PROCESSES OF BIRTH

Breech

buttocks are the presenting parts

Anxiety and excessive stress

can diminish contractions

preparation for childbirth

can enhance a woman's ability to work with her body's effort rather than resist the natural forces

relaxation

can facilitate the natural processes

full bladder

can inhibits the fetal descent because it occupies space in the pelvis

Upper two thirds of the uterus

contracts actively to push the fetus down

anxiety

decrease a woman's ability to cope with pain in labor

attitude

degree of flexion

venous thrombosis

due to the increase of clotting factors during pregnancy the mother is at risk for

uterine contractions

during the first phase of labor, are the primary force that moves the fetus through the maternal pelvis

fetal chest

in face presentations fetal heart sounds are best heard, at the area of the...

occipitomental diameter

in poor flexion, the widest diameter

Support

includes physical comfort measures, providing information, advocacy, praise and reassurance, presence, and the maintenance of a calm and comfortable environment

The woman's past experiences with childbirth, pain, personal success and failure

influences expectations for birth

Prostaglandin Theory

initiation of labor is said to result from the release of arachidonic acid produced by steroid action on lipid precursors. Arachidonic acid, is said to increase prostaglandin synthesis which, in turn, causes uterine contractions.

slowly breathe into paper bag

intervention done when hyperventilating

Childbirth

is a physical and an emotional experience

Childbirth

is an irrevocable event that forever changes a woman and a family

true pelvis

is most important in childbirth

linea terminalis

is the pelvic brim or also know as

bony pelvis

is usually more important to the outcome of labor than the soft tissue

*Labor is inevitable within 24 hours. *The integrity of the uterus has been destroyed. *Umbilical cord compression and/or cord prolapse can occur (especially in breech presentation).

it is IMPORTANT to remember that once membranes (BOW) have ruptured:

Oxytocin theory

labor, being considered a stressful event, stimulate s the hypophysis to produce oxytocin from the posterior pituitary gland. Oxytocin causes contraction of the smooth muscles of the body, e.g., uterine muscles.

Decrement

last phase during which intensity of contraction decreases; also known as decrescendo

Double footling breech

legs unflexed and extended; feet are presenting

physiological retraction ring

marks the division between the upper and lower segments of the uterus

Horizonatal lie

maybe due to a relaxed abdominal wall because of multiparity, pelvic contraction or placenta previa

fontanelles

membrane-covered spaces at the junction of the main suture lines

suboccipitobregmatic diameter

very good attitude when the chin is flexed on the chest), the smallest diameter

the interval between contractions

woman's vital signs are best assessed during

maternal cathecolamines

secreted in response to anxiety and fear can inhibit uterine contractility and placental blood flow

wider in its anteroposterior (AP) diameter than in its transverse diameter

shape of the fetal skull

reproductive system, cardiovascular, respiratory, GI, urinary and hematopoietic systems

significant changes occurs during labor in her

transeverse lie

Shoulder presentation

includes physical comfort measures *providing information *advocacy *praise and reassurance *presence * the maintenance of a calm and comfortable environment

Support includes

110-160 bpm

The FHR is rapid and ranges from

Both the mother and fetus

The birth process affects the physiologic systems of

intervillous spaces

The exchange of oxygen, nutrients, and waste products between the mother and fetus occurs in the

Theory of Aging Placenta

- because of the decreased blood supply, the uterus contracts.

Increased Activity Level

- due to increase in epinephrine secreted to prepare the body for the coming "work" ahead. Advise the pregnant woman not to use this increased energy for doing household chores.

*Right anterior *Right posterior *Left anterior *Left posterior

The pelvis is divided into four quadrants

*Ice chips *Small amounts of clear liquids, juices, popsicles, and hard nonsugar candy *Solid food are withheld to prevent vomiting and aspiration of undigested food in the event that general anesthesia is required (CS)

Treatment when the woman is experiencing dry mouth and thirsty

breech presentation

at or above the level of the umbilicus (RUQ or LUQ)

Show

a pinkish vaginal discharge

Sphenoid, Ethmoid, and Temporal

3 least important cranial bones

Frontal, Occipital, Parietal

3 most important cranial bones

cesarean birth

birth not preceded by labor are more likely to have transient breathing difficulty

intermittent

allow relaxation of the uterine muscle and resumption of blood flow to and from the placenta

should be put to bed immediately and the fetal heart tones taken consequently.

A woman in labor seeking admission to the hospital and saying that her BOW has ruptured

Psyche

A woman's psychological response to labor and birth

anxiety, culture, expectation, life experiences, and support

A woman's psychological response to labor and birth are influenced by

Uterine Stretch Theory

any hollow body organ when stretched to capacity will necessarily contract and empty.

suture lines

are important because they allow the bones to move and overlap

Culture

Affects her values, expectations for and responses to birth and the practice surrounding it

*Suboccipitobregmatic *Occipitofrontal *Occipitomental

Anteroposterior diameter

coordinated, involuntary, intermittent

Characteristics of contraction

7 cm

Bimastoid

9.5 cm

Biparietal

8 cm

Bitemporal

Passage

Consists of the maternal pelvis and soft tissues

Vertex presentation (cephalic)

FHS are usually located in either the left or right lower quadrant (RLQ or LLQ);

Fetal hemoglobin, High hemoglobin and hematocrit levels, high cardiac output

Fetal protective mechanism include:

power, passage ,passenger, and psyche

Four major factors interact during normal childbirth.

10 cm

Full dilation is approximately

* Cord compression * Abruptio placenta * Erb-duchenne paralysis

Hazards of breech delivery

the first nursing action is to put her on Trendelenburg position and apply a warm saline-saturated OS on the prolapsed cord to prevent drying of the cord

If a woman in labor says that she feels a loop of the cord coming out of the vagina

the initial nursing action is to take the fetal heart tones.

If a woman in the Labor Room says that her membranes have ruptured

fetal back

In vertex and breech presentations, fetal heart sounds are best heard, at the area of the...

20,000-30,000/mm3

Leukocyte count

increment, acme, decrement

Phases of uterine contractions

*Gastric motility is reduced, which result to nausea and vomiting *Mostly thirsty and have dry mouths

Physiological effect of GI system during labor

*Depth and rate of respirations increases during labor *May experience hyperventilation *She may feel tingling of her hands and feet, numbness and dizziness

Physiological effect of Respiratory System during labor

reduced sensation of a full bladder

Physiological effect of Urinary system during labor

*Occiput *Chin *Buttocks/feet *Scapula (acromic)

Points of direction in the fetus

*Increase in urinary frequency *Relief of abdominal tightness and diaphragmatic pressure *Shooting pains down to legs because of pressure on the sciatic nerve *Increase in the amount of vaginal discharges.

Results of lightening

increment

first phase during which the intensity of contraction increases; also known as crescendo

Ripening of the cervix

from Goodell's sign, the cervix becomes "buttersoft".

suboccipitobregmatic

from below the occiput to the anterior fontanelle = 9.5 cm (the narrowest AP diameter)

Occipitofrontal

from the occiput to the mid-frontal bone = 12 cm.

hemoglobin level of 10.5 grams per deciliter, hematocrit of 33%

give most women an adequate margin of safety for blood loss

Cephalic

head is the presenting part

Vertex

head sharply flexed, making the parietal bone the presenting part

Engagement

occurs when the presenting part has descended into the pelvic inlet

Loss of weight

of about 2-3 lbs 1 to 2 days before labor onset, probably due to decrease in progesterone production, leading to decrease in fluid retention.

Single footling breech

one leg unflexed and extended; one foot presenting

Dilation

opening

Braxton Hicks contractions

painless, irregular practice contractions

Duration

period from the beginning of a uterine contraction to the end of the same contraction

Frequency

period from the beginning of one uterine contraction to the beginning of the next

Brow

poor flexion

fetal lungs

produce fluid to allow normal development of the airways

Cathecolamines

produced by the fetal adrenal glands in response to the stress of labor appear to contribute of the infant's adaptation to extra-uterine life

Progesterone Deprivation theory

progesterone, being the hormone designed to promote pregnancy, is believed to inhibit uterine motility. Thus, if its amount decreases, labor pains can occur.

cardiac contraction and breathing

quicken the clearance of remaining lung fluid, and aid in temperature regulation

Position

relationship of the fetal presenting part to a specific quadrant of the mother's pelvis

The lower third of the uterus

remains less active, promoting downward passage of the fetus

continue to propel that fetus through the pelvis

second stage of labor the uterine contraction...

intensity

strength of a contraction

300-500 mL

the amount of blood back into maternal systemic circulation thereby causing a relative increase in the woman's blood volume

30-40 % (1 and 1/2L)

the blood volume increases during pregnancy by

*It is the largest part of the body *It is the most frequent presenting part *It is the least compressible of all parts

the fetal skull is the most important part of the fetus because:

Acme

the height of the uterine contraction

Anterior fontanelle

the larger, diamond-shaped fontanelle which closes between 12-18 months in an infant

500 mL

the maximum normal blood loss during vaginal birth (NSD)

coronal suture line

the membranous inter-space which joins the frontal bone and the parietal bones

Lambdoid suture line

the membranous inter-space which joins the occiput and the parietals

sagittal suture line

the membranous interspace which joins the 2 parietal bones

Lightening

the settling of the fetal head into the pelvic brim.

posterior fontanelle

the smaller, triangular shaped fontanelle which closes between 2-3 months in the infant

Frank breech

thighs are flexed and legs are extended, resting on the anterior surface of the body

complete breech

thighs flexed on the abdomen and legs are on thighs

Effacement

thinning and shortening

inlet, mid pelvis, outlet

three sub divisions of true pelvis