Labor and Birth Process

Study Notes

True Labor

True labor contractions are regular, get closer together, last longer, and become more intense.
True labor contractions lead to cervical dilation.

Factors Affecting Labor Process

Passageway (Birth Canal)

The gynecoid pelvis is ideal for childbirth.
The gynecoid pelvis helps with internal rotation during labor.
Cervical effacement is the thinning of the cervix.

Passenger (Fetus)

Head:
- Molding is the change in the fetal skull shape due to overlapping cranial bones.
- Sutures aid in identifying the fetal head position.
Attitude:
- The fetal head is usually flexed.
- The fetal shoulders should not enter the pelvis first.
Lie:
- The fetal head is the first part to enter the pelvic inlet.
Presentation:
- During a vaginal exam, the caregiver can feel the fetal head or hand/arm.
Position:
- Cervical exams assess the fetal position based on bony pelvis landmarks.
- Document and relay findings to the provider.
Station:
- Describes the fetal descent through the pelvis.
Engagement:
- Refers to the fetal head entering the pelvic inlet.

Powers (Contractions)

Contractions cause cervical effacement.
Frequency measures the time between contractions.
Duration measures the length of a contraction.
Intensity refers to the strength of a contraction.
Primary powers are uterine contractions.
Secondary powers are pushing efforts.

Position (Maternal)

Lithotomy position: Increases provider control and fetal monitoring.
Upright positions: May reduce labor time, increase vaginal delivery rates, enhance comfort, and aid fetal descent.

Psychological Response

Factors promoting a positive birth experience:
- Support from loved ones.
- Self-confidence and a sense of mastery.
- Trust in the care team.
- Positive pregnancy experiences.
- Control of breathing.
- Preparation for childbirth.
- Emotional, physical, and spiritual support.
Clear explanations about procedures help patients feel in control, potentially reducing medical interventions and the need for analgesia or anesthesia.

Stages of Labor

First Stage: Dilation

The longest stage of labor.
Focus on admission and education.
Characterized by progressive cervical dilation.
Ends at 10 cm dilation.
Membranes may rupture.
Latent phase: 0-6 cm dilation, 0-40% effacement, mild cramping pain.
Active phase: 7-10 cm dilation, 40-100% effacement, intense pain.

Second Stage: Expulsive

Fetus moves through the birth canal.
Pushing phase.
Pelvic phase: Fetal descent.
Perineal phase: Active pushing, contractions lasting 60-90 seconds every 2-3 minutes.

Third Stage: Placental

Begins with baby delivery and ends with placenta delivery.
Ideal newborn placement is skin-to-skin with the mother.
Placental separation and delivery takes 5-10 minutes.
Fundal massage can help prevent postpartum hemorrhage.
Monitor for postpartum hemorrhage, the most frequent cause of maternal morbidity.

Fourth Stage: Restorative

Starts after placenta expulsion and ends with initial maternal stabilization.
Monitor for hemorrhage, bladder distention, and venous thrombosis.

Assessing the Laboring Mother and Baby

Vaginal Examination

Invasive procedure.
Offer privacy and education.
Purpose: Assess dilation, effacement, membrane status, presentation, station, swelling, and molding.
Procedure: Sterile gloves, water-based lubricant, index and middle fingers.

Leopold Maneuvers

Determine the presentation, position, and lie of the fetus.

Amniotic Fluid Analysis

Can be spontaneous or induced rupture.
Clear fluid is normal.
Cloudy or foul-smelling fluid indicates infection.
Green fluid indicates meconium passage.
At 42 weeks, the placenta starts to degrade, potentially impacting fetal health.

Fetal Heart Rate (FHR) Analysis

Important for fetal well-being and oxygen status.
Assessed intermittently by fetoscope or Doppler.
Intermittent auscultation is the primary method for fetal surveillance in labor.

Location

FHR is most clearly heard over the fetal back.

FHR Patterns

Category 1: Normal, predictive of normal fetal acid-base status, no intervention needed.
- Baseline: 110-160 bpm.
- Variability: Moderate.
- Accelerations: Present or absent.
- Early decelerations: Present or absent.
- Late or variable decelerations: Absent.
Category 2: Indeterminate, requires further evaluation and monitoring.
Category 3: Abnormal, predicts fetal acidosis and requires intervention.

General Nursing Interventions

Monitor vital signs, especially FHR.
Encourage frequent urination.
Offer comfort measures like warmth, massage, and reassurance.
Educate patients on the labor process and available interventions.
Advocate for the patient's needs and preferences.
Maintain a safe and supportive environment.

Description

This quiz focuses on understanding true labor and the key factors affecting the labor process, including the birth canal and fetal characteristics. Delve into topics such as cervical dilation, fetal positioning, and the anatomical considerations for childbirth. Test your knowledge on how these elements influence labor.