Maternal Health Quiz: Labor and Delivery

Pain Management During Labor

• Methods for pain management during labor are based on three premises:
  • Discomfort can be minimized if a woman understands the labor process and uses breathing techniques during contractions.
  • Discomfort can be minimized if the woman's abdomen is relaxed, allowing the uterus to rise freely against the abdominal wall during contractions.
  • Pain perception can be altered by distraction techniques or by the gating control theory of pain perception.

The Bradley (Partner-Coached) Method

• Originated by Robert Bradley
• Childbirth is a natural process
• Emphasizes the crucial role of the partner during pregnancy, labor, and the early newborn period.
• Mothers are encouraged to trust their bodies and focus on diet and exercise throughout pregnancy
• Teaches couples to manage labor through deep breathing and partner/labor coach support.
• Simple method of self-awareness.
• Encourages mothers to trust their bodies using natural breathing, relaxation, nutrition, exercise, and education.

The Psychosexual Method

• Developed by Sheila Kitzinger in the 1950s
• Stresses pregnancy, labor, and birth as pivotal points in a woman's life cycle.
• Includes a conscious relaxation program and progressive breathing techniques to help women "flow with" contractions rather than struggle against them.
• Techniques include:
  • Deliberate relaxation of one set of muscles, then another, until the entire body is relaxed.
  • Cleansing breath exercises, which involve deep inhalations and exhalations.
  • Different levels of consciously controlled breathing based on the stage of labor and cervical dilation.

The Dick-Read Method

• Based on the belief that fear leads to tension, which leads to pain.
• Aims to reduce pain by focusing on abdominal breathing during contractions, stressing relaxation to reduce fear and tension.

The Lamaze Method

• One of the most common methods taught in the U.S.
• Based on stimulus-response conditioning.
• Teaches women to use controlled breathing to reduce labor pain.
• Originally termed psychoprophylactic labor method
• Focuses on mind use to prevent labor pains.
• Developed by a French obstetrician, Ferdinand Lamaze.
• Centers on utilizing controlled breathing for coping with pain.
• Goal is to increase women's confidence in birthing abilities.

6 Major Concepts in Labor

• Labor should begin naturally, not be artificially induced.
• Women should move freely during 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, and breast-feeding should have unlimited opportunity.

Effleurage

• Light abdominal massage
• Encourages relaxation, displacing pain
• Used in the Lamaze method.
• A woman traces a pattern on her abdomen using her fingertips as a distraction technique.

Focusing or Imagery

• Concentrating intensely on an external object or mental image.
  • Example: A partner's photograph or a calming image, like a beach.
• Used as a distraction technique during 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.

Factors influencing Labor Onset

• Uterine muscle stretching, resulting in prostaglandin release, promoting cervical ripening and uterine contractions
• Pressure on the cervix, stimulating oxytocin release from the posterior pituitary, initiating contractions.
• Oxytocin stimulation, working with prostaglandins to initiate contractions.
• Change in the ratio of estrogen to progesterone (progesterone deprivation), increasing estrogen relative to progesterone stimulates uterine contractions.
• Placental age triggering contractions at a set point.
• Rising fetal cortisol levels, reducing progesterone formation and increasing prostaglandin formation.
• Prostaglandin theory, where in late pregnancy, fetal membranes and uterine decidua increase prostaglandin levels.

Preliminary Signs of Labor

• Lightening: The fetal presenting part drops into the pelvis. This may happen 10-14 days before labor begins in first-time mothers (primiparas).
• Increase in activity level: This is related to an increase in epinephrine, partially due to a decrease in progesterone.
• Braxton Hicks contractions: These are typically stronger and more frequent in the week or days before labor.
• Ripening of the cervix: Seen only on pelvic examination; the cervix feels progressively softer, similar to an earlobe initially, then to soft or "butter-soft" consistency at term.

Signs of True Labor

• Uterine contractions: These are involuntary, typically intense, and without warning.
• Show: The expulsion of the mucus plug that sealed the cervix during pregnancy. The blood-mixed mucus is often pink in color.
• Rupture of membranes: The breaking of the amniotic sac, either with a sudden gush or a slow seeping of fluid from the vagina.

Differentiation Between True and False Labor Contractions

• False Contractions: Irregular, confined to the abdomen and groin, often stop with ambulation or sleep, no change in frequency, duration, or intensity, don't cause cervical dilation
• True Contractions: Become regular and predictable in frequency and intensity, start in the back and move around the abdomen, continue regardless of activity, increase in intensity and duration, and cause cervical dilation

Components of Labor

• Passage: The route the fetus takes from the uterus through the cervix and vagina to the external perineum.
• Passenger: The fetus and the presenting part (usually the head).
• Powers: Uterine contractions, which cause cervical dilation and expulsion.
• Psyche: The woman's psychological state during labor and birth.

Pelvic Measurements

• Diagonal Conjugate: The anteroposterior diameter of the pelvic inlet.
• Transverse Diameter: The transverse diameter of the pelvic outlet.

Fetal Skull Structure & Fontanelles

• The fetal skull has 8 bones, including 4 superior bones (frontal, two parietal, and occipital)
• Fontanelles are membrane-covered spaces at suture lines. The anterior fontanelle (bregma) is diamond-shaped and lies at the coronal and sagittal suture junctions.
• Posterior fontanelle (lies at the junction of the lambdoid and sagittal sutures) is triangular. Important because the compression of fontanelle spaces assists in molding the fetal head during birth

Fetal Lie, Presentation & Position

• Fetal lie: The relationship between the long axis of the fetus and the long axis of the mother's body. Longitudinal is most frequent (99%).
• Fetal presentation: The body part of the fetus that will first enter the birth canal (e.g., head [cephalic], buttocks [breech]). Cephalic Presentation is most common.
• Fetal position: Defines the relationship of a fetal landmark to the front or back of a mother's pelvis, right or left.

Mechanisms of Labor

• Engagement: Fetal presenting part is at the level of the ischial spines.
• Descent: The fetus moves downward through the birth canal.
• Flexion: Fetal head flexes to allow the smallest diameter to enter the pelvis.
• Internal Rotation: Fetal head rotates to align with the mother's pelvis.
• Extension: Fetal head extends as it emerges from the vaginal opening.
• External Rotation: Fetal head rotates to align with the mother's pelvis.
• Expulsion: The entire baby is expelled.

Stages of Labor

• Stage 1: Begins with regular contractions and ends with cervical dilation. Divided into latent, active, and transition phases.
• Stage 2: Begins with complete cervical dilation (10 cm) and ends with the birth of the baby.
• Stage 3: Begins after the birth of the baby and ends with the delivery of the placenta.
• Stage 4: The first 2 hours after the placenta is delivered. Focuses on monitoring the mother and assessing for complications. This focuses on monitoring the mother's recovery and well-being.

Episiotomy

• A surgical incision made in the perineum to prevent or reduce tearing during delivery. Two types of episiotomies exist: midline and mediolateral.

Cutting & Clamping the Cord

• Proper techniques for cutting and clamping fetal umbilical cords.

Maternal Responses to Labor

• Physiologic effects of labor on women's systems (cardiovascular, hematopoietic, respiratory, temperature regulation, fluid balance, urinary, musculoskeletal, gastrointestinal, neurologic).

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 contractions, pathologic retraction ring, abnormal lower abdominal contour, increasing apprehension

Nursing Care During Labor

• Information on nursing interventions for each phase of labor, including comfort measures, monitoring, and managing potential complications.

Test your knowledge on labor and delivery with this quiz focused on maternal health concepts. From fetal presentations to uterine contractions, explore key aspects of childbirth. This quiz is essential for anyone studying obstetrics or preparing for childbirth education.