Labor and Birth Process-The five Ps that affect labor--passenger (fetus & placenta)-passageway (birth canal)-powers (contractions)-position of mother-psychological response

Terms used to describe passenger-size of fetal head

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 axisfetal attitude- posture; relation of fetal parts to each other in uterus -all parts flexed, apf except neck extended, etcfetal position- position in relation to mom’s pelvis1st letter- position in relation to mom (left, right or none)Middle letter- part of baby (o-occiput, s-sacrum, m-mentum chin, sc-scapula)Last letter-opposite where baby is facing (p-posterior, a-anterior, t- to the side)

Passageway- Station- relation of presenting part to mom’s spine 0= even w/ spine+3,4= crowning

Powers- contraction- measured in intensity (how hard), duration (how long) & frequency (how often); assessed w/ intrauterine contraction monitor or by palpating fundus

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 phases-Premonitory signs-Lightening- baby settles down into pelvisBraxton Hicks- “false labor”, helps get cervix readyCervical changes- dilation/effacementBloody show- blood tinged discharge or mucus plug

Rupture of membranes- can be gush or slow leakSudden burst of energy- need to conserve for laborOther- diarrhea, nausea, 1-2lb wt loss, nestingStage 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 & fatigueStage 2- begins w/ full dilation of cervix, ends w/ delivery of fetus-pushing, 3x/contraction, mom in “C” positionStage 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

Terms used to describe cervical exam-Effacement- thinning of cervix; measured in %Dilation- opening of cervix; measured in cm

Mechanisms of Labor- Every Darn Fool In Rotterdam Eats Rotten Eggs EverydayE-engagementD- descentF- flexionI-internalR- rotationE- extensionR- restitutionE- external rotation E-expulsion

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” shapedLate decels- occur after peak of contraction; 2o uteroplacental insufficiency; non reassuring, need to be treatedVariable decels 2o cord compression; “V” shaped; reposition momProlonged decels- 15bpm<baseline, at least 2 in <10mins, tx-intrauterine rescusitationReassuring- normal baseline & variabilityReactive- HR inc in reaction to fetal activity; normalNon-Reactive- not HR change in relation to fetal activity; not normalNon-Reassuring- “warnings”, fetus not tolerating contractions, needs interventionIntrauterine Resuscitation (IUR)- reposition side to side, knee chest; O2 per mask 8lpm, inc IV wide open, dec or turn off pitocin

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)

Preterm labor-ROM 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

Induction/Augmentation-Induce- to cause contractionsAugment- to inc strength/frequency of contractions & progress laborCervical ripening- mechanical (foley bulb), Cervadil (gel), Cytotec (pill inserted), Laminaria (absorbs fluid, expands)Pitocin- initiates contractions, given IVAROM- if ready but not contraction; inc’s intensity, frequency

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/e- muscle 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; vasodilationorthostatic hypotension-prostoglandin synthetase inhibitor- indomethacin; s/e- dec amniotic fluid & premature closure of ducturs arteriosus, masks fever

Fetal loss-

MVA or trauma involving a pregnant patient- assess fetal HR/movement; if abd bruising present, keep 24hr for observation (2-4hrs w/o bruising)

Dystocia- 2o dysfunctional labor, alterations in pelvic structure, maternal positionTx- 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