Labor & Delivery Stations (PDF)

**Station 1: Identify Contraction Cycle** - **Define:** - Increment - Peak/Acme - Decrement: - Frequency - Duration - Intensity - Interval - **Draw the Contraction cycle and label using the above terminology** **Station 1: Identify Contraction...

**Station 1: Identify Contraction Cycle** - **Define:** - Increment - Peak/Acme - Decrement: - Frequency - Duration - Intensity - Interval - **Draw the Contraction cycle and label using the above terminology** **Station 1: Identify Contraction Cycle Answers** - **Define:** - Increment - Occurs as the contraction begins in the fundus and spreads throughout the uterus - Peak/Acme - Period during which the contraction is most intense - Decrement - Period of decreasing intensity as the uterus relaxes - Frequency - Period from the beginning of one uterine contraction to the beginning of the next - Duration - Length of each contraction from beginning to end - Example: 55-65 seconds - Intensity - Strength of the contractions - Mild, moderate or strong - Interval - Period between the end of one contraction and the beginning of the next - **Draw the Contraction cycle and label using the above terminology** X:\\Course-N\\Graphics\\Frames\\Mckinney\\images\\016001.jpg **Station 2: Cervical Dilation & Effacement** - Define: - Effacement - Dilation - Identify Effacement & Dilation - Watch YouTube video and follow along using balloon & ping pong ball - **Station 2: Cervical Dilation & Effacement Answers** - Define: - Effacement - Thinning and shortening - Cervix is a cylindrical structure which is about 2 cm before labor - Effacement is expressed in % - 100% is fully effaced - Dilation - Opening - Dilation is expressed in cm - 10 cm is fully dilated - Identify Effacement & Dilation  **Station 3: Components of the Birthing Process** - Identify the Components of the Birthing Process - Powers - Passage - Passenger - Psyche **Station 3: Components of the Birthing Process Answers** - Identify the Components of the Birthing Process - Powers - The two powers of labor are uterine contractions and the maternal pushing efforts. - During the first phase of labor (onset through dilation) uterine contractions are the primary force moving the fetus through the maternal pelvis. - During the second stage of labor (dilation through birth) the woman uses her voluntary pushing efforts to propel the fetus through the pelvis. - Passage - The passage for birth of the fetus consists of the maternal pelvis and its soft tissues. - The bony pelvis is more important to the outcome of labor, because the bones and joints do not readily yield to the forces of labor. - Softening of the cartilage linking the pelvic bones increases as term approaches and the hormone relaxin increases. - Passenger - Consists of fetus and the placenta. The size of the fetal head, presentation, lie, attitude and position affect the ability of the fetus to navigate the birth canal. - Presentation - The part of the fetus that is entering the pelvic inlet first and leads through the birth canal during labor - Occiput, mentum, scapula or breech - Lie - The relationship of the maternal longitudinal axis (spine) to the fetal longitudinal axis (spine) - Transverse, parallel/longitudinal - Attitude - Relation of fetal body parts to one another - Flexion or extensions - Fetal position - Relationship of the presenting part of the fetus (sacrum, mentum or occiput) in reference to its directional position as it relates to one of the four maternal pelvis quadrants - Right ® or left (L) - Occup (O), sacrum (S), mentum (M) or scapula (Sc) - Anterior (A), posterior (P) or transverse (T) - Psyche - The state of the mother's psyche is a crucial aspect of childbirth. - Marked anxiety, fear, or fatigue decreases a woman's ability to cope with labor pain. - Maternal catecholamines are secreted in response to anxiety or fear - They inhibit uterine contractility and placental blood flow. - Relaxation augments the natural process of labor. **Station 4: Leopold Maneuver, Fetal Lie & Presentation** - Practice the Leopold ManeuverLeopold Maneuver - Have your partner position baby and have you identify fetal lie - Longitudinal - Transverse - Oblique - Have your partner position baby and have you identify fetal presentation - Cephalic - Breech - Shoulder **Station 5: Identify Position of Infant** - **Using the baby identify the fetal presentations and positions** - Left occiput anterior - Right occiput anterior - Left occiput transverse - Right occiput transverse - Left occiput posterior - Right occiput posterior - Left mentum anterior - Right mentum anterior - Right mentum posterior - Brow presentation - Shoulder presentation - Left sacrum anterior - Left sacrum posterior **Station 5: Identify Position of Infant Answers**  **Station 6: Premonitory Signs of Labor** - Identify & Define Premonitory Signs of Labor **Station 6: Premonitory Signs of Labor Answers** - Identify Premonitory Signs of Labor - Braxton Hicks - Being with irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity - Lightening - Fetal head descends into true pelvis about 14 days before labor; feeling that the fetus has "dropped"; easier breathing, but more pressure on bladder, resulting in urinary frequency; more pronounced in clients who are primigravida - Increased vaginal discharge or bloody show - Expulsion of the cervical mucus plug may occur. Brownish or blood-tinged mucus plug resulting from the onset of cervical dilation and effacement - Energy spurt - Sometimes called "nesting" response - Small weight loss - 0.5-1.5 kg (1-3.5 lbs) weight loss - Cervical Ripening - Cervix becomes soft (opens) and partially effaced and can being to dilate - Rupture of membranes - Spontaneous rupture of membranes can initiate labor or can occur anytime during labor, most commonly during the transition phase - Labor usually occurs within 24 hours of rupture of members - Prolonged rupture of membranes greater than 24 hours before delivery of fetus can lead to an infection - Assessment of amniotic fluid - Completed once the membranes rupture - Amniotic fluid should be watery, clear and have a slightly yellow tinge - Odor shouldn't be foul - 700-1,000 mL - Use nitrazine paper to confirm that amniotic fluid is present - Amniotic fluid is alkaline - Nitrazine paper should be deep blue, indicating pH of 6.5-7.5 - Urine is slight acidic: nitrazine paper remains yellow **Stations 7: True vs False Labor** - Identify True vs False Labor - Compare and Contrast True vs False Labor **Stations 7: True vs False Labor Answers** - Identify True vs False Labor - Compare and Contrast True vs False Labor **Station 8: Mechanisms of Labor** - Identify & Define Mechanisms of Labor **Station 8: Mechanisms of Labor Answers** - Identify & Define Mechanisms of Labor - Descent - Fetal presenting part through the true pelvis - Engagement of presenting part - Fetal presenting part as its widest diameter reaches the level of ischial spines of the mother's pelvis - Flexion of the fetal head - Fetal head so that the smallest head diameter passes through the pelvis - Internal rotation - Allow the largest fetal head diameter to match the largest maternal pelvic diameters - Extension of the fetal head - Fetal head as it passes beneath the mother's symphysis pubis - External rotation - Fetal head to allow the shoulders to rotate internally to fit the mother's pelvis - Expulsion - Fetal shoulders and fetal body **Station 9: Stages of Labor** - Identify & Define the Stages of Labor - First stage - Latent - Active - Transition - Second stage - Third Stage - Describe placenta - Fourth Stage **Station 9: Stages of Labor Answers** - Identify & Define the Stages of Labor - First stage - Onset of true labor contractions and ends with complete dilation (10cm) and effacement (100%) of the cervix - Latent - Beginning of labor until approximately 3-5 cm of dilation - Contraction - Irregular, mild to moderate - Frequency: 5-30 mins - Duration: 30-45 seconds - Subtle fetal position change - Woman is usually sociable and excited during this phase - Active - Cervix dilates rapidly, 4-6 cm - Contractions - More regular, moderate to strong - Frequency: 3-5mins - Duration: 40-70 seconds - Effacement and dilation of cervix are completed - Internal rotation occurs as the fetus descents in the pelvis - Discomfort usually increases as the pace of labor picks up - Transition - Intense contractions of fetal descent and final cervical dilation, 7-8 cm to complete - Contractions - Strong to very strong - Frequency: 2-3mins - Durations: 45-90 seconds - Bloody show increases with completion of cervical dilation - Strong urge to push - Leg tremors, nausea and vomiting - Woman becomes more anxious and may feel irritable and helpless - Second stage - Begins with complete dilation and full effacement of the cervix and ends with birth of the baby - Strong urge to push - Crowning of the fetal head - May feel sensation of stretching or burning - Third stage - Begins with the birth of baby and ends with expulsion of the placenta - Describe placenta - Shiny Schultze: shiny fetal side first - Dirty Duncan: rough maternal side first - Fourth stage - Stage of physical recovery for mother and infant **Station 10: Identify Nursing Actions Preprocedure** - **Identify Nursing Actions Preprocedure (PT in triage or pre-admission to labor room)** **Station 10: Identify Nursing Actions Preprocedure Answers** - **Identify Nursing Actions Preprocedure** - Leopold maneuvers - External electronic monitoring - External fetal monitoring (EFM) - Labs - Group B streptococcus - Culture is obtained if results are not available from screening 35-37 weeks. If positive, an intravenous prophylactic antibiotic is prescribed - Urinalysis - Clean catch urine sample obtained to assess the client for - Dehydration - Ketonuria (impaired nutrition vs uncontrolled glucose) - Proteinuria (gestational hypertension or preeclampsia) - Glucosuria (gestational diabetes) - Urinary tract infections - Blood Type, CBC **Station 11: Identify Nursing Actions Intraprocedure** - Identify Nursing Actions Intraprocedure. (PT in labor and is admitted) - Identify Nursing Actions Intraprocedure - Assess maternal vital signs - Q5-30mins - Assess FHR - Assess uterine labor contraction characteristics - Frequency - Duration - Intensity - Resting tone of uterine contraction - Intrauterine pressure catheter - Assist with vaginal examination - Check dilation - Descent of fetus - Fetal position, presenting part and lie - Membranes that are intact or ruptured - Completed once the membranes rupture - Amniotic fluid should be watery, clear and have a slightly yellow tinge - Odor shouldn't be foul - 700-1,000 mL - Use nitrazine paper to confirm that amniotic fluid is present - Amniotic fluid is alkaline - Nitrazine paper should be deep blue, indicating pH of 6.5-7.5 - Urine is slight acidic - Nitrazine paper remains yellow - Mechanism of labor in vertex - Engagement - Descent - Flexion - Internal rotation - Extension - External rotation - Birth by expulsion **Station 12: Accelerations & Decelerations** - Define Acceleration - Define Decelerations - Early - Late - Variable - Examples - Identify Deceleration  - Identify Deceleration - Identify Deceleration  **Station 12: Acceleration & Deceleration Answers** - Define Acceleration - Temporary increase in FHR that peaks at least 15 bpm above baseline and lasts at least 15 seconds - Examples: fetal movement, vaginal exams, uterine contractions, mild cord compression & when fetus is in breech presentation - Reassuring sign - May be periodic and nonperiodc (having no relation to contraction) - Accelerations lasting longer than 2 mins but less than 10 mins are prolonged accelerations - Define Decelerations - Early - Are mirror images of the contraction (lowest point in FHR occurs with the peak of the contraction) - Return to baseline FHR by the end of the contraction - Are usually unaffected with respect to pattern by maternal position changes - Are associated with fetal head compression - Are not associated with fetal compromise and require no added interventions - Late - Impaired oxygen exchange - Begin after the peak of the contraction and return to baseline after contraction ends - Not reassuring - Late decelerations look similar to early decelerations but shifted to the right. - Nursing intervention required to improve placental blood flow and fetal oxygen supply. - - Variable - Caused by reduced flow through umbilical cord (cord compression) - Shape, duration, and degree of fall below baseline rate are variable. - Fall and rise in rate are abrupt. - May be nonperiodic - Require nursing intervention - Examples - Identify Deceleration - Late - Identify Deceleration - Variable - Identify Deceleration - Early **Station 13: Fetal Heart Rate Patterns** - Identify Fetal Heart Rate Patterns & Interventions - Category I - Category II - Category III **Station 13: Fetal Heart Rate Patterns Answers** - Identify Fetal Heart Rate Patterns & Interventions - Category I: Normal (reassuring) - Associated with fetal well-being - Baseline fetal heart rate of 110-160 - Baseline fetal heart rate variability: moderate - Acceleration: present or absent - Variable or late decelerations: absent - Category II: Indeterminate (equivocal or ambiguous data) - Describe patterns or elements of reassuring characteristics but also data that may be nonreassuring - Tachycardia - Bradycardia with presence of variability - Minimal or marked baseline variability - Absent variability with no recurrent decelerations - Absence of accelerations after fetal stimulation - Periodic or episodic variations - Variable decelerations with other characteristics - Category III: Abnormal (nonreassuring) - Favorable signs are absent. - Absent variability - Recurrent late decelerations - Recurrent variable decelerations - Bradycardia - Sinusoidal pattern - A visually undulating pattern (rare) **Station 14: Clarification of Fetal Heart Rate Patterns** - Identify Clarification of Fetal Heart Rate Patterns - Fetal scalp stimulation - Vibroacoustic stimulation (VAS) - Fetal scalp blood sampling - Cord blood gases **Station 14: Clarification of Fetal Heart Rate Patterns Answers** - Identify Clarification of Fetal Heart Rate Patterns - Fetal scalp stimulation - Examiner applies pressure to the scalp (or other presenting part) with a gloved finger and sweeps the fingers in a circular motion - An acceleration in FHR of 15 bpm for at least 15 secs is a reassuring response suggesting normal oxygen and acid-base balance - Contraindications: preterm fetus, prolonged rupture of membranes, chorioamnionitis, placenta Previa, maternal fever - Vibroacoustic stimulation (VAS) - Supplement fetal scalp stimulation or if scalp stimulation is contraindicated - Stimulator that uses a combo of sound and vibration is applied to the mother's lower abdomen and is turned on for up to 3 secs - An acceleration in FHR of 15 bpm for at least 15 secs is a reassuring response - Fetal scalp blood sampling - Requires rupture of membranes - Normal scalp pH is 7.25-7.35. Acidosis is present if the pH is \60 minutes - Arterial is the first choice of blood gases and venous is second choice