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Labor & Birth
MAMC exam 9 nursing care during labor & birth
| Question | Answer |
|---|---|
| describe traditional setting | small functional room for labor moved to delivery area transferred to recovery area to postpartum unit |
| advantages of traditional | safe |
| disadvantages of traditional | impersonal multiple moves uncomfortable for mother disrupts family's time together separate parents & infant |
| describe labor, delivery, and recovery room (LDR) setting | one setting for labor, delivery, recovery remain in LDR for 1-2 hours |
| advantages of LDR | home-like & comfortable healthy infant remains with mother throughout stay |
| disadvantages of LDR | family may regard technologic components as disadvantages |
| describe LDRP setting | similar to LDR not transferred to a postpartum unit after recovery |
| advantages of LDRP | support person encouraged stays with the mother and infant sleeping equipment may be provided |
| describe birth center setting | designed to provide maternity care to low-risk women outside the hospital setting birth often by certified nurse midwife |
| advantages of birth center | less expensive safe and home-like setting for low-risk |
| disadvantages of birth center | not equipped for major obstetric emergencies |
| advantages of home births | keeps family together in own environment |
| disadvantages of home births | long transfer time to hospital in an emergency |
| guidelines for reporting to a birthing facility | contractions ruptured membranes bleeding other than bloody show decreased fetal movement other concerns |
| contraction guidelines for reporting | 5 minutes apart for 1 hour for first labor 10 minutes apart for 1 hour for 2nd & subsequent labors |
| cultural considerations | important for l&d shapes values, their expectations of birth & response to it knowledge provides framework to assess & care for woman & family |
| traditional practices of Southeast Asia | father usually not present stoic response to pain side-lying position preferred |
| traditional practices of Laos | squat for birth prefer female attendants |
| traditional practices of India | natural childbirth methods used female relatives present as caregivers |
| traditional practices of Iran | father not present female caregivers & support people present at birth |
| traditional practices of Mexico | stoic about pain until 2nd stage father & female relatives present |
| traditional practices of American Indians | bury placenta for good luck |
| maternal physiologic changes during birth | cervix thins & dilates supine hypotension depth & resp rate increase, hyperventilation may occur reduced sensation of a full bladder decreased GI motility may result in N/V clotting factors increased even higher |
| fetal physiologic changes during birth | placental circulation - compression by uterine muscle, the maternal supply to placenta decreases cardiovascular - reflect normal labor effects or suggest fetal intolerance pulmonary - lung fluid must be cleared to allow normal breathing after birth |
| 4 Ps: components of the birth process | powers passage passenger psyche |
| powers | involuntary uterine contractions which cause the cervix to open and that propel the fetus downward through the birth canal |
| primary powers | responsible for effacement and dilation of the cervix |
| secondary powers | bearing down efforts of the woman which add to the power of the expulsive forces but have no effect on cervical dilation |
| contractions | coordinated uterine contractions are the primary powers of labor during the first stage involuntary |
| effects of contractions | effacement dilation |
| effacement | thinning of the cervix & is described as a percentage of the original length of the cervix |
| dilation | enlargement or widening of the opening of the cervix & the cervical canal. increases from less than 1cm - 10cm |
| characteristics of contractions | frequency duration intensity interval |
| hypertonic contractions (tachysystole) | less than 2 mins apart longer than 90-120 secs intervals shorter incomplete relaxation of the uterus report immediately |
| maternal pushing | when cervix fully dilated the combination of contractions & the maternal pushing propel the baby downward through the pelvis |
| factors affecting pushing | maternal exhaustion epidural anesthesia some women may want to push prematurely due to fetal head causing rectal pressure |
| the passage | bony pelvis and the soft tissue of the pelvis and perineum |
| bony pelvis | false pelvis true pelvis |
| soft tissues of the passage | uterus - upper walls thicken, lower thin cervix vagina perineum |
| the passenger | includes the fetus along with the placenta and membranes |
| fetal lie | relationship o the fetal head & buttocks axis to that of the mother longitudinal transverse |
| most common fetal lie | longitudinal |
| fetal attitude | relationship of fetal body parts to one another |
| ideal fetal attitude | where the back is bowed outward, chin touches sternum, and arms are crossed on the chest with thighs flexed onto the abdomen |
| the psyche | crucial part of childbirth marked anxiety & fear decrease a woman's ability to cope with pain in labor catecholamines inhibit uterine contractions & divert bloodflow from the placenta |
| contractions of TRUE labor | regular close together stronger last longer start in lower back then lower ABD can't be stopped |
| cervix and fetal changes in true labor | cervix softens, effaces, dilates fetus descends into the pelvis |
| contractions of FALSE labor | rarely follow a pattern vary in length & intensity frequently stop with ambulation & position changes & eventually stop with relaxation interventions discomfort in ABD & groin |
| cervix and fetal changes in false labor | cervix doesn't change no significant change in fetal position |
| focused assessment r/t false labor | fetal heart tones maternal VS presence & frequency of contractions |
| fetal condition | fetal HR regular, rhythm normal FHR 110-160 w/ 6-25 beat flutuations presence of accelerations & absence of decelerations |
| confirm ruptured membranes with | nitrazine paper fern test |
| signs of impending birth | sitting on one buttock making grunting sounds bearing down with contractions "the baby's coming" bulging of perineum |
| what to do if birth imminent | don't leave patient, but call for help |
| process of childbirth | descent engagement internal rotation extension external rotation expulsion |
| stages of labor | dilation delivery delivery of placenta stabilization |
| precipitous labor | labor that's completed in less than 3 hours |
| signs & symptoms in precipitous labor | labor begins abruptly & intensifies quickly contractions may be frequent & intense |
| maternal risks of precipitous labor | uterine rupture cervical/vaginal lacerations & hematoma amniotic fluid embolism postpartum hemorrhage abruptio placentae can be associated |
| fetal risks of precipitous labor | hypoxia resulting from decreased periods of uterine relaxation between contractions intracranial hemorrhage nerve damage law apgar scores |
| external devics for EFM | doppler transducer TOCO with a pressure-sensitive button |
| internal devices for EFM | fetal spiral electrode IUPC - 2 types |
| nursing response to reassuring to monitor patterns | accelerations are reassuring & require no intervention early decelerations are caused by head compression & require no intervention other than continued observation |
| nursing response to variable decelerations caused by cord compression (non-reassuring) | repositioning usually first response, may require several changes before pattern improves amnioinfusion may be used to increase the fluid around the fetus & cushion the cord |
| nursing response to late decelerations caused by placental insufficiency (non-reassuring) | initially treated by measures to increase maternal oxygenation & blodd flow to the placenta - repositioning usually first IV fluid bolus of NS or LR per SOP to increase placental perfusion |
| nursing response to monitor patterns (non-reassuring) | O2 at 8-10L/min per SFM stop Pitocin if it's infusing treat hypertonic contractions with terbutaline if ordered notify the doctor of any non-reassuring fetal pattern |
Created by:
ealongo
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