Labor
The fetal heart rate patterns that would be considered non-reassuring, and would require interventions (like intrauterine resuscitation measures).
What is:
Late, variable, prolonged decelerations
The decelerations are recurring (happening with > 50% of contractions in a 10-minute period)
Minimal or absent variability
Non-invasive and non-pharmacological ways to support the first stage of labor
Frequent position changes
Ambulation
Controlled, rhythmic breathing
Hydration
Counter pressure
Dimmed lights
Heat/cold therapy on back or abdomen to help with contraction pain
Open glottis vs. Closed glottis pushing
What is:
Open glottis pushing is when the patient breaths in out and slowly during the contraction. Closed glottis pushing is when the client holds her breath and bears down to push.
Open glottis pushing = reduced risk of hemorrhage, decreased pushing time, less risk of fetal hypoxia during the second stage of labor.
Intrauterine resuscitation measures
What is:
- Administer tocolytics (terbutaline, nifedipine)
- Discontinue uterotonics (oxytocin)
- Administer amnioinfusion
- Increase IV Fluids
- Patient repositioning (lateral, hands/knees)
- Perform sterile vaginal exam (to rule- out prolapsed cord)
- Supplemental 02 (if maternal hypoxia is present)
- Prepare for emergent delivery if non-reassuring FHR does not resolve
Signs of false labor (or Braxton Hicks contractions) compared to signs of true labor
False labor: Rest, hydrotherapy, hydration, or ambulation decrease the contraction pain. No cervical change occurs (dilation or effacement)
True labor: irregular contractions initially that become more intense, more frequent, and last longer over time despite efforts to make them go away (ambulation, hydration, rest, etc). True labor contractions will result in cervical dilation and effacement, and descent of the fetus into the pelvis.
The birthing position the increases labor and birth, increasing risk for prolonged labor and dysfunctional labor.
What is lithotomy?
Name the 5 P's of Labor
Power
Passenger
Passageway
Psyche
Position
Stage 1: 0 cm- 10 cm (includes latent phase and active phase)
Stage 2: 10 cm- delivery of baby (the pushing part of labor)
Stage 3: delivery of baby- placenta expulsion (the placenta part of delivery)
Stage 4: The immediate 2 hrs following birth and placenta delivery (nursing responsibility to monitor mom and baby closely for their transitions and for signs of complications)
How often to check a maternal temperature
What is every 1-2 hours?
The impact anxiety has on labor and birth
What is:
Decreases strength of contractions
4 manifestations of labor to evaluate your patient for:
What is:
1. Rupture of membranes
2. True labor contractions
3. Vaginal bleeding
4. Cervical dilation
Nursing evaluation for effectiveness of medications that prevent/ treat PPH
What is:
uterine tone
decreased bleeding
The beneficial effects of Oxytocin to augment/ induce labor
What is:
Initiates strong and frequent contractions
Definition of lightening
What is:
Fetus descends into the pelvis, reducing diaphragm pressure
Nursing interventions for a patient with a laceration/ episiotomy that is getting repaired during the 3rd stage of labor.
What is:
- pain management and pain medication administration.
- reposition the patient for laceration repair
- gather supplies for the provider
- ensure adequate lighting
(Bonus points: which of the above should you do first?)