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Medical 2 - Labor Process Module


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Define family in this module?
all of the people who are important to the Mother and the newborn infant and who will be affected by the birth.
What is meant by labor?
the process by which the uterus expels or attempts to expel the fetus, placenta, and amniotic sac
List the phenomena which occurs prior to onset of labor and which results in a weakening and softening of the cervix which facilitates cervical stretching and effacement
estrogen is known to stimulate uterine muscle contractions to permit softening, stretching, and eventual thinnning of cervix

collagen fibers in cervix are broken down by the action of enzymes such as collagenase and elastase

increase in water content of cervix
What are Braxton Hicks contractions and why do they occur?
contractions of the uterine muscle beginning at 16 weeks, and are usually painless

they become more frequent and intense and are often mistaken for true labor

only digital exam can positively differentiate false and true labor

certain symptoms can help differentiate false and true labor
Signs of true labor?
contractions are regular
begin in lower back and
radiate to abdomen
become stronger at more
frequent intervals
are stimulated by exercise
effacement and dilation of
cervix are progressive
Signs of false labor?
contractions are irregular
felt mainly in abdomen
do not become stronger or
more frequent with time
are decreased by or have no
effect on with exercise
no change in cervix
Describe the first of four stages of labor?
lasts from the beginning of labor until the cervix is completely dilated
broken down into latent, active, and transitional phase
Describe the second of four stages of labor?
begins with complete dilation of the cervix and ends with the birth of the baby
Describe the third of four
stages of labor?
begins after the birth of the baby and ends when the placenta has been delivered
Describe the fourth of four stages of labor?
begins after the expulsion of the placenta and lasts at least one hour or until the mother's vital signs are stable, the uterus remains contracted, and the lochia flow is not excesssive
The latent phase of the first stage of labor begins?
with the initiation of labor and ends when the cervix is about 3 cm dilated
The active phase of the first stage of labor begins?
from the time the cervix is about 4 cm dilated until it is about 7 cm dilated
The transitional phase of the first stage of labor begins?
8-10 cm; the cervix dilates to 10 cm and the rate of fetal descent increases
Define gravida?
refers to theh number of times that the woman has been pregnant regardless of the duration of the pregnancy;
so when the mother becomes pregnant for the first time, she is said to be gravida 1 and so on
Define parity?
refers to the number of birth experiences past the age of viability (20 weeks gestation)
the baby does not have to be alive at the time of birth

multiple births (twins, triplets) still count as one birth
Define T-pal system?
number of full-term
pre-term births (before 20
weeks gestation)
living children

Ex: a woman who has ONLY had 3 full-term pregnancies that all resulted in living children would be designated "3003" - that is, three full-term pregnancies, no premature births, no abortions, three living children
Use T-PAL. A woman has been pregnant 3 times, but, the first pregnancy ended in a miscarriage at 14 weeks and the others terminated at 38 and 40 weeks, respectively, and resulted in live births, would be noted as?
(If she was currently pregnant, the
"2012" - two full-term pregnancies, no pre-term births, one abortion and two living children
The number of children a woman has delivered has an influence on?
the length of the stages of labor
Although the actual time of labor is highly variable, the primagravida will spend
______ to ______hours in STAGE 1, whereas the multipara might spend only ___to____ hours.

This is due to the fact that the multiparas cervix will dilate and efface simultaneously.
The second stage, as well as the first stage, varies from one hour for the primigravida to about _____ ______ for the multipara.
20 minutes
The third and fourth stages can vary for the primigravida and multipara with the average length of the third stage of _____ _____ and the fourth stage _____ _____.
3-20 minutes
1-4 hours
Know the anatomy and physiology of the pelvis and reproductive organs.
By using manual x-rays, the bony structure can be evaluated in relation to the anticipated size of the fetus in a procedure known as?
(look up in textbook)
Define station?
refers to the relationship of the presenting part to an imaginary line drawn between theh ischial spines of maternal pelvis
What do the ischial spines of the pelvis mark in a normal pelvis?
the narrowest diameter through which the fetus must pass
they are blunted (not sharp) prominences at midpelvis
designated zero station
What happens if the presenting part is higher than the ischial spines?
a negative number is assigned, noting cm above zero station
Station -5 is the _____?
Station +4 is the _____?
If the presenting part can be seen at the perineum, birth will occur __________?
During labor the presenting part should move progressively from the _________ stations to the _________ and into the _________ stations.
Failure of the presenting part to descend in the presence of strong contractions may be due to?
disproportion between the maternal pelvis and fetal presenting part.
(found online source)
In the third trimester, maternal position has a great impact on intravascular pressures and cardiac output. In the supine position, the uterus obstructs both the inferior vena cava and the aorta. Venous pressures in the lower l
place the patient with a left pelvic tilt via a wedge.
Define lie?
refers to the relatioinship of the cephalocaudal axis (spinal column) of fetus to cephalocaudal axis of woman
ex: longitudinal and transverse
Define presentation?
determined by fetal lie and by the body part of fetus that enters maternal pelvis first; may be cephalic, breech, shoulder
Leopold's maneuvers?
systemic way to evaluate maternal abdomen
The two lie postitions are?
The three major presentations are?
When the presenting part is at a minus station, it is
_________the level of the mother's ischial spine.
(check on this)
The presenting part is said to be engaged when the head is at _______ station?
What is the name of the maneuvers that the fetus undergoes when it turns itself to present itself to the largest diameter of the
pelvis? and Why?
Mechanism of labor
(this is because the maternal vaginal canal is not a straight passage)
The six or seven cardinal movements are?
internal rotation
external rotation
Define the first cardinal movement, descent?
occurs due to pressure of amniotic fluid
pressure of fundus of uterus on breech of fetus contraction of abdominal muscles
extension and straightening of fetal body
Define the second cardinal movement, flexion?
occurs as fetal head descends and meets resistance from soft tissues of pelvis, musculature of pelvic floor, and cervix
Define the third cardinal movement, internal rotation?
fetal head must rotate to fit diameter of pelvic cavity
Define the fourth cardinal movement, extension?
resistance of pelvic floor and mechanical movement of vulva opening anteriorly and forward assist with extension of fetal head as it passes under symphysis pubis
Define the fifth cardinal movement, restitution?
shoulders of infant enter pelvis obliquely and remain oblique when head rotates to anteroposterior diameter through internal rotation
Define the sixth cardinal movement, external rotation?
shoulders rotate to antero-posterior position in pelvis
Define the seventh cardinal movement, expulsion?
external rotation and through expulsive efforts of laboring woman
Contractions usually begin in the __________ and progress toward the _________.
The contractions cause the cervix to _________, or thin out and dilate.
How wide must the cervix open before it is considered completely dilated?
10 cms
What is meant by complete effacement of the cervix?
When the cervix is completely effaced and dilated, the _____ _____ and _____ ______ lie in close proximity.
internal os
external os
Uterine contractions (UCs) can be divided into what 3 parts?
onset or increment
peak or acme
termination or decrement
Define frequency of contractions?
measured from beginning of one contraction to the beginning of the next.
Define duration of contractions?
measured from beginning of contraction to end of contraction.
Define intensity of contractions?
rise in uterine pressure that occurs when the uterus tightens.
How can the intensity of contractions can be invasively measured?
*with an IUPC in cms of mercury
*subjectively measured with external palpation
*subjectively measured by
palpating fundus with fingertips
What stage does engagement generally occur in?
latent phase (first stage)
contractions will probably be 15-30 minutes apart and will last 30-45 seconds
By the end of the latent phase, the mother's contractions will be occurring how often?
4-10 minute intervals and last 45 seconds; cervix may be dilated 3 cms
During the active phase, the mother will continue to have contractions every _____ to _____ minutes up to every ____ minutes, lasting _____ to _____ seconds. Her cervix will dilate to _____ to _____ cms
In the transition phase, the woman's contractions are ____ to _____ minutes apart and last ______ seconds
Since the mother is primagravida, you would expect her first stage of labor to last _____ to _____ hours.
During the second stage of labor, contractions occur at
____ to ____ minute intervals.
During the second stage of labor, the contractions last from ____ to ____ seconds and are accompanied by an uncontrollable urge to push.
During second stage of labor, to be effective, only ____ to ____ breaths per contraction should be taken to sustain the pushing effort.
The mother's pushing efforts will be enhanced by taking which position?
raising head and shoulders which increases intra-abdominal pressure
If mother's pushing is effective, the ________ of the vagina will change from oval to round and the baby's head will _______.
During the third stage of labor, ____ _____ _____ occur and the uterus rises in the abdomen indicating the separation of the _____ from the uterine wall. This rising firm uterus indicates that the placenta is ready for ______.
firm uterine contractions
An absence of contractions
may indicate _________ bleeding.
During the fourth stage of labor, the uterine muscles contract very firmly to decrease the _________ and ________.
The fetus communicates with the world primarily by changes in his/her _______ _______.
heart rate
A slow, steady fetal heart rate may indicate the fetus is __________
Normal fetal heart rate ranges from?
120-160 bpm
Fetal heart rate may be monitored by? (4)
external monitor
internal monitor
The Doptone and Fetoscope provide for ________ monitoring.
The external and internal monitor provide for _________ monitoring.
The external monitor uses two _______ placed on the mother's abdomen and when connected to the monitor displays both the _____ _____ _____ and ________ contractions.
fetal heart tones
Fetal heart rate is an average displayed rate and does not reflect _____ to ____ changes, but does indicate long term variability.
________ and ______ of contractions can be evaluated by the EXTERNAL monitor, but ______ indicators are skewed and will need to be assessed by palpation.
With FETAL monitoring, the INTERNAL monitor uses an electrode attached to the presenting part of the fetus, usually the scalp. This offers the most accurate measurement of FHR including _____ to _____ changes, long and short term variability.
With UTERINE monitoring, the EXTERNAL monitor uses an intrauterine pressure catheter (IUPC) placed inside the uterus through the vagina. It is a precise method of monitoring uterine contractions _______. The IUPC measures the ______ created by the uterus
Internal monitoring is considered invasive and may increase the risk of ______
and/or ______ to both mother and fetus. Additionally, they can't be utilized unless the ______ are ruptured and the _____ has begun dilating.
_______ monitoring provides a constant readout of fetal heart rate while _______ may only detect marked deviations from normal.
Why is it difficult to hear the fetal heart with a fetoscope during a contraction?
the tightened muscle is difficult to hear through
How often is FHR checked during latent phase?
every 30 - 60 minutes
How often is FHR checked during active phase?
every 15 minutes
How often is FHR checked during transition?
every 5 minutes
How often is FHR checked at beginning of second stage?
every 5 minutes
When do periodic FHR changes occur?
when the uterus contracts and exerts pressure on the fetus, placenta, and cord.
Fetal "well-being" can be assessed through these periodic FHR changes.
When the fetal skull becomes compressed at the peak of a contraction, it can result in a ______ of the heart rate. It should return to normal immediately following relaxation of the ________.
This variation indicates a well developed _____ ______ me
nervous system
early deceleration
"Variability" of the FHR demonstrates ______ ______
Can he take it? It is the ______ irregularity of the cardiac rhythm, resulting from the _____-_____ of the
_________ and __________ divisions of the ANS.
Don't confuse "v
fetal reserve (tolerance or endurance).
Can you list 4 interventions which require assessment of FHR PRIOR to implementing?
if vaginal bleeding observed
before ambulation
before medication
before induction of labor
Now, which interventions require assessment of FHR FOLLOWING implementation?
always after membrane rupture
following epidural
following abnormal pattern
ex: deceleration
following implementation
ex: reassessment
following anesthesia
following acceleration
Besides assessing mother's contractions and FHR, remember Maslow's.
nutrition and fluid and electrolyte balance
oxygenation and circulation
rest and comfort
love and belonging
self esteem
mother may have decreased
sensation to void
Why might a mother in labor have a decreased sensation to void?
due to stimuli from uterine contractions
pressure from descent of fetus
stretching of cervix of uterus
Why must mother be assessed frequently for bladder distention?
due to decreased capacity of blaader due to fetal occupied space, mother may have increased urinary output if she is receiving IV fluids
Dehydration is a real concern due to allowance of ice chips, sips of water, or nothing at all
Oxygenation and circulation
Is metabolic rate increased or decreased, particularly during transition phase?
What happens to mother's blood pressure during a contraction?
What happens to mother's respirations and pulse during
a contraction?
Rest and Comfort
What are some reasons mother may be feeling discomfort?
stretching of muscles of
pressure of fetus' head on
stretching of vagina and
perineum and of course,
discomfort of IVs and
pelvic examinations
also back labor may be felt
during transition phase
if not yet felt
Some of the psychological discomforts of mother may include?
fear of the unknown
fear of injury
fear of death
fear of deformity (fetal)
or injury
Safety...fatigue and exhaustion are real. How is fatigue assessed? How can one reduce mother's energy demands or expenditures?
Because of fatigue, during
_____ _____ of ______, the mother can be expected to sleep for an extended period if undisturbed
fourth stage of labor
Shaking and chills can also be anticipated during the
_______ _______ of _______ and is thought to relate to presence of ________ _______ ________ in maternal bloodstream or from sudden decrease in _______ _______ _______. Extended chilling or shak
fourth stage of labor
fetal blood cells
inner abdominal pressure
Rutpure of membranes usually occurs during _______ ______ of _______ and should be included when assessing safety needs.
first stage of labor
How can one validate whether mother's membranes have ruptured?
test vaginal secretions with Nitrazine paper to determine presence of a basic solution, such as amniotic fluid, by turning paper blue
What should be recorded should mother's membranes rupture?
time of rupture
color of amniotic fluid
odor of amniotic fluid
fetal heart rate
The amount of blood will also increase as labor progresses and will include more red blood, but should not be profuse. During fourth stage a moderate amount of ______ _______ is expected.
lochia rubra
During the second and fourth stages of labor, the condition of ________ is carefully assessed to determine the presence of injury or edema and its progression, if present.
During the fourth stage, the ______ must be carefully checked for firmness, height, and location
In all stages, the effects of _____ and ______ on mother and fetus must be continuously assessed.
Can you describe physiological changes of newborn transitional phase?
Depending on intrauterine experience, newborn will handle environment accordingly. Intrauterine loud noises will make newborn more tolerant to extrauterine noises. Can select by smell, sensitive to touch, cuddle, and held.
Can you describe physiological changes of newborn transitional phase?
FETAL: not much blood going to pulmonary vessels
NEWBORN: lungs expand; pressure left atrium increases as blood returns from pulmonary veins; pressure right atrium drops, systemic vascular resistance increases as umbilical venous flow is halted when cord clamped
Can you describe physiological changes of newborn transitional phase?
periodic breathing may be present
Can you describe physiological changes of newborn transitional phase?
newborns attempt to stabilize internal core body temperatures within narrow range in spite of significant temperature variations in environment; temp may fall 2c to 3c after birth because of evaporative losses; term neborns can increase metabolic rate by 100% by 15-30 minutes after birth
Can you describe physiological changes of newborn transitional phase?
transitional stools - thin, brown to green
meconium - thick, tarry, black
newborn has difficulty concentrating in dilutional capabilities...void immediately after birth...initial bladder volume 6-44 ml of urine
Memorize APGAR scoring!
Why is the APGAR done?
evaluates physical condition of newborn and need for resuscitation
How to weigh and measure infant?
weigh naked
measure on back...extend legs
What are the safety and legal factors concerning mother and newborn?
mother and newborn have identical bracelets; infant's on ankle and wrist; footprint and fingerprint both
Normal vital signs for newborn are?
120-160 bpm
30-60 respirations per minute
97.7 - 99.4 F
How do vital signs vary the first few hours of life?
80-60 / 45-40 mmHg at birth
infant weighs more at birth and loses 5-10% of weight in first week
How can nurse assist mother with nutrition needs?
reduce caloric intake by 300 kcal following birth; stress importance of vitamins, minerals and water
How to alleviate nausea and vomiting?
eat small meals, bland; eat before rising
What influence would anesthesia have on nutrition?
? decreases it
What would be appropriate during fourth stage of labor when she is hungry?
dairy, meat, vegetables, whole grains, fruit
Does she have an IV feeding running?
if out of balance
What about her elimination needs?
following birth, female should void within 4 hrs and at least nurse should assess bladder for distention until woman is able to completely empty bladder with each voiding

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