 1. Pain relief without significant respiratory depression in mother or fetus ii. IV or IM (IV preferred due to quicker action) iii. Adverse reactions 1. Crosses placental barrier 1. If given to mother too close to time of delivery, 2. Respiratory depression in neonate 3. Reduces gastric emptying 4. Increases the risk for nausea and emesis 5. Increases the risk for aspiration of food or fluids in the stomach 6. Sedation 7. Tachycardia 8. Hypotension 9. Decreased FHR variability 10. Allergic reaction b. Sedatives (barbiturates) i. Not typically used during birth 1. Do not administer if birth is anticipated within 12-24 hours ii. Can be used during early/latent phase to relieve anxiety & induce sleep 1. Secobarbital (Seconal)