Labor Basics
Name premonitory signs that labor may be approaching
Lightening, energy burst, mucus plug, bloody show, cervical thinning
What is the 2nd stage, and what happens?
10cm dilated, pushing, birth of newborn
What is a normal FHR baseline? What could tachy or brady indicate?
110-160. Fetal stress or infection/fever, fetal stress or severe hypoxia.
How to assess amniotic fluid leakage
Fetal heart rate 1st, then COAT (color, odor, amount, time). Think about fetal well-being and risk for infection!
What safety measures are in place for IV Pitocin?
2-RN check prior to administration, infuse via pump
Define true labor contractions
Become stronger, longer, closer together to cause cervical change. Do not go away with rest.
Cephalic (vertex), breech, transverse (also can add hand, chin, foot, etc.)
Early decels are noted & patient says "I have to have a BM!" Priority intervention?
Sterile vaginal exam (SVE) d/t head compression/suspected fetal descent
What does green amniotic fluid indicate? Priority actions?
Meconium fluid d/t post-term or hypoxic event. Continuous FHR assessment & notify newborn team.
Why would the RN need to limit or refrain from performing a SVE?
If +GBS/membranes ruptured = to decrease infection risk, if bleeding or previa = decrease bleeding risk
Define Braxton Hicks contractions
Irregular, do not intensify, go away with rest
Differences between the 2 phases of the 1st stage
0-6 cm vs. 7-10 cm, chatty/trying positions/nonpharmacological vs. focused/anxious/breathing/requesting med
What is the priority intervention for variable and late decels?
Reposition patient to left lateral or right lateral, increase IV fluids
What is the purpose of fundal massage (4th stage)?
Stimulates uterine contractions, compresses uterine blood vessels, lessens risk for hemorrhage
If IV narcotic is given and mother quickly delivers, what concern do we have for the newborn?
Respiratory depression; notify team to be prepared to provide resp support or Narcan if needed
How to we determine contraction frequency?
From the beginning of one contraction to the beginning of the next, in minutes
What happens in the 4th stage? Priority assessment?
Physiological adjustment. Fundus (massage), VS, fluid volume balance
Uterine tachysystole is occurring; what is the priority concern?
Reduced uteroplacental blood flow/fetal reoxygenation between contractions
Side effects/risk of epidural medication; what would you assess for?
Respiratory depression, hypotension=treat with ephedrine, fetal well-being, urinary retention
What is a VBAC, and what assessements are pertinent?
Fetal status/presentation, reason for previous C/section, contraindicated if classical (vertical) scar