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symptoms of true labor
- Strong UC, become longer, frequent and more regular over time
- UC consist of abdominal tightening or often back pain
- UC rarely >60 sec
- not reduced by change in maternal activity
- GI-frequent bowel movements, nausea, vomiting, diarrhea
- UC=progressive cervical change(both effacement/dilation changes)
- intact membranes feel tense on SVE (sterile vaginal exam)
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Oxytocin-released by posterior pituitary gland-responsible for UC
Oxytocin regulatory mech. unknown-nerve impulses from Uterus "may" cause release of oxytocin. Contractions continue after birth to prevent post-partum hemorrhage and to accomplish uterine involution.
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Primipara length of labor?
12-18 hours
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Multipara length of labor?
6-10 hours
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Uterine distension theory
degree of distension causes muscle fibers to release prostaglandin causing cervical ripening and stimulating UC.
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Aging theory of the placenta
- May cause drop in maternal progesterone levels rendering the uterus more sensitive to oxytocin.
- also the aging placenta may not work as well towards the end of pregnancy which causes the adrenal glands from the fetus to produce labor inducing "substance"
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Cervical changes during labor
- Increased vaginal secretions
- Loss of mucous plug (bloody Show)
- Ripening
- Dilation of cervix
- effacement-cm of cervical length
- cervical status: 3/100%/-1Dilatation/effacement/station
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The P's of labor (need to know for test)
- Power: physical forces of labor
- passage: maternal pelvis
- Passenger: fetus
- Relationship: of passenger and passage
- Psyche: personality and emotional forces
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Latent phase-longest phase of labor 2-9 hours
- UC-backache, menstrual cramps
- contractions should be palpated
- slowly the UC open the cervix to allow passage
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First stage of labor (active labor)
- 3-4cm-(10cm) of dilation
- Time of most rapid CD(cervical dilation)
- Progressive effacement and presentation of part
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Minimum rates of cervical dilation?
- 1.2cm/hr=primipara
- 1.5cm/hr=multipara
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Transitions of labor
- each phase shorter and more intense
- UC 60-90 sec long, 1-2 min apart making it hard to cope
- Do not leave a laboring pt in transition alone
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Pain management-Non-pharmacologic
- Effleurage
- Massage
- Water therapy
- Aroma therapy
- Hypnosis
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pain management Pharmacologic methods
- IV narcotic administration
- Epidural anesthesia
- Spinal anesthesia
- Local anesthesia
- General anesthesia
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Lumbar Epidural
- ligamentum flavum and the dura matter of L3-L4 of the spine
- Medication blocks sodium channels and prevent continuation of nerve impulses to decrease pain and allow lower doses of pain meds.
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Physiologic changes of labor
- BP rises-later recumbent position will help prevent rises in BP
- Check other parameters of pre-eclampsia
- Check BP between UC
- Metabolism increases=increased body temp, respirations, pulse, cardiac output and fluid loss.
- Renal: Polyuria common, proteinuria 2+ is abnormal. evaluate bladder q2 to insure empty bladder and allow the presenting part of baby to progress.
- GI: gastric juices severely reduced-inability to digest food during active labor-limit to fluids NV common.
- Hematological: hemoglobin increases (1.2gm/100ml)-coagulation time decreases-to help prevent post-partum hemorrhage, WBC increase to around 15,000-consider infection if sustained or further elevated. BG drops with muscle activity.
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Second stage of labor (pushing) up to one hour
Also caused rest and descend depending on the mother and baby. waiting on passage to vagina/pelvis
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Episiotomy
surgical incision mediolateral to help with passage.
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Third stage of labor 5-20min
- after birth, waiting on placenta to be delivered should be <30mins.
- UC continues with less intensity to help with delivery of placenta and to prevent post partum-hemorrhage.
- Inspect cord and placenta after delivery
- Critically important that uterus remain contracted after placental delivery, functions as tourniquet(up to 4L loss)-frequent check of fundus for firmness to confirm contraction.
- Never massage uterus before placental delivery-helps return to contracted state.
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Post-partum warning signs?
- BP stable? pre-eclampsia/hypovolemia?
- respiratory changes? pulmonary embolism?
- Vaginal bleeding? just a trickle is considered abnormal
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Fourth stage of labor 1-4 hours
- Close observation of both patients freq. assessments, vitals should stabilize, slight elevated temp-normal is <2 degree.
- Insure bladder emptied-full bladder can impair uterine contraction.
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Fetal Mechanisms of labor
- Flexion of baby head to chest
- engagement internal rotation to mothers side
- descent-throughout first and second stage
- internal rotation baby facing maternal coccyx
- extension birth of head
- restitution-untwists the fetal neck to realign with shoulders
- external rotation fetal shoulders into the AP diameter of the pelvis
- expulsion of entire body
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