Chapter 13 - Labor and Birth Process Comb
Ways to determine Rupture of Membranes
Pooling of amniotic fluid in the vaginal canal, Nitrazine paper that test pH (alkalinity of the fluid; will turn blue), Speculum exam with obtaining of fluid to look at under a microscope.
Position (P)
Position changes for mom can help influence progression of labor. Some positions more favorable for progression. Upright position assists with gravity pushing baby down.
Stages of labor
Start of Labor (Cervically Change) First Stage (Dilation up to start of expulsion) Second Stage ( Expulsion of baby) Third Stage (from baby delivery to expulsion of placenta) Fourth Stage (Recovery)
Describe Dilation measurements
Measured in cm from 0-10 0cm: external cervical opening is completely closed 5cm: external cervical opening is about halfway open, 5 cm measurement 10cm: external cervical opening (os) is fully dilated and ready to birth baby, approximately 10 cm wide measurement.
signs and symptoms of false labor
-Irregular contractions, not close together in timing -No pattern in timing of the contractions -strength of contractions is not increasing -pain from contraction is first felt in abdomen -contractions slow down or stop with change of position -Eating, drinking, walking around all should lead to diminishment of false labor contractions
Describe measurement of effacement
0-100% (can be subjective) 0% cervical canal is approximately 2cm long 50% cervical canal is 1cm long 100% cervical canal is gone.
Factors influencing onset of labor
Uterine stretch Progesterone withdrawal Increased oxytocin sensitivity Increased release of prostaglandins
Premonitory signs of labor
- Cervical changes - Lightening - Increased energy level - "Bloody show" - Braxton Hicks contractions - Spontaneous rupture of membranes
signs and symptoms of true labor
-At beginning regular contractions, 4-6 minutes apart, lasting 30 to 60 seconds. -Contractions become stronger with time and vaginal pressure is felt -Discomfort starts in back and radiates toward front. -Position change does not change the contraction or intensity
Implications of breech presentation
Vaginal delivery is possible, especially with a proven pelvis. However, c-section is likely due to increase risks involved with breech vaginal delivery
Make up of pelvis
3 planes -inlet: The pelvic inlet, entrance into true pelvis, is the anatomical limit between the true pelvis below and the false pelvis above -mid pelvis: the cavity, the bulk of the pelvic structure that baby has to descend and rotate through to then be born. -outlet: the inferior opening of the pelvis
2. Which of the following would indicate to the nurse that the placenta is separating? A) Uterus becomes globular B) Fetal head is at vaginal opening C) Umbilical cord shortens D) Mucous plug is expelled
Ans: A Feedback: Placental separation is indicated by the uterus changing shape to globular and upward rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening, and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a premonitory sign of labor.
19. The nurse is reviewing the monitoring strip of a woman in labor who is experiencing a contraction. The nurse notes the time the contraction takes from its onset to reach its highest intensity. The nurse interprets this time as which of the following? A) Increment B) Acme C) Peak D) Decrement
Ans: A Feedback: Each contraction has three phases: increment or the buildup of the contraction; acme or the peak or highest intensity; and the decrement or relaxation of the uterine muscle fibers. The time from the onset to the highest intensity corresponds to the increment.
13. Assessment of a fetus identifies the buttocks as the presenting part, with the legs extended upward. The nurse identifies this as which type of breech presentation? A) Frank B) Full C) Complete D) Footling
Ans: A Feedback: In a frank breech, the buttocks present first, with both legs extended up toward the face. In a full or complete breech, the fetus sits cross-legged above the cervix. In a footling breech, one or both legs are presenting.
24. During a follow-up prenatal visit, a pregnant woman asks the nurse, "How long do you think I will be in labor?" Which response by the nurse would be most appropriate? A) "It's difficult to predict how your labor will progress, but we'll be there for you the entire time." B) "Since this is your first pregnancy, you can estimate it will be about 10 hours." C) "It will depend on how big the baby is when you go into labor." D) "Time isn't important; your health and the baby's health are key."
Ans: A Feedback: It is difficult to predict how a labor will progress and therefore equally difficult to determine how long a woman's labor will last. There is no way to estimate the likely strength and frequency of uterine contractions, the extent to which the cervix will soften and dilate, and how much the fetal head will mold to fit the birth canal. We cannot know beforehand whether the complex fetal rotations needed for an efficient labor will take place properly. All of these factors are unknowns when a woman starts labor. Telling the woman an approximate time would be inappropriate because there is no way to determine the length of labor. It is highly individualized. Although fetal size and maternal and fetal health are important considerations, these responses do not address the woman's concern.
25. A nurse is describing how the fetus moves through the birth canal. Which of the following would the nurse identify as being most important in allowing the fetal head to move through the pelvis? A) Sutures B) Fontanelles C) Frontal bones D) Biparietal diameter
Ans: A Feedback: Sutures are important because they allow the cranial bones to overlap in order for the head to adjust in shape (elongate) when pressure is exerted on it by uterine contractions or the maternal bony pelvis. Fontanelles are the intersections formed by the sutures. The frontal bones, along with the parietal and occipital bones are bones of the cranium that are soft and pliable. The biparietal diameter is an important diameter that can affect the birth process.
7. The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth? A) Cesarean B) Vaginal C) Forceps-assisted D) Vacuum extraction
Ans: A Feedback: The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate.
8. Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in: A) Latent phase of the first stage B) Active phase of the first stage C) Transition phase of the first stage D) Perineal phase of the second stage
Ans: A Feedback: The latent phase of the first stage of labor involves cervical dilation of 0 to 3 cm, cervical effacement of 0% to 40%, and contractions every 5 to 10 minutes lasting 30 to 45 seconds. The active phase is characterized by cervical dilation of 4 to 7 cm, effacement of 40% to 80%, and contractions occurring every 2 to 5 minutes lasting 45 to 60 seconds. The transition phase is characterized by cervical dilation of 8 to 10 cm, effacement of 80% to 100%, and contractions occurring every 1 to 2 minutes lasting 60 to 90 seconds. The perineal phase of the second stage occurs with complete cervical dilation and effacement, contractions occurring every 2 to 3 minutes and lasting 60 to 90 seconds, and a tremendous urge to push by the mother.
15. After teaching a group of students about the factors affecting the labor process, the instructor determines that the teaching was successful when the group identifies which of the following as a component of the true pelvis? (Select all that apply.) A) Pelvic inlet B) Cervix C) Mid pelvis D) Pelvic outlet E) Vagina F) Pelvic floor muscles
Ans: A, C, D Feedback: The true pelvis is made up of three planes: the pelvic inlet, mid pelvis, and pelvic outlet. The cervix, vagina, and pelvic floor muscles are the soft tissues of the passageway.
23. A nurse is preparing a presentation for a group of pregnant women about the labor experience. Which of the following would the nurse most likely include when discussing measures to promote coping for a positive labor experience? (Select all that apply.) A) Presence of a support partner B) View of birth as a stressor C) Low anxiety level D) Fear of loss of control E) Participation in a pregnancy exercise program
Ans: A, C, E Feedback: Numerous factors can affect a woman's coping ability during labor and birth. Having the presence and support of a valued partner during labor, engaging in exercise during pregnancy, viewing the birthing experience as a meaningful rather than stressful event, and a low anxiety level can promote a woman's ability to cope. Excessive anxiety may interfere with the labor progress, and fear of labor and loss of control may enhance pain perception, increasing the fear.
18. A nurse is preparing a class for pregnant women about labor and birth. When describing the typical movements that the fetus goes through as it travels through the passageway, which of the following would the nurse most likely include? (Select all that apply.) A) Internal rotation B) Abduction C) Descent D) Pronation E) Flexion
Ans: A, C, E Feedback: The positional changes that occur as the fetus moves through the passageway are called the cardinal movements of labor and include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. The fetus does not undergo abduction or pronation.
3. When assessing cervical effacement of a client in labor, the nurse assesses which of the following characteristics? A) Extent of opening to its widest diameter B) Degree of thinning C) Passage of the mucous plug D) Fetal presenting part
Ans: B Feedback: Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody show is a premonitory sign of labor. The fetal presenting part is determined by vaginal examination and is commonly the head (cephalic), pelvis (breech), or shoulder.
14. A woman in her third trimester comes to the clinic for a prenatal visit. During assessment the woman reports that her breathing has become much easier in the last week but she has noticed increased pelvic pressure, cramping, and lower back pain. The nurse determines that which of the following has most likely occurred? A) Cervical dilation B) Lightening C) Bloody show D) Braxton-Hicks contractions
Ans: B Feedback: Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis. The uterus lowers and moves into the maternal pelvis. The shape of the abdomen changes as a result of the change in the uterus. The woman usually notes that her breathing is much easier. However, she may complain of increased pelvic pressure, cramping, and lower back pain. Although cervical dilation also may be occurring, it does not account for the woman's complaints. Bloody show refers to passage of the mucous plug that fills the cervical canal during pregnancy. It occurs with the onset of labor. Braxton-Hicks contractions increase in strength and frequency and aid in moving the cervix from a posterior position to an anterior position. They also help in ripening and softening the cervix.
4. A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which of the following? A) Increased energy level with alternating strong and weak contractions B) Moderately strong contractions every 4 minutes, lasting about 1 minute C) Contractions noted in the front of abdomen that stop when she walks D) Pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds
Ans: B Feedback: Moderately strong regular contractions 60 seconds in duration indicate that the client is probably in the active phase of the first stage of labor. Alternating strong and weak contractions, contractions in the front of the abdomen that change with activity, and pink-tinged secretions with irregular contractions suggest false labor.
11. After teaching a group of students about the maternal bony pelvis, which statement by the group indicates that the teaching was successful? A) The bony pelvis plays a lesser role during labor than soft tissue. B) The pelvic outlet is associated with the true pelvis. C) The false pelvis lies below the imaginary linea terminalis. D) The false pelvis is the passageway through which the fetus travels.
Ans: B Feedback: The maternal bony pelvis consists of the true and false portions. The true pelvis is made up of three planes—the inlet, the mid pelvis, and the outlet. The bony pelvis is the more important part of the passageway because it is relatively unyielding. The false pelvis lies above the imaginary linea terminalis. The true pelvis is the bony passageway through which the fetus must travel.
9. A client is admitted to the labor and birthing suite in early labor. On review of her medical record, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal delivery. Which pelvic shape would the nurse have noted? A) Platypelloid B) Gynecoid C) Android D) Anthropoid
Ans: B Feedback: The most favorable pelvic shape for vaginal delivery is the gynecoid shape. The anthropoid pelvis is favorable for vaginal birth but it is not the most favorable shape. The android pelvis is not considered favorable for a vaginal birth because descent of the fetal head is slow and failure of the fetus to rotate is common. Women with a platypelloid pelvis usually require cesarean birth.
21. When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage? A) Regular contractions B) Cervical dilation C) Fetal movement through the birth canal D) Placental separation
Ans: B Feedback: The primary change occurring during the first stage of labor is progressive cervical dilation. Contractions occur during the first and second stages of labor. Fetal movement through the birth canal is the major change during the second stage of labor. Placental separation occurs during the third stage of labor.
10. A woman telephones her health care provider and reports that her "water just broke." Which suggestion by the nurse would be most appropriate? A) "Call us back when you start having contractions." B) "Come to the clinic or emergency department for an evaluation." C) "Drink 3 to 4 glasses of water and lie down." D) "Come in as soon as you feel the urge to push."
Ans: B Feedback: When the amniotic sac ruptures, the barrier to infection is gone and there is the danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that the woman come in for an evaluation. Calling back when contractions start, drinking water, and lying down are inappropriate because of the increased risk for infection and cord prolapse. Telling the client to wait until she feels the urge to push is inappropriate because this occurs during the second stage of labor.
1. A woman in her 40th week of pregnancy calls the nurse at the clinic and says she's not sure whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor? A) "I'm feeling contractions mostly in my back." B) "My contractions are about 6 minutes apart and regular." C) "The contractions slow down when I walk around." D) "If I try to talk to my partner during a contraction, I can't."
Ans: C Feedback: False labor is characterized by contractions that are irregular and weak, often slowing down with walking or a position change. True labor contractions begin in the back and radiate around toward the front of the abdomen. They are regular and become stronger over time; the woman may find it extremely difficult if not impossible to have a conversation during a contraction.
16. A nurse is documenting fetal lie of a woman in labor. Which term would the nurse most likely use? A) Flexion B) Extension C) Longitudinal D) Cephalic
Ans: C Feedback: Fetal lie refers to the relationships of the long axis (spine) of the fetus to the long axis (spine) of the mother. There are two primary lies: longitudinal and transverse. Flexion and extension are terms used to describe fetal attitude. Cephalic is a term used to describe fetal presentation.
26. Assessment of a pregnant woman reveals that the presenting part of the fetus is at the level of the maternal ischial spines. The nurse documents this as which station? A) -2 B) -1 C) 0 D) +1 .
Ans: C Feedback: Station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. Zero (0) station is designated when the presenting part is at the level of the maternal ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spines, the distance is recorded as plus stations
17. The nurse is reviewing the medical record of a woman in labor and notes that the fetal position is documented as LSA. The nurse interprets this information as indicating which of the following is the presenting part? A) Occiput B) Face C) Buttocks D) Shoulder
Ans: C Feedback: The second letter denotes the presenting part which in this case is "S" or the sacrum or buttocks. The letter "O" would denote the occiput or vertex presentation. The letter "M" would denote the mentum (chin) or face presentation. The letter "A" would denote the acromion or shoulder presentation.
6. A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating: A) Latent phase of the first stage of labor B) Active phase of the first stage of labor C) Transition phase of the first stage of labor D) Pelvic phase of the second stage of labor
Ans: C Feedback: The transition phase is characterized by cervical dilation of 8 to 10 cm, effacement of 80% to 100%, contractions that are strong, painful, and frequent (every 1 to 2 minutes) and last 60 to 90 seconds, and irritability, apprehension, and feelings of loss of control. The latent phase is characterized by mild contractions every 5 to 10 minutes, cervical dilation of 0 to 3 cm and effacement of 0% to 40%, and excitement and frequent talking by the mother. The active phase is characterized by moderate to strong contractions every 2 to 5 minutes, cervical dilation of 4 to 7 cm and effacement of 40% to 80%, with the mother becoming intense and inwardly focused. The pelvic phase of the second stage of labor is characterized by complete cervical dilation and effacement, with strong contractions every 2 to 3 minutes; the mother focuses on pushing.
5. A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor? A) Supine B) Lithotomy C) Upright D) Knee-chest
Ans: C Feedback: The use of any upright position helps to reduce the length of labor. Research validates that nonmoving back-lying positions such as supine and lithotomy positions during labor are not healthy. The knee-chest position would assist in rotating the fetus in a posterior position.
20. A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction? A) Heart rate increase from 76 bpm to 90 bpm B) Blood pressure rise from 110/60 mm Hg to 120/74 C) White blood cell count of 12,000 cells/mm3 D) Respiratory rate of 10 breaths /minute
Ans: D Feedback: During labor, the mother experiences various physiologic responses including an increase in heart rate by 10 to 20 bpm, a rise in blood pressure by up to 35 mm Hg during a contraction, an increase in white blood cell count to 25,000 to 30,000 cells/mm3, perhaps as a result of tissue trauma, and an increase in respiratory rate with greater oxygen consumption due to the increase in metabolism. A drop in respiratory rate would be a cause for concern.
22. A nurse is caring for several women in labor. The nurse determines that which woman is in the transition phase of labor? A) Contractions every 5 minutes, cervical dilation 3 cm B) Contractions every 3 minutes, cervical dilation 5 cm C) Contractions every 21/2 minutes, cervical dilation 7 cm D) Contractions every 1 minute, cervical dilation 9 cm
Ans: D Feedback: The transition phase is characterized by strong contractions occurring every 1 to 2 minutes and cervical dilation from 8 to 10 cm. Contractions every 5 minutes with cervical dilation of 3 cm is typical of the latent phase. Contractions every 3 minutes with cervical dilation of 5 cm and contractions every 21/2 minutes with cervical dilation of 7 cm suggest the active phase of labor.
12. A fetus is assessed at 2 cm above the ischial spines. The nurse would document fetal station as: A) +4 B) +2 C) 0 D) -2
Ans: D Feedback: When the presenting part is above the ischial spines, it is noted as a negative station. Since the measurement is 2 cm, the station would be -2. A 0 station indicates that the fetal presenting part is at the level of the ischial spines. Positive stations indicate that the presenting part is below the level of the ischial spines.
Frank Breech
Baby's butt (sacrum) presents first, the legs are extended upward, toes at head.
Posterior
Baby's face is facing out, towards mothers front surface. Back of baby's head/back is "posterior".
False labor is also known as
Braxton Hicks contractions
Full/Complete Breech
Butt, sacrum first, knees bent, feet near butt
Confirmation of True Labor
Can only be confirmed by cervical exam.
Brow fetal presentation
Cephalic, the baby has their chin untucked, and the neck is extended slightly backward. The longest diameter of the fetal head is presenting.
When should a women experiencing contractions arrive at labor and delivery
Contractions are about 5 minutes apart and lasting 45 to 60 seconds. The contractions should be strong enough that the women can not have a conversation while experiencing them.
Powers
Contractions; uterine contractions; Primary and Secondary Forces
Can cause false labor contractions
Dehydration
Problem with fetal attitudes other then flexion
Extension or other fetal attitudes may present larger fetal diameters, harder for passage through birth canal.
longitudinal fetal lie
Favorable vaginal birthing position. spine of baby (long axis) is parallel to the spine of the mother.
Types of breech presentations
Frank, Full/Complete, Single/Double Footling
Nursing Assessment of Uterine Contractions
Frequency, Duration, Intensity (can be palpated), Resting tone of Uterus (should be soft).
Pelvic Shapes
Gynecoid Anthropoid Android Platypelloid
Fetal Station
High high, measured in cm, the top of the babies head (cephalic presentation) is in the pelvis. Fetal station is the measurement of how high or low baby is in the pelvis. Fetal station is measured by assessing where baby's presenting portion (usually the head) is in relation to the ischial spines, two bony protrusions on the back of the pelvis.
Primary Force (Power)
Involuntary uterine contractions, can be increased with pharmaceutical oxytocin.
Most favorable fetal presentation for vaginal delivery
LOA; -Left (slightly towards mothers left hip) - Occipitious (cephalic, head down) -Anterior (back of babies head is anterior in relationship to position of mothers womb)
Fetal Presentation
Looking at which fetal structure is lying nearest the mothers cervix. This is the middle letter in the fetal positioning acronym. -O- for Occipitus (occiput-head first) and -S- for Sacrum (breech)
5 P's of Labor
Passageway, passenger, powers, position, and psychological (psyche) response
PROM
Premature Rupture of Membranes: Prelabor rupture of membranes at greater then 37 weeks of gestation but prior to onset of true labor.
ROP
Right occipitus posterior
What should happen if a women believes she has experienced rupture of membranes?
She needs to be seen at the hospital to determine if ROM has occurred. Nurse's priority should be status of baby, time of rupture, color of fluid, amount of fluid, and odor of fluid.
Back/Back of head
The anatomical landmarks that determine if the baby is considered in a posterior or anterior fetal presentation.
transverse fetal lie
The baby's spine (long axis) is perpendicular to the mothers spine (think + sign). This usually indicates a C-section is needed, unless able to turn baby.
Passenger (P)
The baby, membranes and placenta
When does the cervical changes begin
The softening and ripening of the cervix can begin 1 month to 1 hour prior to onset of labor. This occurs prior to effacement and dilation which occurs during true labor.
True Pelvis
The true pelvis is the area between the pelvic inlet, and the pelvic outlet.
Passageway (P)
This is the women's pelvis and cervix.
Psychological (Psyche) (P)
Trust and rapport should be built, clear education provided on what is happening/going to happen, mother's birthing plan should be followed if possible, care team should be supportive of mother during labor.
Second letter in the fetal presentation acronym -X-
Which part of baby is presenting first. -O- (occiput, cephalic, head first) -S- (scrum, breech, butt first)
Leopold's Maneuver
a method of abdominal palpation used to determine fetal position or placement within the uterus.
Anterior
baby's face is facing the other's back, the baby's head/back is "anterior" in relationship to mothers womb.
Occiput fetal presentation
cephalic with back of head first, chin tucked (most common and favorable)
Sinciput fetal presentation
cephalic with frontal part of the skull including forehead and the top of the head first to descend into the birth canal. Think normal position of head on shoulders of mature individual.
Face fetal presentation
cephalic; occurs when baby's spine extended until the head is shifted back so baby's face comes through the pelvis first.
Molding
cranial suture slightly overlaps during delivery
What cervical changes occur during labor?
dilation and effacement (shortening and thinning)
Single or Double footling
feet, either single or both, presents first
Cephalic Presentation
head first position of labor, most favorable for vaginal delivery. Sinciput: Front of the head first, head straight up or flexed back slightly
linea terminalis
imaginary line that separates the true pelvis from the false pelvis. Process between the ilium and symphysis pubis.
Android
inlet is heart shaped, poor labor prognosis.
Platypelloid
inlet is wide and shallow (narrow), least common shape, poor labor prognosis due to shallowness of inlet and outlet.
LOA
left occipitus anterior
LOP
left occipitus posterior
LSA
left sacrum anterior
LSP
left sacrum posterior
Sagittal Suture
located between the parietal bones and divides the skull into the right and left halves.
Third letter in the fetal presentation acronym. --X
location of babies back/back of head in mother's womb. --P (posterior) --A (anterior).
shoulder/transverse presentation
long axis of baby's body is across the long axis of the mother's body (transverse lie); shoulder is presented at the cervical opening
Fetal Station measurement
measured from -4cm to +4 cm. (-) station= Negative numbers the baby is considered above the ischial spine; 1-4cm, one being lower baby, 4 higher "floating baby". 0 Station= baby is considered engaged in the pelvis, top of babies head is at the ischial spine (+) station= Positive numbers, the bigger the number the lower the baby is, closer to delivery. Baby is descending down the birth cannel and head is below the ischial spine. +4 the babies head is out and delivering, think +4 on the floor
Gynecoid
most favorable for vaginal delivery; occurs in about 40% of women; inlet is round and outlet is roomy.
Describe flexion
normal intrauterine fetal attitude, the fetal back is rounded, head is forward "tucked" toward chest, the arms and legs are folded in against body. Spine should be C shaped (cannon ball presentation).
Anthropoid
ovular and deep inlet (toilet seat looking). Not as favorable as gynecoid for vaginal delivery.
PPROM
preterm premature rupture of membranes: occurs when prelabor rupture of membranes happens prior to onset of true labor at less then 37 weeks gestation.
Fetal Lie
refers to the position of the fetal spine to mother's spine, relationship of long axis-longitudinal
Fetal attitude
relationship of fetal parts to one another, degree of flexion
ROA
right occipitus anterior
RSA
right sacrum anterior (breech)
RSP
right sacrum posterior
premonitory meaning
signs or symptoms a women experiences prior to the onset of labor; alerting her that labor may begin soon.
first letter in the fetal presentation acronym X--
the direction the fetal occiput, back of head, is directed towards in relationship to mother. L-- (left, the babies back of head is more directed "slightly" towards mothers left hip/side) R-- (right, the babies back of head is more directed towards mothers right hip/side)
Secondary Force (Power)
voluntary, bearing down efforts, pushing. Creates intra abdominal pressure. Mom has control over this.
Breech
when the babies sacrum (butt) presents first in birth canal, mothers pelvis