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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