Chapter 13 - Labor & Birth

The Four P's

- the powers - the passage (pelvic) - the passenger (fetus) - the psyche

First Stage - Early (Latent)

- 0 - 3 cm dilation - 0 - 40% effacement - frequency every 5-10 mins - duration 30-45 secs - intensity = mild

Fourth Stage

- 1 - 4 hours after the birth of the newborn - time of maternal physiologic adjustment - cramp-like discomfort

First Stage - Active

- 4 - 7 cm dilation - 40 - 80% effacement - frequency 2-5 mins - duration 45-60 secs - intensity = moderate

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?

- Provide the client clear information on procedures involved. - Encourage the client to have a sense of mastery and self-control. - Encourage the client to have a positive reaction to pregnancy.

True Labor

- cervical change

Second Stage

- complete dilation (10cm), birth

Flexion

- the chin is brought into contact with the fetal thorax & the presenting diameter is change from occipitofrontal to suboccipitobregmatic

The Passenger

- the fetus : lie (fetus spinal cord to mom spinal cord) : attitude (relationship of fetus parts to one another) : presentation (what comes out first) **best position for baby (Right Occiput Anterior)**

Extension

- the head emerges through extension under the symphysis pubis along with the shoulder. The anterior fontanle, brow, nose, mouth, chin are born

Explusion

- the rest of body occurs more smoothly after birth of the head & shoulders

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response?

pain from the dilation or stretching of the cervix

Leopold's Maneuvers

- position the baby - where to get fetal heart tones (feel for rump and head *bigger & round*)

Power

- primary (contractions) (palpate during Acme) : mild = nose : moderate = chin : strong = forehead - secondary (pushing)

Duration

- refers to how long a contraction lasts & is measured from the beginning of one contraction to the end of that same contraction

Intensity

- refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter.

Third Stage

- separation & delivery of placenta

Induction of Labor

- start labor from scratch

First Stage - Transition

- 8 - 10 cm dilation - 80 - 100% effacement - frequency 1-2 mins - duration 60-90 secs - intensity = strong

Cardinal Movements of Labor

- Engagement - Descent - Flexion - Internal Rotation - Extension - External Rotation (Restitution) - Expulsion

Phases of Contractions

- Increment - Acme (peak) - Decrement

Desecent

- downward movement of the feta head until it is within the pelvic inlet

Cervical Changes

- effacement - dilation - respiratory

Relationship between the passage & the passenger (fetus)

- engagement - station - fetal position

Gastrointestinal

- everything slows down - urinate before labor (full bladder restricts baby)

Engagement

- head is in the pelvis

Third Stage - Placental Explusion

- placenta coming outside

Cesarean Birth

Indications = transverse baby, baby in distress (too long to deliver) Risk for Infection *vertical cut on uterus = NO vag delivery*

Hematopoietic

- Hgb 11g/dl - Hct 33% adequate

When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories?

- change in estrogen-to-progesterone ratio

A new dad is alarmed at the shape of his newborn's head. When responding to the dad, the nurse reminds him this is due to:

- cranial bones overlapping at the suture lines.

Third Stage - Placental Separation

- detaching from uterine wall

Contractions

- frequency - intensity - duration

Doula

- greek word meaning woman servant or caregiver. Now commonly refers to a woman who offers emotional & practical support to a mother or couple before, during and after birth.

Pelvic Type

- gynecoid (true female pelvis) less common in men. Good for vaginal birth - anthropoid (common in men and most common in non-white females) - android (male shaped) - platypelloid (least common)

Agumentation of Labor

- helping along labor (labor already started)

Frequency

- how often the contractions occur & is measured from beginning of one contract to the beginning of the next contraction

Place the following stages of labor in order from what occurs first to last.

- latent stage - active stage - transition stage - second stage - third stage

Physiology of Normal Labor

- lightening or quickening - Braxton Hick's Contractions - cervical changes - bloody show - rupture of membranes - sudden burst of energy - other : diarrhea, N/V

Station

- location of baby in relation to maternal pelvic ischial spines

Psyche

- motivation for pregnancy - support - preparation - trust in staff - maintaining control - cultural influences

The Birth Passage

- pelvic types for labor & delivery (pelvic divisions & measurements)

Second Stage - Perineal Phase

- period of active pushing - frequency every 2-3 mins or less - duration = 60-90 secs - intensity = strong - strong urge to push - cardinal movements of labor

Second Stage - Pelvic Phase

- period of fetal descent

Internal Rotation

- the head rotates about 45 degrees anteriorly to the midline under the symphysis

External Rotation (Restitution)

- the head rotates back to normal position, which allows the shoulders to rotate internally to fit the maternal pelvis

Non-Stress Test (NST)

- the non-stress test (NST) is a non-invasive procedure done to evaluate fetal maturity & determine how well a fetus responds to stress. A healthy fetus will respond to activity with a short acceleration in the FHR of approximately 10-15/min lasting approximately 15 to 20 secs before returning to healthy baseline FHR (ranging from 120-160 bpm).

Dilation

- the opening or enlargement of the external cervical os

Fetal Position

- the relationship of given point on the presenting part of the fetus to a designated point of the maternal pelvis

Effacement

- thinning of the cervix (softening)

Bishop Scoring System

- use to evaluate the cervix for induction (score of 5-7 is good indication)

Induction & Augmentation of Labor Contraindications

- vertical incision on the uterus

The nurse is appraising the post birth laboratory results of a client and discovers the WBC is 22,000 cells/mcL. The nurse predicts which action should be prioritized in response?

An elevation of WBC up to 30,000 cells/mcL can be a normal variation for any woman after birth. This is related to the stress on her body from labor and birth.