Labor and Its Signs

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary physiological process of labor?

Retention of the fetus in the uterus

Relaxation of the uterine muscles

Expulsion of the products of conception (correct)

Engagement of the fetus in the pelvic inlet

Which sign indicates that lightening has occurred?

Increase in maternal energy

Softening of the cervix

Settling of the presenting part into the pelvic inlet (correct)

Decreased frequency of voiding

How do Braxton Hicks contractions differ from true labor contractions?

Braxton Hicks contractions are regular and progressive

Braxton Hicks contractions relieve with activity (correct)

Braxton Hicks contractions increase intensity over time

Braxton Hicks contractions are painful

What does the term 'show' refer to in the context of labor?

Mucus mixed with blood from the cervix Signup and view all the answers

Which sign is NOT considered a premonitory sign of labor?

Increase in progesterone levels Signup and view all the answers

What characterizes true labor contractions?

Progressive contraction with increasing intensity Signup and view all the answers

What change in maternal weight may occur before labor, and what causes it?

Slight decrease due to fluid excretion Signup and view all the answers

Which of the following indicates that the cervix is changing in preparation for labor?

Softening and ripening of the cervix Signup and view all the answers

What is the expected duration of contractions during the transition phase?

60-90 seconds Signup and view all the answers

What emotional responses are typical during the transition phase of labor?

Intense discomfort and panic Signup and view all the answers

What is one of the nursing responsibilities during the active phase of labor?

Assist in voiding before analgesics Signup and view all the answers

How often do contractions occur during the active phase of labor?

Every 3-5 minutes Signup and view all the answers

What happens at full dilatation during the transition phase?

Membranes usually rupture Signup and view all the answers

What is a common physical sign during the transition phase of labor?

Leg shaking Signup and view all the answers

Why is it important to monitor blood pressure 30 minutes after administering analgesics?

To assess for hypotension Signup and view all the answers

Which breathing technique is recommended during the active phase of labor?

Abdominal breathing Signup and view all the answers

What generally determines the outcome of labor in women with a small stature?

The fetal size in relation to the maternal pelvis Signup and view all the answers

Which pelvis is characterized by a wedge or heart-shaped inlet and a robust structure?

Android pelvis Signup and view all the answers

What is a common feature of the anthropoid pelvis?

Long oval brim with longer anteposterior diameter Signup and view all the answers

Which type of pelvis is noted to generally have fewer complications during labor?

Anthropoid pelvis Signup and view all the answers

What defines the sacrum in relation to the pelvis?

The triangular shaped bone forming the posterior portion of the pelvis Signup and view all the answers

What characterizes the platypelloid pelvis?

Kidney-shaped brim with reduced anteposterior diameter Signup and view all the answers

What is a function of the ischial tuberosities?

To support the body during sitting Signup and view all the answers

Which is NOT a characteristic of the android pelvis?

Wider pubic arch Signup and view all the answers

What is the primary action a woman must avoid while pushing during labor?

Holding her breath for more than 5 seconds Signup and view all the answers

Which of the following describes the process of descent during labor?

Downward movement of the fetal head to the pelvic inlet Signup and view all the answers

What is the consequence of the Valsalva maneuver during labor?

Increased cardiovascular pressure Signup and view all the answers

What benefit does abdominal muscle contraction provide during the push?

Supports full descent of the fetal head Signup and view all the answers

Which cardinal movement refers to the fetal head's downward movement towards the pelvic inlet?

Descent Signup and view all the answers

During which cardinal movement does the fetal head bend forward onto the chest?

Flexion Signup and view all the answers

Which of the following is NOT a cardinal movement during labor?

Contraction Signup and view all the answers

What could be a result of diminished feto-placental gas exchange during labor?

Fetal hypoxia Signup and view all the answers

What is the color and characteristic of lochia rubra during the first three days after birth?

Bright red and moderate in amount Signup and view all the answers

What does the presence of bright red bleeding or blood clots in lochia indicate?

Possible lacerations Signup and view all the answers

During which days is lochia serosa characterized, and what is its typical appearance?

Days 4-10; pinkish to brownish and light Signup and view all the answers

Which observation suggests a full bladder that could affect lochia flow?

Spongy mass between the fundus and pubis Signup and view all the answers

What is the recommended method to monitor the patient's vital signs during the postnatal period?

Every 15 minutes for one hour, then every 30 minutes for an hour Signup and view all the answers

What is expected regarding lochia alba after the 10th day post-delivery?

It can last until 6 weeks postpartum Signup and view all the answers

What is a common cause of chills in a postpartum mother?

Circulatory changes after delivery Signup and view all the answers

Which of the following describes appropriate documentation while assessing lochia flow?

Document flow upon fundal massage every 15 minutes for one hour Signup and view all the answers

Study Notes

Labor

Labor is the process of expelling the fetus, membranes, umbilical cord, and placenta from the uterus.
Labor involves changes in connective tissue, cervical effacement and dilation, and rhythmic uterine contractions.

Premonitory Signs of Labor

Lightening: The presenting part of the fetus settles into the pelvic inlet.
- Occurs 10-14 days before labor in primiparas and 1 day before or on the day of labor in multiparas.
- Signs: Relief of dyspnea, relief of abdominal tightness, increased frequency of voiding, increased varicosities, shooting pains down the legs/leg cramps.
Increased Braxton Hicks' Contractions: Painless, irregular abdominal contractions that are relieved by walking.
- Occur 3-4 weeks before labor.
Sudden Burst of Maternal Energy/Activity: Due to the hormone epinephrine.
Slight Decrease in Maternal Weight: About 2-3 lb.
- Attributed to a drop in progesterone levels, leading to fluid excretion.
Show: Mucus mixed with a small amount of blood from the torn capillaries of the cervix.
- Differentiate from bleeding.
Softening/Ripening of the Cervix.
Rupture of the Bag of Water: An occasional sign.
Nesting Behavior: A psychosocial sign of approaching labor.
- The woman prepares for the baby's arrival (sewing diapers, buying a crib, etc.).

True Labor

Contractions:
- Regular, progressive, with increasing duration, intensity, and decreasing intervals.
- Discomfort starts from the back (lumbosacral) radiating to the front.
- Intensified by walking and enemas.
Show: Present and increasing.
Cervix: Open and dilates and effaces.

Pelvic Types

Gynecoid Pelvis: Most common female pelvis, favorable for vaginal delivery.
Android Pelvis: Has masculine features (wedge or heart-shaped inlet, reduced outlet).
- Possible problems during childbirth due to the narrower outlet.
Anthropoid Pelvis: Long, oval brim with a longer anteposterior diameter than the transverse.
- Labor usually presents no difficulties.
Platypelloid Pelvis: Flat pelvis with a kidney-shaped brim, reduced anteposterior diameter, and increased transverse diameter.
- Potential for cephalopelvic disproportion.

Pelvic Structures

Innominate Bones: Form the anterior and lateral aspects of the pelvis.
- Ilium: Upper flaring portion, forms the hip bone.
- Ischium: Located below the hip joint, supports the body when sitting.
- Pubes: Front bones, connected by the symphysis pubis.
Sacrum: Triangular shaped bone forming the posterior portion of the pelvis.
- Composed of 5 sacral vertebrae.
- The sacral promontory is an important obstetrical landmark.
Coccyx: Posterior portion of the pelvis composed of five fused vertebrae.

Stages of Labor

Latent Phase: Contractions grow stronger, lasting 40-60 seconds, and occur every 3-5 minutes.
- Lasts approximately 3 hours in nulliparas and 2 hours in multiparas.
- Increasing vaginal secretions and spontaneous rupture of membranes may occur.
Active Phase:
- Contractions become more intense, lasting longer, and cause true discomfort.
- Emotional Response: Discomfort, perspiration, flushed, fear of losing control, irritable, self-focused.
- Nursing Responsibilities: Coach woman on breathing and relaxation techniques, administer prescribed analgesics (taking maternal vital signs and fetal heart rate before and after).
Transition Phase: Contractions reach their peak intensity, occurring every 2-3 minutes, lasting 60-90 seconds, and causing maximum dilatation of 8-10 cm.
- Membranes usually rupture at full dilatation.
- Emotional Response: Intense discomfort, nausea and vomiting, feeling of loss of control, discouragement, anxiety, panic, resistance to touch, focus on birthing.
- Nursing Responsibilities: Reassure the woman that labor is nearing its end, reinforce breathing and relaxation techniques, encourage pant-blow breathing to remove the urge to bear down.

Pushing

The woman contracts her diaphragm and abdominal muscles while relaxing her pelvic floor and pushes out the contents of the birth canal.
How to Push: Deep breath, hold, close mouth, chin to chest, bear down.
- Short pushes are ineffective, prolonged pushes (holding breath > 5 seconds) are not recommended.
Consequences of Prolonged Pushing:
- Valsalva Maneuver: Increases intrathoracic and cardiovascular pressure, dangerous for cardiac mothers.
- Diminished Feto-placental Gas Exchange: Reduced oxygen perfusion across the placenta.
- Fetal Hypoxia and Distress: Possible complications from reduced oxygen delivery to the fetus.

Cardinal Movements of Labor

Descent: Downward movement of the biparietal diameter of the fetal head through the pelvic inlet.
- Full descent occurs when the fetal head extrudes beyond the dilated cervix and touches the posterior vaginal floor.
Flexion: The fetal head bends forward onto the chest, presenting the smallest AP diameter to the birth canal.
Internal Rotation: The fetal head rotates to align with the AP diameter of the pelvis.
Extension: The fetal head extends as it moves past the pubic symphysis.
External Rotation: The fetal head rotates back to its original position.
Expulsion: The fetus is delivered.

Postpartum Care

Lochia: Maternal discharge of blood, mucus, and tissue from the uterus.
- Lochia Rubra: Bright red, occurs during the first 3 days.
- Lochia Serosa: Pale, serosanguinous, pinkish to brownish, occurs on days 4-10.
- Lochia Alba: Whitish or yellowish-white, occurs from day 10-14 or up to 6 weeks postpartum.
Assess the Patient's Vital Signs:
- Temperature: Every hour.
- Blood Pressure, Pulse, and Respirations: Every 15 minutes for an hour, then every 30 minutes for an hour, then every hour as long as the patient is stable.
Observe for Uterine Atony or Hemorrhage.
Observe for Untoward Effects from Anesthesia.
Orient Patient to Surroundings (bathroom, call bell, lights, etc.).
Encourage Fluid Intake.
Assess for Urinary Bladder Distention
- Signs of Full Bladder: Bulging lower abdomen, spongy mass between the fundus and the pubis, displaced uterus from the midline, increased lochia flow.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the process of labor, including the physiological changes that occur during childbirth. It also addresses premonitory signs such as lightening, Braxton Hicks contractions, and maternal energy bursts. Familiarize yourself with these essential concepts for a deeper understanding of the labor process.