![]() Descent: downward movement thru pelvic inlet, thru dilated cervix, reaches posterior vaginal floor. “2nd stage” Engagement: presenting part enters midpoint of ischial spines. 17ġ8 Mechanism of Labor: passage of fetus thru birthĬanal involves position changes called: Cardinal Movements of Labor: mechanical & spontaneous. Effacement: 0 –100 % Station: Relationship of presenting part to pelvic ischial spines -midway in pelvic cavity. Pressure of fetal head reduces bladder tone. 15ġ6 Pressure of fetal head reduces bladder tone.Įlimination Monitor UO q 2-4 hr. end of 1st stage when contx.’s strongest. Pant-Blow: quick breaths, with forceful exhalation. Combination: quicker, lighter breaths Used during active labor one slow breath in beginning & quicker breaths to follow. Record time of delivery, Apgar score, spontaneous cry, & resuscitative efforts to infant Monitor infant for extrauterine life adjustment Encourage family bonding > delivery 14ġ5 Breathing Techniques Slow chest: 6-12 “easy” breaths/min. * Observe & document time of ROM Supine hypotension – Position on side - pressure off vena cava Role of coach during active/transitional stages Assist with pushing during 2nd stage. * Provide comfort measures * Explain equipment & procedures. Monitor/document maternal VS q hr Assess pain & provide pain relief as prescribed. Triage - Admit client to birthing area Emotional support & encourage rest Progress of labor Monitor/document contractions & FHR q 15 min. Antibiotics 11ġ2 Placenta out mother recovers in “LDR” “Labor, delivery, & recovery”įourth Stage Placenta out mother recovers in “LDR” “Labor, delivery, & recovery” Lasts ~ 1 hr. If no spontaneous delivery of placenta, manually removed. “ Crede’s Maneuver” Pitocin > placenta delivered to avoid retained placenta. Separation should be automatic Don’t palpate non-contracted uterus –possible eversion. Positions: Sitting, Side Lying, Standing, Squatting, All Fours, Kneeling. Strong urge to push & bear down as infant passes through vagina & rectum – may have BM. Most difficult & uncomfortable part of labor. Can last up to 3 hrs.! Cardinal movements occur here. No change 6Ĩ Onset of true labor to complete dilation = 10 cm.įirst Stage Onset of true labor to complete dilation = 10 cm. contx.’s ↑ in duration & intensity False Labor A. intensity of contx.’s ↑ with ambulation F. Interval between contx.’s become shorter E. progressive cervical dilation/effacement D. discomfort begins in back & spreads to abdomen. PROM or prolonged ROM – intrauterine infection 5Ħ Difference Between True & False Labor: True Labor A. Green/brown, danger sign Meconium aspiration > distress/infection. Bloody Show: pink tinged secretions d/t softening cervix.(aka mucous plug) Rupture of Membranes: (ROM) Labor in 24 hrs. Uterine Contractions: regular & frequent compared to Braxton-Hicks. 4ĥ Signs True Labor: closer to time of delivery ↑ epinephrine resulting from ↓ progesterone Cervix in posterior position. Burst of Energy: Nesting instinct cleans house, sets up nursery. Cervical changes: cervix effaces & dilates slightly Baby's head in pelvis pushes against cervix causing relaxation and effacement. Braxton-Hicks: Irregular intermittent contractions “false labor” DO NOT initiate true labor. ![]() Lightening: Fetus settles into pelvic cavity. 3Ĥ Premonitory signs of labor: weeks before real labor AKA “False Labor” Amniotic membranes (sac) makes arachidonic Acid → Prostaglandin - ^ uterine contractility. Distention: uterine muscles stretch causing ↑ prostaglandin. Fetal Cortisol: Changes biochemistry of fetal membrane: ↓ progesterone & ↑ prostaglandin in placenta. ![]() Estrogen Stimulation: ↓ progesterone allows estrogen to ↑ contractile response of uterus. Progesterone Withdrawl: ↓ progesterone by fetus & ↑ prostaglandins in chorioamnion results in ↑ uterine contxs. THEORIES: Oxytocin Stimulation: Term uterus sensitive to oxytocin ↑ d/t pressure exerted on cervix by fetus. 2ģ Distention: uterine muscles stretch causing ↑ prostaglandin. Estrogen ↑ uterus response & progesterone ↓ it. THEORIES of LABOR: Combination of factors start labor: Oxytocin & prostaglandin - most important biochemical factors in stimulating uterine contractions. Myometrium - muscle layer – middle Perimetrium - outer layer -extra support to whole structure. Introduction Uterus: pear-shaped muscle made of 3 layers: Endometrium – inner lining - shed during menses. 2 Uterus: pear-shaped muscle made of 3 layers:
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