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Labor/birth process

Factors affecting the labor process

What are the 5 P's of Labor? 1. Passenger (Fetus and Placenta) 2. Passageway (Birth Canal) 3. Powers (Contractions) 4. Positions of the mother (moving mother is important) 5. Psychologic response
1st P-What factors affect the way of the passenger? -Size of head -Fetal Presentation -Fetal lie -Fetal attitude -Fetal Position
Passenger--> Fetal head size consist of what bones and united by? -2 parietal bones -2 temporal -frontal -occipital. united by sutures and fontanels.
Where are fontanels? And what do they reveal among palpation? -Located where the sutures intersect -Palpated with sutures during vaginal exam reveals fetal presentation, position, attitude
What are the most important fontanels? Anterior and Posterior
Anterior Fontanels 3x2cm, closes by 18 months
Posterior Fontanels 1x2cm, closes 6-8 weeks after birth
What are the purpose of fetal sutures and fontanels? -Make the skull flexible -Molding -slight overlapping of bones -permits adaptation to maternal pelvis (sutures override each other so baby could fit)
1st P-Passenger--What is Presentation? Part of the fetus that enters the pelvis first
What are the 3 main presentations? -Cephalic (Head first) 96% -Breech (Frank, single footling, complete) 3% --> c-section -Shoulder 1%
What is Presenting Part? the part that can felt during vaginal exam
What is Fetus-Lie? Relation of the spine of the fetus to the spine of the mother.
What are the 2 fetus lies? -Logitudinal or vertical--> long axis of fetus is parallel with long axis of mother -Transverse/horizontal/oblique-->long axis of fetus is at right angle to the long axis of the mother
What is fetus-attitude (Posture)? Relation of fetal body part to each other
What is normal-general flexion? (attitude) Back of fetus is rounded so that chin is flexed on the chest, thighs are flexed to abdomen, legs flexed at knees, arms crossed.
Where is the occiput located? back of head towards neck
Where is the mentum located? Chin
Where is the sinciput located? between eyebrows to top of forehead
Where is the vertex located? Back of head
What is Fetal position? (How to determine the 3 letter abbreviation) -The relation of the presenting part to the 4 quadrants of the maternal pelvis (R or L)(Which way is back facing) -Prsenting parts> Occiput (O), Sacrum (S), Mentum/chin (M -Location of presenting part to anterior or posterior portion of pelvis (A or P)
2nd P--Passageway (birth Canal) What happens to the cervix? The Pelvic floor muscles? and Vagina? Cervix-effaces (thins) and dilates (opens) Pelvic floor muscles-helps fetus rotate anterior (looking towards back) as it passes through birth canal Vagina-dilate to accommodate fetus
3rd P--Powers (contractions) What is primary power? -Uterine contractions-frequency (how often), duration (how long), and intensity -Effacement and dilation of cervix -Ferguson's Reflex
What causes the cervix to dilate and efface? the contractions of the uterine body thus exert downward pressure on the fetus, pushing it against the cervix
What hormone causes increased mobility of the pelvic joints and ligaments? Relaxin
What is Secondary Powers? (3rd P) -Involuntary urge to push -bearing down effort to aid in expulsion of fetus
What is Ferguson's Reflex? urge to bear down, caused by stretch receptors in the posterior vagina.
4th P-Positions (of Mother)What can frequent changes do? Relieve fatigue, increase comfort, and improve circulation
What is Station? measure of degree of dissent of the presenting part of the fetus through the birth canal. When lowest part is 1 cm above the spines is -1, at level of the spines is zero, 1 cm below the spines is +1
4th P- Positions for mothers upright-walking, sitting, kneeling, squatting- -all fours -lithotomy (least effective with gravity but most common)
5th P- Psychologic Response for a mother is determined by? UDPAE -unique to each woman -depends on cultural beliefs -Previous experience -Anxiety level -environment-keep mother relaxed
Signs that labor may begin soon? -Lightening (Mothers can breathe) -Urinary frequency -backache -Braxton Hicks contractions gettng stronger -Weight loss -Energy (nesting) -bloody show -Cervix changes -ROM
Why weight loss close to labor? electrolyte shift--miserable not eating
What is the advantage of upright position? benefits because of gravity and benefits cardiac output "With the woman in an upright position, pressure on the maternal vessels is reduced, and compression is prevented. If the woman wishes to lie down, a lateral position is suggested "
What is the advantage of hands and knees position? (helps to rotate baby from posterior to anterior, shoulder dystocia baby, back labor)
Stages and phases of labor? -1st Stage -onset of regular ctx to full dilation -3 phases-Early/active/transition -2nd stage-full dilation to birth -3rd-birth of baby thru placenta delivery -4th-recovery-approx. 2 hours
1st Stage Early Considered what phase? How Long? Ctx? Dilation? Emotions? Fun Phase -6-12 hours -Ctx: 5-30 min. apart/ 30-45 sec. in length -Dilation: 0-3cm -Emotions: happy/excited, some anxiety
2nd stage Active Considered what phase? How Long? Ctx? Dilation? Emotions? Work Phase -3-5 hours -Ctx: 3-5 min. apart/ 45-60 sec in length dilation: 3-7 cm emotions: serious and focused
1st stage-Transition Considered what phase? How Long? Ctx? Dilation? Emotions? Hurricane Hour -30min.-2 hours Ctx: 1-3 min apart/ 60-90 sec. in length Dilation: 7-10 cm Emotions: Frustrated/dependent
2nd Stage Pushing/delivery When is it? How long? Ctx: Continues after the cervix is dilated to 10 cm until the delivery of the baby -30min-2hrs+ Ctx: 3-5 min. apart/ 60-90 sec in length
Mechanisms of labor- 7 cardinal movements -engagement -descent -flexion -internal rotation -extension(head reaches perineum) -external rotation -expulsion
What is engagement (7 cardinal movements)? head passes pelvic inlet
What is descent (7 cardinal movements)? progress through pelvis
What are the 4 forces affecting decent? 1-pressure exerted by the amniotic fluid 2-direct pressure exerted by the contracting fundus on the fetus 3-force of the ctx of the maternal diaphragm and abdominal muscles in the second stage of labor 4-extension and straightening of fetal body
What is flexion (7 cardinal movements)? descending part meets resistance from cervix --Chin to chest
What is internal rotation(7 cardinal movements)? begins at the level of the ischial spines completed until the presenting part reaches the lower pelvis.
What is extension(7 cardinal movements)? fetal head reaches the perineum for birth first the occiput, then the face, and finally the chin
What is external rotation (7 cardinal movements)? realign at 45 degrees head and shoulder are aligned
What is expulsion(7 cardinal movements)? after birth of the shoulders.
3rd Stage of labor? When is it? What happens? 5-20 minutes after birth Delivery of placenta-placenta detaches from the uterine wall -May feel mild ctx-these help separate placenta from uterine wall a small push will help move out placenta
What is the 4th stage? Immediate postpartum recovery. -last 1-2 hours -observations for what complications? Hemorrhage
What are the fetal adaptation to labor? Fetal Heart Rate-monitoring provides reliable & predictive info about condition of baby-baseline, variability, accelerations/decels Fetal circulation Fetal respirations-chemoreceptors prepare the fetus for initiating respirations immediately after birth
What is fetal circulation affected by? Maternal position, contractions, BP, umbilical cord flow
What are maternal adaptation to labor? Can be objective and subjective Cardiovascular-Increased cardiac output Resp. Changes-increase O2 consumption Renal-Proteinurea Integumentary-Stretching Musculoskeletal-joints, muscles Neurologic-anesthesia GI-decrease absorption N/V Endocrine-increased metabolism, decreased BS
Created by: ygwallace
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