Chapter 13

A client calls the prenatal clinic and tells the nurse, "I think I am in labor." The nurse determines that the client is in true labor based on which client statement?

"I feel pressure in my vagina when I have the contraction."

When does lightening take place with primiparas?

2 weeks or more prior to labor initiation

A woman at 38 weeks' gestation is in labor and oxytocin is prescribed to augment her labor. When preparing to administer this medication, what action by the nurse would be appropriate?

Administer the medication piggybacked into a primary IV line using a pump.

What is the most common fetal attitude when labor begins?

All joints flexed; back rounded, chin on the chest, thighs flexed at the abdomen, legs flexed at the knees

The nurse is teaching a class to a group of pregnant women in their second trimester. Which information about the effects of maternal position on labor will the nurse include?

Being upright promotes a sense of control for the mother.

false pelvis (greater pelvis)

Between the ala of the iliac and superior to the pelvic inlet

A nurse is monitoring a woman in labor. When interpreting the assessment findings, an increase in which finding would the nurse identify as a deviation from the expected body response?

Blood glucose levels

true pelvis (lesser pelvis)

Bounded superiorly by the pelvic inlet and inferiorly by the pelvic diaphragm

Contractions that do not contribute in a measurable way towards the goal of birth

Braxton Hicks contractions False Labor Prodromal Labor

Signs/symptoms women notice once lightening has taken place

Breathing is easier Decrease in GERD Increased pelvic pressure Leg cramping Dependent edema Low back discomfort Increase in vaginal discharge Increased frequency in urination

Premonitory signs of labor

Cervical changes Lightening Increased energy level Bloody show Braxton Hicks Spontaneous rupture of membranes

How does the cervix change as labor approaches?

Cervix becomes shortened, softened, and thinned; collagen fibers are rearranged to facilitate water absorption

What does the myometrial gap junction increase result in?

Coordination of uterine contractions and myometrial stretching

How does the third trimester hormone shift impact gap junctions?

Creates an increase in myometrial gap junctions

Anterior fontanel

Diamond shaped space on the anterior fetal head that measures 1-4 cm and remains open 12-18 months after birth.

Caput Succedaneum

Diffuse edema of the fetal scalp that crosses the suture lines. Reabsorbes within 1 to 3 days

What hormone levels increase during third trimester of pregnancy?

Estrogen

Attitude

Fetus' degree of body flexion

How to pelvic floor muscles assist in childbirth?

Help the fetus rotate anteriorly as it passes through the birth canal.

Fetal Station

Location of the presenting part in relation to the midpelvis or ischial spines; expressed as cm above or below the spines; station 0 is engaged, station -2 is 2 cm above the ischial spines

Fetal Presentation

Manner in which the fetus enters the birth canal.

When does lightening take place with multiparas?

May not occur until labor starts

How to Braxton Hicks aid labor?

Moving the cervix from posterior to anterior position Help ripen the cervix

Lightening

Occurs when fetal presenting part begins to descend into the true pelvis. Uterus lowers and moves into more anterior position.

Neurotransmitter receptor increases in the uterus at the end of pregnancy

Oxytocin

How do cranial sutures and fontanels play a role in identification of fetal positioning?

Palpation of the sutures and fontanels reveal the position of fetal head and the degree of rotation that has occurred.

The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2030 related to women in labor?

Reduce the rate of cesarean births among low-risk women

Fetal Position

Refers to the direction of a reference point in the fetal presenting part to the maternal pelvis.

Fetal Molding

Shaping of the fetal head during movement through the birth canal.

Fetal Engagement

Signifies the entrance of the largest diameter of the fetal presenting part into the smallest diameter of the maternal pelvis

What is the largest fetal structure?

The fetal head

Passenger

The fetus

Which is the most favorable fetal position for birth?

The normal fetal position

Dilation

The opening or enlargement of the external cervical os

Cervix

The opening to the uterus

Effacement

The thinning of the cervix during child labor that allows the presenting fetal part to descend into the vagina

Posterior fontanel

Triangular space at the back of the fetal head; measures 1-2 cm and closes 8-12 weeks after birth

T/F: Not all contractions indicate labor

True

Primipara

a woman who has borne one viable child

A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure?

allowing the woman time to be alone

False Labor

condition occurring during the latter weeks of some pregnancies when irregular uterine contractions are felt, but the cervix is not affected.

The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as:

frequency.

A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility?

increased risk of infection

A client calls the clinic asking to come in to be evaluated. She states that when she went to bed last night the fetus was high in the abdomen, but this morning the fetus feels like it has dropped down. After asking several questions, the nurse explains this is probably due to:

lightening

A new dad is alarmed at the shape of his newborn's head. Assessment reveals swelling at the area of the presenting part. The swelling crosses the suture lines. The nurse suspects which condition?

molding

Myometrium

muscular middle layer of the uterus

While discussing labor with a client and her partner, the nurse is asked what the best position is for giving birth to the baby. The nurse provides them with information that indicates research has shown which position as the best?

position of comfort for the mother

A young couple are anxious for the birth of their first child. The nurse discusses the options, including elective induction of labor for nulliparas. The nurse determines that additional teaching is necessary when the couple identifies which condition as being associated with this procedure?

shorter hospitalizations

During the examination, the health care provider mentions the fetus has a good attitude. The nurse explains to the parents that this means:

the posture of the fetus is with all joints flexed for birth.

Multipara

woman who has given birth to two or more children

Two main functions of uterine contractions

1. dilation of the cervix 2. push fetus through the birth canal

Critical Factors Affecting Labor (The 5 Ps)

1. passageway (birth canal) 2.Passenger (fetus and placenta) 3. Powers (contractions) 4. Position (maternal) 5. Psychological response

What hormone levels decrease during third trimester pregnancy?

Progesterone

What are cervical changed secondary to?

Prostaglandin activity Braxton Hicks contractions

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.

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process?

crowning

A 19-year-old female presents in advanced labor. Examination reveals the fetus is in frank breech position. The nurse interprets this finding as indicating:

the buttocks are presenting first with both legs extended up toward the face.

Role of prostaglandins in labor

Lead to additional contractions, cervical softening, gap junction induction, and myometrial sensitization, and progression of dilation

True Labor

Characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity.

Preterm rupture of membranes (PROM)

Rupture of membranes with loss of amnionic fluid prior to the onset of labor

What is bloody show?

Ruptured cervical capillaries that mix with cervical mucus resulting in pink-tinged secretions. A result of the expulsion of the mucus plug due to cervical softening.

Cephalohematoma

Collection of blood between the periosteum and skull bone

Fontanels

Gaps between a baby's skull that slowly close up during the first 18 months of life

Fetal Lie

The relation of the long axis (spine) of the fetus to the long axis (spine) of the mother

What causes the energy that leads to "nesting" in pregnant women?

The result of an increase in epinephrine release caused by a decrease in progesterone

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 nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared?

need for someone to control the situation

A nurse is teaching a woman in her third trimester about Braxton Hicks contractions. When describing these contractions, which information would the nurse likely include? Select all that apply.

"They often spread downward before they go away." "They go away when you walk around or change position." "They usually feel like a tightening across the top of your uterus."

A client in her third trimester comes to the clinic for an evaluation. Assessment reveals that the cervix is thinning. The client says, "I know my cervix needs to dilate, but why does it get thinner?" Which response by the nurse would be appropriate?

"You need the cervix to thin so it can stretch more easily."

The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is:

1 cm above the ischial spines.

When do cervical changes take place before labor is initiated?

1 month to one hour before actual labor begins

Five Additional Factors Affecting the Labor Process

1. Philosophy (low tech, high touch) 2. Partners (support caregivers) 3. Patience (natural timing) 4. Patient preparation (childbirth knowledge base) 5. Pain management

When does "nesting" or energy before labor initiation take place?

24-48 hours before labor begins

How long to Braxton Hicks contractions usually last?

30 seconds to 2 minutes

Late Preterm Infant

34 0/7 - 36 6/7 weeks' gestation

Possible danger to fetus once membrane is ruptured

Increased risk of ascending infection Danger of cord prolapse

Role of Oxytocin in Labor

Initiates uterine contractions stimulates prostaglandin synthesis

Braxton Hicks contractions

Intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses.

What factors play a role in the initiation of labor?

Interplay of maternal, fetal, and endocrine signaling

Birth Passageway

The route through which the fetus must travel to be born vaginally; consists of maternal pelvis and soft tissue

Decidua

The thick layer of modified mucous membrane that lines the uterus during pregnancy and is shed with the afterbirth.

When teaching a group of soon-to-be parents about the structures of the fetal skull, the nurse describes the anterior fontanel (fontanelle). Which description would the nurse include?

approximately 2 to 3 cm in size

The nurse is assessing a client who has given birth within the past hour. The nurse would expect to find the woman's fundus at which location?

at the level of the umbilicus

The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding?

duration

A pregnant woman at 37 weeks gestation calls the clinic to say she thinks that she is in labor. The nurse instructs the woman to go to the health care facility based on the client's report of contractions that are:

occurring about every 5 minutes.

A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic?

relaxin

Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation?

shoulder