Medical 2 - L & D Module - Stages of Labor
Terms
undefined, object
copy deck
- The 4 stages of labor are?
-
Dilation and Effacement
latent
active
transitional
Expulsion
Placental
Transitional Figuration - The primagravida stays in stage 1 (D&E) on the average of?
- 14 hours
- The primagravida stays in stage 2 (E) an average of?
- 1.25 hours
- The primagravida stays in stage 3 (P) an average of?
- 1-20 minutes
- The multigravida stays in stage 1 (D&E) on the average?
- 8 hrs
- The multigravida stays in stage 2 (E) on the average?
- 30 minutes
- General observations and behavior of mother in latent phase?
-
Entertainment:
talkative
excited
apprehensive
alert
follows directions
has backache
thoughts center on self
may also be mute, calm, tense - General observations and behavior of mother in active phase?
-
Relaxation:
molar flush serious
doubtful
threatened
suspicious
apprehensive
desires company
has more difficulty in
following directions
attention span becomes more
inner-directed, tired,
flushed - General observations and behavior of mother in transition phase?
-
Transition:
growing in voice
perspiration
nausea
vomiting
membranes may rupture
hiccups
coughing
leg cramps
leg shaking
tremors
perspiration on lips and
forehead
facial flush
increases show increased apprehension
feel frustrateed
trapped
emotional
irritable
thoughts are on self
vague in commincations
amnesia between contractions - General observations and behavior of mother in stage 2?
-
Working: Presentation
position
episiotomy
forceps
patient usually feels relief, urge to push, sometimes panic when head reaches perineum - General observations and behavior of mother in stage 3?
-
Schultz - 80%
Duncan - 20%
1. uterus becomes globular
2. umbilical cord descends
3 or more inches further
out of vagina
3. sudden gush of blood
alert, often euphoric, (if not sedated)
proud, happy, and relieved
concerned over baby, maternal feelings may or maya not be evident at this time..may also weep or be angry - General observations and behavior of mother in stage 4?
-
chilled
euphoria
too exhausted to sleep - Dilations of cervix in latent phase?
- 0-3 cm
- Dilations of cervix in active phase?
- 4-7 cm
- Dilations of cervix in transition phase?
- 8-10 cm
- Dilations of cervix in stage 2?
- complete
- Dilations of cervix in stage 3?
- cervix is flabby and soft
- Contractions in latent phase?
- mild, brief, irregular
- Contractions in active phase?
- stronger, longer, closer
- Contractions in transition phase?
- intense, firm, hard
- Contractions in stage 2 are?
- expulsive
- Frequency of contractions in latent phase are?
- 5-30 minutes
- Frequency of contractions in active phase are?
- 3-5 minutes
- Frequency of contractions in transition phase are?
- 2-3 minutes
- Frequency of contractions in stage 2 are?
- 2.5 minutes (almost continuous)
- Duration of contractions in latent phase are?
- 10-30 seconds
- Duration of contractions in active phase are?
- 30-45 seconds
- Duration of contractions in transition phase are?
- 60-90 seconds
- Duration of contractions in stage 2 are?
- 90 seconds
- Station of contraction in latent phase is?
- -2 to 0
- Station of contraction in active phase is?
- +1 - +2
- Station of contraction in transition phase is?
- +2 - +3
- Station of contraction in stage 2 is?
- increases through expulsion
- Take vital signs in latent phase every?
- 30 minutes to 1 hour
- Take vital signs in active phase every?
- 15 minutes
- Take vital signs in transition phase every?
- 5-10 minutes
- Take vital signs in stage 2 every?
- every contraction
- Take vital signs in stage 3?
- no
- Take vital signs in stage 4?
-
fundus every 15 minutes for 1 hour or for 4 hours???
fundus every 15 x 4 - Check fetal heart rate in latent phase?
- tone: every 15 minutes
- Check fetal heart rate in active phase?
- tone: every 5 minutes
- Check fetal heart rate in transition phase?
- tone: every 5 minutes
- Check fetal heart rate in stage 2?
- after each contraction
- Check fetal heart rate in stage 3?
- no
- Check fetal heart rate in stage 4?
- 30 x 2
- Temperature, pulse, and respirations in latent phase?
- every 4 hours unless otherwise indicated (check temp every 2 hrs after membranes rupture)
- Blood pressure in latent phase?
- every 1 hour and before medication immediately, then every 3-5 minutes after caudal, spinal, or epidural anesthesia
- Pulse and respirations in stage 4?
-
every 15 minutes x 4;
every 30 minutes x 2
temperature - once - Bladder in all phases of stage 1?
- encourage to void every 2 hours, check for distention
- Bladder in stage 4?
- every 15 minutes; check for distention or residual
- Nutrition and hydration in latent phase?
- clear liquids with CHO added if ordered by phsician
- Nutrition and hydration in active phase?
- usually NPO
- Nutrition and hydration in transition phase?
- ice chips if ordered by doctor
- Nutrition and hydration in stage 2?
- usually NPO
- Nutrition and hydration in stage 4?
- offer fluids and diet as tolerated
- Fatigue in latent stage?
- preserve strength, no bearing down every 30 minutes
- Fatigue in active stage?
- bear down every 15 minutes between amnesia
- Fatigue in transition stage?
- bear down every 5 minutes
- Fatigue in stage 4?
- sleepy and drowsy
- Vaginal secretions in latency?
- bloody show
-
Vaginal secretions in active
phase? - check every 30 minutes because membranes may or may not be present intact or ruptured (assess nature and amount)
- Vaginal secretions in transition phase?
-
check every 15 minutes because membranes may or may not be present intact or ruptured (assess nature and amount)
heavy show means rupture??? - Vaginal secretions in stage 4?
- lochia and perineum every 15 minutes
- Supportive measures companionship?
- In all 3 stages, patient prefers to be dependent; husband or nurse should be present
- In stage 4, the mother may prefer to be ______ to rest and/or _________
-
alone
sleep - The position mother takes in latent phase is?
- any comfortable position
- The position mother takes in active phase is?
- relaxation position on side or back...keep body supported
- The position mother takes in transition phase is?
- semi-fowler..exaggerated Sims turned on opposite side from back of fetus (favors anterior rotation of the fetal head)
- The position mother takes in stage 2 is?
-
sitting -llithotomy table...
for pushing support mother's legs with knees flexed upon abdomen - The position mother takes in stage 3 is?
- delivery table or flat bed
- The position mother takes in stage 4 is?
- any comfortable position
- Comfort measures in latent phase are?
- read, listen to music, games, cards, instructions and teaching
- Comfort measures in active and transition phase are?
- cool wet cloth to forehead; back rubs, sacral pressure backache, clean and dry linens, quiet restful surroundings, analgesic drugs
- Comfort measures in stage 2 and stage 3 are?
- support legs, feet, hands, arms to help mother push more effectively
- Comfort measures in stage 4 are?
- keep mother warm, partial bath, change of gown, linens, etc
- Relaxation and breathing exercises in latency are?
- pelvic rocking for backache, practice controlled breathing
- Relaxation and breathing exercises in active phase?
- abdominal breathing until no longer able to walk or talk, then chest breathing.
- Relaxation and breathing exercises in transition phase are?
- costal breathing...panting to help control nausea and bearing down urge...oxygen for nausea
- Relaxation and breathing exercises in stages 2 & 3?
- pushing, panting to slow down descent of head...small short push to deliver baby's trunk after a waiting interval
- Relaxation and breathing in stage 4?
- post partum exercise
- Interpretation, direction, and reassurance in latency?
- explanation of birth process, illustrate with birth atlas, allay patient's fears, strengthen bond between mother and father; keep father informed about progress of labor
-
Interpretation, direction,
and reassurance in active phase? -
same as procedure in early stage
explanation of birth process, illustrate with birth atlas, allay patient's fears, strengthen bond between mother and father; keep father informed about progress of labor -
Interpretation, direction,
and reassurance in transition stage? - patient is becoming oblivious to surroundings, begins to think only of herself and her work of labor
-
Interpretation, direction,
and reassurance in stages 2 and 3? - feelingn of stretching in perineum as baby's head is delivered..may fear tearing and stop pushing...may become panicky
-
Interpretation, direction,
and reassurance in stage 4? - first question if awake "is it all right?" Wants to see the baby ASAP
-
The dilation stage begins with the onset of _____ _____
and ends with complete _____ of ______. -
true labor
dilation
cervix - Transition phase usually lasts through _____ to _____ contractions?
- 10 to 20
- The expulsive stage begins with complete ______ of cervix and ends with birth of baby.
- dilation
- The placental stage begins with birth of baby and ends with _______ of placenta and membranes
- expulsion
- The total time of stage 3 is anywhere from ____ to_____ minutes or more.
- 1-20
- Total time of first stage is anywhere from ____ to_____ hours or more.
- 2 to 16
- Characteristics of stage 1 latent phase?
-
in early phase, when cervix dilates 0 cm to 3 cm uterine contractions may follow a regular pattern and may be accompanied by:
abdominal cramps
backache
rupture of membranes
show (blood tinged mucoid vaginal discharge) - How she may feel in stage 1 latent phase?
-
in early phase, excited.
she may also feel a sense of anticipation, a sense of relief, happy and some apprehension - What she may do in stage 1 latent phase?
- carry on with normal activities that are possible or keep diverted with other activities of interest; try pelvic rocking if back aches; try slow chest breathing for contractions; ask doctor when to to to hospital
- Characteristics of stage 1 active phase?
- in mid phase when cervix dilates 4 cm to 7 cm, uterine contractions become stronger, longer (30-45 sec), more frequent and may be accompanied by pain
- How she may feel in stage 1 active phase?
- in midphase, apprehension; she may also feel a growing seriousness, ill-defined doubts and fears...desire for companionship...uncertain if she can cope with contractions
- What she may do in stage 1 active phase?
- in mid phase, assume most comfortable position...try shallow chest breathing with contractions and breathe normal between contractions; try pelvic rocking or have back rubbed if it aches...ask for medications if unable to relax...when doctor does a recall examination, relax pelvic floor
- Characteristics in stage 1 transition phase?
-
when cervix dilates 8 cm to 10 cm...uterine contractions may become stronger and longer 45-60-90 sec., and may be accompanied by:
amnesia between contractions
cramps in legs
generalized discomfort
hiccoughing
irritable abdomen
marked restlessness
nausea and possible vomiting
pain
perspiration on upper lip
and forehead
profuse, dark, heavy show
pulling or stretching sensation
deep in pelvis
severe, low backache
shaking of legs - How she may feel in stage 1 transition phase?
-
increasingly apprehensive;
bewildered by intensity of
contractions
irritable and unwilling to
be touched
frustrated and unable to cope
with contraction if left
alone; eager to be "put to
sleep" - What she may do in stage 1 transition phase?
-
relax as much as possible..
slow, deep chest breathing usually becomes immpossible at this time...
try pant blow breathing...
if nauseated, prevent vomiting by taking and holding a deep breath...
have pressure applied to small of back if this area aches
ask for medication to ease sharpness of contraction...
keep in mind that contractions have now reached maximum strength and that relief will soon come with pushing -
Characteristics of stage 2
expulsive stage? -
full dilation of the cervix, accompanied by:
increased show
expulsive grunt when exhaling
rectal bulging with flattening of perineum
increased amnesia between contractions
gradual appearance of presenting part of vaginal opening; the doctor may do an episiotomy to facilitate delivery of baby - How she may feel in stage 2 expulsive stage?
-
increasingly involved in birth process
relief because second stage has begun
desire to bear down or push..
tremendous satisfaction with each push
desire to move bowels
complete exhaustinon after each expulsive contraction
unable to follow direction readily
desire to particpate full in total birth process or conversely to be "put to sleep"
a splitting sensation due to vaginal stretching as baby is born - What she may do in stage 2 expulsion stage?
-
notify nurse of desire to bear down
respond to urge to push
if in own bed
take deep breath
bend knees, spread them apart and grasp them firmly while bringing them up toward shoulders
with mouth closed, pull back on knees while bearing down or pushing keeping hips flat on bed
if no energy reserve or epidural anesthesia limits mobility
grip hand rails on side of bed
with mouth closed, pull back on hand grips while bearing down or pushing, keeping hips flat and relaxing pelvic floor, continue to push down for as long as each contraction lasts
attendants to flex mother's kneees bringing them back toward
shoulders with each pushing effort or to place legs in support
rest completely between contraction
take anethesia as it is offered if necessary ask for anesthesia
pant when asked to do so or when asked to push - Characteristics stage 3 placental stage?
-
contractions temporarily cease upon birth of baby...
when they resume, they usually are painless and may be accompanied by:
upward rise of uterus in abdomen
uterus assuming globular shape visible lengthening of umbilical cord as placenta moves into vagina
trickle or gush of blood - How she may feel stage 3 placenta stage?
-
exhausted, but elated and proud of achievement...she may also feel
eager to hear and see the baby...
a sense of relief...
delight that abdomen is flat
ravenously hungry and thirsty - What she may do stage 3 placenta stage?
-
relieve tension by giving in to emotions
watch expulsion of placenta and membranes in overhead mirror
ask to have baby put to breast for a first feeding