Labor: Mechanics & Physiology
The stage of labor that begins with uterine contractions that cause cervical dilation and ends when the cervix is fully dilated.
What is the first stage of labor?
Tip: The first stage includes latent and active phases; active is where dilation accelerates.
This quick nursing measure is first for abrupt variable decelerations suspected to be from cord compression.
What is reposition the mother, for example to the left lateral position?
Tip: Repositioning often improves cord blood flow and the fetal heart tracing.
This supportive measure provided throughout labor and birth by a trained person or partner reduces labor length and interventions.
What is continuous labor support?
Tip: Continuous presence improves outcomes even without pharmacologic analgesia.
By about 24 hours postpartum the fundus is typically located at this landmark relative to the umbilicus.
What is at or about the level of the umbilicus?
Tip: Expect the fundus to descend ~1 cm per day afterward.
Soaking one perineal pad every hour postpartum most likely indicates this and requires this immediate nursing action (two-word answer + one action).
What is possible hemorrhage; assess and notify provider?
Tip: Simultaneously fundal check, pad count, vitals, and start resuscitation per protocol if unstable.
This cardinal movement occurs when the fetal head rotates to align the longest diameter with the maternal pelvic outlet.
What is internal rotation?
Tip: Rotation helps the widest fetal head diameter negotiate the maternal pelvis.
Repetitive late decelerations on the fetal monitor most commonly indicate this underlying problem.
What is uteroplacental insufficiency?
Tip: Late decels are ominous — escalate assessment and interventions promptly.
This water-based nonpharmacologic option often reduces maternal perception of contraction pain and muscle tension.
What is hydrotherapy?
Tip: Check unit policy for tub use and fetal monitoring rules.
The typical progression of lochia color from birth through the first weeks goes from this color to this color to this color (three-word sequence).
What is rubra → serosa → alba?
Tip: Rubra is bright red early, serosa pinkish-brown around day 3, alba creamy/white later.
A postpartum patient on day 5 reports fever, abdominal pain, and foul-smelling lochia; the nurse should suspect this diagnosis and do this next (two-word diagnosis + one action).
What is endometritis; arrange in-person evaluation?
Tip: Early evaluation, cultures as indicated, and initiating antibiotics per protocol may be needed.
Describes this change in the cervix and is measured as a percentage from 0% to 100%.
What is effacement or thinning?
Tip: Effacement often precedes dilation in nulliparous patients.
This fetal heart-rate change plus maternal fever should make you suspect chorioamnionitis or intraamniotic infection.
What is sustained fetal tachycardia greater than 160 beats per minute?
Tip: Maternal fever plus fetal tachycardia should prompt evaluation for infection and initiation of treatment per protocol.
This common physiologic side effect of epidural analgesia should be anticipated and managed; name the effect and one nursing intervention.
What is maternal hypotension, and one intervention is IV fluid bolus with uterine displacement and vasopressor per protocol?
Tip: Preload or bolus and vigilant blood-pressure monitoring reduce hypotension risk.
A common, expected breast change in the first 2–5 days postpartum that can cause firmness and tenderness as milk production increases.
What is breast engorgement?
Tip: Supportive measures include frequent breastfeeding or pumping, warm showers before feeding, cool packs after, and good latch technique.
Unilateral calf pain, redness, and swelling in the postpartum period raises concern for this condition and one immediate diagnostic test.
What is deep venous thrombosis (DVT); obtain venous Doppler ultrasound?
Tip: Consider risk factors (immobilization, cesarean, hypercoagulable states) and avoid massage of the limb.
In assessing fetal descent, station describes the relationship of the presenting part to this bony landmark.
What are the maternal ischial spines?
Tip: Station 0 equals at the spines; negative is above; positive is below.
A short nitrous oxide teaching point to give a patient in labor.
What is it is self-administered, has rapid onset and offset, and the patient must be able to hold the mask and cooperate?
Tip: Emphasize patient control and rapid offset for safety.
Explain briefly why an epidural can lengthen the second stage and name one nursing strategy to help the patient deliver effectively despite this.
What is epidural analgesia can reduce the maternal urge to bear down and decrease pelvic floor sensation, which may prolong pushing; one strategy is active coaching of pushing with position changes and using open-glottis pushing or assisted delivery if indicated?
Tip: Pain control is valuable — combine coaching and positioning to restore effective expulsive efforts.
Name two physiologic cardiovascular changes expected postpartum (brief).
What are increased cardiac output and a return toward pre-pregnancy blood volume with diuresis?
Tip: Monitor for resolution of pregnancy hypervolemia and watch BP trends, especially in hypertensive patients.
New-onset severe headache and visual changes on postpartum day 7 should make the nurse prioritize evaluation for this condition and advise the patient to do this immediately (one diagnosis + one patient instruction).
What is postpartum preeclampsia; seek urgent medical evaluation/ED?
Tip: Preeclampsia can present postpartum — headache/visual change = red flag requiring BP check and assessment.
Name two physiologic reasons contractions become more effective in active labor, one uterine and one fetal/mechanical.
What are increased coordinated myometrial contractility (greater oxytocin responsiveness) and improved fetal engagement/descent (better mechanical alignment with the pelvis)?
Tip: Tie hormonal/receptor changes to mechanical alignment — both improve expulsive force.
This fetal heart tracing findings may result from fetal sleep, prematurity, or maternal medications (eg, opioids, magnesium), but can also signal early hypoxia
What is minimal variability, and the initial actions are check maternal medications/vitals, stimulate the fetus, reposition, give IV fluid bolus/oxygen, and notify the provider if persistent?
Tip: Distinguish benign causes (sleep, meds) from pathologic causes — if minimal variability persists or is paired with decels, act quickly.
A patient in labor has a contraindication to neuraxial analgesia (eg, significant maternal coagulopathy); appropriate alternative pain-management options may include
What are alternatives to neuraxial analgesia: judicious IV opioids, nitrous oxide if safe, and nonpharmacologic methods like continuous support, hydrotherapy, position changes, or TENS?
Tip: When neuraxial is contraindicated, combine safe pharmacologic choices with active nonpharmacologic coping techniques and close fetal monitoring.
Explain briefly why postpartum diuresis commonly occurs in the first 1–2 days (one-sentence physiologic
What is that with delivery the excess plasma volume accumulated in pregnancy shifts back into the circulation and hormonal changes (decreased aldosterone) promote natriuresis and diuresis?
Tip: Expect increased urine output and encourage hydration while monitoring for excessive fluid loss and orthostatic changes.
A postpartum wound (episiotomy or cesarean) that is red, tender, and draining with fever — name two initial nursing actions (brief).
What are assess wound and wound culture if indicated, notify provider and start antibiotics per orders?
Tip: Protect wound, document findings, and escalate care; obtain imaging only if abscess or deeper infection suspected.