Labor and Birth ProcessThe five Ps that affect labor-passenger (fetus & placenta)
-passageway (birth canal)
-powers (contractions)
-position of mother
-psychological response
Terms used to describe passengersize of fetal head
Powers- contraction- measured in intensity (how hard), duration
(how long) & frequency (how often); assessed w/ intrauterine
contraction monitor or by palpating fundus
fetal presentation-part of fetus that first enters pelvis & lies over
the inlet
-cephalic- head first (crown, face, brow)
-breech- feet/shoulder (complete- butt first w/ legs flexed;
incomplete- butt first w/ 1 leg extended; frank- butt first, both legs
hyperextended)
fetal lie-relationship between long axis of fetus & long axis of
mother (spine to spine)
-longitudinal- fetus lengthwise or vertical
-transverse- fetus crosswise or horizontal
-oblique- fetal long axis at angle to mom’s long axis
fetal attitude- posture; relation of fetal parts to each other in uterus
-all parts flexed, apf except neck extended, etc
fetal position- position in relation to mom’s pelvis
1st letter- position in relation to mom (left, right or none)
Middle letter- part of baby (o-occiput, s-sacrum, m-mentum chin, scscapula)
Last letter-opposite where baby is facing (p-posterior, a-anterior, tto the side)
Passageway- Station- relation of presenting part to mom’s spine
0= even w/ spine
+3,4= crowning
Position of mother-
Psychological response- if scared, pt will tighten muscles, teach to
relax
Stages/phases of labor and Nursing Care of Patient during the
stages and phasesPremonitory signsLightening- baby settles down into pelvis
Braxton Hicks- “false labor”, helps get cervix ready
Cervical changes- dilation/effacement
Bloody show- blood tinged discharge or mucus plug
Rupture of membranes- can be gush or slow leak
Sudden burst of energy- need to conserve for labor
Other- diarrhea, nausea, 1-2lb wt loss, nesting
Stage 1- 3 phases
-Early/Latent- dilation 0-3cm, effacement, contractions 5-20mins
apart, & 20-30sec duration; stay hydrated, eat w/ caution, may
experience nausea & diarrhea, best if done at home
-Active- dilation 4-10cm, effacement, contractions 2-4mins apart &
30-40secs duration; now the hard work, pt tired, back pain, key is
relax; augment w/ AROM or Pitocin; meds/sedation/epidural for
pain
-Transition- dilation 8-10cm, can feel head, 100% effaced,
contractions q1-2mins & last 60-90sec; multiple peaks, obedience,
severe pressure & urge to push, diaphoresis & fatigue
Stage 2- begins w/ full dilation of cervix, ends w/ delivery of fetus
-pushing, 3x/contraction, mom in “C” position
Stage 3- delivery of placenta
-placenta separates from uterus- inc bleeding, cord lengthening,
change in uterine shape (globular)
-do NOT pull- may break cord or cause uterine inversion
Preterm laborROM assessed w/ Nitrozene (+if turns from yel to blue), Ferning
(swab of fluid on slide, salt dries in Fern pattern), & pooling
Abnormal labor patterns (image pg 17, Intrapartum Complications
ppt)
- normal (2-3min apart, last 60-90s)
-not strong enough; tx pitocin
-not frequent enough; tx pitocin or AROM
-irritable; tx pitocin
-too frequent; tx stop/dec pitocin, hydration, terbutaline, c-section if
baby not recovering
Prolapsed cord- keep pressure off cord w/ maternal positioning or
counterpressure on baby’s head; c-section
Terms used to describe cervical examEffacement- thinning of cervix; measured in %
Dilation- opening of cervix; measured in cm
Induction/AugmentationInduce- to cause contractions
Augment- to inc strength/frequency of contractions & progress labor
Cervical ripening- mechanical (foley bulb), Cervadil (gel), Cytotec (pill
inserted), Laminaria (absorbs fluid, expands)
Pitocin- initiates contractions, given IV
AROM- if ready but not contraction; inc’s intensity, frequency
Mechanisms of Labor- Every Darn Fool In Rotterdam Eats Rotten
Eggs Everyday
E-engagement
D- descent
F- flexion
I-internal
R- rotation
E- extension
R- restitution
E- external rotation
E-expulsion
Precipitous Birth- hydration & tocolytic therapy
- beta2 adrenergic- terbutaline; s/e- restless, jittery, inc HR, pulm
edema
-CNS depressant- MgSO4; s/e- drowsy, hot flashes, SOB; fetal s/emuscle weakness, dec reflexes, initial tachy dec’d variability
brady (if reaches this point, likely lose baby); antidote- Ca gluconate
-Ca channel blockers- nifedipine (procardia, adalat); used after
contractions have been stopped w/ MsSO4;
vasodilationorthostatic hypotension
-prostoglandin synthetase inhibitor- indomethacin; s/e- dec amniotic
fluid & premature closure of ducturs arteriosus, masks fever
Fetal Heart Rate Characteristics and Interventions-You will need to
identify the baseline, variability, accelerations, decelerations, and
the interventions necessary, if any.Baseline- rounded to 5’s; brady<110, tachy>160(#1 cause is
maternal temp)
Variability- fluctuations in baseline (absent-undetectable; minimal
</=5; moderate 6-25bpm; marked>25bmp)
Accelerations- abrupt inc from baseline (15bpmx15sec, <2min from
onset to return to baseline for >32wks; 10x10<32wks)
Early decels- occur w/ peak of contraction; 2o head compression’
“U” shaped
Late decels- occur after peak of contraction; 2o uteroplacental
insufficiency; non reassuring, need to be treated
Variable decels 2o cord compression; “V” shaped; reposition mom
Prolonged decels- 15bpm<baseline, at least 2 in <10mins, txintrauterine rescusitation
Reassuring- normal baseline & variability
Reactive- HR inc in reaction to fetal activity; normal
Non-Reactive- not HR change in relation to fetal activity; not normal
Non-Reassuring- “warnings”, fetus not tolerating contractions,
needs intervention
Intrauterine Resuscitation (IUR)- reposition side to side, knee chest;
O2 per mask 8lpm, inc IV wide open, dec or turn off pitocin
Fetal loss-
Epidurals- catheter inserted in epidural space of the lumbar spine,
can be left in longer than spinal; s/e- hypotension (prevent w/ 1L+
before & frequent monitoring)
MVA or trauma involving a pregnant patient- assess fetal
HR/movement; if abd bruising present, keep 24hr for observation (24hrs w/o bruising)
Dystocia- 2o dysfunctional labor, alterations in pelvic structure,
maternal position
Tx- position McRoberts Manuever (legs up & open as far as can to
open passageway), suprapubic pressure (can cause broken clavicle)
Pregnany induced hypertension-assess- VS, FHR, DTR (inc inc risk of seizures, tx MgSO4), I/O,
uninalysis, daily wt, emotional status
-care- reduce stimuli, emotional support, supportive care, meds as
ordered, seizure precautions
Placenta Previa- placenta over vag opening; NO vag exams, FHR
monitoring, monitor bleeding, prepare for delivery; tx: c-section
Placenta abruption- premature separation of placenta; assess
bleeding & baby; need to get baby out;
External version- turn a fetus from a breech position or side-lying
position into a head-down position; before: stress test, tocolytic,
FHR<120