Fast Track into OB
Labor and Delivery
Lightening
Five Ps of Labor
Passage
Passenger
Psyche
Powers
Pain
Passage: the bony pelvis and soft
tissue
False pelvis (upper flaring part)
True pelvis (lower part)
Inlet
Middle
Outlet
Shaped like a wide curved funnel
Soft Tissue
Impacted by previous births
Impacted by scaring
More on the true and false pelvis
See text page 25
Divided by false line: linea terminalis
Extends from sacroiliac joint to anterior
iliopubic prominence
The upper false pelvis support the
enlarging uterus and guides fetus into
true pelvis
The TRUE pelvis however dictated
the bony limits of the birth canal
Anatomical picture of pelvic inlet
Passage dimensions
Anatomical features of the pelvic
outlet Page 25-26
Transverse diameter between the
inner surfaces of the ischial
tuberosities (spines) (bi ischial
diameter)
Anterior posterior measurement of
outlet is between lower border of
symphysis pubis and tip of sacrum.
Passenger Page 122
Fetal skull page 123
Lie: orientation to Mom’s spine
Attitude: normally flexed
Presentation: part entering pelvis
Position: how a reference point on the
fetal presenting part oriented within
the mother’s pelvis
The Passenger
Passenger
Molding
Transverse Lie
Fetal Lie
Fetal Lie Longitudinal
Fetal Presentation: Vertex
Attitude: Flexion/Extension
Fetal Attitude: a well flexed head
Attitude; Brow
Presentation: Breech
Presentation
Fetal Positions
Position: Posterior
Fetal Positions
Using Fetal Heart Tones to
Determine Position
Psyche
Woman’s mental state
Emotional; not described as surgical
procedure
Mental State greatly impacts mothers
ability to cope and tolerate discomfort
Perception of pain
Anxiety
Powers of Labor
Involuntary forces of labor
Contractions
Voluntary forces of labor
Mother’s pushing efforts
Contraction Cycle
Effects of contractions on the cervix
Effacement
Thins the cervix
Before labor approximately 2 cm long
Thinning of cervix is expressed in %
100% thin slick membrane at edge of fetal head
Dilation
Opening of the cervix
Described in cm of opening
Full dilation at 10 cms
Effacement and Dilation
Effects of Contractions on Cervix
Effacement
Dilation
Mechanisms of Labor
Descent
Flexion
Rotation
Extension
Restitution
External Rotation
Engagement: Stations
Mechanisms of labor with
effacement and dilation
Read to learn activity
Signs of impending labor (page 131)
Signs of True Labor (136)
Signs of False Labor (135-136)
Read those sections and then we will
do a quiz together. RELAX!
Contractions; Page 120-21
Frequency
Duration
Interval
Increment/Peak/decrement
Intensity: Mild, moderate, strong
Contraction Monitoring
The basics
Frequency
From the beginning of one contraction to the
beginning of the next contraction
Duration
From the beginning of one contraction to the
end of that contraction
Interval
The space between two contractions; from the
end of one contraction to the beginning of the
next one
Rule of contractions
Based on infant getting adequate
oxygenation
The frequency must not be less than
two minutes
The duration must not be more than
90 seconds
The interval must not be less than 60
seconds
Fetal Heart monitoring
Intermittent
Allows freedom of movement
Does not offer a continuous record
Obtain a baseline rate
Rule: any FHR outside the normal limits
or slowing that persists after the
contraction ends is promptly reported to
the health care provider
See box 6-2 page 133
Continuous Fetal Heart Monitoring
Offers a written record
Allows collection of more data
May however run a strip on admission
and then re run a strip at regular
intervals during the labor
Referred to in terms of reassuring and
non reassuring patterns.
Box 6-3 page 135
Fetal and Contraction Monitoring
The Basics
Top of strip is the fetal heart
monitoring
Bottom of strip is the contraction
pattern
Each small square is 10 seconds
Between each bold line is 60 seconds
Reassuring fetal heart/contraction
pattern
110-160 bpm
Variability
Accelerations
Early decelerations
Contraction frequency greater than
every 2 minutes, duration less than
90 seconds; relaxation interval of at
least 60 seconds.
Non reassuring patterns
Fetal tachycardia
Fetal bradycardia
Variable decelerations
Late decelerations
Absences or decreased variability
Decelerations
Early
Due to fetal head compression during
contractions and are expected
Late
Due to utero-placental insufficiency and
are non reassuring
Variable
Due to cord compression and are non
reassuring.
Early decelerations
Reassuring pattern of deceleration
during the early contraction due to
fetal head compression
Always return to baseline before the
end of the contraction
They often mirror a contraction
Picture of an early deceleration
Late deceleration
NON reassuring
Due to lack of oxygen to the baby
Uteroplacental insufficiency
Do NOT return to baseline FHR after
the contraction ends
Picture of late deceleration
Variable Deceleration
Due to cord compression
V, W, or U shaped
Do not exhibit a consistent pattern in
relation to the contractions
Picture of variable deceleration
Nursing responses to non
reassuring patterns
Reposition mom, especially helpful in
the variable decelerations
Oxygen 100% per tight face mask
IV fluids to expand blood volume and
to dilute Pitocin (if given)
Stopping Pitocin
Giving tocolytic drugs to decrease
uterine contractions
More FH patterns to look at
Stages of Labor
First
Onset of labor until cervical effacement and
dilation is complete (10 cm)
Second
From the completion of effacement and dilation
until the baby is born
Third
Expulsion of placenta
Fourth
Recovery phase
First stage divisions
Latent
4-6 hours
1-4 cm
Mild to moderate intensity
Active
2-6 hours
4-7 cm
Moderate to firm intensity
Transition
.5-2 hours
7-10 cm
Firm intensity
Descent
Mechanism of Labor, Continued
Mechanism of labor; continued
Delivery of shoulders
Second Stage
Second stage is also divided into
three stages in other texts
Uncontrollable urge to push if no
epidural
Exhaustion after each contraction
Unable to follow directions
“BABY IS COMING!!!”
Baby is HERE!
Third stage
Expulsion of placenta
Elation and relief
Shivers and tremors
Signs of placental seperation
Lengthening of cord
Uterus rises and becomes firm
Fresh blood expelled from vagina
Recovery Period
Number one priority for the mother’s
care is prevention of hemorrhage
Infant care focuses on
airway,
breathing and circulation
maintaining body temperature
maintaining blood glucose
Critical period of bonding and breast
feeding.
Immediate care of Mother
Assessment and care bullets; Page 148
Observing for hemorrhage
Maintaining a firm fundus
Preventing bladder distention
Promoting comfort
Ice pack
Warm blanket
Assisting with breast feeding
Assessment of lower extremities
Immediate Care of the Infant
First hour infant is in “quiet alert”
phase and this is critical time form
bonding and breast feeding.
Unless the infant is in a medical
emergency most of care can be done
right at mother’s breast
Now let’s see what will happen when
you observe a birth!!!!
Immediate Care of Infant
APGAR score
Keep warm: dry and place on mothers
chest: skin to skin with blanket over and
cap on
Assure that the nose is clean, bulb suction
nose as well as mouth. Usually done at
perineum
Clamp the cord.
Vigilant observation of infants
cardiorespiratory status
Later Needs of the Infant
Detailed examination
Bath
Erythromycin eye ointment
Aquamephyton (vitamin K injection)]
Hepatitis B vaccination
APGAR Score; Page 143
APGAR Score
Let’s take some time to score to do
the critical thinking exercise on
APGAR scoring found in your
workbook
NCLEX Prep question
A client at 38 weeks gestation tells the
nurse that it feels like her baby is sitting on
her bladder causing her to urinate more
frequently. However, the client states it
has made it easier for her to breathe. The
nurse recognizes that this is a sign of:
Lightening
Quickening
Contractions
Flexion
NCLEX Prep Question
A client reports that her contractions started about
2 hr ago, did not go away when she had two glass
of water and rested, and became stronger since
she started walking. She thinks the contractions
occur every 10 minutes and last about half a
minute. She hasn’t had any fluid leak from her
vagina, however, she did think she saw some
blood when she wiped after voiding. The nurse
should recognize that the client is experiencing:
Braxton Hick contractions
Rupture of membranes
Fetal descent
True Contractions
NCLEX Prep Question
A nurse is monitoring the FHR and contractions of
a client in labor. The FHR is in the 140s.
Contractions are every 5 min and 45-50 sec in
duration. The nurse performs a vaginal exam and
finds the cervix is 2 cm dilated, 50% effaced and
the fetus is at the -2 station. One hour later the
dilation is still 2 cm, but now the effacement is
80% Which of the following stages and phases of
labor is this client experiencing?
The first stage, latent phase
The first stage, active phase
The first stage, transition phase
The second stage of labor
NCLEX Prep Question
A nurse is admitting a client to the birthing unit.
The client suddenly states, A”I think I urinated on
myself. It’s all wet down there, I’m so
embarrassed.” Which of the following actions
should the nurse take at this time?
Test the fluid with Nitrazine paper, it will confirm
urine by turning blue
Test the fluid with Nitrazine paper, which will
confirm urine by turning pink.
Test the fluid with Nitrazine paper, which will
confirm amniotic fluid by turning it blue
Test the fluid with Nitrazine paper, which will
confirm amniotic fluid by turning it yellow.
NCLEX Prep Question
A client experiences a large gush of
fluid from her vagina while walking in
the hallway of the birthing unit. The
nurse’s first action should be to:
Test to see if the fluid is amnionic fluid
Monitor fetal heart rate for distress
Dry the client and make her comfortable
Monitor the client’s maternal
contractions
NCLEX prep question
While conducting an admission history for
a client at 39 weeks gestation, the client
tells the nurse that she has been leaking
water from her vagina for 2 days. The
nurse knows that this client is at risk for:
Cord prolapse
Infection
Malpresentation.
hydramnios
NCLEX Prep Question
A client in active labor becomes nauseous
with emesis, is very irritable, and feels she
needs to have a bowel movement. She
states, “I’ve had enough. I can’t do this
anymore. I want to go home right now.”
The nurse knows that these signs indicate
the client is in the:
Second stage of labor
Fourth stage of labor
Transition phase of labor.
Active phase of labor