Stages of Labor and Childbirth
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Stages of Labor and Childbirth

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Questions and Answers

What is the McRobert Maneuver used for in labor and delivery?

  • Laying flat on back, pushing knees back, and applying pressure to the abdomen to facilitate shoulder fitting and baby delivery (correct)
  • Performing Leopold maneuvers to determine fetal positioning
  • Feeling for the fetal head and flexed areas to assess engagement
  • Adjusting the angle of the pelvis to aid in fetal descent

    • What is the characteristic feature of hypertonic uterine dysfunction?

  • No progression in cervical dilation in 2 hours
  • Uterus never fully relaxes between contractions (correct)
  • Contractions quality decreases and fails to dilate & efface cervix
  • Contractions are not as effective or coordinated

    • In which condition does labor progress too quickly, completing in less than 3 hours?

  • Precipitated labor (correct)
  • Arrest disorder
  • Dystocia
  • Hypotonic uterine dysfunction

    • What is the main concern associated with meconium-stained amniotic fluid?

    <p>Decreased oxygen to the baby</p> Signup and view all the answers

    What is the primary purpose of performing Leopold maneuvers during labor and delivery?

    <p>To determine the presenting part of the fetus</p> Signup and view all the answers

    What does the term 'dystocia' refer to in the context of labor and delivery?

    <p>Problems with power during labor</p> Signup and view all the answers

    Which condition is characterized by no progression in cervical dilation in 2 hours despite initial progress?

    <p>Arrest disorder</p> Signup and view all the answers

    What is the primary risk associated with hypotonic uterine dysfunction during labor?

    <p>Decreased contraction strength and duration</p> Signup and view all the answers

    'Meconium aspiration syndrome' occurs when a baby:

    <p>Breathes in meconium during delivery</p> Signup and view all the answers

    During which stage of labor does the maternal urge to push occur?

    <p>Second stage</p> Signup and view all the answers

    Which obstetric emergency is characterized by sudden painless bleeding?

    <p>Placenta previa</p> Signup and view all the answers

    What type of pain management in labor may increase the second stage of labor?

    <p>Epidural</p> Signup and view all the answers

    Which type of analgesia/anesthesia may cause hypotension and fetal distress as complications?

    <p>Combined spinal/ epidural</p> Signup and view all the answers

    What is the primary focus during the fourth stage of labor?

    <p>Monitoring for hemorrhage</p> Signup and view all the answers

    What is the most common symptom of placental abruption?

    <p>Vaginal bleeding</p> Signup and view all the answers

    Which factor affecting the labor process relates to the fetal and placental position?

    <p>Passenger (fetus and placenta)</p> Signup and view all the answers

    Which type of analgesia/anesthesia may cause CNS depression in both mother and newborn?

    <p>Benzodiazepines</p> Signup and view all the answers

    Which obstetric emergency is characterized by tearing of the uterus at the site of a previous scar into the abdominal cavity?

    <p>Uterine rupture</p> Signup and view all the answers

    What is the most likely consequence of umbilical cord prolapse in cases of premature birth?

    <p>Fetal bradycardia</p> Signup and view all the answers

    What is the typical and most favorable fetal attitude during labor?

    <p>Flexed position with rounded back</p> Signup and view all the answers

    Which fetal lie is the only possible lie for vaginal delivery?

    <p>Longitudinal</p> Signup and view all the answers

    What is considered engaged when the fetus is at 0 station?

    <p>At ischial spine</p> Signup and view all the answers

    Which of the following is characteristic of true labor?

    <p>Vaginal pressure felt with contractions</p> Signup and view all the answers

    What information can a vaginal exam provide about labor progress?

    <p>Dilation, effacement, and station</p> Signup and view all the answers

    In Stage 1 labor, which fetal heart rate pattern is predictive of normal acid-base balance?

    <p>Baseline FHR 110-160 with moderate baseline variability</p> Signup and view all the answers

    Which category of fetal heart rate tracings requires interventions such as notifying the MD and increasing IV fluids?

    <p>Category 3</p> Signup and view all the answers

    What intervention is required for fetal tachycardia in Stage 2 labor?

    <ul> <li>Baseline FHR &gt;160 for &gt;10 minutes</li> </ul> Signup and view all the answers

    What is a characteristic maternal physiological response to labor?

    <ul> <li>Increased basal metabolic rate</li> </ul> Signup and view all the answers

    What physiologic response is characteristic of the fetus during labor?

    <ul> <li>Periodic FHR decelerations</li> </ul> Signup and view all the answers

    What is the function of Braxton Hicks contractions?

    <p>To help move the cervix from a posterior position to an anterior position</p> Signup and view all the answers

    What is the significance of the 'bloody show' in the premonitory signs of labor?

    <p>It is a sign that the body is preparing for labor</p> Signup and view all the answers

    What occurs when the fetal presenting part descends into the pelvis?

    <p>The shape of the abdomen changes</p> Signup and view all the answers

    What is the purpose of nesting in the premonitory signs of labor?

    <p>To prepare for the arrival of the baby</p> Signup and view all the answers

    What is the role of intra-abdominal pressure during pushing in labor?

    <p>To coordinate pushing</p> Signup and view all the answers

    What is effacement in relation to labor?

    <p>The thickness of the cervix</p> Signup and view all the answers

    What are the functions of contractions during labor?

    <p>Voluntary (actively pushing) &amp; involuntary (contractions)</p> Signup and view all the answers

    What does lightening refer to in relation to labor?

    <p>The fetal presenting part descending into the pelvis</p> Signup and view all the answers

    'Platypelloid' is associated with which type of pelvis?

    <p>Pelvic shapes - gynecoid= female pelvis</p> Signup and view all the answers

    What is the primary complication associated with precipitated labor?

    <p>Maternal injury</p> Signup and view all the answers

    What is the purpose of performing Leopold maneuvers during labor and delivery?

    <p>To identify the presenting part of the fetus</p> Signup and view all the answers

    What is the characteristic feature of hypertonic uterine dysfunction?

    <p>Uterus failing to fully relax</p> Signup and view all the answers

    What is the McRobert Maneuver used for in labor and delivery?

    <p>Assisting in fetal head engagement</p> Signup and view all the answers

    What results from meconium-stained amniotic fluid?

    <p>Potential meconium aspiration syndrome for the baby</p> Signup and view all the answers

    What is the primary risk associated with hypotonic uterine dysfunction during labor?

    <p>Fetal distress</p> Signup and view all the answers

    What fetal lie is determined through Leopold Maneuver 2?

    <p>Longitudinal lie</p> Signup and view all the answers

    What is characteristic of hypotonic uterine dysfunction?

    <p>Failure to fully relax between contractions</p> Signup and view all the answers

    What is the primary concern associated with IUGR (Intrauterine growth restriction) in relation to labor?

    <p>Fetal malpresentation</p> Signup and view all the answers

    What is the primary consequence of cord compression during labor?

    <p>Fetal hypoxia and distress</p> Signup and view all the answers

    Which condition is characterized by no progression in cervical dilation in 2 hours despite initial progress?

    <p>Arrest disorder</p> Signup and view all the answers

    What is the primary risk associated with hypotonic uterine dysfunction during labor?

    <p>Postpartum hemorrhage</p> Signup and view all the answers

    What is the purpose of performing Leopold maneuvers during labor and delivery?

    <p>Determining the fetal presentation and position</p> Signup and view all the answers

    What is the primary consequence of hypertonic uterine dysfunction during labor?

    <p>Excessive tone and ineffective contractions</p> Signup and view all the answers

    What is the primary risk associated with precipitated labor?

    <p>Maternal injury due to hard contractions</p> Signup and view all the answers

    What is the purpose of the McRobert Maneuver in labor and delivery?

    <p>Laying flat on the back and pushing knees back to make space for the baby to come out</p> Signup and view all the answers

    Study Notes

    Pelvic Shapes and Functions

    • Pelvic shapes: gynecoid (female pelvis), platypelloid, anthropoid, android (male pelvis)
    • Functions of contractions:
      • Voluntary (actively pushing) and involuntary (use of intra-abdominal pressure)
      • Rhythmic, intermittent, can be altered with deflation, pain medication, illness, anxiety
    • Effacement (softness of the cervix): 2cm thick cervix = 0% effaced, 1cm = 50% effaced, paper thin = 100% effaced

    Premonitory Signs of Labor

    • Cervical changes: softening of the cervix and possible dilation, effacement and dilation only possible once the cervix is soft
    • Lightening: fetal presenting part descends into the pelvis, shape of abdomen changes, baby "dropped"
    • Nesting: extra energy, typically 24-48 hours before labor, focused on getting ready for baby
    • Bloody show: mucous plug expelled due to increased pressure and softening of the cervix, prevents bacteria from coming in
    • Braxton Hicks: becomes stronger and more frequent, helps move the cervix from a posterior position to an anterior position, improves with walking, change in position, water, rest, voiding, and eating
    • SROM: prelabor rupture of membranes, water breaks prior to onset of labor, must go to the hospital, note color, odor, amount, and time

    Fetal Attitude, Lie, and Position

    • Fetal attitude: amount of flexion, flexed is the typical and most favorable, want all joints flexed with rounded back, chin on chest, thighs on abdomen, legs flexed at the knees
    • Fetal lie: relationship of the fetal spine to the maternal spine, longitudinal, only possible lie for vaginal delivery
    • Fetal position: presenting part of the fetus to a designated point of the maternal pelvis, identify the presenting part, want occipital anterior position
    • Fetal station: relationship of the presenting part with the maternal ischial spines, considered engaged when fetus is at 0 station, floating means the presenting part is above the pelvic inlet and is freely movable

    True vs. False Labor

    • True labor: regular, becomes closer together, usually 4-6 minutes apart, lasts 30-60 seconds, becomes stronger with time, vaginal pressure felt, starts in the back and radiates around toward the front of the abdomen
    • False labor: irregular, not occurring close together, frequently weak, not getting stronger with time, usually felt in the front of the abdomen, contractions may stop or slow down with walking or making a position change

    Vaginal Exams and Labor Progress

    • Vaginal exams: way to assess labor progress, tells you dilation, effacement, station, presentation, position, attitude, and membrane status
    • Dilation, effacement, station: measurements of labor progress

    Labor Management

    • Category 1: normal, predictive of normal acid-base balance, baseline FHR 110-160, moderate baseline variability, present or absent accelerations, present or absent decelerations, no late or variable decelerations, safe to monitor fetus intermittently, requires no interventions
    • Category 2: intermediate, not predictive of abnormal fetus acid-base status, requires evaluation and continued surveillance, can include fetal tachycardia, fetal bradycardia, absent baseline variability, minimal or marked variability, recurrent late deceleration, and recurrent variable deceleration
    • Category 3: abnormal, predictive of abnormal fetus acid-base status, requires intervention, includes fetal bradycardia, recurrent late decelerations, recurrent variable decelerations, and sinusoidal pattern

    Maternal and Fetal Physiologic Responses to Labor

    • Maternal:
      • Increased heart rate, cardiac output, and blood pressure
      • Increased WBC, respiratory rate, and oxygen consumption
      • Decreased gastric emptying and gastric pH
      • Slight temperature elevation
      • Muscle aches/cramps
      • Increased basal metabolic rate
      • Decreased blood glucose levels
    • Fetal:
      • Periodic FHR accelerations and slight decelerations
      • Decrease in circulation and perfusion
      • Increase in arterial carbon dioxide pressure
      • Decrease in fetal breathing movements
      • Decrease in fetal oxygen pressure and partial pressure of oxygen

    Stages of Labor

    • First stage: longest stage, from 0-10cm, latent, active, and transitional phases
    • Second stage: from complete dilation until birth of baby, latent and active phases
    • Third stage: begins at the birth of the newborn and ends at the separation and birth of the placenta
    • Fourth stage: begins after the delivery of the placenta, focuses on monitoring for hemorrhage, bladder distension, and venous thrombosis

    Obstetric Emergencies

    • Uterine rupture: tearing of the uterus at the site of a previous scar, symptoms include sudden fetal bradycardia, acute and continuous abdominal pain, vaginal bleeding, hematuria, and loss of fetal station
    • Placental abruption: detachment of the placenta, symptoms include partial separation, concealed hemorrhage, and complete separation
    • Placental previa: placenta partially or fully covering the internal os of the cervix, symptoms include sudden painless bleeding
    • Umbilical cord prolapse: umbilical cord goes through the cervix and around the baby's neck, increased risk factors include breech, premature birth, and hydramnios

    Pain Management in Labor

    • Pharmacologic measures:
      • Regional analgesia/anesthesia
      • Pain relief without loss of consciousness
      • Obstetrical referring to loss of pain sensation
      • Epidural, combined spinal/epidural, and local infiltration
    • Systemic analgesia:
      • Given PO, IM, or IV
      • Need to avoid giving before delivery due to CNS depression in the newborn
      • Opioids, antiemetics, and benzodiazepines
    • Nonpharmacologic measures:
      • Continuous labor support
      • Hydrotherapy
      • Ambulation
      • Maternal position changes
      • Attention focusing and imagery
      • Therapeutic touch and massage
      • Gate control theory
      • Application of heat and cold
      • Breathing techniques

    Dystocia

    • Definition: abnormal progression of labor
    • Causes: issues with powers, passenger, and passageway
    • Types: failure to progress, including arrest in dilation and failure to descend

    10 P's Factors Affecting Labor Process

    • Passageway (birth canal)

    • Passenger (fetus and placenta)

    • Powers (contractions)

    • Position (maternal)

    • Psychological response

    • Philosophy (low-tech/high touch)

    • Partners (support)

    • Patience (natural timing)

    • Patient (client-childbirth knowledge base)

    • Pelvic shapes### Labor Stages

    • First stage: from 0-10cm dilation, divided into latent, active, and transitional phases

      • Latent phase: 0-4/6cm dilation, contractions q5-10 minutes, lasting 30-35 seconds, mild
      • Active phase: 6-10cm dilation, contractions q2-5 minutes, lasting 45-60 seconds, moderate
      • Transitional phase: 8-10cm dilation, faster progression, feels everything

    • Second stage: from complete dilation to birth of baby, contractions q2-3 minutes, lasting 60-90 seconds

    • Third stage: from birth of newborn to separation and birth of placenta, placental separation, uterus continues to contract

    • Fourth stage: after delivery of placenta, beginning of postpartum period, monitoring vital signs, lochia, and for hemorrhage, bladder distension, and venous thrombosis

    Obstetric Emergencies

    • Uterine rupture: tearing of uterus at previous scar site, sudden fetal bradycardia, acute and continuous abdominal pain, vaginal bleeding, hematuria, loss of fetal station, hypovolemic shock
    • Placental abruption: placenta detaches, partial or complete separation, concealed or apparent hemorrhage
    • Placenta previa: placenta partially or fully covers internal os of cervix, sudden painless bleeding
    • Umbilical cord prolapse: cord goes through cervix and around baby's neck, increased risk with breech, premature, and hydramnios

    Pain Management

    • Pharmacologic measures: regional analgesia/anesthesia, pain relief without loss of consciousness
    • Epidural: may increase second stage labor, doesn't slow down labor, complications: hypotension, fetal distress, N/V, fever, pruritus, respiratory depression
    • Combined spinal/epidural: rapid onset, limited duration, injection of anesthetic agent in subarachnoid space
    • Local infiltration: pudendal block, provides long-lasting perineal analgesia, pain relief to lower vagina
    • Systemic analgesia: given PO, IM, IV, need to avoid before delivery due to CNS depression in newborn
    • Nonpharmacologic measures: continuous labor support, hydrotherapy, ambulation, maternal position changes, attention focusing and imagery, therapeutic touch and massage, gate control theory, application of heat and cold, breathing techniques

    Signs of Shock

    • Hypotension
    • Increase HR/pulse
    • Rapid respiration
    • Hnh increase
    • Peripheral cyanosis
    • Hypovolemia
    • Altered mental state
    • Decreased urine output
    • Weakness

    Dystocia

    • Definition: abnormal progression of labor, can be an issue with powers, passenger, or passageway
    • Failure to progress: arrest in dilation, failure to descend, baby will be OP, eyes looking up and head facing mother's butt

    Factors Affecting Labor Process

    • Passageway (birth canal): bony pelvis is important, relaxin and estrogen work on soft tissue and ligaments for flexibility
    • Passenger (fetus and placenta)
    • Powers (contractions)
    • Position (maternal)
    • Psychological response
    • Philosophy (low-tech/high touch)
    • Partners (support)
    • Patience (natural timing)
    • Patient (client-childbirth knowledge base)
    • Pelvic shapes: gynecoid, platypelloid, anthropoid, android

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    Description

    Learn about the different stages of labor and childbirth, including the latent, active, transitional, and second stages. Understand the progression, contractions, and experiences associated with each stage.

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