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Active labor

the second phase in the first stage of labor contractions become longer, stronger, and more frequent and the cervix dilates to 4 centimeters

True versus False Labor​

Contraction timing - from beginning of one to next; 5 mins apart lasting 60sec​ Contraction strength​ Contraction discomfort - starts in back​ Change in contraction activity​ True labor = cervical change

third stage of labor

Expulsion of the placenta birth of infant to placental separation​

Cardinal Movements of Labor

engagement descent flexion internal rotation extension external rotation expulsion

second stage of labor

the stage during which the baby moves out through the vagina and is delivered cervix 10 cm dilated to birth of baby​

fourth stage of labor

Recovery: the first 1-4 hours after delivery of the placenta

Powers of labor

Uterine Contractions - eval freq, duration, intensity​ Intra-abdominal pressure from mother pushing and bearing down​ Contractions: involuntary — thin and dilate cervix; Three parameters: Frequency, Duration, Intensity ​IUPC measures contraction strength inside uterus

Factors Influencing the Onset of Labor​

Uterine Stretch​ Progesterone Withdrawal​ Increased Oxytocin Sensitivity (Pitocin is artificial version which is used to induce)​ Cortisol increases​ Increase Release of Prostaglandins ​

A nurse is providing care to a woman in labor. When reviewing the woman's medical record, the nurse notes that fetal position is documented as LSA. The nurse interprets this to mean that which part of the fetus is presenting?

buttocks

fetal presentations

*Vertex* - most favorable with fetal head fully flexed *Military* - head isn't flexed or extended *Brow* - head is partly extended, longest part is presenting first. Will usually convert to vertex or face. *Face* - head is fully extended and face presents *Breech* - In frank the legs are flexed at hips and extend toward shoulders (most common) butt first In Full or complete the butt and feet are coming first.

Presenting part: When refering to LSA or ROA, etc, what do these letters indicate In this case, it is "S" which is for sacrum or buttocks. "O" refers to the occiput; "M" would be used to refer to the chin. "A" would be used to refer to the acromion process.

1st letter - Left or right 2nd Letter "S"= sacrum or buttocks "O" = occiput "M" =chin. "A" = acromion process.

Latent phase of labor:

1st part of the 1st stage of labor cervix 0-3cm, contractions irregular, mild to mod frequency 5-30m and duration of 30-45s, some dilation and effacement, pt talkative and eager Use slow/ deep breathing

Premonitory Signs of Labor​

Cervical changes; typically the length of index finger, then becomes short/thin​ cervical softening, possible cervical dilation to 10cm​ Increased energy level ​ nesting​ Braxton Hicks contractions​ Irregular, drink water and take tylenol...True labor = cervical change​ Spontaneous rupture of membranes - water breaks on its own ​ Lightening - baby settles in birth canal, light feeling, breathe easier "dropping"​ Bloody show - means cervix is softening​

Pelvic shapes

Gynecoid: favorable for vaginal delivery​ Android: male shaped, not favorable, heart shape​ Anthropoid: usually adequate ​ Platypelloid: not favorable, shallow cavity​

Physiological Response to Labor

INCREASED heart rate, cardiac output, blood pressure (during contractions)​ white blood cell count​ respiratory rate and oxygen consumption​ DECREASED gastric motility and food absorption​ gastric emptying and gastric pH​ blood glucose levels​ ​

Ideal fetal position for delivery

Left occipital anterior & Right occipital anterior

Passageway: Bony Pelvis ​

Linea terminalis: division of false and true pelvis ​ True pelvis (below linea terminalis)​ Inlet:​ Mid-pelvis​ Outlet (pelvic measurements for childbirth adequacy)​ False pelvis (above linea terminalis)​ Upper flared parts of two iliac bones and concavities​ Wings of base of sacrum​

Landmarks (what you feel during exam and how it means baby is sitting)​ ​

Occipital bone (O): vertex presentation ​ ​ Chin (mentum [M]): face presentation​ ​ Buttocks (sacrum [S]): breech presentation​ ​ Scapula (acromion process [A]): shoulder presentation​

5 P's of labor

Passageway (birth canal: cervix, pelvis and soft tissues)​ Passenger (fetus and placenta)​ Powers (contractions) ​ Position (maternal) ​ Psychological response ​

Physiological Response to Labor: Fetal

Periodic Fetal HR accelerations and slight decelerations ​ Decrease in circulation and perfusion​ Increase in arterial carbon dioxide pressure​ Decrease in fetal breathing movements​ Decrease in fetal oxygen pressure; decrease in partial pressure of oxygen

Five Additional Factors Affecting the Labor Process​

Philosophy (low tech, high touch) ​ Partners (support caregivers) ​ Patience (natural timing) ​ Patient preparation (childbirth knowledge base)​ Pain control (comfort measures)

Signs of Placental Separation

The uterus rises upward​ The umbilical cord lengthens​ A sudden trickle of blood is released from the vaginal opening​ The uterus changes its shape to globular​ Oxytocin after placenta is delivered bc want uterus to contract back down to preuterine state​

First stage of labor

True labor to complete cervical dilatation (10 cm)​ Longest of all stages (12-24hrs​ Two phases​ Latent phase -may be at home, irregular contraction​ Active phase - epidural / iv pain meds​