Labor & Birth Process Ch. 13 workbook

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

An increase in prostaglandins leads to myometrial what?

An increase in prostaglandins leads to myometrial contractions and to a reduction in cervical resistance.

Oxytocin aids in stimulating prostaglandin synthesis through receptors in the what?

Decidua

Downward movement of the fetal head until it is within the pelvic inlet.

Descent

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

Effacement

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

Engagement

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

Extension

Allows the shoulders to rotate internally to fit the maternal pelvis.

External rotation

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

Flexion

"When should I come to the hospital?"

Follow instructions of health care provider but generally stay home until contractions are 5 minutes apart, lasting 45-60 seconds & strong enough that a conversation during one is not possible. Drink fluids and walk to assess if there is any change in contractions. In true labor, contractions are regular, become closer together, and become stronger with time. the contraction starts in the back and radiates around toward the front of the abdomen.

Identify the different types of breeched positions. In which clients are such cases observed?

Frank, complete, single footling & double footling Breech presentations are associated with prematurity, placenta prevue, multiparty, uterine abnormalities (fibroids), and some congenital anomalies such as hydrocephaly.

Vaginal birth is most favorable with what type of pelvis?

Gynecoid because the inlet is round and the outlet is roomy.

Identify the four types of pelvic shapes. Which of the four is the most favorable for a vaginal birth?

Gynecoid: considered the true female pelvis anthropoid: deep pelvis, wider front-to-back than side-to-side android: characterized by its funnel shape; prognosis for labor is poor, usually leads to c-section platypelloid: flat pelvis; least common; pelvic cavity is shallow but widens at the pelvic outlet; usually results in c-section Gynecoid is the most favorable for a vaginal birth.

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

Reduce length of 2nd stage of labor; reduce episiotomies & perineal tears; contribute to fewer abnormal fetal heart rate patterns; reduces number of assisted deliveries (forceps & vacuum), increases comfort & reduces requests for pain medication, alters the shape & size of the pelvis, which assists descent.

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

Increase in heart rate by 10-20 BPM; increase in cardiac output by 12% - 31% during the 1st stage of labor & by 50% during the 2nd stage of labor; increase in BP up to 35 mm Hg during uterine contractions; increase in white blood cell count to 25,000 - 30,000; increase in respiratory rate along with greater O2 consumption r/t increase in metabolism; decrease in gastric motility and food absorption, which may increase the risk of n/v during the transition state of labor; decrease in gastric emptying and gastric pH, which increases the risk of vomiting with aspiration; slight elevation in temperature; muscle aches/cramps; increase in basal metabolic rate (BMR) and decrease in blood glucose levels because of the stress of labor.

Give the correct sequence of the phases of labor.

Latent phase - active phase - transition phase - pelvic phase - perineal phase - placental separation - placental expulsion

What term describes what occurs when the fetal presenting part begins to descend into the maternal pelvis?

Lightening

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

Molding

A sudden increase in energy on the part of the expectant woman 24-48 hours prior to the onset of labor is sometimes referred to as what?

Nesting

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

Previous birth experiences and their outcomes; current pregnancy experience; involvement of support system; childbirth preparation; expectations of the birthing experience; anxiety level & fear of labor experience; feelings of loss of control; fatigue & weariness; anxiety levels

"How do we determine when it's time to push?"

Pushing occurs in the 2nd stage of labor, which begins with complete cervical dilation (10 cm) and effacement. Second-stage characteristics that help indicate that pushing can occur include: contractions occurring every 2 -3 minutes, last 60 - 90 seconds, and are describes as strong by palpation. Pushing can either follow a spontaneous urge or be directed by the nurse and/or health provider.

What is the route through which the fetus must travel to be birthed vaginally?

The birth passageway.

"How will I know I am in labor?"

With first pregnancies it can take up to 20 hours to dilate completely. False labor, irregular uterine contractions are felt but the cervix is not affected. In contrast, true labor contractions bring about progressive cervical dilation and effacement.

What suture is located between the parietal bones and divides the skull into the right and left halves?

The sagittal suture.

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

Zero station

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

clear info on procedures; positive support & not being alone; self-confidence & self-mastery; trust in staff; positive reaction to pregnancy; personal control over breathing; preparation for the childbirth experience.