Midwifery Management First Stage of Labor

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Questions and Answers

What items should be verified in the woman's history during the initial evaluation?

Fitness level before pregnancy

Drug allergies and previous blood transfusions (correct)

Family history of diabetes

Home environment and support system

What is the significance of documenting an interim history during the evaluation of a woman in labor?

To create a treatment plan that includes medication preferences

To identify any changes in health status since the last visit (correct)

To assess the travel history before labor

To summarize the woman's dietary habits during pregnancy

What laboratory investigations are crucial for assessing a woman's health during labor?

Vitamin D and calcium levels

Blood pressure and pulse rate

Blood type, Rh status, and anemia (correct)

Cholesterol and triglyceride levels

At what cervical dilation does active labor typically initiate for many women?

6 cm Signup and view all the answers

Why is a comprehensive physical examination necessary?

When no prenatal records are available or care was inadequate Signup and view all the answers

What could be a consequence of inadequate prenatal care?

Unexpected adverse obstetric complications Signup and view all the answers

How often should cervical examinations be spaced when determining labor status?

2 to 4 hours apart Signup and view all the answers

What is a primary purpose of a thorough initial evaluation of laboring women?

To identify actual and potential problems Signup and view all the answers

What is an indicator that a woman may be in active labor?

Regular, painful contractions and complete effacement Signup and view all the answers

Continuously supporting a laboring woman can lead to which of the following outcomes?

Less use of pain medication Signup and view all the answers

Why is it advised for women to assume upright positions during labor?

It shortens labor durations by approximately 1 hour Signup and view all the answers

What is a benefit of lateral positions during labor?

Reduction of aortic/vena cava compression Signup and view all the answers

In what situations might ambulation or upright positions be contraindicated?

Upon rupture of membranes with unengaged fetal head Signup and view all the answers

What should happen to women with severe medical conditions during labor?

Their activity will be restricted due to instability Signup and view all the answers

How does maternal position during labor impact uterine contractions?

Lateral positions improve contraction coordination Signup and view all the answers

What is a common outcome for women who maintain a recumbent position during labor?

They require more epidurals Signup and view all the answers

What factors may influence a woman's comfort and labor progression if she has physical mobility disabilities?

Modifications to her labor environment Signup and view all the answers

Why should women be encouraged to maintain fluid intake during labor?

To maintain hydration, as it can shorten the first stage of labor Signup and view all the answers

What is a common rationale for withholding food and fluids during labor?

To prevent gastric content aspiration during anesthesia Signup and view all the answers

What is a risk associated with artificial rupture of membranes (AROM)?

Cord compression with fetal heart rate decelerations Signup and view all the answers

What is the significance of establishing intravenous access prior to epidural anesthesia?

To administer isotonic fluids to prevent hypotension Signup and view all the answers

What effect does amniotomy have when used with oxytocin for induction?

It statistically decreases labor duration but may not be clinically relevant Signup and view all the answers

What outcome is not significantly influenced by the type of fluid intake during labor?

Maternal weight gain Signup and view all the answers

Which condition could trigger discomfort for women with a history of abuse during labor?

Providers standing over her in the lithotomy position Signup and view all the answers

What is the focus of continuing evaluation during labor?

Maternal well-being, fetal well-being, and labor progress Signup and view all the answers

What should be confirmed prior to performing an amniotomy?

The fetal head is engaged in the pelvis Signup and view all the answers

How often should maternal vital signs be checked during the first stage of labor for a woman without epidural anesthesia?

Every hour Signup and view all the answers

What is the first step in addressing bladder distension during labor?

Facilitating spontaneous voiding Signup and view all the answers

What procedure should be followed when performing an amniotomy to prevent complications?

Ensure the fetal head is well applied to the cervix Signup and view all the answers

What is a potential risk if the fetal head is not properly engaged prior to performing an amniotomy?

Prolapsed umbilical cord Signup and view all the answers

If a woman's temperature is abnormal during labor, how often should it be checked?

Every 1 to 2 hours Signup and view all the answers

Which method is suggested for encouraging a woman in labor to void her bladder?

Having her listen to the sound of running water Signup and view all the answers

Study Notes

Midwifery Management During the First Stage of Labor

Midwifery management during the first stage of labor focuses on the initial evaluation of the woman and the fetus.
Initial evaluation includes review of medical history, physical assessment, laboratory investigations, current physical well-being of the woman and fetus, woman's medical and obstetric history, social situation, and expectations.
A comprehensive approach is necessary to identify actual and potential problems and create a mutually agreeable and appropriate plan of care. This approach must include history, physical examination, and laboratory investigation.
Women who haven't received adequate prenatal care are at increased risk of adverse obstetric complications like preterm birth, stillbirth, and infants who are too large or small for their gestational age.
Critical history items should be double-checked with the woman to confirm the existence of drug allergies, blood transfusions or reactions, and major obstetric or medical complications during the pregnancy.
The prenatal record reviewed should be included in the intrapartum medical record.
An interim history includes any change in health status since the last documented visit, chief complaint, history of present illness, and a brief review of relevant systems. This completes the history database and guides the physical examination.

History

History includes elements like the woman's age and parity (number of pregnancies)
Estimated date of delivery and weeks of gestational age
Complications of the current pregnancy (e.g., Group B Streptococcus status)
Major complications of previous pregnancies (prenatal, intrapartum, and postpartum periods)
Previous labor experience (including duration and mode of delivery)
Size of previous babies
Fetal movement pattern
Vaginal bleeding
Status of membranes
Time of onset of contractions (character, frequency, duration, intensity)
Aggravating and relieving factors of contractions
Last oral intake

Physical Examination

A comprehensive physical examination is indicated when a woman has no prenatal records available or has received inadequate prenatal care.
Components include vital signs (blood pressure, temperature, pulse, respirations), auscultation of heart and lungs, abdominal palpation (to determine contraction pattern, fetal lie, presentation, position, and engagement), abdominal palpation (to determine estimated fetal weight and fundal height), visual inspection of abdominal scars, assessment of peripheral or facial edema, pelvic and cervical exam.
Cervical effacement and dilation, cervix position, station of presenting part, fetal lie, presentation, position, tone and elasticity of the vagina and perineum, and confirmation of membrane status.
Visual inspection of the perineum and assessment of fetal heart rate.

Pelvic and Cervical Examination

Progressive cervical effacement and dilatation is a sign of true labor.
Cervical position (anterior or posterior) affects labor readiness.
Fetal station indicates fetal descent and pelvic adequacy.
Molding or caput succedaneum indicates fetal adaptation to the pelvis.
Digital examination findings enhance abdominal assessments of fetal lie, presentation, and position.
Palpation of the vagina and perineum can help assess risk of perineal lacerations.
Membrane status and examination of the perineum for lesions or discharge are considered.
Assessment of fetal heart rate is important to assess fetal well-being.

Optional or Supplemental Examinations

Measurement of maternal weight is relevant when compared to pre-pregnancy weight or previous prenatal visits.
Clinical pelvimetry supports clinical judgment when estimating pelvic adequacy.
Evaluation of reflexes (Hyperreflexia and clonus) and determination of clonus presence are signs of severe preeclampsia/eclampsia.
Speculum examination facilitates visualization of the cervix and vaginal vault, confirmation of membrane rupture, collection of specimens, and estimate of cervical dilation and effacement.

Laboratory Investigation

Identification of the woman's blood type, Rh status, and presence of anemias.
Glucose tolerance testing
Perinatal infections (e.g., hepatitis B infection or carrier status, HIV status).

Confirmation of Labor Status

Active labor begins when cervical dilatation reaches 6 cm or more.
Labor status is determined based on at least two adequately spaced cervical examinations (e.g., 2-4 hours apart.)
Regular, painful contractions and complete or near-complete effacement can indicate active labor, even if dilation is only 4 cm or 5 cm if immediately preceded by cervical change.

Components of Midwifery Care for Laboring Women

Labor support and pain management.
Maternal position and level of activity.
Hydration and nutrition.
Intravenous access.
Membrane management
Fetal Heart Rate Monitoring
Uterine Contraction Monitoring

Continuing Evaluation During Labor

Continuing evaluation focuses on maternal well-being, fetal well-being, and labor progress.

Maternal Well-being

General maternal condition includes fatigue, physical depletion, behavior, pain perception, and ability to cope.
Maternal vital signs (blood pressure, pulse, respirations, temperature) are monitored for specific schedules related to labor and membrane rupture.

Urinary Output

Women in labor should empty their bladder every two hours during the active phase.
Methods to encourage voiding are spontaneous voiding, ambulation to toilet, or common methods (listening to water, warm water on perineum, light suprapubic pressure).
Catheterization might be considered if above methods are unsuccessful.

Bladder Distension

Bladder distension can occur, especially with epidurals.
Receiving a fluid bolus prior to an epidural increases the likelihood of bladder distension.
Once the epidural is active women are unable to sense the urge to urinate and have reduced muscle control to void.
An intermittent or indwelling catheter may be required to drain the bladder to minimize risk of infection or retention.

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Description

This quiz focuses on midwifery management during the first stage of labor, emphasizing the importance of initial evaluations for both the mother and the fetus. Key areas include medical history review, physical assessments, and understanding of potential complications stemming from inadequate prenatal care. Test your knowledge on creating effective care plans based on comprehensive evaluations.