The 5 P’s of Labor Psychology

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Questions and Answers

What is the consequence of bearing down before complete cervical dilation?

It aids in fetal descent.

It enhances maternal comfort.

It can cause cervical swelling or edema. (correct)

It stimulates uterine contractions.

In a semi-recumbent position, what angle should the head of the bed be elevated to for effective fetal monitoring?

15 degrees

60 degrees

30 degrees (correct)

45 degrees

What advantage does the upright position offer during labor?

Helps with back pain relief.

Facilitates fetal monitoring.

Improves internal rotation of the fetus.

Reduces pressure on major maternal structures. (correct)

Which position is most beneficial for increasing cardiac output during labor?

Lateral (side-lying) position Signup and view all the answers

Which maternal position is best for helping with back labor?

Hands and knees position Signup and view all the answers

What defines the fetal position in relation to the maternal pelvis?

The relationship of the fetal presenting part to one of the quadrants of the maternal pelvis Signup and view all the answers

Which type of fetal presentation accounts for the majority of births?

Cephalic or vertex presentation Signup and view all the answers

What is the purpose of primary powers during labor?

To facilitate the dilation and effacement of the cervix Signup and view all the answers

What do the terms effacement and dilation specifically refer to in labor?

Effacement is the gradual disappearance of the cervix; dilation is the widening of the cervical os Signup and view all the answers

Which fetal position is most commonly associated with the baby's head facing the front of the mother's pelvis?

Occipito-anterior Signup and view all the answers

What is the primary hormone produced by the placenta at the beginning of pregnancy that has a relaxing effect?

Progesterone Signup and view all the answers

Which of the following best describes Braxton Hicks contractions?

Irregular contractions that stop with a change in activity Signup and view all the answers

What does 'lightening' refer to in the context of labor?

Descent of the fetus into the pelvic inlet Signup and view all the answers

Which factor contributes to cervical ripening during labor?

Inhibition of collagen fiber binding Signup and view all the answers

What is typically considered a sign of true labor rather than preliminary signs?

Progressive dilation and effacement of the cervix Signup and view all the answers

Which type of pelvis is considered the ideal shape for female childbirth?

Gynecoid Signup and view all the answers

Which hormonal effect can both prostaglandin and fetal cortisol lead to during labor?

Stimulation of smooth muscle contractions Signup and view all the answers

What is a common symptom experienced during the 'nesting syndrome' prior to labor?

A burst of energy and organizational activity Signup and view all the answers

What does the term 'fetal lie' refer to in obstetrics?

The relationship of the cephalocaudal axis of the fetus to the mother Signup and view all the answers

What change in the mother's body is likely to occur due to uterine distention?

Heightened urinary frequency Signup and view all the answers

Which fetal attitude is considered the most optimal for delivery?

Flexion Signup and view all the answers

What is the role of sutures in the fetal head during labor?

They facilitate head molding as it passes through the birth canal. Signup and view all the answers

Which pelvic division is primarily used to assess pelvic adequacy?

True pelvis Signup and view all the answers

What defines the 'outlet' of the pelvis during labor?

Distance between the ischial spines Signup and view all the answers

What is the average time for the latent phase of labor in nulliparas?

20 hours Signup and view all the answers

Which pelvic shape resembles a heart and is typically associated with male anatomy?

Android Signup and view all the answers

What does a blood show during pregnancy indicate?

The onset of true labor may occur within 24 to 48 hours. Signup and view all the answers

What is the presentation of a fetus during childbirth?

The first part of the fetus to enter the birth canal Signup and view all the answers

What is a potential risk if the rupture of membranes occurs before fetal engagement?

Umbilical cord prolapse Signup and view all the answers

When is labor considered to be arrested during the active phase?

No cervical change in 4 hours with adequate contractions. Signup and view all the answers

What is the average duration of the active phase for multiparas?

14 hours Signup and view all the answers

Which method is used to artificially rupture the membranes?

Hook and knick Signup and view all the answers

What common symptom may arise with fetal descent during labor?

Pelvic pressure and urge to push Signup and view all the answers

Which phase of labor includes the complete dilation of the cervix?

Stage 2 Signup and view all the answers

What is the antidote for opioids that should be on hand if giving morphine during labor?

Narcan Signup and view all the answers

What percentage of females experience rupture of membranes before labor onset?

12% Signup and view all the answers

Study Notes

The 5 P’s of Labor

Passageway, passenger, powers, position, and psychological response.

Passageway

False pelvis: above the pelvic brim, not indicative of pelvic adequacy.
True pelvis: measurement of pelvic adequacy.
- Pelvic inlet: upper margin of the pubic bone.
- Midpelvis: short anterior wall, long curved posterior wall.
Pelvic shapes:
- Gynecoid: classic female type, circular.
- Android: resembles male pelvis, heart-shaped.
- Anthropoid: vertical oval.
- Platypelloid: horizontal oval.
Inlet: anterior/posterior, from symphysis pubis to spine.
Midplane: symphysis to coccyx, normally the largest plane.
Outlet: transverse diameter, distance between ischial spines.
Other considerations: fetal head, fetal attitude, fetal lie, fetal presentation, fetal position, and placenta.

Passenger: Fetal Head

Composed of bony parts that either hinder or facilitate birth.
Key influential variables:
- Sutures: between skull bones.
- Fontanelles: posterior & anterior.
- Molding: overlapping of sutures.
- Overriding sutures: bones of the fetal skull overlapping.

Passenger: Fetal Lie

Relationship of the fetal cephalocaudal axis to the mother's cephalocaudal axis.
Types:
- Longitudinal lie: fetal cephalocaudal axis is parallel to the mother’s cephalocaudal axis, ideal for birth.
- Transverse lie: fetal cephalocaudal axis is at a right/90-degree angle to the mother’s cephalocaudal axis, not ideal for birth.

Passenger: Fetal Attitude

Relation of fetal parts to one another.
Expected fetal attitude is flexion: head tucked and in a ball.
Flexion of head/chin-to-chest, arms folded across the chest, and legs flexed up onto the abdomen.
Deviations, especially related to the head, will present a larger diameter of the head for the pelvis.

Passenger: Fetal Presentation

The presenting part.
Station: how far the baby is in the pelvis, measured in centimeters.
Engagement: when the presenting part has entered the pelvic inlet.
Types of presentations:
- Cephalic or vertex (head first): 95%.
- Breech: frank, complete, or footling.
- Shoulder: transverse lie.

Passenger: Fetal Position

Relationship of the fetal presenting part to 1 of the 4 quadrants of the maternal pelvis.
Most common fetal position is occipitoanterior: back of the baby’s head (occipito) is facing the front of mom (anterior).
3 notions used to describe fetal position:
- Right (R) or left (L) side of maternal pelvis.
- Landmark of fetal presenting part (occiput).
- Anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in the front, back, or side of the maternal pelvis.

Primary Powers: Contractions

Rhythmic and intermittent with periods of relaxation between contractions.
Uterine rest between contractions is important so that the baby can get oxygen.
Phases: increment, acme, decrement.
Characteristics: frequency, duration, intensity.
Purpose of uterine contractions: dilation and effacement of cervix.
Effacement: the taking up, drawing up, and disappearance of the internal os and cervical canal into the uterine side walls.
Dilation: widening of the cervical os from less than a cm to approximately 10 cm.

Secondary Powers

Pushing: contraction of the maternal abdominal musculature for fetal and placental expulsion.
Only after complete cervical dilation.
If the cervix is not completely dilated, bearing down causes cervical swelling or edema, lacerations, and maternal exhaustion.
Valsalva maneuver: holding your breath and bearing down/tightening abdominal muscles.

Maternal Positions

Upright position:
- Gravity assists with fetal descent.
- Facilitates dilation and effacement.
- Reduces pressure on major maternal structures.
Lateral (side-lying):
- Increases cardiac output.
- Improves perfusion to organs.
- Removes pressure on major maternal structures.
- Helps with back pain and facilitates counterpressure.
Semi-recumbent:
- Sitting with the back elevated.
- Head of bed elevated at least 30 degrees.
- Convenient for fetal monitoring and exams.
Hands and knees:
- Helps with back labor.
- Facilitates internal rotation of the fetus.
- Good for OP presentation.

Psychological Response

Knowledge/preparation.
Past experience.
Stress response.
Support.
Social factors.
Cultural factors.

Theories of Labor

Progesterone: relaxing effect.
Estrogen: stimulating effect.
Prostaglandin: stimulates smooth muscles to contract.
Fetal cortisol: same effect as prostaglandin.
Uterine distention.

Preliminary Signs of Labor

Lightening: "dropping," movement, or engagement of the fetus into the pelvic inlet.
- Descent moves the uterus downward and the fundus away from the diaphragm.
- Results in ability of the female to breathe easier.
- At some time, the female may experience:
  - Leg cramps or pains.
  - Increased pelvic pressure.
  - Increased venous stasis that leads to lower extremity edema.
  - Increased urinary frequency.
  - Increased vaginal secretions resulting from congestion of vaginal mucous membranes.
Sudden burst of energy: "Nesting syndrome," occurs approximately 24-48 hours prior to labor onset.
Braxton Hicks contractions:
- Irregular, intermittent contractions that occur throughout pregnancy.
- Tend to disappear or stop with change in activity.
- Discomfort centered in the abdomen.
- Cervical dilation does not occur.
- Can increase in occurrence closer to term.
Cervical changes:
- Cervical ripening: softening of the cervix.
- Main sign of TRUE labor is progressive dilation & effacement of the cervix.

Signs of Labor: Preliminary or True?

Blood show: pink blood-tinged secretions that accompany expulsion of the cervical mucous plug that seals the cervix during pregnancy.
Rupture of membranes (ROM):
- 12% of females experience rupture prior to labor onset.
- 80% of females who experience ROM will experience true labor within 24 hours.
- If rupture occurs prior to engagement, the umbilical cord may be washed out with fluid, resulting in prolapsed cord.
- 4 types of ROM:
  - Spontaneous rupture: SROM, happens naturally.
  - Artificial rupture: AROM, amniotomy.
  - Premature rupture: PROM.
  - Preterm premature rupture: PPROM.

Stages of Labor

Stage 1:
- Latent Phase:
  - Nulliparas: 20 hours.
  - Multiparas: 14 hours.
- Active Phase:
  - Increased bloody show.
  - Emotional changes.
- Transition Phase:
  - Complete cervical dilation: 10 cm.
  - Perineum bulges, flattens, and moves anteriorly.
  - Crowning: fetal head encircles by the external opening of the vagina.
Stage 2:
- Complete cervical dilation to birth of infant.
- Cardinal movements: allow passage of the infant through the pelvis.
- Cord clamping: delayed?
Stage 3:
- Birth of placenta.
Stage 4:
- Recovery.

Arrest of Labor

Adequate contraction pattern: No cervical change in 4 hours.
Inadequate contraction pattern: No cervical change in 6 hours.
Interventions depend on the situation.

Narcan

The antidote for opioids.
Key concept for potential test question.

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Description

This quiz explores the five critical factors of labor: passageway, passenger, powers, position, and psychological response. Dive into the specifics of pelvic shapes, measurements, and the influence of fetal head anatomy on childbirth. Test your knowledge on these essential aspects of labor and delivery.