Labor Onset Theories and The Five Ps

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Questions and Answers

What does the term 'lie' refer to in relation to fetal positioning?

The psychological response of the mother during labor

The position of the placenta within the uterus

The relationship of the maternal spine to the fetal spine (correct)

The descent of the fetus through the pelvis

Which of the following describes the best practice for maternal positioning during labor?

Sitting with legs elevated to reduce swelling

Constantly changing positions to prevent discomfort

Lying flat on the back to facilitate fetal monitoring

Upright positions to improve labor outcomes (correct)

Which of the following is not a sign of impending labor?

Increased appetite (correct)

Nesting behavior

Lightening

Braxton Hicks contractions

What does a negative station indicate regarding the fetal presenting part?

The fetus is still floating and not engaged Signup and view all the answers

What is a likely psychological factor influencing a woman's response to labor?

Outcomes of previous births Signup and view all the answers

Which statement accurately describes cervical effacement?

It refers to the thickness of the cervix measured as a percentage Signup and view all the answers

The '411 Rule' is used to differentiate between which types of labor?

True and false labor Signup and view all the answers

What role do fetal proteins in the lungs play in labor onset?

They may provide a cue for initiating labor Signup and view all the answers

Which of the following is a sign that true labor has begun?

Increase in cervical effacement Signup and view all the answers

What does the term 'fetal lie' refer to?

The orientation of the fetus in the womb Signup and view all the answers

Which nursing action is crucial prior to administering epidural anesthesia?

Obtain a maternal blood pressure reading Signup and view all the answers

How is the strength of uterine contractions primarily assessed?

By palpating the abdomen during contractions Signup and view all the answers

Which statement describes primary power during labor?

It is the primary force moving the fetus through the maternal pelvis. Signup and view all the answers

What is true about Breech presentation?

It can be complete, frank, or footling. Signup and view all the answers

Which of the following medications is specifically classified as an opioid agonist-antagonist analgesic?

Nalbuphine Signup and view all the answers

Which characteristic is unique to the pain associated with childbirth?

Pain that can be relieved with repositioning Signup and view all the answers

Which part of the pelvis is not part of the true pelvis?

The false pelvis. Signup and view all the answers

What is the primary purpose of monitoring fetal heart rate (FHR) during labor?

To assess fetal well-being Signup and view all the answers

What characterizes the vertex presentation?

The fetal chin is flexed towards the chest. Signup and view all the answers

Which of the following describes a secondary power in labor?

It is the mother’s voluntary pushing efforts during labor. Signup and view all the answers

Which of the following describes 'effacement' in the context of labor?

The thinning of the cervix Signup and view all the answers

Which fetal attitude is characterized by a chin extended away from the chest?

Brow presentation. Signup and view all the answers

What triggers the increasing frequency of uterine contractions as labor progresses?

Spontaneous or induced labor processes. Signup and view all the answers

Which statement accurately describes the role of the passageway in labor?

It includes the bony pelvis and soft tissue structures. Signup and view all the answers

What monitoring equipment should be placed on the mother upon admission during labor?

External Uterine Toco and External Fetal Heart Rate Monitor Signup and view all the answers

Which question is relevant when assessing a patient during the initial admission for labor?

How frequent are your contractions? Signup and view all the answers

What is the appropriate action for a patient assessed as high risk for hemorrhage?

Type and Cross match for 2 units PRBCs and review hemorrhage protocol Signup and view all the answers

What factor places a patient in a medium risk category during hemorrhage assessment?

Multiple gestation Signup and view all the answers

During labor assessment, which prior medical history is crucial to note?

History of STI's and surgeries Signup and view all the answers

Which statement is true regarding low-risk hemorrhage assessment?

Involves drawing blood and holding the specimen Signup and view all the answers

What condition is NOT associated with high-risk hemorrhage assessment?

Singleton pregnancy Signup and view all the answers

What assessment is appropriate 30-60 minutes after giving birth?

Reassess pain scale and maternal vital signs Signup and view all the answers

What characterizes the latent phase of the first stage of labor?

Cervix dilation from 0-3 cm Signup and view all the answers

During which phase does the cervix dilate from 4 to 7 cm?

Active Phase Signup and view all the answers

Which movement is characterized by the fetal head rotating to align the widest part with the widest part of the pelvis?

Internal Rotation Signup and view all the answers

What is the proper management for a nulliparous woman during the active phase of labor?

Monitor for cervical change of 1.5 cm/hr Signup and view all the answers

What does the Ferguson reflex signify during labor?

Urge to push Signup and view all the answers

What is the significance of the term 'four one one' in the context of labor?

Hospital admission criteria based on contraction timing Signup and view all the answers

Which factor indicates that it may be time to inquire about an epidural in labor?

Cervical dilation between 4-7 cm Signup and view all the answers

Which stage of labor begins with the birth of the baby?

Third Stage Signup and view all the answers

Study Notes

Theories Concerning Labor Onset

A cue from fetal proteins in the lungs may play a significant role in initiating labor.

Impending Signs and Symptoms of Labor

Braxton Hicks contractions
Bloody show
Lightening
Nesting
Cervical changes
GI symptoms
Weight loss

The Five Ps

Power: The force that moves the fetus through the maternal pelvis
- Primary power: Involuntary uterine contractions and the Ferguson reflex (reflex to push)
- Secondary power: Voluntary pushing
Passageway: Anatomy of the bony pelvis and soft tissues
- True pelvis is the most important, consisting of the inlet, midpelvis, and outlet.
- Softening of cartilage due to increased relaxin levels.
Passenger: The fetus
- Fetal head: Size and molding
- Fetal presentation: Part entering the pelvis first (cephalic, breech, or shoulder)
- Fetal attitude: Relationship of fetal body parts to each other (vertex, sinciput, brow, facial)
- Fetal lie: Relation of maternal spine to fetal spine (longitudinal or transverse)
- Fetal position: Relationship of the presenting part to the maternal pelvis (described with a 3-letter abbreviation: L or R, O, M, Sc, S, P, A, T)
Psyche: Psychological factors
- Anxiety, culture, expectations, life experiences, and support affect response to labor and birth.
Position: The laboring woman's posture
- Upright positions may result improved outcomes: decreased Cesarean section, surgical vaginal birth, episiotomy, and spontaneous lacerations; shorter first and second stages; and increased maternal control and comfort.

True vs. False Labor

4-1-1 Rule: Contractions are 4 minutes apart, last for 1 minute, for 1 hour.

Labor Progression: Cervix

Dilation: The drawing up and opening of the cervix (ranges from fully closed to 10 cm)
Effacement: The thinning and shortening of the cervix (expressed as a percentage)

Labor Progression: Station

Describes the descent of the presenting part through the true pelvis using the ischial spines as reference.
- Level of ischial spines is Zero and means the part is “engaged”
- Negative numbers mean the presenting part is still “floating” and not engaged
- When the presenting part moves beyond the ischial spines, it has a positive number (+1 to +3, with +3 being the most descended).

Cardinal Movements of Labor

Engagement: Head reaches the ischial spines.
Descent: Fetus moves past “0” (pt typically feels Ferguson reflex [urge to push] at +1).
Flexion: Fetal head moves chin to chest, causing biparietal diameter to be the widest dimension of the presenting part.
Internal Rotation: Fetal head rotates to align the widest part with the widest part of the pelvic cavity.
Extension: Fetal chin comes off chest and neck arches as it is born.
External Rotation (restitution): Fetal head, now born, rotates to align with the shoulders.

Stages of Labor

First Stage: Cervical dilation and effacement occur.
- Latent Phase: Cervix dilation 0-3 cm
- Active Phase: Cervix dilation 4-7 cm
- Transition Phase: Cervix dilation 8-10 cm
Second Stage: The expulsion stage, begins with full dilation and effacement of the cervix and ends with the birth of the baby.
Third Stage: Begins with the birth of the baby and ends with the expulsion of the placenta.
Fourth Stage: The stage of physical recovery for mother and infant, begins with the delivery of the placenta and lasts 1-4 hours after birth.

Initial Admission Assessment of Labor

Maternal vital signs: HR, Temp, RR, O2 saturation, Blood Pressure, Pain scale
External Uterine Toco and External Fetal Heart Rate Monitor (FHR): Uterine toco placed at the top of the fundus and midline, firmly in place; external FHR monitor placed by the fetal back using Leopold’s maneuvers.

Hemorrhage Risk Assessment

All women in labor and delivery should be assessed for hemorrhage risk on admission, 30-60 minutes before birth, and 30-60 minutes after birth.
Categories of Risk:
- Low Risk: Draw blood and hold specimen
- Moderate Risk: Draw and send Type and Screen and Review Hemorrhage Protocol.
- High Risk: Type and Cross match for 2 units PRBC’s, Review Hemorrhage Protocol, Team Prebrief.

Stage 1: Latent Phase

Historically 0-3 cm (recent research suggests it can last up to 6 cm)
Length varies (typically longer for nulliparous than multiparous)
May report cramping-like sensations similar to menstrual cramps; often able to talk through the contractions.
Admission to the hospital in the absence of maternal and fetal complications is not ideal during this phase.
"Six is the new Four": Delay admission until 6 cm dilated?
Encourage walking, showering, light snacking, and hydration.

Stage 1: Active Phase

Dilation between 4-7 cm
Fetus descends into the pelvis, and internal rotation begins.
Multiparous woman should have cervical change of 1.5 cm/hr and nulliparous woman 1.2 cm/hr.
Known as the Friedman’s curve and is an approximation.
Contractions are 3-5 minutes apart with a duration of 30-45 seconds and are moderate to strong intensity.
Optimal time for an epidural block.
Behavior changes include anxiety, helplessness, intense focus throughout the contraction, and an inability to engage socially as she is concentrating very hard on her task at hand.
Treatment with Ibuprofen and ice packs.

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Description

Explore the theories concerning labor onset, including the role of fetal proteins and the impending signs and symptoms of labor. Additionally, discover the Five Ps that influence labor: Power, Passageway, Passenger, and their vital components. This quiz is essential for understanding the critical aspects of labor and childbirth.