Sherpath chapter 13 Labor and Birth Process

largest portion of the fetal head

biparietal diameter

dilation and effacement of the cervix

widening and thinning of the cervix, as uterine contractions become more frequent and powerful, during the first stage of labor

Powers - uterine contractions, maternal, pushing

- uterine contractions - maternal - pushing

Midpelvis (pelvic cavity)

-curved passage bonded by symphysis pubis, ischium, portion of ilium, sacrum, and coccyx Narrowest part of the passage that the fetus hasa to pass

fetal attitude/posture

fetal body parts in relationship to one another. flexion =normal = good extension = neck back = bad

Frank Presentation (breech)

fetal legs are extended across the abdomen toward the shoulders.

involuntary contraction

-spasm -Suffix -Symptomatic Uterine contractions are not under conscious control. Walking or other activity may stimulate existing labor contractions. Anxiety and excessive stress can diminish them. A woman with a spinal cord injury who is unable to move will still experience strong, coordinated contractions. Epidural and spinal anesthesia do not inhibit uterine contractions once labor is well established.

The Psyche Stress Response in Labor

1. The body releases catecholamines. 2. This release results in decreased blood flow to the placenta and may inhibit uterine contractility. This effect can result in fetal intolerance to labor and failure to progress in labor.

At. _______ cm, the cervix is considered to be fully dilated.

10 The cervix is fully dilated at 10 cm.

What would the nurse expect when caring for a full-term primigravida who presents for a routine office visit and is not in labor? A fundal height that measures 30 cm A fetus that is engaged in the maternal pelvis A cervix that is already 3 cm dilated Fetal station of −3

A fetus that is engaged in the maternal pelvis Fetal engagement often occurs before the beginning of labor in primigravidas, where with multigravidas the fetus often does not engage until labor begins.

Powers: maternal pushing efforts

Begin after the cervix has dilated to 10 cm and the woman feels the urge to push (bear down), known as the Ferguson reflex

Which terms describe progressive changes that occur in the cervix during labor? Select all that apply. Rupture Prolapse Dilatation Laceration Effacement

Dilatation Dilatation (opening) of the cervix occurs when the cervix is pulled downward and the fetus is pushed upward. Effacement Effacement (thinning and shortening) of the cervix occurs when the cervix becomes shorter and thinner as it is drawn over the fetus and amniotic sac.

Dilation Effacement, dilation, and station are subjective assessments.

Dilation is expressed in centimeters. Full dilation is considered approximately 10 cm. A cervix is fully dilated when the examiner can no longer feel cervical tissue upon palpation and it is open 10 cm.

effacement Effacement, dilation, and station are subjective assessments.

Effacement is estimated as a percentage of the amount the cervix has thinned, so that a fully thinned cervix is 100% effaced. Effacement also may be recorded as cervical length, estimated in centimeters during vaginal examination with ultrasound.

Which action taken by the patient will reduce discomfort during Leopold maneuvers and make fetal presenting parts easier to feel? Standing Lying prone Emptying the bladder Pushing or bearing down with contractions

Emptying the bladder Emptying the bladder reduces discomfort during palpation and makes fetal parts easier to feel.

A woman with an epidural is 10 cm dilated and the baby is at 0 station. There is a reassuring fetal heart pattern, although the woman does not feel the urge to push. Which are appropriate actions by the nurse? Select all that apply. Encourage the patient to wait to push until she feels the urge. Perform another vaginal examination to check for dilation. Encourage the patient to push so that the baby can be born. Encourage frequent position changes while remaining in the bed. Turn off the epidural so the patient can feel the urge to push.

Encourage the patient to wait to push until she feels the urge. Even with an epidural, a patient usually feels the urge to push as the fetal head descends. This is known as the Ferguson reflex. She should be encouraged to "labor down." Encourage frequent position changes while remaining in the bed. Frequent position changes help the fetus to descend in the pelvis. This will help trigger the Ferguson reflex. It also promotes uteroplacental perfusion.

Which phrases describe how cephalic presentation of the fetus facilitates labor? Select all that apply. Facilitates dilatation of the cervix Facilitates the delivery of the fetal buttocks first Allows the fetal head to adapt to the maternal pelvis Hastens labor because of cephalopelvic proportion Enables fetal parts to be born from smallest to largest

Facilitates dilatation of the cervix The fetal head is smooth, round, and hard, making it an effective fetal part to dilate the cervix, which is also round. Allows the fetal head to adapt to the maternal pelvis During labor the fetal head can gradually change shape to adapt to the size and shape of the maternal pelvis.

A woman is visibly anxious, refuses position changes in labor, and verbalizes, "I'm afraid I'm going to die." The nurse knows it is important to help the woman relax through effective coaching because of which responses to stress experienced in labor? Select all that apply. Fetal intolerance to labor Bradycardia related to a vagal response Release of catecholamines in the mother's body Inhibited uterine contractions because of decreased blood flow to the placenta Umbilical cord prolapse

Fetal intolerance to labor Stress results in the release of catecholamines, which decrease blood flow to the placenta and fetus and can lead to fetal intolerance to labor. Release of catecholamines in the mother's body Stress in labor results in the release of catecholamines. Inhibited uterine contractions because of decreased blood flow to the placenta Decreased blood flow to the uterus can lead to inhibited uterine contractions.

Which pelvic type is most favorable for vaginal birth? Gynecoid Platypelloid Anthropoid Android

Gynecoid This is the classic female pelvis and is most favorable for vaginal birth.

The Passage: The Four Main Pelvic Types

Gynecoid Pelvis Android Pelvis Anthropoid Pelvis Platypelloid Pelvis3

Inlet

If the inlet is small, the fetal head may not be able to enter it. Because it is almost entirely surrounded by bone, except for cartilage at the sacroiliac joint and symphysis pubis, the inlet cannot enlarge much to accommodate the fetus. The bony measurements are essentially fixed.

intermittent Labor contractions

Labor contractions are intermittent rather than sustained, allowing relaxation of the uterine muscle and resumption of blood flow to and from the placenta.

fetal station

Location of the presenting part in relation to the midpelvis or ischial spines; expressed as cm above or below the spines; station 0 is engaged, station -2 is 2 cm above the ischial spines

4 P's

Powers Passage Passenger Psyche *position

Occiput posterior refers to which component of the birth process? Powers Passenger Passage Psyche

Powers The powers of labor are uterine contractions and maternal pushing efforts.

Which statements explain how the maternal psyche facilitates childbirth? Select all that apply. Fatigue numbs the woman's reaction to pain. Relaxation supports the natural process of labor. Increased anxiety can motivate the woman to push more effectively. Calmness increases a woman's ability to cope with pain during labor. Maternal catecholamines secreted in response to anxiety can increase uterine contractility.

Relaxation supports the natural process of labor. Relaxation techniques, such as slow breathing patterns, augment the natural process of labor. Calmness increases a woman's ability to cope with pain during labor. In contrast, marked anxiety, fear, or fatigue decreases a woman's ability to cope with pain in labor.

footling breech presentation

Single or double, extension at thighs and knees, foot or feet present. caesarean it is

Outlet

The angle of the pubic arch also is an important pelvic outlet measure. The angle of the pubic arch should be at least 90 degrees. A narrow pubic arch displaces the fetus posteriorly toward the coccyx as it tries to pass under the arch.

Which statements describe how the Ferguson reflex supports maternal pushing efforts? Select all that apply. The Ferguson reflex causes the cervix to dilate to 10 cm. The fetal head pushing on the vaginal tissue triggers the Ferguson reflex. When tissues are stretched, an endogenous surge of oxytocin is released. The Ferguson reflex is a biological response causing an overwhelming urge to bear down. When tissues are stretched, an endogenous surge of progesterone is released.

The fetal head pushing on the vaginal tissue triggers the Ferguson reflex. When the head is engaged, the tissues are stretched, and an endogenous surge of oxytocin is released. When tissues are stretched, an endogenous surge of oxytocin is released. The endogenous surge of oxytocin causes the woman to feel an overwhelming urge to bear down. The Ferguson reflex is a biological response causing an overwhelming urge to bear down. The urge to bear down is known as the Ferguson reflex and facilitates birth.

Fetal presentation and position

The fetal presenting part acts as a wedge to efface and dilate the cervix as each contraction pushes it downward. Cephalic Presentation Breech Presentation Shoulder Presentation

A pregnant woman arrives at the emergency department, and after completing a vaginal examination the nurse midwife states that the patient is 5 cm dilated and 75% effaced and the fetus is at −3 station. Which statement is accurate regarding this assessment? The patient may initiate pushing efforts. The cervix is fully dilated. The cervix is fully effaced. The fetus is not engaged within the maternal pelvis.

The fetus is not engaged within the maternal pelvis. Fetal engagement begins at 0 station.

Coordinated contractions

The uterus contracts in a coordinated way. Labor contractions gradually assume a regular pattern of increasing frequency, duration, and intensity. Coordinated labor contractions begin in the uterine fundus and spread downward toward the cervix to propel the fetus through the pelvis.

How is effacement measured? select all that apply Through digital palpation by a trained professional Using transvaginal ultrasound By estimating the stage of labor Though palpation of cervical dilation Through Leopold maneuvers

Through digital palpation by a trained professional Digital palpation and transvaginal ultrasound can estimate cervical effacement. Using transvaginal ultrasound Digital palpation and transvaginal ultrasound can estimate cervical effacement.

Which passenger position would interfere with a safe vaginal birth? Transverse fetal lie Flexed fetal head Cephalic presentation Longitudinal fetal lie

Transverse fetal lie The fetal lie is the relationship of the long axis of the baby to the long axis of the mother. With a transverse fetal lie, there is a significant risk for fetal distress, trauma, and maternal trauma if vaginal delivery occurs.

breech presentation

common abnormality of delivery in which the fetal buttocks or feet present first rather than the head butt = not as slippery as the head umbilical cord gets compressed between head and mom's pelvis

Normal labor contractions are

coordinated, involuntary, and intermittent

Platyplelloid Pelvis

exaggerated female pelvis least common (3%) flat shape wide opening if the widest part of the fetus can pass through the pelvic inlet, then vag delivery is fine

complete breech presentation

flexion at the thighs and knees, feet and buttocks present reversed presentation

The True Pelvis

inlet, midpelvis, outlet

Braxton Hicks contractions

irregular prelabor contractions of the uterus

shoulder presentation, transverse presentation

long axis of baby's body is across the long axis of the mother's body; shoulder is presented at the cervical opening you get. caesarean

gynecoid pelvis

most favorable pelvis for successful labor. 50% of women have this shape round with blunt ischial spines

Anthropoid pelvis

oval shaped, with a wider anteroposterior diameter fetus descends weird - presents in occiput posterior position 24% of women

The Passenger: Assessing Fetal Position

passenger = baby 3 keys: fetal lie attitude presentation

Leopold Maneuvers (Abdominal Palpation)

performing external palpations of the maternal uterus through the abdominal wall to determine the following: -number of fetuses -presenting part - fetal lie - fetal attitude - location of the fetus's back to check fetal heart tones

fetal lie

relationship of the long axis of the baby to the long axis of the mother transverse or langitudinal (99%)

Ferguson reflex

stretch receptors in the posterior vagina cause release of endogenous oxytocin that triggers the maternal urge to bear down Won't start until 10 cm dilated and fetus descends to pelvis PUSHING IS A VOLUNTARY EFFORT

first stage of labor

the initial stage of childbirth in which regular contractions begin and the cervix dilates Uterine Contractions are the primary force moving the fetus through the pelvis

The Passage

the pelvic structures and soft tissues of the woman giving birth

android pelvis

the typical male pelvis; in the woman, the heart shape of the android pelvis is not favorable to a vaginal delivery 23% of women difficult vaginal delivery probs a caesarean

cephalic (vertex) presentation (crowning)

when the baby is coming head first - head can change shape - The fetal head is smooth, round, and hard, making it an effective part to dilate the cervix, which is also round.

At. ____________ station, the fetal head is considered "engaged" in the maternal pelvis.

zero 0 The fetal head is considered engaged in the maternal pelvis when it reaches the ischial spines, or 0 station.