Week 2 Pre Work Assignment 5 P’s of Labor List and explain · · Powers o Uterine contractions causes effacement (shortening and thinning of the cervix) during the first stage of labor and dilation of the cervix (enlargement or widening of the cervical opening and canal) that occurs once labor has begun and the fetus is descending. o Involuntary urge to push and voluntary bearing down in the second stage of labor helps in the expulsion of the fetus. Passenger o Consists of the fetus and the placenta. o Size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position affect the ability of the fetus to navigate through the birth canal. · Passageway o The birth canal is composed of the bony pelvis, cervix, pelvic floor, vagina, and introitus (vaginal opening). · Position o The client should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation. o Position during the second stage is determined by maternal preferences, provider preferences, and the condition of the mother and the fetus. · Psychological Response o Maternal stress, tension, and anxiety can produce physiological changes that impair the progress of labor. · Type of Bony Pelvis o Gynecoid (Most common type and found in about 50% of women) o Android o Anthropoid o Platypelloid (Least common type and found in about 3% of women) · Cephalopelvic disproportionà condition in which size, shape, or position of the fetal head prevents it from passing through the lateral aspect of the maternal pelvis or when the maternal pelvis is of a size or shape that prevents the descent of the fetus through the pelvis. · Premonitory Signs of Labor (5) -ATI o Backache à constant low, dull § Caused by pelvic relaxation o Weight loss § 1 to 3.5 lb o Lightening § Fetal head descends into true pelvis about 14 days before labor. · · · § Feeling that the fetus has “dropped”à easier breathing, but more pressure on the bladder. o Contractions § Begins with Braxton Hicks (irregular) § Contractions eventually become regular and increase in strength. o Increased Vaginal Discharge/Blood Show § Expulsion of cervical mucous plug § Brownish or blood-tinged mucous plugà onset of cervical dilation and effacement. o Energy Burst § “Nesting” o Gastrointestinal Changes § Nausea, vomiting, indigestion. Mechanisms of Labor/Cardinal movements o Engagement § Occurs when the greatest diameter of the fetal head passes through the pelvic inlet. § Referred to as 0 station. o Descent § The movement of the fetus through the birth canal during the 1st and 2nd stage of labor. o Flexion § When the chin of the fetus moves toward the fetal chest; flexion occurs when the descending head meets resistance from maternal issues. o Internal rotation § The rotation of the fetal head, aligns the long axis of the fetal head with the long axis of the maternal pelvis; occurs mainly during the second stage of labor. o Extension § Facilitated by resistance of the pelvic floor that causes the presenting part to pivot beneath the pubic symphysis and the head to be delivered; occurs during the second stage of labor. o External rotation § The sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis. o Expulsion § The shoulders and remainder of the body are delivered. Ferguson’s Reflex o Physiological response of the woman, activated when the presenting part of the fetus is at least +1 station; it is usually accompanied by spontaneous bearing down efforts Leopold’s maneuver o A series of four maneuvers used to palpate a gravid uterus to determine fetal position, presentation, and size. o Abdominal palpation of the fetal presenting part, lie, attitude, descent, and the probable location where fetal heart tones can be best auscultated on the client’s abdomen. Pain management during labor · Pharmacological o Analgesia § Sedatives (barbituates) · · · Can be used during the early or latent phase of labor to relieve anxiety or induce sleep. § Opioid analgesiscs (meperidine hydrochloride, fentanyl, butorphanol, nalbuphine). · Act in the CNS to decease the perception of pain without the loss of consciousness. · Butorphanol and nalbuphine provide pain relief without causing significant respiratory depression in mother and fetus. § Metoclopramide · Can control nausea and anxiety. · Does not relieve pain. § Puodenal block · Local anesthetic (lidocaine, bupivacaine) adminstered transvaginally into the space in front of the puodenal nerve. § Epidural block · Local anesthetic bupivacaine, along with an analgesic, morphine or fentanyl injected into the epidural space at fourth and fifth vertebrae. § Spinal anesthesia (block) · Local anesthetic that is injected into the subarachnoid space into the spinal fluid at the third, fourth, or fifth lumbar space. Non-Pharmacological o Cognitive Therapies § Childbirth preparation methods (Lamaze, patterned breathing exercises) promote relaxation and pain management. § Doulas § Biofeedback o Sensory Stimulation Strategies § Aromatherpy § Breathing techniques § Imagery § Music § Use of focal points § Subdued lighting o Cutaneous Stimulation Strategies § Therapeutic touch and massage · Back rubs § Walking § Rocking § Effleruge · Light, gentle circular stroking of the client’s abomen with fingertips in rhythm with breathing during contractions. § Sacral counterpressure · Consistent pressure is applied by the support person using the heel of the hand or fist against the client’s sacral area to counteract the pain in the lower back. Epidural Episiotomy o An incision in the perineum to provide more space for the presenting part at delivery. · · · § Median/midline episiotomy is at midline and tends to heal more quickly with less discomfort. § A medilateral episiotomy is cut at a 45-degress angle to the left or right and may be used for a large infant. It tends to heal more slowly, causes greater blood loss, and is more painful. Lacerations o First Degree § Laceration extends through the skin of the perineum and does not involve the muscles. o Second Degree § Laceration extends through the skin and the muscles of the perineum but not the anal sphincter. o Third Degree § Laceration extends through the skin, muscles, perineum, and external anal sphincter. o Fourth Degree § Laceration extends through skin, muscles, anal sphincter, and the anterior rectal wall. What is the priority nursing actions immediately after delivery of the newborn? o Neonate is placed on skin-to-skin on mothers abdomen. o Await the delivery of the placenta. o Encourage the woman to breathe with contractions and relax between contractions. o Assess maternal vital signs every 15 minutes. o Administer pain medications. How do you assign Apgar? (memorize the box)
