Lamaze Method and Labor Overview

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Questions and Answers

What is the primary purpose of effleurage in the Lamaze Method?

To stimulate uterine contractions

To decrease fetal heart rate

To provide distraction and relaxation during contractions (correct)

To promote cervical dilation

Which theory suggests that pressure on the cervix triggers labor by releasing oxytocin?

Uterine Stretch Theory

Prostaglandin Theory

Progesterone Deprivation Theory

Oxytocin Theory (correct)

What role do rising fetal cortisol levels play in the labor process?

They prevent uterine contractions.

They enhance oxytocin release.

They increase progesterone formation.

They decrease progesterone and increase prostaglandins. (correct)

What is the primary purpose of consciously controlled breathing during labor?

To reduce pain and manage contractions. Signup and view all the answers

What breathing technique is utilized during strong contractions in Level 5 breathing?

Quiet, continuous, very shallow panting. Signup and view all the answers

Which of the following is a preliminary sign of labor that all pregnant women should recognize?

Light menstrual-like cramps Signup and view all the answers

Which level of breathing is suggested for transition contractions at 8 – 10 cm cervical dilation?

Level 3 Signup and view all the answers

What hormone plays a significant role in cervical ripening and uterine contractions during labor?

Prostaglandins Signup and view all the answers

What is a key concept of the Lamaze method of childbirth?

It aims to prevent labor pains through controlled breathing. Signup and view all the answers

In which theory is the balancing of estrogen and progesterone crucial for initiating labor?

Progesterone Deprivation Theory Signup and view all the answers

What is the effect of placental age related to labor onset?

It triggers contractions at a specific developmental point. Signup and view all the answers

According to the Dick-Read method, which of the following sequences describes the relationship between fear, tension, and pain?

Fear leads to tension, which in turn leads to pain. Signup and view all the answers

What is the maximum breathing rate during Level 2 breathing?

40 breaths/min Signup and view all the answers

Which technique allows a woman to mentally focus on an object during contractions?

Focusing or imagery Signup and view all the answers

Which statement best describes a key principle of the Lamaze method regarding labor interventions?

Natural onset of labor should be encouraged without artificial induction. Signup and view all the answers

What does the term 'bloody show' refer to during labor?

The expulsion of the mucus plug mixed with blood Signup and view all the answers

What breathing technique in Level 4 involves multiple quick breaths followed by a forceful exhalation?

Pant-blow pattern. Signup and view all the answers

What typically happens if labor does not start within 24 hours after the rupture of membranes?

Labor is induced to lower the risks of infection Signup and view all the answers

Which of the following is NOT a characteristic of true labor contractions?

Disappear with ambulation Signup and view all the answers

Which risk is associated with ruptured membranes during labor?

Intrauterine infection Signup and view all the answers

In contrast to false contractions, true contractions are characterized by which of the following?

Achieve cervical dilation Signup and view all the answers

How can a woman differentiate true labor from false labor based on contraction timing?

True contractions become regular and predictable Signup and view all the answers

What are two common misconceptions about contractions during labor?

That all contractions are painful and regular Signup and view all the answers

Which component is crucial to monitor for recognizing complications during labor?

Frequency and duration of contractions Signup and view all the answers

What defines a vertex presentation in terms of fetal head position?

The head is flexed, presenting the parietal bones or vertex. Signup and view all the answers

Which type of cephalic presentation is characterized by the fetus having its head extended, resulting in the face being the presenting part?

Face presentation Signup and view all the answers

How often do breech presentations occur in births?

Approximately 3% Signup and view all the answers

What does the middle letter in the fetal position abbreviation indicate?

The presenting body part Signup and view all the answers

Which cephalic presentation is least favorable for vaginal delivery?

Mentum Signup and view all the answers

Which mechanism of labor involves the fetal head rotating after descent?

Internal rotation Signup and view all the answers

In which fetal presentation does the brow or sinciput become the presenting part?

Brow presentation Signup and view all the answers

What does a footling breech presentation indicate?

One or both feet are the presenting part. Signup and view all the answers

What is effacement in the context of cervical changes during labor?

Thinning and shortening of the cervical canal Signup and view all the answers

During which phase of labor do contractions last approximately 20-40 seconds and have a frequency of 15-30 minutes?

Latent phase Signup and view all the answers

What psychological state is commonly experienced by women during labor?

Apprehension and fright Signup and view all the answers

What is the main focus during the implementation of care in the latent phase of labor?

Encouraging mother and partner participation in care Signup and view all the answers

The first stage of labor ends when which of the following occurs?

Rapid cervical dilatation begins Signup and view all the answers

How long does the latent phase typically last in nulliparas?

6 hours Signup and view all the answers

Which of the following is NOT a recommended comfort measure during the latent phase of labor?

Administering pain medications Signup and view all the answers

What does the term 'dilatation' refer to in cervical changes during labor?

Enlargement of the cervical os Signup and view all the answers

What is a primary concern regarding an infant's thermoregulation at birth?

Inability to produce heat through shivering Signup and view all the answers

What should be included in the initial admission assessment of a laboring mother?

Parity & gravidity Signup and view all the answers

What is the correct action to take if prolonged contractions of 90 seconds or more occur during labor?

Discontinue oxytocin administration Signup and view all the answers

How often should the fetal heart rate (FHR) be monitored during active labor for low-risk patients?

Every 30 minutes Signup and view all the answers

What type of monitoring may be employed to observe fetal heart rate

Fetoscope or Doppler Signup and view all the answers

Which of the following is a common risk factor for an infant immediately after birth?

Ineffective airway clearance Signup and view all the answers

What should a nurse do first when admitting a laboring mother?

Obtain vital signs Signup and view all the answers

What does 'ineffective airway clearance' in an infant typically relate to?

Excessive mucus production Signup and view all the answers

Study Notes

Pain Management During Labor

Methods for pain management during labor are based on three premises: minimizing discomfort by educating the woman about labor, preparing her with breathing techniques for contractions, and encouraging relaxation.
Discomfort during labor is minimized if the woman is aware of what is happening and prepared with breathing techniques.
Pain perception can be altered by distraction techniques or the gating control theory of pain perception.

The Bradley Method (Partner-Coached)

Originated by Robert Bradley, this method views childbirth as a natural process.
It emphasizes the role of the woman's partner throughout pregnancy, labor, and the early newborn period.
Mothers are encouraged to trust their bodies and focus on diet and exercise throughout pregnancy.
It teaches couples to manage labor through deep breathing and the support of a partner or labor coach.
The Bradley Method is a system of natural labor techniques in which a woman and her coach play an active part.
It's a simple method of increasing self-awareness, teaching a woman how to deal with the stress of labor by tuning in to her own body.
The method encourages mothers to trust their bodies using natural breathing, relaxation, nutrition, exercise, and education.

The Psychosexual Method

Developed by Sheila Kitzinger in England during the 1950s.
This method stresses that pregnancy, labor, and birth, and the early newborn period are important points in a woman's life cycle.
It includes a program of conscious relaxation and levels of progressive breathing encouraging the woman to "flow with" rather than struggle against contractions.

Conscious Relaxation

Deliberately relaxing one set of muscles, then another, until the body is completely relaxed.

Cleansing Breath

Used to start and end each breathing exercise.
Deeply inhaling and exhaling.
Limits the possibility of hyper- and hypoventilation.
If respiratory alkalosis develops, breathing into a paper bag to re-breathe CO2 is helpful.

Consciously Controlled Breathing

Level 1: Slow, chest breathing. 6-12 breaths per minute. Used for early contractions.
Level 2: Lighter and more rapid than Level 1. Up to 40 breaths per minute. Used for contractions with 4-6 cm cervical dilation.
Level 3: More shallow and rapid breathing. 50-70 breaths per minute. Exhale slightly stronger than inhale to prevent hypoventilation. Keeps tongue tip on the roof of mouth to prevent mucosa drying. Used for transition contractions (8-10 cm cervical dilation).
Level 4 (Pant-Blow): 3-4 quick breaths, followed by a forceful exhale.
Level 5: Very shallow panting. About 60 breaths per minute. Used for strong labor contractions or during the second stage when pushing before full dilatation.

Dick-Read Method

Emphasizes that fear leads to tension, which leads to pain.
A woman achieves relaxation and reduces pain through abdominal breathing during contractions.

Lamaze Method

One of the most prevalent methods in the U.S.
Based on the stimulus-response conditioning that women can use controlled breathing to reduce pain during labor.
Originally known as psychoprophylactic labor method.
Focuses on preventing labor pains through the use of the mind.
Lamaze is a method of childbirth developed by French obstetrician Ferdinand Lamaze.
The core of Lamaze is on the utilization of controlled breathing to cope with pain.
Lamaze International aims to increase women's confidence in their ability to give birth.

Six Major Concepts for Effective Labor

Labor should begin naturally, not artificially induced.
Women should move freely throughout labor, not be confined to bed.
Women should receive continuous support during labor.
No routine interventions such as IV fluids are needed.
Women should be allowed to assume a non-supine (upright or side-lying) position for birth.
Mother and baby should be housed together following birth, with unlimited opportunity for breast-feeding.

Effleurage

Light abdominal massage.
An additional technique used to encourage relaxation and displace pain in the Lamaze method.
A woman traces a pattern on her abdomen with her fingertips, serving as a distraction technique.

Focusing or Imagery

Focusing intently on an object (sensate focus).
Examples include photographs of a partner or children, or graphic designs.
The woman concentrates on the object during contractions.
Imagery, such as imagining being in a calm place like a beach.

Theories of Labor Onset & Signs of Labor

Labor is believed to be influenced by a combination of factors originating from the mother and the fetus.
Factors include uterine muscle stretching (releasing prostaglandins), pressure on the cervix (stimulating oxytocin release), oxytocin stimulation, hormonal changes (estrogen/progesterone ratio changes) placental age, and fetal cortisol levels.
Prostaglandin theory: Fetal membranes increase prostaglandin levels in the latter part of pregnancy
A decrease in progesterone also elevates prostaglandin levels in return causing uterine contraction initiating labor.

Preliminary Signs of Labour

Lightening: The fetal presenting part descends into the pelvis, providing relief from the pressure on the diaphragm and shortness of breath. It is usually noticeable 10-14 days before labor begins in primiparas, and on or even after onset in multiparas
Increase in Activity Level: An increase in epinephrine, triggered by decreased progesterone, often results in a surge of energy.
Braxton Hicks Contractions: Irregular, intermittent contractions that may be mistaken for true labor in the days or weeks before.
Ripening of the Cervix: An integral sign that can only be seen during a pelvic examination. The cervix softens, losing its normal consistency for a more flexible, doughy feel similar to an earlobe to a "butter soft" feeling

Signs of True Labor

Uterine Contractions: Productive, involuntary contractions that increase in intensity, frequency, and duration.
Show: The expulsion of the mucus plug that was present during pregnancy. A slight, pinkish tinge is indicative of a "bloody show."
Rupture of Membranes: The breaking of the amniotic sac, resulting in the release of amniotic fluid from the vagina.

Differentiation Between True and False Labor Contractions

False Contractions: Irregular, remain localized to the abdomen and groin, often resolve with ambulation or sleep and do not increase in duration, frequency or intensity. Do not achieve cervical dilation.
True Contractions: Regular, sweep around the abdomen in waves, persist regardless of activity level, increase in duration, frequency, and intensity, and achieve cervical dilation

Components of Labor

Labor depends on four concepts: passage (woman's pelvis), passenger (fetus), powers (uterine factors), and psyche (woman's view)

The Pelvic Inlet and Outlet

Pelvic adequacy is determined by the diagonal conjugate (anteroposterior diameter of the inlet) and the transverse diameter of the outlet.
At the pelvic inlet, the narrowest dimension is the anteroposterior diameter (12.5 cm).
At the pelvic outlet, the narrowest dimension is the transverse diameter (11 cm).
If there's a disproportion between the fetus and the pelvis, the pelvis is the structure at fault.

The Passenger (Fetus)

The fetus (passenger), specifically the head, is the widest part of the fetus presenting at birth.
The shape of the fetal skull (bones, fontanelles, sutures) and its alignment with the pelvis are crucial.
The fetal skull bones are structured to allow for molding during childbirth.

Fetal Skull Structure

The fetal skull comprises 8 bones : 4 Superior (frontal - two fused bones, 2 parietal, and occipital). The other 4 skull bones are the temporal bones, ethmoid bone, and sphenoid bone, all found at the base of the cranium are usually not considered presenting parts during birth.
Sutures are the interspaces which allow for molding or diminishing of the skull during birth.
Fontanelles are membrane-covered spaces at the junction of the main suture lines allowing to assess the fetal head position for a favorable birth position: Anterior fontanelle (bregma) and Posterior fontanelle (lambda).

Fetal Presentation and Position

Attitude: The degree of flexion the fetus assumes; complete flexion is preferable.
Engagement: The settling of the presenting part into the pelvis, assessed via vaginal and cervical exam. A presenting part that is not engaged is "floating". A presenting part that is descending but not engaged is "dipping".
Station: The relationship of the presenting part to the level of the ischial spines in the pelvis. Measured as negative above, zero at, and positive below the spines.
Lie: The relationship between the cephalic-caudal axis of the fetus and the woman's body, usually longitudinal.

Types of Fetal Presentation (continued)

Cephalic Presentation: The fetal head presents first. This is the most common type.
- Vertex (full flexion): Parietal bones or vertex is the presenting part.
- Brow (moderate flexion): Brow presents.
- Face (poor flexion): Face presents.
- Menton (Poor flexion): Chin presents.
Breech presentation: The buttocks or feet present first.
Position: The relationship of the landmark on the presenting part to a specific side or quadrant (R, L, A, P, T) of the mother's pelvis. Example: LOA (left occipitoanterior)

Mechanisms of Labor

The components of the mechanism of labor include engagement, descent, flexion, internal rotation, extension, and external rotation, in the process of pushing the baby through the birth canal.

Stages of Labor

Stage 1 (Latent Phase): Characterized by slow cervical dilation (0-3 cm) during early labor with contractions every 15-30 minutes.
- Implementation: Encourage participation, monitor progress, provide comfort measures (fluids, positioning, etc.) and monitor maternal V/S and FHR
Stage 1 (Active Phase): In active labor, cervical dilation speeds up (4-7cm). Contractions increase to every 2-3 minutes.
- Implementation: Maintain breathing patterns, provide quiet environment, promote comfort.
Stage 1 (Transition Phase): Cervical dilation rapidly increases (8-10 cm) with strong contractions and women may experience intense discomfort, feeling of loss of control, and urge to push.
- Implementation: Encourage rest, monitor progress, offer support.
Stage 2: Begins when cervix is fully dilated to birth of infant with regular, strong contractions, sensation of pushing and crowning of the fetal head. Duration of approximately 1 hour.
- Implementation: Frequent assessment of maternal V/S and FHR. Support during pushing efforts, perineum.
Stage 3: In stage 3, placenta separates from uterine wall, and is expelled from the body.
- Care after placental delivery: Inspection and completeness of cotyledons.
- Nursing Management: Monitor and manage maternal responses, address danger signs.
Stage 4 (Recovery): The first 1-2 hours postpartum; focusing on maintaining comfort, nursing management focuses on maternal and infant well being, maintaining adequate fluid intake, and observing for any complications.
- Nursing Management: Observe perineum and vaginal discharge. Maintain comfort measures (warmth, nourishment, rest). Monitor vital signs.

Fetal Monitoring

Evaluate FHR during early and active labor, every 1-2 hours for low-risk. More frequently during active labor, every 30 minutes.
Normal FHR is 120-160 BPM; tachycardia (over 160 BPM) or bradycardia (below 120 BPM, especially less than 100).
Interpreting monitoring data (tachycardia and bradycardia, normal patterns)

Types of Decelerations in Fetal Heart Rate Monitoring

Early Decelerations: Periodic slowing of FHR synchronized with contractions, usually benign and indicate head compression.
Late Decelerations: Repetive, non-remediable slowings of FHR toward the end of contractions, may reflect placental insufficiency, more concern, and intervention is typically needed
Variable Decelerations: Sudden, transient decreases in FHR that are unpredictable in their onset, duration, and depth, usually due to cord compression.

Danger Signs of Labor

Fetal: High or low fetal heart rate, meconium staining, hyperactivity, and fetal acidosis
Maternal: Rising or falling blood pressure, abnormal pulse, inadequate or prolonged contractions, pathologic retraction ring, abnormal lower abdominal contour, increasing apprehension.

General Nursing Care during Intrapartum

Assessment: Includes maternal information such as patient demographics, obstetric history, allergy information, urine specimen, time of last meal and onset of contractions, and assessing for bloody show.
Positioning: Positioning of mother frequently, for comfort and for assessing fetal position during labor.
Monitoring: Monitoring FHR and maternal V/S, and providing nursing interventions and comfort measures.
Implementations: Nursing implementation should focus on maternal comfort measures (breathing, temperature, position regulation, reassurance, hydration) as well as assessments of physiological and psychological aspects of labor.

Comfort Measures

Perineal care and sanitary napkin application to maintain hygiene.
Positioning patient flat on bed for dizziness prevention.
Providing sponge bath or changing soiled clothing.
Initial nourishment and encouragement for rest.

Episiotomy

A surgical incision of the perineum to prevent tearing during birth.
Midline episiotomy: Advantages include easier healing, minimal blood loss, and reduced postpartum discomfort.
Mediolateral episiotomy: If tearing occurs beyond the incision, it will be away from rectum, reducing risk of anal tears or complications.

Cutting & Clamping The Cord

Appropriate method for cutting and clamping fetal umbilical cord.

Maternal responses to Labor

Physiological effects include increased blood pressure and cardiac output, increase in respirations, elevated body temperature, urinary changes (decreased output increased specific gravity), decrease in gastric emptying time, and increased sensations of pain or possible fright and apprehension.

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Description

Test your knowledge on the key concepts of the Lamaze method and the physiological aspects of labor. This quiz covers topics such as effleurage, breathing techniques, and hormonal influence during childbirth. Prepare yourself by understanding the processes that facilitate labor and delivery.