The Birthing Process and Signs of Impending labor

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The 4 P's of the birth process

Power, Passage, Passenger, and Psyche

Powers

uterine contractions, maternal pushing

Passage

bony pelvis, soft tissue

Passenger

fetus, fetal head

Psyche

expectations of birthing process tend to have longer labors if anxious or high anxiety

effacement

thinning of cervix %

dilation

opening of the cervix in cm

Phases of contractions

increment, peak, decrement

Increment

period of increasing strength

Peak

period of greatest strength

decrement

period of decreasing strength

10cm

COMPLETE (no longer palpable)

frequency

beginning of one contraction, to the beginning of another

Duration

beginning of a contraction until the end of the same contraction. <90sec

tetonic contraction

>90sec (slowing blood flow to the fetus, baby lacks oxygen and become stressed)

Intensity

strenght of contraction

Interval (recovery time)

amount of time uterus relaxes between contractions

TRUE LABOR

while walking contractions become more intense

maternal pushing

only push when fully dilated to prevent problems to the pelvis and the muscle

molding

bones overlapping in the head during the birth process

fetal lie

determine a vaginal delivery or not. how the baby lays inside the mothers uterus.

longitudinal lie

the baby lies up and down-parallel spine

transverse Lie

the baby lies crosswise in the uterus-shoulder tries to come out first

Oblique Lie

the baby lies diagonal in the uterus (/)

Breech

BUTT first

Vertex

head fully flexed

military

niether flexed or extended

brow

partially extended- head partially back

face

head is fully extended 9head all the way back)

Frank breech

legs extended toward the shoulder

Complete breech

butt first with flexion of head and extremities. baby sitting cross legged

footling Breech

one foot dangling

Double footling Breech

both feet dangling

Attitude

normal one of flexion- chin on their chest-well flexed best for birth

Engaged

largest diameter of baby is at both the ischial spines

Early deceleration of FHR

FHR slows when contraction occurs

Late deceleration of FHR

BAD---looks like early deceleration, dip doesn't stop until contraction is over. uterol-plcental diffiency due to baby being stressed.

Variable deceleration of FHR

up, down, up, down pattern of FHR, cord compression, shut off oxytocin. C-section if FHR tones go down

Accerlerations of FHR

GOOD viable baby

First Stage of Labor
Dilation and effecement

onset of contraction, ends with complete cervical dilation

Latent Phase

dilation of cervix 0-3cm

Active Phase

dilation of the cervix 4-7cm. more intent and INTENSE. too late to stop labor, able to recieve narcotic now

transition

dilation of the cervix 8-10cm. sweat on upper lip, very uncomfortable.

Stage 2

10cm (complete) --to-- birth. voluntary contractions, mom is able to push baby out

Stage 3

Birth --to-- Delivery of the placenta (norm 20-30min)

Stage 4

highest risk for hemmorhage. blood loss is usually 250ml-500ml. mom may experience chills

epidural block

above the dura-anesthiesiologist cause hypotension. monitor B/P keep bladder empty

Spinal block

spinal anesthetic, just below the breasts on down for a C-section, cannot move legs or toes until it wears off, may have decreased sensation to bladder.

Intrathecal block

remain in a better ability to push

local infiltration

episiotomy--used to stitch up, relieve pain

Pudendal block

anesthetic on both sides of the cervix-makes pain and contractions go away, able to push tho

General anesthesia

Used for crash c-section, baby's heart tones go down drastically (60's) baby is out immediately. <1min. medicine relaxes uterus, can reach in and pull placenta out

Narcan

given to reverse respiatory depression caused from an opiate

Induction

stimulation of uterine contractions before they begin spontaneously

Augmentation

stimulation of contractions after spontaneously beginning but with unsatisfactory progress (dilation doesn't increase)

Induction via Amniotomy

artificial rupture of membranes

Oxytocin (Pitocin)

given to induce the labor

prolapsed cord

the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby.

Care of the infant

Airway
Breathing
Ciculation
warmth

Apgar Score

1.mother's B/P before admin of oxytocic med
2 .fundus firm, midline, below umbilicus
3. maternity/vaginal pads are applied
4. mother and infant aloowed to bond

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