The 4 P's of Birth
Passenger, Passageway, Powers, Psyche
What are the 4 P's that influence labor
Appearance
What does the “A” in APGAR stand for?
Birth of baby
What is the stage of expulsion ends?
Rationale: Second stage lasts from full dilation until delivery of the newborn.
Descent
What is it called when the fetal head moves down and enters the pelvis?
Rationale: Descent continues until birth occurs.
Epidural analgesia
What is the most common pharmacologic pain relief method during labor?
Rationale: Epidurals are widely used for pain relief during labor.
Passageway
Which “P” refers to the passage through the birth canal?
A newborn with active movement
What is 2 points?A newborn with active movement
Third Stage
What is the Delivery of the placenta?
Rationale: Begins after baby is delivered and ends with expulsion of placenta.
Internal rotation
When the baby’s head rotates to align with the pelvis?
Rationale: The fetal head rotates to accommodate the maternal pelvis.
Oxytocin (Pitocin)
Which medication is used to induce or augment labor by stimulating uterine contractions?
Rationale: Oxytocin is titrated IV to strengthen contractions.
Passenger
Which “P” includes the baby’s size, presentation, and position?
Pulse below 100 bpm
What is 1 point?
Fourth stage
What is the stabilization period after delivery?
Rationale: First 1–2 hours after birth where maternal recovery is monitored.
The fetal head remains visible at the vaginal opening
What does “crowning” mean?
Rationale: Occurs at the end of the second stage, just before birth.
Preeclampsia
What is pregnancy complication that is characterized by high blood pressure and proteinuria?
Rationale: Preeclampsia can progress to eclampsia and requires close monitoring.
Psyche
The mother’s emotional state and anxiety level are part of which “P”?
Newborn is blue-gray all over
What is 0 Points
Latent, Active, Transition
What is the 3 phases of the first stage of labor (0–3 cm, 4–7 cm, 8–10 cm).
Rationale: These describe progressive dilation and contraction strength
Put these in order: Crowning, Engagement, Restitution, Extension of head.
Engagement → Descent → Internal rotation → Extension → Crowning → Restitution
Rationale: These are cardinal movements of labor.
Postpartum hemorrhage
What is a postpartum woman with heavy bleeding and a boggy uterus likely has what complication?
Rationale: Commonly caused by uterine atony and requires urgent intervention.
Powers
Explain how uterine contractions fit into the 4 P’s.
The best possible APGAR score a newborn can receive
What is 10? measured at 1 and 5 minutes
Rationale: Score of 7–10 = generally normal, 4–6 = moderate difficulty, 0–3 = severe distress.
Engagement
What is the first stage of birth when the baby begins to move into the pelvis?
Rationale: Engagement is when the presenting part enters the pelvic inlet
Breathing, relaxation, position change, massage, hydrotherapy
What is a non-pharmacological method of pain relief during labor?
Rationale: Non-pharmacologic methods promote coping and relaxation.
Nurses use APGAR to assess newborn transition and provide interventions as needed (e.g., suction, oxygen). Simultaneously, they monitor the mother’s fourth stage of labor for bleeding, uterine tone, and vital signs.
What is how the nurse utilize the APGAR score and the stages of labor together to guide care for both the newborn and the mother immediately after delivery?
Rationale: Integrating newborn and maternal assessments ensures safe transition and recovery for both.