Maternal Physiology Chapter Overview

Labor and Delivery Overview

• Average blood loss at birth ranges from 300-500 ml.
• Blood pressure can increase by 15 mm Hg due to pain response and contractions.
• Epidural anesthesia may lead to hypotension; monitor closely for hemorrhage and hypertensive signs.
• Position mother on her side if receiving epidural and administer intravenous fluids as needed.

Respiratory System

• Increased respiratory rate occurs to accommodate elevated cardiovascular needs.
• Total oxygen demands can double during the second stage of labor.
• Monitor for hyperventilation; if present, offer a paper bag for breathing assistance.

Temperature Regulation

• Maternal temperature may rise during labor.
• Diaphoresis helps cool the body through evaporation.
• Signs of infection should be monitored; cool washcloths can provide comfort.

Fluid Balance

• Insensible water loss increases due to perspiration and deeper respiration.
• Women should be encouraged to hydrate with fluids or ice chips.

Urinary System

• Fetal head pressure reduces bladder tone, hindering the ability to sense fullness.
• Advise mothers to void every two hours to prevent overfilling and maintain bladder tone.

Musculoskeletal System

• Relaxin hormone softens joint cartilage, allowing pelvic joints to open approximately 2 cm for fetal passage.
• Monitor maternal mobility and be cautious of fall risks.

Gastrointestinal System

• GI activity slows during labor, delaying digestion and stomach emptying.
• Some women may experience loose bowel movements as contractions intensify.
• Offer fluids and ice chips to prevent dehydration, but light meals may be permitted.

Stages of Labor and Delivery

• First stage starts with uterine contractions, often prior to arrival at the birthing center.
• Maternal reassurance is crucial; fatigue and pain indicate normal labor progression.

Assessment and Monitoring During First Stage

• Maternal vital signs should be continuously monitored.
• Fetal heart rate (FHR) normal range: 110-160 beats per minute; assessed before, during, and after contractions.
• Monitor uterine contractions through palpation.
• Evaluate cervical dilation and effacement.
• Determine fetal station, presentation, and position via Leopold’s maneuver.
• Assist with pelvic examinations.

Second Stage of Labor (Expulsion)

• Lasts from full dilation and cervical effacement to the birth of the infant.
• Contractions shift to an uncontrollable urge to push, accompanied by heavy perspiration.
• As fetal head descends, crowning occurs, expanding from the size of a dime to a half-dollar.

Transition Phase

• Contractions peak in intensity, occurring every 2-3 minutes and lasting 60-90 seconds, achieving maximum dilation (10 cm).
• If not ruptured, membranes usually break at full dilation.
• Nausea, vomiting, and intense discomfort are common in this phase; feelings of loss of control may arise.

Care Strategies During Labor

• Encourage natural labor initiation without artificial induction.
• Promote mobility rather than bed confinement during labor.
• Ensure continuous support throughout labor.
• Avoid routine intravenous fluid administration unless necessary.
• Support non-supine birthing positions for mothers.
• Facilitate mother-baby bonding and breastfeeding post-birth.
• Favor spontaneous membrane rupture over amniotomy for natural progression.

This quiz covers key concepts of maternal physiology during childbirth. It discusses blood loss at birth, blood pressure changes in response to pain, and the implications of epidural anesthesia. Additionally, it highlights the importance of monitoring respiratory responses and managing potential complications.