Ch. 13 - Labor and Birth Processes
Signs that precede labor include (Select all that apply):
-Lightening. -Bloody show. -Rupture of membranes. Signs that precede labor may include lightening, urinary frequency, backache, weight loss, surge of energy, bloody show, and rupture of membranes. Many women experience a burst of energy before labor. A decrease in fetal movement is an ominous sign that does not always correlate with labor.
Which factors influence cervical dilation (Select all that apply) ?
-Strong uterine contractions -The force of the presenting fetal part against the cervix -The pressure applied by the amniotic sac -Scarring of the cervix
Nurses can advise their patients that which of these signs precede labor? (select all that apply)
- A return of urinary frequency as a result of increased bladder pressure - Persistent low backache from relaxed pelvic joints - Stronger and more frequent uterine (Braxton Hicks) contractions
The maternity nurse should notify the health care provider about which assessment findings during labor? (select all that apply)
- Positive urine drug screen - Increased systolic blood pressure during first stage - Respiratory rate of 10 breaths/min
The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are (select all that apply)
- passenger - passageway - psychologic response - powers - position
A new mother asks the nurse when the "soft spot" on her son's head will go away. The nurse's answer is based on the knowledge that the anterior fontanel closes after birth by _____ months.
18 The larger of the two fontanels, the anterior fontanel, closes by 18 months after birth.
Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?
Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours
When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:
Attitude. Attitude is the relation of the fetal body parts to one another.
As relates to fetal positioning during labor, nurses should be aware that:
Birth is imminent when the presenting part is at +4 to +5 cm below the spine. The station of the presenting part should be noted at the beginning of labor so that the rate of descent can be determined. Position is the relation of the presenting part of the fetus to the four quadrants of the mother's pelvis;station is the measure of degree of descent.
Which occurrence is associated with cervical dilation and effacement?
Bloody show As the cervix begins to soften, dilate, and efface, expulsion of the mucous plug that sealed the cervix during pregnancy occurs. This causes rupture of small cervical capillaries.
Which presentation is described accurately in terms of both presenting part and frequency of occurrence?
Cephalic: occiput; at least 95% In cephalic presentations (head first), the presenting part is the occiput; this occurs in 96% of births.
To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor?
Cervical dilation and effacement The conclusive distinction between true and false labor is that contractions of true labor cause progressive change in the cervix.
The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products:
Diminishes as the spiral arteries are compressed. Uterine contractions during labor tend to decrease circulation through the spiral electrodes and subsequent perfusion through the intervillous space. The maternal blood supply to the placenta gradually stops with contractions.
A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:
Discharged home to await the onset of true labor. This situation describes a woman with normal assessments who is probably in false labor and will probably not deliver rapidly once true labor begins. These are all indications of false labor without fetal distress.
To care for a laboring woman adequately, the nurse understands that the __________ stage of labor varies the most in length?
First The first stage of labor is considered to last from the onset of regular uterine contractions to full dilation of the cervix. The first stage is much longer than the second and third stages combined. In a first-time pregnancy the first stage of labor can take up to 20 hours
Which description of the four stages of labor is correct for both definition and duration?
First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours Full dilation may occur in less than 1 hour, but in first-time pregnancies it can take up to 20 hours.
While providing care to a patient in active labor, the nurse should instruct the woman that:
Frequent changes in position will help relieve her fatigue and increase her comfort. Frequent position changes relieve fatigue, increase comfort, and improve circulation. Blood flow can be compromised in the supine position; any upright position benefits cardiac output.
The nurse would expect which maternal cardiovascular finding during labor?
Increased cardiac output During each contraction, 400 mL of blood is emptied from the uterus into the maternal vascular system. This increases cardiac output by about 51% above baseline pregnancy values at term.
Which statement is the best rationale for assessing maternal vital signs between contractions?
Maternal circulating blood volume increases temporarily during contractions. During uterine contractions, blood flow to the placenta temporarily stops, causing a relative increase in the mother's blood volume, which in turn temporarily increases blood pressure and slows pulse. It is important to monitor fetal response to contractions; however, this question is concerned with the maternal vital signs.
For vaginal birth to be successful, the fetus must adapt to the birth canal during the descent. The turns and other adjustments necessary in the human birth process are termed the "mechanism of labor." Please list the seven cardinal movements in the mechanism of labor in the correct order.
One = Engagement Two = Descent Three = Flexion Four = Internal rotation Five = Extension Six = External Rotation Seven = Expulsion
Which basic type of pelvis includes the correct description and percentage of occurrence in women?
Platypelloid: flattened, wide, shallow; 3% A platypelloid pelvis is flattened, wide, and shallow; about 3% of women have this shape. The gynecoid shape is the classical female shape, slightly ovoid and rounded; about 50% of women have this shape.
The factors that affect the process of labor and birth, known commonly as the five Ps, include all except:
Pressure. The five Ps are passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.
In relation to primary and secondary powers, the maternity nurse comprehends that
Primary powers are responsible for effacement and dilation of the cervix. The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus.
In order to care for obstetric patients adequately, the nurse understands that labor contractions facilitate cervical dilation by:
Pulling the cervix over the fetus and amniotic sac. Effective uterine contractions pull the cervix upward at the same time that the fetus and amniotic sac are pushed downward.
When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus?
RSA The fetus is positioned anteriorly in the right side of the maternal pelvis with the sacrum as the presenting part. RSA is the correct three-letter abbreviation to indicate this fetal position. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis.
Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?
Squatting Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet.
The nurse has received report regarding her patient in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and ?2-2. The nurse's interpretation of this assessment is that:
The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. The correct description of the vaginal examination for this woman in labor is the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.
With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that:
The effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head. The size of the maternal pelvis and the ability of the fetal head to mold also affect the process.
In order to evaluate the condition of the patient accurately during labor, the nurse should be aware that:
The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation. The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.
On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data?
The fetal presenting part is 1 cm above the ischial spines Station of -1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet
With regard to factors that affect how the fetus moves through the birth canal, nurses should be aware that
The normal attitude of the fetus is called general flexion. The normal attitude of the fetus is general flexion.
Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?
The vulva bulges and encircles the fetal head. During the active pushing (descent) phase, the woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor. The vulva stretches and begins to bulge encircling the fetal head. Birth of the head occurs when the station is +4.
The primary difference between the labor of a nullipara and that of a multipara is the
Total duration of labor. In a first-time pregnancy, descent is usually slow but steady; in subsequent pregnancies, descent is more rapid, resulting in a shorter duration of labor. Cervical dilation is the same for all labors.
A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe
bloody show Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens
The slight overlapping of cranial bones or shaping of the fetal head during labor is called:
molding. Fetal head formation is called molding. Molding also permits adaptation to various diameters of the maternal pelvis.
The nurse should tell a primigravida that the definitive sign indicating that labor has begun would b
progressive uterine contractions with cervical change Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change.
Concerning the third stage of labor, nurses should be aware that
the duration of the third stage may be as short as 3 to 5 minutes The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits
In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that
the endogenous endorphins released during labor raise the woman's pain threshold and produce sedation In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain
The nurse knows that the second stage of labor, the descent phase, has begun when:
the woman experiences a strong urge to bear down During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation.
