Factors affecting the labor process
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| 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
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| 1st P-What factors affect the way of the passenger? | -Size of head
-Fetal Presentation
-Fetal lie
-Fetal attitude
-Fetal Position
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| Passenger--> Fetal head size consist of what bones and united by? | -2 parietal bones
-2 temporal
-frontal
-occipital.
united by sutures and fontanels.
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| 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
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| What are the most important fontanels? | Anterior and Posterior
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| Anterior Fontanels | 3x2cm, closes by 18 months
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| Posterior Fontanels | 1x2cm, closes 6-8 weeks after birth
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| 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)
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| 1st P-Passenger--What is Presentation? | Part of the fetus that enters the pelvis first
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| What are the 3 main presentations? | -Cephalic (Head first) 96%
-Breech (Frank, single footling, complete) 3% --> c-section
-Shoulder 1%
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| What is Presenting Part? | the part that can felt during vaginal exam
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| What is Fetus-Lie? | Relation of the spine of the fetus to the spine of the mother.
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| 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
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| What is fetus-attitude (Posture)? | Relation of fetal body part to each other
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| 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.
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| Where is the occiput located? | back of head towards neck
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| Where is the mentum located? | Chin
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| Where is the sinciput located? | between eyebrows to top of forehead
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| Where is the vertex located? | Back of head
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| 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)
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| 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
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| 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
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| 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
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| What hormone causes increased mobility of the pelvic joints and ligaments? | Relaxin
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| What is Secondary Powers? (3rd P) | -Involuntary urge to push
-bearing down effort to aid in expulsion of fetus
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| What is Ferguson's Reflex? | urge to bear down, caused by stretch receptors in the posterior vagina.
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| 4th P-Positions (of Mother)What can frequent changes do? | Relieve fatigue, increase comfort, and improve circulation
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| 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
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| 4th P- Positions for mothers | upright-walking, sitting, kneeling, squatting-
-all fours
-lithotomy (least effective with gravity but most common)
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| 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
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| 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
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| Why weight loss close to labor? | electrolyte shift--miserable not eating
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| 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 "
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| What is the advantage of hands and knees position? | (helps to rotate baby from posterior to anterior, shoulder dystocia baby, back labor)
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| 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
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| 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
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| 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
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| 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
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| 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
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| Mechanisms of labor- 7 cardinal movements | -engagement
-descent
-flexion
-internal rotation
-extension(head reaches perineum)
-external rotation
-expulsion
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| What is engagement (7 cardinal movements)? | head passes pelvic inlet
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| What is descent (7 cardinal movements)? | progress through pelvis
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| 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
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| What is flexion (7 cardinal movements)? | descending part meets resistance from cervix --Chin to chest
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| What is internal rotation(7 cardinal movements)? | begins at the level of the ischial spines completed until the presenting part reaches the lower pelvis.
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| What is extension(7 cardinal movements)? | fetal head reaches the perineum for birth
first the occiput, then the face, and finally the chin
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| What is external rotation (7 cardinal movements)? | realign at 45 degrees head and shoulder are aligned
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| What is expulsion(7 cardinal movements)? | after birth of the shoulders.
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| 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
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| What is the 4th stage? | Immediate postpartum recovery.
-last 1-2 hours
-observations for what complications? Hemorrhage
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| 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
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| What is fetal circulation affected by? | Maternal position, contractions, BP, umbilical cord flow
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| 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
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