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What are the four P's that make up the process of labor and birth?


Other than the 4 P's of labor and birth, what are some other "p" words that influence it also?

professional help

Forces that cause the cervix to open and that propel the fetus downward through the b irth canal.

powers of labor-uterine contractions and the mother's pushing

What are the primary powers of labor during the first stages of labor, from onset to full dilation?

uterine contractions

Uterine contractions are _______ _______ muscle contractions.

involuntary, smooth

What are some things that influence the intensity and effectrivemenss of a woman's contractions?

maternal anxiety
vaginal examinations

What are the purpose of uterine contractions?

to cause the cervix to efface (thin) and dilate (open) to allow the fetus to descend into the birth canal.

Contractions push the fetus ________ as the cervix is pulled _________, causing the cervix to become thinner and shorter.


How is effacement determined?

by vaginal exam (touch), using percentage to indicate how much it has effaced from the original cervical length.

How is dilation of the cervix determined?

with vaginal exam (touch), described in centimeters

What is considered full dilation?

10 cm

What are the 3 phases of contractions?

peak, or acme

The period of time when contractions are increasing in strength


the period of greatest contraction strength

peak or acme

the period of decreaseing strength of contractions


How are contractions described?


The elapsed time from the beginning of one contraction until the beginning of the next contraction


How is frequency noted?

in minutes and fractions of minutes

When should you report frequency of contractions to the HCP?

when they are occurring more often than every 2 minutes

Why should contractions occurs more often than every 2 minutes be reported to the doctor?

they may be reducing fetal oxygen supply

the elapsed time from the beginning of a contraction until the end of the same contraction.


How is durating noted?

in seconds

When should the duration of contractions be reported to the doctor?

If they are lasting longer than 90 seconds, because it may reduce fetal oxygen supply.

The approximate strength of the contraction


How is intensity noted?

mild, moderate, strong

This intensity of contraction is when the fundus is easily indented with the finger. feels similar to the tip of a nose.

mild contraction

This intensity of contraction is when teh fundus can be indented with figers but with more difficulty, fundus feels similar to the chin

moderate contractions

This intensity of contraction is when the fundus cannot readily be indented with the figer, and it feels harder, similar to the forehead.

firm contractions

The amount of time the uterus relaxes between contractions.


With each contractions, blood flow from the mother to placenta decreases, but resumes during the __________.


When should length of interval be reported to the doctor?

persistent contraction intervals shorter than 60 seconds may reduce fetal oxygen supply

What 3 instances during contractions should be reported to the doctor?

contractions more frequent than every 2 minutes
lasting longer than 90 seconds
having intervals shorter than 60 seconds

When does a woman start pushing?

When dilated to 10

When does the mom feel a strong urge to push or bear down?

When the cervix is fully dilated and the fetus starts to descend

What can eliminate the natural urge to push?

epidural anesthesia

If a woman is feeling a premature urge to push (before cervix is fully dilated), what might the problem be?

the fetus is pushing against the rectum

What are some problems that can occur from anxiety and fear during the birth process?

greater pain
inhibit labor progress
reduce blood flow to the fetus

What is the bag of waters called?

amniotic sac

What is more likely to occur if many hours elapse between rupture of the membranes and birth?

infection (because the amniotic sac seal the uterine cavity against organisms from the vagina.

Why should a woman go right to the hospital when her amniotic sac ruptures?

1. infection is more likely
2. the umbilical cord may slip down and become compressed between the mom's pelvis and the fetal presenting part

The level of the presenting part (usually the head) in the pelvis.


How is station estimated?

in cm's from the livel of the schial spines in the mom's pelvis

Where is zero at in the stations?

the ischial spine of the mom's pelvis

Where are minus stations located?

above the ischial spines

Where are plus stations located?

below the ischial spines

the positional changes that allow the fetus to fit through the pelvis with the least resistance.

mechanisms of labor (cardinal movements)

What is the last cardinal movement (or mechanism of labor)?

placenta is expelled and uterus contracts

What do stations tell us?

how the baby is progressing down the birth canal

What does intrapartum care of the fetus include?

assessment of FHR
assessment of amniotic fluid for meconium

What does electric fetal monitoring record continuously?

fetal heart rate
contraction patterns

What type of monitoring promotes walking during labor?

intermittent monitoring

How often are FHR and contractions monitored if using intermittent monitoring?

every 30-60 minutes

If internal EFM is done, what is required first?

membranes have ruptured
cervix dilated to 1-2 cm for device insertion

If internal EFM is done, where is the probe attached to the baby?

the presenting part of the fetus

What are the two types of EFM?

fluid filled catheter connected to pressure sensitive device, and solid catheter with a pressure sensor in it's tip.

What is used for external fetal heart monitoring?

doppler transducer (uses sound waves)

How are contractions measured externally?

a tocotransducer wiht a pressure sensitive button over the fundus

What should the baseline fetal heart rate be?

110 bpm-160bpm for at least 2 minutes

This describes fluctuation or constant changes in the baseline fetal heart rate within a 10 minute window

baseline variability

temporary, abrupt rate increases of at least 15 beats per minute above the baseline FHR that last less than 30 seconds.


What kind of pattern do accelerations show?

a reassuring pattern

When is acceleration considered prolonged?

when it lasts 2-10 minutes

If an acceleration lasts longer than 10 minutes, what is it considered to be?

a baseline fetal heart rate change

Temporary, gradual rate decreases during contractions, where the FHR always returns to the baseline reate by the end of the contractions.

early decelerations

When is the peak of deceleration?

at the peak of the contraction

What kind of pattern are early decelerations?

a reassuring pattern

abrupt decreases of 15 beats per minute below the baseline, lasting 15 seconds to 2 miuntes. They begin and end abruptly, and do not exhibit a consistent pattern.

variable decelerations

what do variable decelerations suggest?

the umbilical cord is being compressed, often because it is around the fetal neck, or insufficient amniontic fluid to cushin the cord.

This is when the umbilical cord is around the baby's neck in uetero

nuchal cord

When should you call the doctor related to variable decel?

fhr decreases to 70 bpm
decrease lasts longer than 60 seconds

What are the nonreassuring patterns?

decreased or absent variability
late decel
variable decel

FHR decelerations that being AFTER the beginning of the contractions and do not return to the baseline until after the contraction ends

late deceleration

What does late decelrations suggest?

placenta not delievering enough o2 to the fetus

What is it called when the placenta is not delivering enough o2 to the fetus?

uteroplacental insufficiency

What is usually the first nursing response to variable decel (a nonreassuring pattern)

respositioning the woman to relieve pressure on the umbilical cord and improve blood flow through it.

What can be done to infuse fluid into the amniotic cavity?


What things can be done about late decels?

giving o2 at 8-10L via face mask
increasing IV fluid to expand blood volume
stopping pitocin
preparing to give tocolytic drugs to stop contractions

a procedure to artificially rupture amniotic membrane


What is recorded when the bag of waters is broken?

amount of fluid

What is the normal color of amniotic fluid?

clear with possible white flecks of vernix in it

What does green amniotic fluid mean?

fetus has passed meconium

How is amniotic fluid volume estimated?

moderate (500 mL)
Large (1000 mL)

What might cloudy or yellow amniotic fulid with an offensive odor indicate?


What test can be performed if it is unclear if a woman's membranes have ruptured?

nitrazine test, fern test

Amniotic fluid is ________ and turns pH paper dark blue green or dark blue.


This is a test to see if membranes ruptured where amniotic fluid is spread on a microscope slide and viewed under the microscope to see if the cyrstals in the fluid look like tiny fern leaves

fern test

What would you suspect if a woman loses control and becomes irritable?

she has progressed to the transition phase of labor

what is a VBAC?

vaginal birth after cesarean

What is the main concern with VBAC?

the uterine scar will rupture and disrupt the placental blood flow and cause hemmorrhage

What are the four stages of labor?

dilation and effacement
expulsion of the fetus
expulsion of placenta

What are the 3 phases of the dilation and effacement stage?

latent phase (1-4)
active phase (4-7)
transition phase (7-10)

In what phase of labor does the woman start pushing?

second stage-expulsion of fetus

What stages of labor fall into the immediate postpartum period?

third and fourth stage

how long does the fourth stage of labor (recovery) last?

1-4 hours after expelling placenta or until the mom is physiolocially stable

What 2 non-medical things can be done to stimulate labor contractions via oxytocin?

nipple stimulation

when the baby's head is too big to fit thru the birth canal

cephalopelvic disproportion

What does ROM stand for? and SROM and AROM?

rupture of membranes
spontaneous rupture of membranes
artificial rupture of membranes

What is the age of viability?

20 weeks

what is considered a "term" baby?

37-38 weeks

A pregnancy that did not go on past 20 weeks


The number of pregnancies a woman has had


A woman who has never been pregnant


a woman who is pregnant for the first time


a woman who has been pregnant before


a woman who has given birth to one or more children who reached the age of viability


a woman who has given birth to her first child past the point of viability


a woman who has given birth to 2 or more children past the point of viability


prenatal age of the developing fetus calculated from the first day of a womans LMP

gestational age

Nageles rule to determine the estimated date of delivery

determine the first day of the LNMP
count backward 3 months
add 7 days

the word ______ indicates the number of pregnancies. The word _____ indicates the outcome of the pregnancies. Para increases ONLY when a woman delivers at at least 20 weeks.


If a fetus is aborted spontaneously before 20 weeks it is considered to be:


Recommended schedule for prenatal visits in an uncomplicated pregnancy

conception-28 weeks: q4weeks
29-36 weeks: q2weeks
37 weeks to birth: every week

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