Childbirth Methods Overview Quiz

Pain Management During Labor

• Methods for pain management during labor are based on three premises: Minimizing discomfort by educating women about the labor process and preparing them with breathing exercises. Relaxing the abdominal muscles to allow the uterus to expand freely during contractions. Altering pain perception through distraction techniques or gating control theory of pain perception.

The Bradley (Partner-Coached) Method

• Originated by Robert Bradley, this method emphasizes childbirth as a natural and joyful process.
• Partners are encouraged to participate during pregnancy, labor, and the early newborn period.
• Mothers are encouraged to trust their bodies and focus on diet and exercise throughout pregnancy.
• The method teaches couples to manage labor through deep breathing and the support of a partner or a labor coach.

The Psychosexual Method

• Developed by Sheila Kitzinger in the 1950s, this method stresses the importance of pregnancy, labor, birth, and the early newborn period in a woman's life cycle.
• It includes a program of conscious relaxation and progressive breathing to encourage women to "flow with" contractions rather than struggle against them.

Conscious Relaxation

• Deliberately relaxing one muscle group at a time, progressively relaxing the entire body.

Cleansing Breath

• A breathing technique used to begin and end each breathing exercise.
• Involves deep inhalation and exhalation.
• Limits hyper- and hypoventilation.
• If respiratory alkalosis develops, breathing into a paper bag can help.

Consciously Controlled Breathing

• Different levels of controlled breathing are taught to manage labor pain.
• Level 1: Slow, comfortable chest breathing (6-12 breaths/min), used for early contractions.
• Level 2: Lighter, more rapid breathing (up to 40 breaths/min), used for contractions with 4-6 cm cervical dilation.
• Level 3: More shallow and rapid breathing (50-70 breaths/min), used for transition contractions (8-10 cm cervical dilation). Exhalation should be slightly stronger than inhalation. The tip of the tongue should be held against the roof of the mouth to prevent oral mucosa drying.
• Level 4: "Pant-blow" pattern (3-4 quick breaths, then a forceful exhalation).
• Level 5: Very shallow panting (about 60 breaths/min), used during strong contractions or the second stage of labor to prevent pushing before full dilatation.

The Dick-Read Method

• Based on the premise that fear leads to tension and ultimately pain.
• The method emphasizes relaxation, particularly abdominal breathing to reduce pain during contractions.

The Lamaze Method

• One of the most commonly taught childbirth methods in the U.S.
• Relies on stimulus-response conditioning and controlled breathing to reduce pain during labor.
• Originally termed "psychoprophylactic labor method".
• Focuses on preventing pain through managing thoughts and emotions.

Lamaze Method Details

• Developed by Ferdinand Lamaze, a French obstetrician
• Aims to increase women's confidence in their birthing ability
• Centers on controlled breathing techniques for managing pain.

Six Major Concepts Stressed for Labor

• Labor should begin naturally, not be artificially induced.
• Women should be free to move around during labor without being confined to bed.
• Women should receive continuous support during labor.
• No routine interventions like IV fluids are needed.
• Women should be allowed to assume upright or side-lying birth positions.
• Mother and baby should be housed together after birth with unlimited opportunity for breastfeeding.

Effleurage

• A form of light abdominal massage as a distraction technique to relieve pain during contractions.
• A woman traces patterns on her abdomen with her fingertips.

Focusing or Imagery

• Focusing intently on an object (e.g., a photo of a loved one or a graphic design).
• Imagery: Imagining a calm place, like a beach or nature scene to reduce the discomfort of contractions.

Theories of Labor Onset and Signs of Labor

• Labor is influenced by a combination of factors originating from both the mother and the fetus.

Uterine Muscle Stretching (Uterine Stretch Theory)

• Uterine muscle stretching leads to prostaglandin release.
• It triggers cervical ripening and uterine contractions.
• In late pregnancy, a greater amount of prostaglandins (PGE2 and PGE2a) is present to aid in uterine contractions.

Pressure on the Cervix (Oxytocin Theory)

• Pressure on the cervix stimulates oxytocin release.
• Oxytocin collaborates with prostaglandins to initiate contractions.

Change in Estrogen to Progesterone Ratio (Progesterone Deprivation Theory)

• Increasing estrogen compared to progesterone in the mother stimulates uterine contractions.

Placental Age

• Influences the initiation of contractions at a specific developmental point in the placenta's life cycle

Rising Fetal Cortisol Levels

• Rising fetal cortisol levels reduce progesterone and increase prostaglandin formation.
• These factors, in turn, stimulate uterine contractions.

Prostaglandin Theory

• Fetal membranes and uterine decidua increase prostaglandin levels later in pregnancy.
• This hormone is secreted from the lower area of the fetal membrane.
• The decrease in progesterone increases prostaglandin levels further.
• Prostaglandin synthesis initiates uterine contractions.

Preliminary Signs of Labor (Lightening)

• The fetal presenting part descends into the pelvis.
• Primiparas (first-time mothers): It may occur approximately 10-14 days before labor.
• Multiparas (mothers who have already given birth one or more times): It typically occurs on or around the day labor starts, or even after the onset of labor.

Increase in Level of Activity

• Related to an increase in epinephrine levels and reduced progesterone, triggering more energy in the mother.

Braxton Hicks Contractions

• Often strong contractions, simulating true labor.
• Occur in the last week or days before labor.

Ripening of the Cervix (Goodell's Sign)

• An integral sign observed only during a pelvic examination.
• The cervix feels softer, almost like an earlobe (Goodell's sign).
• The cervix becomes even softer (described as "butter-soft") during term.
• Cervix ripening signifies that labor is approaching.

Signs of True Labor - Uterine Contractions

• Frequent, powerful, involuntary contractions that can cause discomfort.
• These uterine contractions are essential in initiating the birth process.
• To aid the mother, and partner, education and techniques such as controlled breathing can reduce discomfort.

Signs of True Labor - Show

• The cervix softens and ripens leading to the expulsion of the mucus plug which was present during pregnancy.
• Blood seeps from the exposed cervical capillaries resulting from pressure exerted by the fetus.
• The blood mixed with mucus is referred to as "show" or "bloody show" and women should be aware of this event.

Rupture of Membranes

• Labor may begin when the membranes rupture, either with a sudden gush or slow seeping of fluid from the vagina.
• Two risks associated with ruptured membranes are intrauterine infection and cord prolapse.
• If labor has not started spontaneously within 24 hours after membrane rupture and the pregnancy is at term, labor is induced to decrease these risks.

Differentiation Between True and False Labor Contractions

• False labor: Contractions are irregular (do not have a definite pattern), confined to the abdomen and groin, and often cease with ambulation or sleep.
• True labor: Contractions are regular and more noticeable in the lower back, moving around the pelvis, continue no matter what activity level, and increase in intensity.

Components of Labor

• Passage: The route taken by the fetus from the uterus through the cervix and vagina to be delivered. Important pelvic measurements include diagonal conjugate and the transverse diameter of the outlet. The narrowest diameter at the pelvic inlet is the anteroposterior diameter. The transverse diameter of the outlet is the narrowest diameter.
• Passenger: Refers to the fetus. The fetus's head is the widest part of the body and is therefore least likely to pass through the pelvic ring. The fetal skull's bony structure, fontanelles and sutures, and its alignment with the pelvis all influence the ease of natural birth..
• Powers: Uterine contractions, providing the force necessary to dilate the cervix and for expulsion.
• Psyche: The woman's psychological and emotional state during labor, which affects her experience and responses.

Learning Objectives

• Describe the components of labor.
• Demonstrate skill in identifying abnormal patterns in fetal heart tone in relation to uterine contractions.
• Monitor frequency, interval, and duration of uterine contractions.
• Identify maternal danger signs of labor.
• Distinguish early deceleration from late and from variable decelerations.
• Assess a family in labor and birth and identify the woman's readiness, stage, and progression.
• Formulate nursing diagnoses related to the physiologic and psychological aspects of labor and birth.
• Develop expected outcomes to meet the needs of a family throughout the labor process.
• Devise a nursing care plan using identified nursing diagnoses.
• Implement nursing care for a family during labor, such as teaching about the stages of labor.
• Evaluate expected outcomes for achievement and effectiveness of care.
• Integrate knowledge of labor and birth with the interplay of nursing process to promote quality maternal and child health nursing care.

Components of Labor: (PASSAGE, PASSENGER, POWERS, PSYCHE)

• Passage (woman's pelvis): The route the fetus takes through the birth canal. Pelvic size and shape are crucial.
• Passenger (the fetus): The fetus's size, position, and attitude (flexion/extension of head) influence the labor process. The head, typically, is the largest component and the largest body part that must pass through the pelvis.
• Powers (uterine contractions): The contractions force the fetus through the cervix and vagina.
• Psyche (woman's emotions): The mother's psychological state is significant during birth and affects the course of labor.

Fetal Presentation and Position

• Attitude: Refers to the degree of flexion of the fetal head and the relationship of the fetal parts to one another. Good attitude is in full flexion with the spinal column bowed forward.
• Engagement: Indicates when the presenting part has descended into the pelvis to the level of the ischial spines. Engagement is termed as "floating" if the presenting part is not yet engaged, and "dipping" if the part is on descent but not yet at the level of the ischial spines.
• Station: The relationship of the presenting part to the ischial spines of the pelvis as a measure of fetal descent. The presenting part is at zero station when at the level of the spines. Minus stations are above the spines and indicated as -1, -2, -3, -4. Stations above zero are indicated with a plus sign (+).
• Fetal Lie: Relationship between the long axis of the fetus and the mother. Longitudinal lie is most common (99% of births).

Types of Fetal Presentation

• Cephalic Presentation (Most common): The fetal head is the presenting part. Type of presentation depends on the fetal head and how it is positioned relative to the birth canal. These include:
  • Vertex (fully flexed head)
  • Brow (partially extended head)
  • Face (less flexed head with face presenting)
  • Mentum (chin presenting).
• . Breech Presentation (Less common): Fetal buttock or feet are the presenting part. There are 3 types of breech presentation: Complete, Frank, and Footling.
• Fetal Position: Indicated by a 3 letter abbreviation that delineates the presenting part and its position r/t the mother's pelvis (R or L) and whether it is A (anterior), P (posterior), or T (transverse).

Mechanisms of Labor

• Engagement
• Descent
• Flexion
• Internal Rotation
• Extension
• External Rotation
• Expulsion

Stages of Labor (Stages 1,2,3,4)

• Stage 1: Labor begins with contractions that cause cervic
• Latent Phase: Early labor where cervix dilates 0-3 cm, contractions are mild (20-40 sec) and occurring every 15-30 minutes.
• Active Phase: Cervix dilates 4-7 cm, contractions become more frequent (every 3-5 minutes), and stronger (40-60 sec).
• Transition Phase: Cervix dilates 8-10cm and contractions are intense (every 2-3 minutes lasting 60-90 sec).
• Stage 2: Expulsion of the baby, starting when the cervix is fully dilated (10 cm).
• Stage 3: Delivery of the placenta.
• Stage 4: Recovery stage, lasting 1-2 hrs after delivery. During this time, the mother's body is recovering and the postpartum period is in progress.

Episiotomy

• Surgical incision of the perineum to prevent tearing.
• Midline or mediolateral.

Cutting and Clamping the Cord

• Details on length in centimeters of the umbilical cord that must be cut and clamped.

Maternal Responses to Labor

• Physiological effects on women's bodies. Includes a number of changes.
• Cardiovascular System: Increased cardiac output, blood pressure.
• Hematopoietic: Leukocytosis (increased WBC count).
• Respiratory System: Increased respiratory rate.
• Temperature Regulation: May increase by 1°F.
• Fluid Balance: Increase in insensible water loss
• Urinary System: Decrease in urine output and increases specific gravity.
• Musculoskeletal System: Relaxin hormone softens the uterine cartilage.
• Gastrointestinal: Delayed gastric emptying.
• Neurologic and Sensory: Pain responses.

Danger Signs of Labor

• Fetal: High or low fetal heart rate, meconium staining, hyperactivity, fetal acidosis.
• Maternal: Rising or falling blood pressure, abnormal pulse, prolonged or inadequate contractions, pathologic retraction ring, abnormal lower abdominal contour or increasing apprehension. Other maternal concerns include bright red vaginal bleeding, or meconium stained amniotic fluid. There may be some concerns associated with position.

Third Stage of Labor

• Lengthening of the umbilical cord, sudden gush of vaginal blood. Change in uterine shape, firm uterine contractions, placenta appearing at the vaginal opening, are considered signs of placental separation.
• Types of Placental delivery: Schultze (shiny, placenta separates first at its center) and Duncan (red/raw, separates first at its edges).
• Important instructions for nursing management include preventing uterine inversion when delivering the placenta. It would also include appropriate timeframes for vaginal delivery of the placenta.

Nursing Management (Fourth Stage of Labor)

• Method of placental delivery: Do not forcefully pull the umbilical cord to prevent uterine inversion. Correct timing of placental delivery (is typically 20 minutes after the baby is born).
• Care after placental delivery: Inspect placenta for completeness of cotyledons, determine the degree of uterine contraction, and administer oxytocin if needed. Inspect the perineum and assist in suturing.
• Care during and after perineal repair: Vaginal packs are removed after 24-48 hours post delivery to facilitate perineum healing.
• Fourth Stage of Labor: Assessment. Fundal assessment, bladder assessment, vaginal discharge, V/S, perineal assessment every 15 minutes during the first hour, and every 30 minutes for the following four hours to identify early maternal complications.
• Comfort measures: Administer perineal care and sanitary pads. Position the mother flat in bed to prevent dizziness. Provide a sponge bath, change soiled gown/linens. Give mother initial nutrition, and allow for rest and energy recovery.