1
Q
defining sign that labour has started is
A
- regular contractions and cervical changes
- they become stronger, more freq, and last longer as labour progresses
2
Q
cervical changes during labour are:
A
- move from posterior to anterior position, shortening and thinning (effacing) and dilating
3
Q
oxytocin during labour
A
- produced by pituitary gland
- helps prepare the body for labor
- optimizes labour causing rhythmic contractions
- calms, reduces fear and stress
- promotes maternal-infant bonding
- promotes contractions after birth to start involution
4
Q
beta-endorphins during labor
A
- secreted by posterior pituitary gland
- provides natural analgesic and adaptive responses to stress/pain
5
Q
catecholamines during labor
A
- epinephrine, norepinephrine, and dopamine
- released in response to fear, stress, and perceived danger
- can slow labor
- elevations near end of labour help newborn for extrauterine life
6
Q
Cortisol during labor
A
- stress hormone
- promote contractions, increase central oxytocin
- enhance PP mood
- prepares fetus for birth and promotes lung maturation and clearance of fluid
7
Q
catecholamines and cortisol effects on fetus
A
- prepare fetus for birth and support multi-organ transition to extrauterine life
8
Q
estrogen during labor
A
- growth for uterus and breasts
- increases blood flow to uterus
- SM relaxation
- activates and regulates other hormones
9
Q
indications of true labor
A
- regular contractions
- more intense with position change and walking
- felt in lower back, and lower portion of abdomen
- contractions continue despite comfort measures
10
Q
indications of false labour
A
- irregular contractions
- stop when walking or changing positions
- can be felt in the back or abd. above umbilicus
- can be stopped with comfort
11
Q
what are the 5 P’s
A
- passenger
- passage
- powers
- position
- psyche
12
Q
passenger
A
- relates to the fetus and its size, presentation, lie, attitude, position to maternal pelvis
13
Q
passage
A
- maternal pelvis (bones, soft tissues - lower uterine segment, pelvic floor muscles, cervix, vagina)
14
Q
powers
A
- primary: uterine contractions
- secondary: and voluntary bearing down efforts of the mom
15
Q
position
A
- women’s position as they labour (good ones are walking, standing sitting, squatting)
16
Q
psyche
A
- womens strength, history, cope, perception of pain, fears
17
Q
what are the 2 practices that promote, protect, and support normal birth?
A
- upright postures and freedom of movement
18
Q
what are the 7 cardinal movements?
A
- engagement
- flexion
- descent
- internal rotation
- extension
- restitution/external rotation
- expulsion
19
Q
what happens during the first stage of labour?
A
- onset of regular contractions with cervical changes and ends when the cervix is fully dilated
- latent and active phase
20
Q
latent phase of labor (strength, freq., duration)
A
- mild-mod on palpation
- 2-30minute apart (can be irregular)
- duration: 30-40sec
- scant discharge, may be excited, can be in this stage for 6-12 hours
- dilate 0-5cm
21
Q
active phase of labour (stage one) strength, frequency., duration
A
- strong on palpation
- 2-3 minute apart
- 80-90 seconds
- dilate 6-10cm
22
Q
progress guideline for dilations are:
A
- o.5cm per hour or 1cm per hour for parents who have had babies before
23
Q
when does second stage of labor occur:
A
- full dilation, complete effacement of cervix and birth of baby
24
Q
what is crowning
A
- when the widest diameter of the fetuses head distends the opening (biparietal diameter)
25
second stage latent phase:
- fully dilated
- no urge to push
- fetus continues to descend
26
second stage: active phase
- stretch receptors in pelvic floor trigger strong urge to push (Fergusons reflex)
27
contractions during second stage of labor
- 2-3 min progressing to 1-2 mins
- for first timers can last 2 or more without and 3 or more with anesthesia
- not first timers last 1 hour without and 2 with anesthesia
28
stage 3 of labor:
- birth of baby and placenta
29
stage 4 of labor
- first 1-4 hours of PP period
- physiological adjustment and stabilizing of mom and babe
30
first stage of labour assessments include:
- Leopoldo maneuver
- maternal vitals every hour
- assess fetal wellbeing every 15-30minute
- assess freq, duration, intensity and resting tone of contraction Q1h
- assess progress of labor
- assess maternal coping
31
frequency is measured
- from the onset of one contraction to the onset of another
32
duration of a contractions is measured by:
- onset to the end of the contraction
33
what can be assessed during a VE
- cervical position, consistency, effacement, dilation, station, presenting part, and position of the fetus
34
what do assess following a spontaneous rupture of membranes (SROM)
- COAT
- FHR - risk of cord compression
- sterile speculum exam must be performed instead of VE
35
non-pharmacological pain options:
- relaxations
- breathing techniques
- massage
- position changes
- water therapy
36
3 different pharmacological methods used:
- inhalation analgesia
- opioid analgesia
- regional analgesia
37
inhalation analgesia
- nitrous oxide (entonox)
- can be used with others
38
opioid analgesia
- useful in early stages
- can cross the placenta affecting the fetus (change FHR and resps)
39
signs of placental separation include:
- firm contracted funds
- change in shape from discoid to globular
- sudden gush of blood
-cord lengthening
- feeling vaginal fullness
40
during third stage of labour
- lasts up to 30 minutes (birth of fetus to birth of placenta)
- this is the greatest risk for PPH
41
what is given to mom at time of birth during the third stage of labor
- 10 IU of oxytocin
42
maternal assessment at third stage of labour
- assess signs of placental separation
- vitals and fundus assessments Q15min in first hour
- assess pain
43
baby assessments during the third stage
- Apgar score at 1 and 5 minutes
- vital within 15 minutes then hourly until temp stable
- head to toe assessment
- assess readiness to feed
44
what is rapidly assessed once the baby is born
- breathing, heart rate, color, tone, irritability/arousable
45
BUBBLE-E
- Breast
- Uterus
- Bladder
- Bowels
- Lochia
- Episiotomy (perineum/ceasarean site)
- emotions
46
REEDA
-redness
- edema
-echomosis
- drainage
- approximation
NSPN 7100
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