MAMC exam 9 nursing care during labor & birth
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| describe traditional setting | small functional room for labor moved to delivery area transferred to recovery area to postpartum unit
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| advantages of traditional | safe
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| disadvantages of traditional | impersonal multiple moves uncomfortable for mother disrupts family's time together separate parents & infant
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| describe labor, delivery, and recovery room (LDR) setting | one setting for labor, delivery, recovery remain in LDR for 1-2 hours
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| advantages of LDR | home-like & comfortable healthy infant remains with mother throughout stay
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| disadvantages of LDR | family may regard technologic components as disadvantages
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| describe LDRP setting | similar to LDR not transferred to a postpartum unit after recovery
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| advantages of LDRP | support person encouraged stays with the mother and infant sleeping equipment may be provided
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| describe birth center setting | designed to provide maternity care to low-risk women outside the hospital setting birth often by certified nurse midwife
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| advantages of birth center | less expensive safe and home-like setting for low-risk
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| disadvantages of birth center | not equipped for major obstetric emergencies
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| advantages of home births | keeps family together in own environment
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| disadvantages of home births | long transfer time to hospital in an emergency
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| guidelines for reporting to a birthing facility | contractions ruptured membranes bleeding other than bloody show decreased fetal movement other concerns
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| contraction guidelines for reporting | 5 minutes apart for 1 hour for first labor 10 minutes apart for 1 hour for 2nd & subsequent labors
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| cultural considerations | important for l&d shapes values, their expectations of birth & response to it knowledge provides framework to assess & care for woman & family
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| traditional practices of Southeast Asia | father usually not present stoic response to pain side-lying position preferred
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| traditional practices of Laos | squat for birth prefer female attendants
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| traditional practices of India | natural childbirth methods used female relatives present as caregivers
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| traditional practices of Iran | father not present female caregivers & support people present at birth
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| traditional practices of Mexico | stoic about pain until 2nd stage father & female relatives present
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| traditional practices of American Indians | bury placenta for good luck
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| 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
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| 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
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| 4 Ps: components of the birth process | powers passage passenger psyche
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| powers | involuntary uterine contractions which cause the cervix to open and that propel the fetus downward through the birth canal
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| primary powers | responsible for effacement and dilation of the cervix
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| secondary powers | bearing down efforts of the woman which add to the power of the expulsive forces but have no effect on cervical dilation
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| contractions | coordinated uterine contractions are the primary powers of labor during the first stage involuntary
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| effects of contractions | effacement dilation
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| effacement | thinning of the cervix & is described as a percentage of the original length of the cervix
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| dilation | enlargement or widening of the opening of the cervix & the cervical canal. increases from less than 1cm - 10cm
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| characteristics of contractions | frequency duration intensity interval
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| hypertonic contractions (tachysystole) | less than 2 mins apart longer than 90-120 secs intervals shorter incomplete relaxation of the uterus report immediately
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| maternal pushing | when cervix fully dilated the combination of contractions & the maternal pushing propel the baby downward through the pelvis
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| factors affecting pushing | maternal exhaustion epidural anesthesia some women may want to push prematurely due to fetal head causing rectal pressure
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| the passage | bony pelvis and the soft tissue of the pelvis and perineum
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| bony pelvis | false pelvis true pelvis
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| soft tissues of the passage | uterus - upper walls thicken, lower thin cervix vagina perineum
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| the passenger | includes the fetus along with the placenta and membranes
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| fetal lie | relationship o the fetal head & buttocks axis to that of the mother longitudinal transverse
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| most common fetal lie | longitudinal
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| fetal attitude | relationship of fetal body parts to one another
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| 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
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| 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
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| contractions of TRUE labor | regular close together stronger last longer start in lower back then lower ABD can't be stopped
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| cervix and fetal changes in true labor | cervix softens, effaces, dilates fetus descends into the pelvis
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| 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
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| cervix and fetal changes in false labor | cervix doesn't change no significant change in fetal position
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| focused assessment r/t false labor | fetal heart tones maternal VS presence & frequency of contractions
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| fetal condition | fetal HR regular, rhythm normal FHR 110-160 w/ 6-25 beat flutuations presence of accelerations & absence of decelerations
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| confirm ruptured membranes with | nitrazine paper fern test
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| signs of impending birth | sitting on one buttock making grunting sounds bearing down with contractions "the baby's coming" bulging of perineum
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| what to do if birth imminent | don't leave patient, but call for help
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| process of childbirth | descent engagement internal rotation extension external rotation expulsion
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| stages of labor | dilation delivery delivery of placenta stabilization
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| precipitous labor | labor that's completed in less than 3 hours
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| signs & symptoms in precipitous labor | labor begins abruptly & intensifies quickly contractions may be frequent & intense
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| maternal risks of precipitous labor | uterine rupture cervical/vaginal lacerations & hematoma amniotic fluid embolism postpartum hemorrhage abruptio placentae can be associated
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| fetal risks of precipitous labor | hypoxia resulting from decreased periods of uterine relaxation between contractions intracranial hemorrhage nerve damage law apgar scores
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| external devics for EFM | doppler transducer TOCO with a pressure-sensitive button
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| internal devices for EFM | fetal spiral electrode IUPC - 2 types
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| 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
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| 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
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| 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
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| 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
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