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Labor and birth are
affected by the five P’s
  • passenger (fetus & placenta)
    passageway ( birth  canal)
  • powers (Contractions)
  • position of the woman
  • , and psychologic response
 major factor in
determining the course of birth.
The fetal head  because of its size and
relative rigidity
  • determines whether
    vaginal birth is possible and the manner in which the fetus passes down the
    birth canal.
The diameters at the plane
of the pelvic inlet, midpelvis, and outlet, plus the axis of the birth canal
Involuntary uterine
contractions
  • act to expel the
    fetus and placenta during the first stage of labor; these are augmented by
    voluntary bearing-down efforts during the second stage.
first stage of labor
lasts from the time dilation begins with Cx to the time when the cervix is fully dilated and effacement of the cervic.
the second stage  of labor lasts from:
the time the cervix is fully dilated & effaced to the birth of the baby.
The third stage of labor
lasts from the infant’s
birth to the expulsion of the placenta
. The fourth stage
the first 2 hours after
birth/ recovery when hemostasis is reestablished.
The first stage of labor  is divided into three phases:
Latent, active, and transition.
The cardinal movements of
the mechanism of labor are:

(7 tirms amd adjustments  of the fetal head, to facilitate passage through the bith canal  
  • engagement, descent,
    flexion, internal rotation, extension, restitution and external rotation, and
    expulsion of the infant.
    (from the vertex Position) 
the events precipitating
the onset of labor
  • many factors,
    including changes in the maternal uterus, cervix, and pituitary gland, are
    thought to be involved.
When pushing, the woman
should be encouraged to use the ???? method:
  • open-glottis method
    rather than the closed-glottis method.
 
Fontinels
Membrane filled spaces that are located where the membranous sutures that unite the bones in the fetal/neonatal skull intersect.
Define Moilding:
Slight overlapping of the bones of the fetal skull that occurs during childbirth;
permit the skull to adapt to the various pelvic diameters.
Define Presentation:
The part  of the fetus that enters the pelvic inlet first.
What are the three main types felt in presentation?
Cephalic
Sacrum
Scapula
Presenting Part
Part of the fetal body first felt by the examining finger during a vaginal exam.
occiput
sacrum
scapula
Define "lie"
The relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother.
What are the two types of "lie"?
longitudinal- spines are paralelle to each other


Transverse- when the spines are at right angles or diagonal to eachother.
Define Attitude:
the relationship of the fetal body parts to one another.
The most common type is of general flexion.
Biparietal
the largest  transverse diameter of the fetal skull.
Suboccupitalginatic
Smallest anterioposterior diameter of the fetal skull to enter the maternal pelvis ewhen the fetal head is in complete flexion.
Define Position:
The relationship of the fetal presenting part to the four quadrants   of the maternal pelvis.
Define "engagement"
term that indicates that the largest transverse diameter of the presenting part has passed thr4ough the maternal pelvic brim or inlet into the true pelvis reaching the level of the ischial spines.
What is "station" ?
Relationship of the presenting part of the fetus to an imaginary line drawn between the materal ischial spines;
this is a measurement of the degree of fetal decent through the birth canal.
what are the two components  of the maternal passageway or birth canal?
Bony pelvis
soft tissue
What is effecement?
The shortening or widening of the cerv ical opening (os) and the cervical canal.
This is expressed as a percentage...
What is Dilation?
Enlargement or widening of the cervical (os) and the cervical canal.
Expressed in cm (1-10)
What is Lightening?
the descent of the fetus's presenting part into the true pelvis approximately 2 weeks before term.
What are the primary powers of labor?
Involuntary  uterine contractions
what are secondary powers of labor?
Bearing down
What is the "Valsalva Maneuver"?
Pushing method during the second stage of labor characterized by a closed glottis with proged bearing down.
What is fetal fibronectin?
protein found in plasma and cervicovaginal secretions of pregnant women before the onset of labor; this presence predicts the likelihood of preterm labor.
What are the four factors  that affect fetal circulation during labor?
Position
BP
uterine Cx
umbinical cord blood flow
Endogenous endorphins
Morphine like chamicals produced naturally in the body which raise the pain threshold naturally and produce sedation in the body.
Viceral Pain
Pain that predominated during the first stage of labor
Results from cervical changes, distention of the lower uterine segment, and uterine ischemia.
Somatic pain
Pain that predominates during the 2nd stage of labor;
results from stretching and distention of perineal tissues and the pelvic floor to allow passage of the fetus.
*    Nonpharmacologic pain
and stress management strategies are valuable for managing labor discomfort alone
or in combination with pharmacologic methods.
*     By using  distraction, massage, music, focal points, imageru. the capacity of nerve pathways to transmit pain is reduced or completely blocked.
  • The gate-control
    theory of pain and the stress response are the bases for many of the
    nonpharmacologic methods of pain relief.
pain sensations travel along sensory nerve3 pathways to the brain, but only a limited number of sensations or messages  can travel threough these nerve pathways at one time.
The type of analgesic or
anesthetic to be used is determined by :
  • by maternal and
    health care provider preference, the stage of labor, and the method of birth.
What are Endorphins
Endogenous opiods secreted by the pituitary gland that act on the central and peripheral nervous systems to reduce pain.
> during preg, and birth.
Dick-Reed Method
childbirth method also known as the natural childbirth method (childbirth w/o fear) based on theory that pain in birthing is  socially conditioned and caused by a fear-tension pain syndrome.
Lemaze
Method also known as psychoprophylctic metod, conditions a woman to respond to uterine cx with relaxation techniques and breathing patterns.
Bradley Method
also known as  husband-coached childbirth, emphasizes working in harmony with the body using breath control, abdominal breathing, and general body relaxation:
Stresses envionment issues such as darkness, solitude, and quiet to make birth more natural.
Hypnobirthing
method where women (couples) learn  how birthing muscles work when the woman is in a state of relaxation; women will be relaxed, in control.
Birthing from Within
Method based on the belief that childbirth is not a medical event but a profound rite of passage; teaches power of birthing in awareness, finding personal strength and wisdom and to deelop a pain coping mindset.
What is a "cleansing breath"?
Relaxed breath in threugh the nose and out through the mouth - begins each pattern and ends each cx.
Slow paced breathing:
Paced breathing technique, woman breathes at 6 to 8 bpm.
Modified-paced breathing:
paced technique during which a woman breathes at 32 to 40 bpm
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