Chapter 13 Labor and Birth Process

A sudden increase in energy on the part of the expectant woman 25-48 hours before the onset of labor is sometimes referred to as _____________

nesting

____________ Occurs when the fetal presenting part begins to descend into the maternal pelvis

lightening

14) A pregnant client is admitted to a maternity clinic after experiencing contractions. The assigned nurse observes that then client experiences pauses between contractions. The nurse knows that which event marks the importance of the pauses between contractions during labor? a. Effacement and dilation of the cervix b. Shortening of the upper uterine segment c. Reduction in length of the cervical canal d. Restoration of blood flow to the uterus and placenta

D

Extension

The head emerges through extension under the symphysis pubis, along with the shoulders

The thinning out process of the cervix during labor is termed what?

effacement

What are the factors that ensure a positive birth experience for the pregnant client?

- clear information on procedures - positive support - sense of mastery, self confidence - trust in staff - positive reaction to pregnancy - personal control over breathing -preparation for the birth experience

What are the reasons that cause women to adopt back lying positions during labor?

- conserve energy - easier for nurse to keep track of client - facilitates vaginal exams and belt adjustment - familiar - "convenient" for the provider

What are the maternal physiologic responses that occur as a woman progresses through childbirth

- increase in HR by 10-20 beats - increase in cardiac output by 12-31% during first stage of labor and by 50% during the second stage - increase in blood pressure up to 35 mm during uterine contractions in all labor stages - increase in WBC - increase in respiratory rate - decrease in gastric motility and food absorption - decrease in gastric emptying and gastric pH - slight elevation in temperature - muscular aches/cramps - increase in basal metabolic rate

What are the factors influencing the ability of a woman to cope with labor stress

- previous birth expereince - current pregnancy experience - cultural considerations - involvement of support system - preparedness - Expectations - anxiety level and fear of labor - feelings of loss of control - fatigue and weariness

Why should the nurse encourage the pregnant client experiencing contractions to adopt the upright or lateral position?

- reduces duration of the second stage of labor - reduces the number of assisted deliveries - reduces episiotomies and perineal tears - Contributes to fewer abnormal fetal heart rate patters - increases comfort and reduces requests for pain relief - Enhances sense of control by mother - Alters the shape and size of the pelvis which assists with descent - Assists gravity to move fetus downward

What are the signs of separation that indicate the placenta is ready to deliver?

- uterus rises upward - umbilical cord lengthens - blood trickles suddenly from the vaginal opening - Uterus changes its shape to globular

Arrange the phases of labor in order of occurrence 1) pelvic phase 2) perineal phase 3) Placental phase 4) Latent phase 5) Active phase 6) Placental separation 7) Transition phase

4,5,7,1,2,6,3

3) A client experiencing contractions present at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of BH contractions. Which role do BH contractions play in aiding labor? a. These contractions help in softening and ripening the cervix b. These contractions increase the release of prostaglandins c. These contractions increase oxytocin sensitivity d. These contractions make maternal breathing easier

A

12) A nurse is assigned the task of educating a pregnant client about birth. Which nursing interventions should the nurse perform as a part of prenatal education for the client to ensure a positive birth experience? SATA a. Provide the client clear information on procedures involved b. Encourage the client to have a sense of mastery and self control c. Encourage the client to have a positive reaction to pregnancy d. Instruct the client to spend some time alone each day e. Instruct the client to begin changing the home environment

A,B,C

6) A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client, as the client progresses through birth? SATA a. Increase in heart rate b. Increase in blood pressure c. Increase in respiratory rate d. Slight decrease in body temperature d. Increase in gastric emptying and pH

A,B,C

15) A nurse is caring for a pregnant client during labor. Which methods should the nurse use to provide comfort to the pregnant client? SATA a. Hand holding b. Chewing gum c. Massaging d. Accupressure e. Prescribed pain killers

A,C,D

10) A nurse is caring for a client who is in the first stage of labor. The client is experiencing extreme pain due to the labor. The nurse understands which to be causes of the extreme pain in the client? SATA a. Lower uterine segment distention b. Fetus moving along the birth canal c. Stretching and tearing of structures d. Spontaneous placental expulsion e. Dilation of the cervix

A,C,E

External Rotation

Allows the shoulders to rotate internally to fit the maternal pelvis

1) A client in her third trimester of pregnancy arrives at a health career facility with a report of cramping and low back pain; she also notes that she is urinating more frequently and that her breathing has become easier the past few days. Physical exam conducted by the nurse indicates client has edema of the lower extremities along with an increase in vaginal discharge. What should the nurse do next? a. Notify the health care provider b. Continue to monitor the client c. Assess the client's blood pressure d. Prepare the client for birth

B

11) A pregnant client in labor has to undergo a sonogram to confirm the fetal position of a shoulder presentation. For which condition associated with should presentation during a vaginal birth should the nurse assess? a. Uterine abnormalities b. Fetal abnormalities c. Congenital anomalies d. Prematurity

B

13) A pregnant client is admitted to a maternity clinic for birth. Which assessment finding indicates that the client's fetus is in the transverse lie position? a. Long axis of fetus is at 60 degrees to that of client b. Long axis of fetus is parallel to that of client c. Long axis of fetus is perpendicular to that of client d. Long axis of fetus is at 45 degrees to that of client

C

4) A pregnant client wants to know why the labor of a first time pregnant woman usually lasts longer than that of a woman who has already delivered once and is pregnant a second time. What explanation should the nurse offer the client? a. Braxton Hicks contractions are not strong enough during the first pregnancy b. Contractions are stronger during the first pregnancy than the second c. The cervix takes around 12-16 hours to dilate during the first pregnancy d. Spontaneous rupture of membranes occurs during first pregnancy

C

8) A client in the third stage of labor has experienced placental separation and expulsion. Why is it necessary for a nurse to massage the woman's uterus briefly until it is firm? a. To reduce boggy nature of the uterus b. To remove pieces left attached to uterine wall c. To constrict the uterine blood vessels d. To less the chances of conducting an episiotomy

C

5) A pregnant client is admitted to. maternity clinic for birth. The client wishes to adopt the kneeling position during labor. The nurse knows that which to be an advantage of adopting a kneeling position during labor? a. It helps the woman in labor to save energy b. It facilitates vaginal exams c. It facilitates external belt adjustment d. It helps to rotate fetus into a posterior position

D

7) A nurse is caring for a client during labor who is delivering. For which fetal response should the nurse monitor? a. Decrease in arterial carbon dioxide pressure b. Increase in fetal breathing movements c. Increase in fetal oxygen pressure d. Decrease in circulation and perfusion to the fetus.

D

9) A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which sign marks the termination of the first stage of labor? a. Diffuse abdominal cramping b. Rupturing of the fetal membranes c. Start of regular contractions d. Dilation of cervix diameter to 10 cm

D

Descent

Downward movement of the fetal head until it is within the pelvic inlet. A maneuver that occurs throughout the laboring process

Vaginal birth is most favorable with ______ type of pelvis because the inlet is round and the outlet is roomy

Gynecoid

Flexion

Occurs as the vertex meets resistance from the cervix, walls of the pelvis, or the pelvic floor

Engagement

Occurs when the greatest transverse diameter of the head in vertex passes through the pelvic inlet

___________ station is designated when the presenting part is at the level of the maternal ischial spines

Zero

2) The assessment of a pregnant client, who is toward the end of her third trimester, reveals that she has increased prostaglandin levels. For which factors should the nurse assess the client? SATA a. Reduction in cervical resistance b. Myometrial contractions c. Boggy appearance of the uterus d. Softening and thinning of the cervix e. Hypotonic character of the bladder

a, b, d

Oxytocin aids in stimulating prostaglandin synthesis through receptors in the ___________

decidua

The elongated shape of the fetal skull at birth as a result of overlapping of the cranial bones is known as _________

molding

The birth ________ is the route through which the fetus must travel to be birthed vaginally

passageway

The ______ suture is located between the parietal bones and divides the skull into the right and left halves

sagittal

An increase in prostaglandins leads to myometrial ____________and to a reduction in cervical resistance

sensitization